Psychological Case Record

DIAGNOSTIC CLARIFICATION: The patient was apparently all right till four years back. During the second year of PUC patient complained to his parents that he had been sexually abused by an elderly male person while he was in a park. He was severely distressed and was taken to a psychologist where he underwent therapy. Following this he was apparently all right and had joined a catering course. He was staying in a hostel in his second year. During this time he was reportedly sexually abused by his hostelmates and when he had tried to resist, had been threatened that he would be killed. Since then, has been expressing that he had frequent repetitive thoughts that semen was continuously passing out of him. He felt that the anal region had some sticky sensation on standing, making him have the urge to pass stools. He also felt that there was a snake inside his abdomen and whenever he touched a metal piece he had the thought that it may become a sickle and cut his body into pieces. Hence he deliberately avoided touching any metal. He says that these thoughts were recurrent, recognizing that it is partly true, struggling to dismiss these thoughts because of its disturbing nature but unable to do so. He had less control over the obsessions and upto fifty percent of time was successful in diverting the attention by imagining that these problems were transferred to another person. CONCLUSIONS: Thought processes lacked clarity. Obsessive nature of thinking was predominant. There was fear of being harmed. Interpersonal relations were poor and group conformity also was poor. His mentation was slow. Inability and inferiority were evident. There was low ego strength and under productivity. Anxiety and depressive features were also evident. Findings revealed that his reality orientation was not very strong; however he did not have responses that were suggestive of a psychosis. There were indicators of a severe level of emotional disturbance. Patient would improve significantly with psychotherapy and medication. NEUROPSYCHOLOGICAL ASSESSMENT: The patient is a known diabetic and hypertensive since fifteen years. In 1998 in his office he was found unconscious and probably not attended for about an hour. In the hospital his blood pressure was found to be high. The CT scan revealed gross intraventricular hemorrhage with large hypo dense area in right tempro-occipital region, small intra cerebral hematoma in left Para ventricular region with few lacunar infarcts on both sides. He regained consciousness in 3 to 4 hours time. The details of his physical status were not known as he was admitted in intensive care unit. The relatives did not notice any features suggestive of any neurological deficits during his stay in the hospital and was discharged in the eighth day. Following the discharge he was found to have problems in memory. He was not able to identify close relatives and used to let strangers into the house. He was not able to remember his address, not aware of the current events, misplace things and forget what he had for the breakfast. He was unable to understand what is spoken and had difficulty in finding correct word. He also had difficulty in using familiar objects like tooth brush and had difficulty in performing simple tasks at home. He was almost fully dependent in ADL like feeding, toileting, bathing, dressing and grooming. He also had difficulty in relating to news paper or TV. He also had difficulty in managing finance or give advice to people regarding the insurance. He also was unable to engage in social activities and behave in socially appropriate way. He improved gradually after a period of 3 to 4 months and has improved up to fifty percent in one year period. He did not show much improvement after these. CONCLUSION: Deficit was evident across lobe functions. DIAGNOSTIC CLARIFICATION: Ten yeas back when patient presented with depressive symptoms like anhedonia, easy fatigability, low mood decreased concentration and memory feeling of worthlessness and hopelessness he was treated with antidepressants but discontinued the medication in less than a month due to the side effects. Details of his clinical status were not known but he had consultations with multiple medical practitioners and underwent numerous investigations over the next five to six years. During this period he completed his PUC, B.Sc. and had joined for MIT in Chennai. In 2004 he was treated with antidepressants and antipsychotics when he presented with depressive symptoms with psychotic features. He seemed to have been on regular antidepressants till date when he presented. While on medication he presented with three to four months history of suspiciousness towards family members, talkative, had spoken proud of himself, and was hyperactive. He had engaged in odd behaviors like sending telegrams that his family members were dead etc. He presented with high irritability, assaultiveness and occasionally threatened to kill himself or other family members. He claimed that he had lodged a complaint with the supreme court and CBI regarding his threat and they were on their way to catch the relatives .The symptoms were worse when he claimed that he heard strange noises that people were coming to kill him .Patient claimed that God had given him information with which he had escaped from several attempts in his life. There were no history of head injury, high grade fever, loss of consciousness, seizure, or vomiting preceding this episode. There was no history of any substance abuse. PERSONALITY ASSESSMENT: Patient had the first episode of abnormal movements of the body three months back. It occurred at school and was characterized by hyperextension of both upper limbs, with flexion of the neck with eyeball moving upwards followed by a loud cry. Patient was fully conscious but could not speak. Each episode lasted for ten to fifteen minutes. This was not associated with any incontinence or generalized tonic clonic movements. Such episodes had occurred multiple numbers of times at school. At times this used to occur three to four times in succession in a short span of time with full recovery in between the episodes. Such episodes were very infrequent at home. There were no such episodes during sleep. Last episode was ten days back. There were no history of headache or vomiting or any features suggestive of neurological deficits. There were no histories of head injury or substance abuse. There were no histories suggestive of depressive, manic or psychotic or obsessive compulsive or anxiety symptoms. The onset of symptoms had a temporal correlation with few stressors following a warning by the headmistress and parents, for the love affair with a boy of the same school And in the same week some unknown person make some sexual advances towards her. Other stressors elicited were, difficulty in studies, the problem in relationship with younger sibling and the critical attitude of the parents. CONCLUSIONS Tests revealed feelings of decreased self-esteem, anxiety, uncertainty, insecurity and apprehensiveness about issues in life. High affection and dependency needs were present and this had lead to helplessness and suffering. Her low average intelligence and poor coping skills and the high expectation of the relatives contributed to her problem. Test findings were suggestive of cluster C personality traits. INTELLIGENCE ASSESSMENT: He was sent to school at three years of age and was average in the studies in the initial few classes .However he gradually started having difficulty in reading complex sentences and in calculation .He was then shifted to a different curriculum in a low functioning school. In class six he had failed once and was currently in class seven during his visit to the hospital. He had been regular to school and but for the past six months prior to the visit had discontinued. Previous consultations – at one and a half years of age he was not able to close the left eye lid with pupils rotated medially. He underwent surgery the following year, the details of which are not known. Two years later he had a sudden deviation of angle of mouth to right side with sixth and seventh cranial nerve palsy. CT scan showed the left lateral ventricle mildly dilated with hemi atrophy features. No specific treatment was advised Five years later he developed mild weakness of the upper limb and was advised physiotherapy. In 2003 the repeat CT scan showed parenchymal volume loss in left hemisphere. There was no history suggestive of seizures, psychosis, depression, obsessive compulsive disorder, tics or other pervasive developmental disorder

Pharmacological Screening of Hepato and Nephro Protective Activity of the Leaves of Orthosiphon Stamineus and Coccinia Grandis Leaves in Male Wistar Rat.

Research is a process of enquiry and investigation; it is systematic, methodical and ethical; research can help solve practical problems. “All that man needs for health and healing has been provided by god in nature, the challenge of science is to find it” “The doctor of the future will no longer treat the human frame with drugs, but rather will Cure and prevent disease with nutrition” - Thomas Edison. The world's disease profile is changing, and chronic diseases now account for the majority of global morbidity and mortality, rather than infectious diseases. During the 20th century, infectious diseases were the major cause of death and disability. However in this century, non communicable, non infectious chronic diseases such as hepatotoxicity and nephrotoxicity have become the major cause of mortality and morbidity around the world. The kidneys and the liver are responsible for important functions of the body. The kidneys work to maintain water and electrolyte balance, regulate the concentration of the acid base balance and to filter waste from the blood for excretion into the urine. The liver secretes bile, helps with the production of certain blood proteins and assists in the metabolism of carbohydrates, fats and proteins. Many chemicals, foods, drugs and infections can cause variety of liver and kidney diseases. Based on the extensive medicinal claims of Orthosiphon stamineus and Coccinia grandis the aim and objectives of the present study is designed to evaluate the Pharmacological screening of Hepato and Nephroprotective activity of Orthosiphon stamineus and Coccinia grandis leaves in male wistar rats. The main objectives of the present study were • To confirm the authenticity and collection of the plant species. • To identify the various phytochemical constituents of methanol extracts of leaves of Orthosiphon stamineus and Coccinia grandis. • To select therapeutically active extract by in-vitro pharmacological studies. • To carryout the Thin Layer Chromatography of methanol extracts of Orthosiphon stamineus and Coccinia grandis. • To carryout the High Performance Thin Layer Chromatography of methanol extracts of Orthosiphon stamineus and Coccinia grandis. • To screen the Nephroprotective (acute and chronic renal failure) activity of the methanol extracts of leaves of Orthosiphon stamineus and Coccinia grandis in wistar rats. • To screen the Hepatoprotective (acute and chronic liver failure) activity of the methanol extracts of leaves of Orthosiphon stamineus and Coccinia grandis in wistar rats. • To carryout the column chromatography of the methanol extracts of leaves of Orthosiphon stamineus and Coccinia grandis. • To screen the Nephroprotective (acute and chronic renal failure) activity of the fractions obtained from the methanol extracts of leaves of Orthosiphon stamineus and Coccinia grandis in wistar rats. • To screen the Hepatoprotective (acute and chronic liver failure) activity of the fractions obtained from the methanol extracts of leaves of Orthosiphon stamineus and Coccinia grandis in wistar rats. • To carryout the docking study for Hepato and Nephroprotective activities of compounds present in the leaves of Orthosiphon stamineus and Coccinia grandis to confirm the therapeutic effect of these plants. • To carryout the isolation and characterization of methanol fractions of Orthosiphon stamineus and Coccinia grandis with maximum activity based on the pharmacological screening of Hepato and Nephroprotective activity. The thesis entitled “Pharmacological screening of Hepato and Nephroprotective activity of Orthosiphon stamineus and Coccinia grandis leaves in male wistar rats” deals with phytochemical and pharmacological investigation of traditionally used medicinal plants. A perusal of the literature revealed that only fragmentary information was available on these plant species regarding pharmacological activity by any other researchers. Plants are becoming potential source for phytoconstituents with varied pharmacological activities. Identification of such plants of potential use in medicine is of significance. Cells in humans and other organisms are constantly exposed to a variety of oxidizing agents, some of which are necessary for life. In the status of normal metabolism, levels of oxidants and antioxidants in humans are maintained in balance, which is important for sustaining optimal physiological conditions. Overproduction of oxidants in certain conditions can cause an imbalance, leading to oxidative damage to large biomolecules such as lipids, DNA, and proteins. Many synthetic drugs protect against oxidative damage but they have adverse side effects. Recently, there has been a considerable interest in finding natural antioxidants from plant materials to replace synthetic ones. Natural antioxidant substances are presumed to be safe since they occur in plant foods, and are seen as more desirable than their synthetic counterparts. Data from both scientific reports and laboratory studies show that plants contain a large variety of substances called ‘‘plant chemicals’’ or ‘‘phytochemicals’’ that possess antioxidant activity Since, secondary metabolites are responsible for biological activity, this study would be the leading path way of information for selection of the extract for pharmacological activity and isolation of constituents responsible for the activity. The mechanisms of synergistic actions of herbal ingredients can be explored for designing new multi-target drugs and drug combinations and for discovering potent drug combinations that are individually sub therapeutic but efficacious in combination. These synergistic properties are unique to phytotherapy and it gives both to efficacy and safety. A plant extract is more than the isolated constituents out of it and it can substantiate the perception that herbal medicinal products have something special to offer, at least a scientifically based explanation for the clinical bioequivalence of many plant extracts with synthetic drugs at the same therapeutic indications with better therapeutic benefits. In my research I found the effective herb-herb combination therapy for both acute and chronic conditions of kidney and liver failure. Orthosiphon stamineus and Coccinia grandis herb-herb combination therapy (1:1) exhibited stongest nephroprotective and hepatoprotective activity especially for treating the following acute and chronic conditions such as Kidney diseases: 1) Renal Tubulopathy, 2) Renal Ischemia, 3) Renal tubular acidosis, 4) Renal Interstitial Fibrosis, 5) Diabetic nephropathy, 6) Glomerulosclerosis, Liver diseases: 1) Cirrhosis, 2) Hepatitis, 3) Fibrosis, 4) Steatosis