DR. S.P. AGRAWAL

Untitled Document

THE GENERAL PRACTITIONER AS A PSYCHIATRIST
by
DR. S.P. AGRAWAL, M.B.B.S, M.D, ALINAGAR, GORAKHPUR. (U.P.)

Paper read at the 44th All India Medical Conference, Allahabad (U.P) – 27th to 29th December 1968

SILEDIN

"Encouraged by the work of Hakim, Soni, Rana & Kale, I tried Sildein, along with E.C.T. My observations regarding this combination of various Indigenous drugs inSiledin are as follow: -"

1.                   No toxicity was observed in any case and as such it is quite safe.

2.                   It worked as good supportive therapy along with E.C.T. in management of psychotics.

3.                   As a routine tranquillizer, as follow up of treated cases, or for management of minor
psychic ailments like neurosis, hysteria, this drug can be used as first line of attack.

4.         It is free from undesirable side effects like drowsiness, hangover or loss of memory.

5. Siledin can be given along with modern chemo-psychiatric drugs to obtain more
sedative or stimulant effect needed in different cases.

 

 

MATERIALS AND METHODS : Analysis of 2303 mental cases treated in my practice dur­ing the last 9 years, from September 1959 to September 1968 are analyzed in this study. Majority of the cases came or were referred to me by the practitioners from the eastern part of U. P., Bihar and Nepal. They came from all strata of society and from all communities. Most of them had already received extensive treatment by stimulants, sedatives or tranquillizers.

USUAL DOSAGE OF DRUGS USED:

1.                  Chlorpromazine - 50 to 100 mg. 3 times a day.

2.                  Prochlorperazine (25 mg.)-1/2 to 1tablet3times a day.

3.                  Tryfluperazine 5 mg. -1/2 to 2 tablets twice a day.

4.                  Imiprimine - 3 to 8 tablets per day.

5.                  Amitriptylene (25 mg.)-1 to2tablets3times a day.

6.                  SILEDIN - Combination of Brahmi, San- khapushpi, Chandrika, Jeevanti, Ug- ragandha,
Bhringraj. : 2 tablets 3 times a day.

 

 

THE PROGRESS OF CASES WAS RE­CORDED AS FOLLOWS:

Marked Improvement - when there was re­mission of all the symptoms and patient found fit enough to resume his original duties.

Moderate Improvement - Remission of most of the major symptoms but unfit to resume his original duties.

Slight Improvement - Cases with mild to minimum improvement in some of the symptoms with slight or moderate social adjust­ment.

Dropped Cases - Cases who failed to con­tinue the treatment after a few sittings only or did not respond to follow up through letters

TABLE-1

Analysis of 2303 cases treated

Disease

Psychotropic Drug

ECT, Psychotropic drug

ECT and Siledin

Total

A- Mania

110

390

130

630

B- Schizophrenia

140

768

228

1136

C – Depression

50

240

-

290

D – Post Puerperal Psychosis

40

50

15

105

E – Organic Psychosis

36

-

-

36

F- Mental deficiency with psychotic manisfestation

60

10

-

70

G- Hypochondriasis

36

-

-

36

 

472

1458

373

2303

 

TABLE-2

Results of treatment of 390 cases of Mania treated with E.C.T. and Chlorpromazine

Duration of illness

No. of patients

E.C.T. No. average

Result (No. of cases) Improved

un-im­

proved

droped

out

Marked

moderate

slight

Less than 6 months

130

1- 5

4

70

30

13

7

10

6 mon. to 2 yrs.

132

2-10

6

66

36

10

12

8

2 to 5 yrs.

110

2- 7

6

62

18

12

13

5

More than 5 years

18

4-15

8

10

4

1

2

1

 

 

 

 


390

 

 

208


88

 

 

 


36


34


24

 

 

 

 

56.8%

24.0%

9.9%

9.3%

 

                                                                                                80.8%

N.B. Percentage calculated after excluding the dropped-out cases.

 

TABLE-3

Results of treatment of 130 cases of Mania treated with E.C.T. and Siledin

Duration of illness

No. of patients

E.C.T. No. average

Result (No. of cases) Improved

un-im­

proved

droped

out.

Marked

moderate

slight

Less than 6 months

76

1- 5

3

48

6

8

6

8

6 mon. to 2 yrs.

21

2- 8

4

13

2

3

2

1

2 to 5 yrs.

28

2-10

6

15

4

2

3

4

More than 5 years

18

4-10

6

1

1

-

1

2

 

130

 

 

77

13

13

12

15

 

 

 

 

66.9%

11.3%

11.3%


10.5%

 

 

 

 

 

78.2%

 

 

 

 

 

 

 

 

 
 
 

 


N.B. Percentage calculated after excluding the dropped out cases.

 

 

 

SCHIZOPHRENIA

 

Results of combination of E.C.T, &Phenothezine derivative and E.C.T. &Siledin group were 80.8% and 78.2% respectively. Phenothezine derivative controlled agitated pa­tients better and quicker.

 

In Siledin group the symptoms controlled 2-3 weeks after. But none of the cases showed any toxicity, unwanted sedation or memory loss though used for as long as 2 years.

 

POST PUERPERAL PSYCHOSIS

 

A total of 105 cases are in the series. Most of the cases were of child bearing age and came for treatment within 6 weeks of the outset of the disease. 80% came within 10 days of the out­set. The results are as below.

 


TABLE - 4


 

Drugs alone

E.C.T & Modern Drugs

E.C.T &Siledin

Marked Improvement

10  (25%)

38  (76%)

10  (66.7%)

Moderate

18  (45%)

7  (14%)

3  (20.0%)

Unimproved

12  (30%)

5  (10%)

2  (13.3%)

Total

40 cases

50 cases

15 cases

Organic Psychosis

 

Out of 36 cases, 24 cases were due to cerebral arteriosclerosis in aged persons in which memory loss, confusions and emotional disturbance were predominant. Along with cerebral vaso-dialators they were given psychotropic drug to normalize their mood; which succeeded in making their life comfortable in 50% of the cases. 8 cases were kept. 7 cases showed marked improvement in mental and physical health.

 

HYPOCHONDRIASIS

 

In 36 cases, all types of treatment were employed, (most of them already had enough including a number of operations) to relieve. We could not get relief in symptoms in 50-60% cases. As most of such cases could not continue prolonged treatment, correct result could not be assessed.

 

DISCUSSION

 

In Short, management of 2303 cases of mental diseases with E.C.T and drugs &Siledin have proved excellent in the present series. E.C.T. is safe and combined with drugs can control majority of psychotics. Given in private practice, it has certain advantages over the institutional methods of management of psychic cases.

 

REFERENCES

 

1. 'Indigenous Drugs in Treatment of Mental Diseases by R.A. Hakim, Hony. Psychiatrist, B.J
      Medical College and the Civil Hospital and Mental Hospital and Mental Hospital, Ahmedabad.
      Paper read before 6th Gujarat & Saurashtra Provincial Medical Conference at Baroda 1953.

 

2. 'Mental Diseases & Their Treatment with indigenous Drugs by S.R Soni, M.B.B.S.
        Paper read before 32nd All India Medical Conference at Jaipur, 1955.

 

3.    Psychosis  due to Cerebral Arterial Sclerosis & its treatment by T.D Rana, D.P .M, Ex. Resident  

       Psychiatrist Warren State Hospital, Warren Pa U.S.A.
       Paper read before 9th Gujarat Saurashtra Provincial Medical Conference at Navsari 1956 
   (also published in Antispetic, Madras)

 

4.  Role of Indigenous Drug in Psychiatry by B.S Kale, M.B.B.S (Bom) D.P.M (Dublin),
     Superintendent, Mental Hospital, Gwalior (MP).
     Paper read before Scientific Session of the 14th Annual Meeting of The Indian Psychiatric
     Society at Ranchi (Bihar) March 1961.