Chittodvega(Anxiety neurosis)

Introduction

Chittodvege(Anxiety) is a psychological and physiological state characterized by cognitive, somatic,emotional and behavioural components. Anxiety is often accompanied by physical sensations such as palpitations, nausea, chest pain, shortness of breath, diarrhaea, chills, dryness of mouth, abdominal pain and headache. Somatic signs of anxiety may include pale skin,sweating, trembling and pupillary dilatation.

Ageing and anxiety is not mutually exclusive, anxiety is as common in the elderly as in the young, although how and when it appears is distinctly different in older adults.

Generalized anxiety disorder is one of the most prevalent anxiety disorders in older persons.Ageing brings with it a higher prevalence of certain medical conditions as a result. In the older people differentiating a medical condition (dementia, depression, fears) from physical symptoms of an anxiety disorder is more complicated. It comes under m!nasa roga in Ayurveda.

Aetiology

The following factors are believed to play an important role in the occurrence of this disease.

1. Genetics and hereditary: Anxiety neurosis tends to run in families.

2. Hormonal/ biochemical imbalance: Imbalance of serotonin and dopamine.

3. Personality type: Certain types of personalities are more prone to anxiety

development e.g. people who have low self esteem and poor coping skills.

4. Social factors: Those who are exposed to abuse, violence and poverty are more prone to this type of disorders.

5. Medical causes: Endocrine and cardio pulmonary disorders

6. Drugs and other substances: amphetamine, transquillsers, steroids etc.

Risk factors

1. Female gender

2. Low resources to cope up with the daily demands.

Pathogenesis

Sympathetic nervous system may always be poised to react, a crisis pulling in a state of constant tension. Various factors may cause over reaction of sympathetic nervous system resulting in anxiety.

Clinical features

1. Palpitation

2. Breathlessness and nervousness

3. Chest pain

4. Trembling

5. Dizziness and fainting

6. Insomnia

7. Anorexia

8. Headache

9. Parasthesia and weakness

10. Fatigue

Investigations

1. Hamilton anxiety rating scale

2. Anxiety disorder interview schedule

3. ECG.

Differential Diagnosis

1. Post traumatic stress disorders

2. Phobias

3. Social anxiety disorders

4. Alcoholism

5. Thyrotoxicosis

6. Hypoglycemia

Management approaches

a. Prevention

1. Use of madhura rasa (sweet in taste) pradh!na Ahara and Buffalo milk

2. Follow sadvritta (Mental hygiene)

3. Practice of yoga and meditation

4. Avoid the causative factors

5. Avoid incompatible food articles

6. Avoid excessive consumption of coffee, tea, soft drinks, hot spicy food, alcohol and smoking

7. Avoid stressful conditions

b. Medical management

Line of treatment

1. Nidana parivarjana (avoidance of aetiological factors) - Manage the disease

conditions like endocrine and cardio-pulmonary disorder. Social factors like abuse,violence etc. and certain medications like tranquillizers and steroid should be avoided.

2. Panchakarma therapies followed by Samana chikitsa (Palliative therapy) should be advocated.

i. Abhyanga (body Massage)

ii. Snehap!na (Internal oleation) – Mahakalyanaka ghrita 30 -50 ml for 3 - 7 days

iii. Shiroabhyanga (head massage) with medicated liquids / oils

iv. Shiro vasti with medicated oils (Candanadi taila/ Himas!gara taila) daily 45

minutes for 7 days

v. shirodhara with medicated liquid (milk, butter milk, water) / oils (Candanadi taila/Himas!gara taila) daily 45-90 minutes for 7 days. Duration of the process

depends upon nature of the illness and physical condition of the patient.

vi. Pichu with Ksheerabala taila

vii. Takra dhara daily 45 minutes for 14 days

viii.Nasya karma (Nasal administration of medicaments) with Brahmi svarasa 5

drops/ nostril/ day for 7 days

ix. shirolepa with Brahmi (Bacopa monnieri Linn.) leaf kalka

3. Drug therapy

Single Medicinal Plants

Drug	Dose	Mode of Administration/Vehicle	Duration
Ashvagandha9Withania somnifera)Powder	3-5 gm	Sugar and ghrita before meal	15 days
Jatamansi(Nardostachys jatamansi DC)Powder	500 mg - 1 gm	Milk after meal	15 days
Br!hmi (Bacopa monnier Linn.)Powder	1-2 gm	Water	15 days
Mandookaparni， (Centella asiatica (Linn.) Urban.)Powder	1-2gm	Water	15 days

COMPOUND AYURVEDIC FORMULATIONS

Drug	Dose	Mode of Administration/Vehicle	Duration
Kalyanaka ghrita	6 gm	Warm milk/	15 days
Br!hmi vati	250-500 mg	Water	15 days
Sarpagandhadi vati	125 mg	Milk	15 days
Sarasvatarishta	10-20 ml	Water	15 days
M!nasa mitra vataka	125 mg	Milk	15 days
Mukta pishti	125-250 mg	Gh.ta	15 days
Mahakalyanaka ghrita	6 gm	Warm milk/ warm water	15 days
Brhmi ghrita	6-12 gm	Warm milk/ warm water	15 days
Chandanadi taila	for airodh!r!/ airovasti		airovasti
Himasagara taila	for airodh!r!/ airovasti		15 days
Ksheerabala taila	for Picu / Talam		15 days

Initially 2 times in a day after meal for 15 days followed by condition of patient and physician's direction

NOTE: Out of the drugs mentioned above any one of the drug or in the combination may be prescribed by the physician.The duration of the treatment may vary from patient to patient. Physician should decide the dosage (per dose) and duration of the therapy based on the clinical findings and response to therapy.

c. Yogic Practices- The following yogic practices are beneficial in Anxiety; however,these should be performed only under the guidance of qualified Yoga therapist. Duration should be decided by the Yoga therapist.

1. Practice of Pranayama (Candra anuloma viloma, cooling Pranayama, Ujjayi,

Bhramari) and meditation along with the practice of Yama and Niyama

2. Regular practice of Kunjala and Jalaneti

3. shashankasana, Tadasana, Matsyasana, Mandukasana, Bhujangasana and shavasana

These techniques may be followed in following sequence

i. shavasana

ii. Deep relaxation techniques

iii. Meditation

iv. Pranayama

v. Asana

Counselling - Advice the patient to

1. Practice light physical activities, yoga and meditation