A case of hypomania

– Dr Prasanna Kumar K. BHMS, MD( Hom)

It was on Thursday evening, when I was seeing a patient inside my consultation room a loud noise was heard from waiting room.  I just called the receptionist to know what was wrong over there. She said that one Mr.  X (name not disclosed) is saying repeatedly that he cannot waste time in waiting room as he has too many other important works outside. I told her to send him next.
Finally that gentleman arrived. Mr X, aged around 40+ entered the consultation room. He was well dressed, but appeared bit restless/agitated. It appeared as if he has too many things to say. Excited flushed face. But before he could sit on the chair he leaned forward to shake hand  with me and did not leave my hand till he finished his detailed introduction.  The loudness of his speech and a thunderous laughter in between the conversation reminded me of Hypomania, a variant of mood disorder.
Our conversation :
( Pt- patient; Dr- Doctor; Wife – Patients wife)

Pt :  I am Mr. X,  MA, M ED, M Phil, MBA . I am working in so and so college as lecturer and visiting professor to some famous colleges all over the state.

Dr: So very nice to meet you sir, you are a highly qualified man.

Pt: Laughs loudly with a characteristic gesture, leaning backwards on the seat firmly  and looking at the roof and mouth wide open.

Dr : So what can I do for you?
Pt : Actually I don’t have any problem, I am the most blessed man on earth, I have enough money and wealth. In fact I wanted to buy a latest car in the city, but my wife somehow is not interested. Her interests her diverse, you know it is very difficult to understand a woman. Even  Einstein said once : he could understand everything on the earth but a woman. Again laughs………….aha..aha………..aha…………aha……..

I interrupted………………

Dr : Any particular complaints ?
Pt : Again laughs, Dr do you feel that I look like a patient. In my life so far I had no illnesses. My wife forcefully brought her here.

Dr :  Where is your wife ?
Pt: She is sitting outside, I told her not to come inside.

I instructed the receptionist to call her and asked her the reason to bring her husband to the clinic.

Wife: He is not getting sufficient sleep.
Dr : Since how many months and how did it start ?

Patient was restless and started shouting at her wife.
Pt- ( Started shouting at her wife ) , I get enough sleep. I don’t want more sleep because I have so many things to do.

I requested the patient to be seated outside for sometime. Unwillingly he left the consultation room.
Dr : So tell me madam…………
Wife : He was perfect till 3 months ago. All of a sudden I noticed his speech was loud, hurried and he started making lots of phone calls to many of his friends.
Dr : so what ?
Wife : Making phone calls in the odd timings. Early morning 5 o clock or even before that.  And last month phone bill has come around 3000 rupees. (Our usual bill will not exceed more than 500 rupees.)

Dr : What will be the contents of the call.
Wife: Nothing, even some of his friends who are the victims of his calls informed me that there is something wrong with my husband.
Dr : Anything else?
Wife : he spends ( wastes) all the money. He was a miser before. But now he is spending lavishly for his clothes, shoes and watch, cell phone etc. Now he is interested to buy a new Honda city car. At present we have only maruthi 800 and suddenly he wants to go for a hi fi car. Also he wants only branded costly shirts.  He purchased unnecessarily so many electronic equipments. His salary will get over by3-4 days. Later he takes from his previous savings and spends. So if this continues we are going to have a tough time ahead.

Dr : what about your financial position.
Wife: We are solely depending on his salary. We don’t have any loans. But the manner in which he is spending all bank balance will get over by another 2 months.

Dr : what about his appetite /food intake.
Wife : everything he does in a hurried manner. His speech also sometimes irreverent. His colleagues are also finding some problem with him. Most of his office works are pending. Recently he fought with his boss and threatened him that he would resign from the job and he will make his own college. So his boss called me and told to take him to a doctor.

Dr : did you not consult any psychiatrist?
Wife : I consulted but he is not ready to take their medications as these make him very drowsy.

Dr: anything else.
Wife : his sexual desire is very much increased and out of control !

Dr : How will you convince him to take medications.
Wife : I will somehow convince him or I will mix the medicines with the food and give him.
Dr : alright, I will give the medicines.

Totality of symptoms:
Loquacious- irrevalent hurried speech.
Speech – loud, restlessness.
Increased sexual desire.
Spending money excessively.
Feeling that he is wealthy.
His physical generals revealed that he was a chilly subject with craving for spicy and hot food.

Relavent rubrics referred in Kents repertory :
MIND, Loquacity : Hyoscy, Lach, Stram; varat.
Mind, Delusions, wealth , imaginations of.
Mind, Squanders, money.
Mind, speech, wandering.
Genitalia, sexual passions, increased.

Considering these rubrics the common remedy which covered  all the rubrics is VERATRUM ALBUM. In rubric- squanders, money Veratrum is the only drug. Other differential remedies considered are Lach, Stram, Hyoscyamus. Finally Veratrum album was selected .

Follow up criteria.

1. Sleep
2. Speech
3. Sexual desire.
4. Restlessness.

Discussion :

This Hypomaniac patient had all the features of Unipolar mania like flight of ideas,  grandiose ideas , reduced need for sleep, talkativenss, increased sexual desire etc.  Veratrum album was prescribed based on the presentation with reportorial reference. There was significant improvement within 3 days after giving  the first dose. Sulphur was prescribed based on Hahneman’s guidelines in 6th edition of Organon  regarding management of mental cases. This case clearly demonstrates the efficacy of veratrum album in mood disorders.