Psychoactive Substance Misuse Disorders
Psychoactive Substance Misuse Disorders
A. Psychopathology:
ALCOHOL:
Alcohol is a widely used recreational drug (even in our culture) because of its relaxing and disinhibiting effect. It is also an extremely common cause of physical and psychiatric morbidity. The psychiatric manifestation of alcohol use form the basis of this lecture,providing the conceptual framework of all substance related disorders.
Mechanism of action:
The biochemical action of alcohol is complex and only partly understood. It has a number of effects on various neurotransmitter system of the brain. The primary effects are thought to be stimulation of GABA receptors and inhibition of excitatory glutamate receptors,causing sedation,relief of anxiety,and amnesia. In addition,alcohol appears to affect noradrenergic,dopaminergic,serotoinergic and opioids systems,giving rise to other effects such as nausea,euphoria and craving.
Metabolism:
Approximately 75% of this takes place in the liver. There are two mechanisms:
- Alcohol dehydrogenase converts alcohol to acetaldehyde;this is then converted to acetate by acetaldehyde dehydrogenase
- Mixed-function oxidases metabolism alcohol within the endoplasmic reticulum hepatocytes
The classification of substance misuse disorder (clinical syndromes caused by excessive use of alcohol and other psychoactive substances):
The terms ‘alcoholism’and ‘alcohol misuse should be avoided;they are often loosely applied and cause confusion.
1. Acute intoxication:
Acute intoxication is the most common manifestation of alcohol use and will be suffered by most users in our culture. The term denotes the acute dose-related effects of a substance which resolve once the substance (or its active metabolites) are expelled from the body.
In the case of alcohol,which is a CNS depressant,low blood alcohol concentrations produce an enhanced sense of wellbeing,greater confidence,relief of anxiety,and social disinhibition. Mood changes vary and include depression,elation,and aggression. Visual reaction times are reduced and motor coordination becomes impaired. As blood alcohol levels increase,coordination,judgment,and level of consciousness deteriorate,leading to ataxia,disorientation,amnesia,incontinence,and eventually death secondary to respiratory depression.
Pathological intoxication:
The term denotes the rare syndrome of uncharacteristic violent or aggressive behaviour after drinking small quantities of alcohol that would not cause intoxication in most people.
2. Harmful use:
The term describes the secondary damaging effects of alcohol or other psychoactive substance misuse.
Using alcohol to illustrate,a number of consequences may result:
- Physical: alcohol adversely affects most systems of the body.
- Neurological: epilepsy-alcohol withdrawal,head injury,cerebellar degeneration,polyneuropathy,delirium tremens/ Wernick’s encephalopathy/ Korsakoff’s syndrome (see later)
- Cardiovascular: hypertension,cardiomyopathy,arrthymias,ischeaemic heart disease (IHD)
- Gastrointestinal:acute gastritis,carcinoma oesophagus/rectum,pancreatitis,haemochromatosis,alcoholic hepatitis/cirrhosis
- Metabolic: hyperuricaemia,hyperlipidemia,hypoglycemia,hypomagnesaemia
- Respiratory: pneumonia
- Endocrine: pseudo-Cushing’s syndrome
- Musculoskeletal: acute &chronic myopathy,osteoporosis,osteomalacia
- Haematological: macrocytosis,thrombocytopenia,leukopenia
- Reproduction: premature babies,foetal alcohol syndrome ( small stature,low birth weight,intellectual impairment,facial abnormality,over-activity)
- Psychological: increased alcohol consumption gives rise to a range of symptoms and behaviours,such as increased depressive symptoms and violence (see later)
- Social: this might include increased absenteeism from work,increased financial difficulties or debt,recurrent drink-driving offences,and problems sustaining relationship
3. Dependence syndrome:
Whereas the previous disorder may occur with sporadic rather than regular consumption,a dependence syndrome develops against a backdrop of heavy,regular consumption. Diagnosis depends on identification of three or more of the following:
- ØCompulsion to take the substance
- ØStereotyped pattern of substance use
- ØPhysiological withdrawal symptoms ‘the shakes’leading to ‘eye-opener’
- ØTolerance
- ØNeglect of other interest
- ØReinstatement after abstinence
4. Withdrawal state with delirium:
This state occurs when a withdrawal syndrome develops characteristic delirium. This is particularly important to diagnose given the life-threatening nature of a delirium. It occurs around two days (48 hours) after cessation of drinking in about 5% of alcohol- dependent individuals (see above for criteria),usually in association with a physical illness such as pneumonia. It is characterised by:
- ØClouding of consciousness
- ØDisorientation
- ØMemory impairment
- ØExtreme agitation
- ØDistressing illusions,hallucinations (Lilliputian hallucinations:visual hallucinations are fleeting miniature humans or animals e.g. spiders)
- ØOther symptoms of CNS excitation
An even rarer neurological syndrome known as Wernicke’s encephalopathy may occur. This is related to chronic deficiency of vitamin B1(thiamine),it is characterised by:
- ØImpaired consciousness
- ØDisorientation
- ØMemory problems
- ØAtaxia (broad gait)
- ØOphthalmoplegia (ocular palsies,nystagmus and fixed pupils)
The syndrome is thought to develop from haemorrhagic lesions within the cerebellum,thalamus,ventricular system,brainstem and mamilary bodies (sub-cortical structures)
5. Psychotic disorder:
Develop within two days of consuming the substance. It is distinct from previous disorders and the effects of intoxication,in that it occurs in clear consciousness and persists beyond the period the original substance exerts its effect. This disorder resolves spontaneously,usually within one month (brief psychotic episode),but may at times appear indistinguishable from an affective psychosis or schizophrenia
Alcohol hallucinosis is a commonly described condition whereby the patient describes persistent second-person auditory hallucinations. These occur in clear (i.e. not during intoxication or withdrawal and sometimes years after stopping the alcohol) and usually consist of simple words or phrases.
6. Amnesic disorder:
Alcohol -induced amnesic syndrome,or Korsakoff’s psychosis,is related to vitamin B1 deficiency and is a common sequel of Wernicke’s encephalopathy (Wernicke’sà acute,Korsakoff’sàchronic).
7. Dementia syndrome:
This present similarly to the typical dementia syndrome (see dementia lecture),although,like amnesic syndrome,must be clearly related to prolonged heavy use of the substance. It is considered as a reversible dementia (as opposed to irreversible dementias,which is the majority of the dementias e.g. Alzheimer’s).
OTHER PSYCHOACTIVE SUBSTANCES
Problems related to the use of illegal (and some time,legal) psychoactive drugs are extremely common in mental health services,particularly among younger population. Some of the main classes of drugs and their mechanism of action will be described below:
Amphetamine:
Route of administration:oral,IV,smoked,snorted
Acute effect: dilated pupils increased or decreased blood pressure and pulse,perspiration,agitation,euphoria,hypervigilance,insomnia,and mood changes.
Chronic effect: weight loss,tolerance,craving and paranoid psychosis. On withdrawal,there may be several days of sleep disturbance,increased appetite,low mood,fatigue,and psychomotor changes.
Mechanism of action: CNS stimulant
- Inhibition of noradrenaline,dopamine,and serotonin uptake
- Increased release of dopamine
Ecstasy or MDMA is similar in effect but additionally gives rise to hyperpyrexia,dehydration and hyponatraemia,due to direct effect on temperature regulation and antidiuretic hormone (ADH) production.
Cocaine:
Route of administration:smoked,snorted,inhaled,IV
Acute effect: similar to those of amphetamine. Vivid hallucinations are often described,including formication (the sensation of insects crawling beneath the skin,so called cocaine bug). In overdose,death may occur from hypertensive crisis or arrhythmias.
Chronic effect: Nasal septum perforation or ulceration. The withdrawal syndrome is similar to amphetamine
Mechanism of action: CNS stimulant:
- Sympathomimetic activity
- Direct action on temperature regulation
- Local anesthetic
- Increase dopamine release,block dopamine,noradrenaline and serotonin reuptake
LSD (Lysergic acid diethylamine):
Route of administration:Oral,IV,smoked
Acute effect: Dilated pupils,tachycardia,perspiration,blurred vision,incoordination,euphoria (or depression),impaired judgment and perceptual disturbances. ‘Synaesthesia’describes blending of sensation e.g. tasting smell
Chronic effect: tolerance and craving. Rarely may cause psychosis,although ‘flashbacks occur- these are re-experiencing of the disturbances after use.
Mechanism of action:hallucinogenic that may causes hyperarousal of the CNS by mediation of the serotonin system
Cannabis (marijuana,grass,hash,weed):
Route of administration:Oral,IV,smoked,snorted
Acute effect: conjunctival injection,dry mouth,tachycardia,euphoria,relaxation and altered time-perception and judgment
Chronic effect: tolerance,craving,psychosis (maybe only in predisposed individuals,great debate regarding if it causes psychosis),flashbacks and withdrawal (rare) in heavy users consisting of sleep disturbance,nausea and tremor.
Mechanism of action:direct action on cannabinoid receptors sites
Opioids (heroin,morphine,pethidine,methadone):
Route of administration:oral,IV,smoked,snorted
Acute effect: conjunctival injection,constructed pupils,slurred speech,euphoria,apathy,and impaired judgment.
Chronic effect: constipation,tolerance,and intense craving. Withdrawal syndrome can last for between six hours and ten days. Symptoms comprise low mood,agitation,dilated pupils,vomiting,muscle pain,lacrimation,diarrhea,cramps,fever,piolerection,gooseflesh (cold turkey),and sleep disturbance. In overdose pupils dilated,respiratory depression,hypotension and coma.
Mechanism of action: direct action on opioid receptors sites (central &peripheral)
Benzodiazepine (BDZ):
Route of administration:Oral,IV
Acute effect: impaired consciousness,nystagmus,disinhibition,mood changes,and perceptual disturbance
Chronic effect: effects are similar to alcohol
Mechanism of action:CNS depressant that causes potentiation of GABA transmission
Inhalants (solvents,glue,paints,petrol):
Route of administration:Inhaled (heated to increase speed of action)
Acute effect: impaired consciousness,nystagmus,unsteady gait,vomiting,euphoria,disinhibition and psychosis.
Chronic effect: weight loss,tolerance,craving and paranoid psychosis. On withdrawal,there may be several days of sleep disturbance,increased appetite,low mood,fatigue,and psychomotor changes.
Mechanism of action:similar to alcohol,initial CNS stimulant then depressant.
Clinical syndromes associated with the use of psychoactive substances:
Drug
Intoxication state
Dependence state
Withdrawal state
Psychotic disorder
Amnesic syndrome/ dementia
Amphetamine
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Cocaine
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LSD
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Phenylacyclidine
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Cannabis
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Opioids
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Benzodiazepine
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Inhalants
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B. Aetiology:
ALCOHOL:
It is widely accepted that the aetiology for substance misuse is multifactorial (Bio-Psycho-Social)
1. Biological theories:
Genetic predisposition: most family studies show an increase risk of dependence among relatives of dependent individuals;adoption studies indicate heritable component,as offspring of dependent parents have higher rates of dependence than their non-dependent adoptive parents. The nature of this influence is unclear. It may operate at the level of heritable personality characteristic or it might relate to the body’s biochemical susceptibility to alcohol and its consequences. For example,50% of east-Asian populations have a deficiency in one of the aldehyde dehydrogenase enzymes,leading to flushing and palpitation after small amount of alcohol;this may explain reduced rates of consumption and dependence in these cultures
Biochemical:the biochemical basis of dependence remains uncertain. A current model postulates decreasing activity of GABA system and increasing activity of glutamate systems in response to chronic alcohol administration. The former is facilitated by increasing calcium channels which reduce chloride ion flow. By decreasing the inhibitory action of GABA to counteract the CNS depressant effect of alcohol,the neurons become more excitable and this leads to the symptoms of CNS excitability that occur on sudden alcohol withdrawal.
2. Psychological theories:
Psychodynamic:several theories. One suggests there are unconscious gains resulting from both intoxication (allows release of aggression) and the personal damage caused (sympathy from others).
Cognitive-behavioural: based on associative learning (classical and operant conditioning),cognitive learning,and social learning theories. In the associative learning theory,a neutral (unconditioned) stimulus such as hotel becomes associated with alcohol;this then becomes a conditioned stimulus,leading to psychological craving. An alternative explanation,according to social learning theory,is that the patterns of alcohol consumption are modeled on the drinking behaviour of relatives or peers. Family studies support the idea that drinking habits follow those of older relatives.
Personality factors:there is little support for the notion of ‘addictive personality’,although there is link with premorbid dissocial (antisocial) and borderline personality traits.
Psychiatric disorders:psychotic,affective and anxiety disorders appear to increase the risk.
3. Social theories:
Level of alcohol consumption:population levels of alcohol consumption are closely related to levels of alcohol-related disorders which in turn are related to the easily measurable number of death cirrhosis. There are wide variations among populations in this prospect,e.g. levels in Italy and France are greater than those of the UK and USA (as usual figures are not present for our culture,but it is reasonable that one could assume that levels are much less than the west). Level of consumptions are influenced by the real cost of alcohol and availability (here it is expensive àless use,in the west cheap àmore use). Cultural attitude also has a major influence (less consumption in Muslim cultures).
Occupation:there is a clear link between certain occupations and death from cirrhosis;again,issues of availability and subcultural attitudes interplay. The highest-risk professions are members of leisure and catering trades,and those involved with shipping and travel. However,when one looks at the overall picture,higher rates of dependence are noted in unskilled workers and the unemployed.
Significant life events:these appear to increase the amount of alcohol consumed and therefore the risk of dependence.
ILLICIT-DRUG DEPENDENCE
The aetiological factors for illicit-drug dependence are even less well understood,although would again appear to be related to a mixture of biopsychosocial factors. Factors of price,availability,and cultural attitudes again appear to operate at a population level. Moreover,social deprivation,family environment,conduct disorder in childhood (see childhood lecture),dissocial personality,psychiatrist prescription habits (major source of addiction in UAE) and severe mental illness increase the likelihood of substance-misuse problems.
The introduction of harsher legal penalties for suppliers and users of illcit drugs (which is the case in this country) and increase education about the ‘real’effect of drug use (which is not the case in this country),surprisingly does not result in significant decrease in illicit drug use (as opposed to alcohol use)
C. Epidemiology:
ALCOHOL
Prevalence:
Accurate figures are difficult to obtain in western cultures (non-existent in ours) to obtain given the complexity of assessing what is still stigmatized and socially undesirable behaviour. Estimates are based on population surveys (weak evidence based method for collecting information),hospital-admission statistic,and cirrhosis statistic (only gives small sample of ‘real’users due to legal ramification).
Demographic factors are:
- Marital status: divorced/separated >single >married
- Age: the highest consumption of alcohol in the west,occur for both sexes in the age band 18-24 (maybe higher in our culture),but problem related to dependence tend to emerge at a later age.
- Social class: as has been mentioned above,alcohol consumption is higher in social class V and the unemployed. This picture applies particularly to men. In women,higher rates of consumption are seen in the higher social classes.
ILLICIT-DRUG DEPENDENCE
Prevalence:
As with alcohol,overall illicit-substance use has increased over the 30 years almost worldwide. Rates are particularly high within urban,socially deprived areas.
Type of drug used:
In the west in general cannabis is the most commonly used,followed by amphetamine,ecstasy and LSD;heroin is used less frequent and cocaine is even less. Here one can presume that BDZ are the most commonly used drug,heroine and cannabis are used more than LSD,ecstasy and cocaine.
Sex difference:
Almost worldwide males are more than females in the UK 3:1;here one can guess that it is much more by males 10:1.
D. Investigations:
Physical examinations:the physical examination is an important part of any assessment of substance-use problems and requires an awareness of the acute and long-term effects of substance use.
The following areas should be considered:
- Evidence of acute use or intoxication e.g. papillary constriction associated with opiates use
- Immediate and short-term medical complications of substance use,e.g. head injury following alcohol intoxication,local infection and abscesses caused by intravenous substance use
- Signs of substance withdrawal,e.g. raised blood pressure,tachycardia,sweating,and pupil dilatation,associated with alcohol or BDZ withdrawal.
- Long-term medical complications,e.g. stigmata of liver disease associated with alcohol (or infectious hepatitis caused by intravenous drug use)
Physical investigations: a wide range of non-specific investigations can be useful when the longer-term medical complications of substance misuse are suspected,these include:
- ØFBC
- ØU&E
- ØLFT
- ØECG
- ØChest X-ray
- ØHepatitis serology
- ØHIV
Other specific investigations for evidence of excessive alcohol consumption include:
- Ø? MCV:occurs in 60%,females more than males and is due to deficiency of vitamin B or as a direct effect on erythropoiesis
- Ø? ?-GT:this occur in 80%;other LFTs are raised once there is an advanced liver disease
- Ø? Blood alcohol or breathalyzer detects recent use (with 24 hours)
- Ø? serum carbohydrate-deficient transferring detects excessive use in the previous seven days
- Ø? TG &cholesterol
- Ø? WCC,? ESR and ? LFTs,these occur in DT
In illicit-substance use urine test is the most commonly used and should be considered for all psychiatric patient presenting in the A&E (provide presence or absence of a drug),blood test(provide quantity,more detailed),hair (good to detect use where there is a time gap,e.g. three month able to detect cannabis use),also salivary test is available.
E. Complications:
Medical: alcohol dependence gives rise to significant morbidity and reduction in life expectancy. This derives from both direct and indirect effect.
Ten % of alcohol-dependent patients develop cirrhosis;females are more susceptible than males. The 5-years mortality figures are 10% if abstinence achieved 40% if drinking continues,and 65% in advanced disease.
Indirect effect of alcohol include increased accident,obesity (or malnutrition),and neglect of other conditions (e.g. diabetes).
Overall mortality rate is twice the expected. Drinkers who remain within safe drinking limits appear to have a lower mortality than lifelong abstainers;this may be related to a cardioprotective effect of alcohol.
Morbidity associated with illicit-substance misuse particularly affects injectable drug users (e.g. HIV,Hepatitis)
Psychological:there is a close association between substance misuse and psychotic,affective and anxiety disorders;lifetime risks of suicide for both alcohol and illicit drugs dependence are around 10%.
Social:the social cost of alcohol can be measured in several ways:
- Drink driving: even al low limit,inexperienced drivers are at a five times higher risk of an accident and a third of all killed drivers are above the legal limits (in the UK,here the rate is probably lower,but present)
- Violent crimes: in a high percentage of murders,alcohol is in one of the participants. Also higher percentage of violence is precipitated by alcohol.
F. Management: (Bio-psycho-social)
The principles of management are similar for both alcohol and substance dependence:
- Short term-treating the acute effect of the substance,such as intoxication or withdrawal syndrome
- Medium term-rehabilitating patient after withdrawal syndromes
- Long term-dealing with the medical,psychological and social consequences
Good prognostic factors:
- ØA stable relationship
- ØEmployed
- ØStable living conditions with good social support
- ØGood insight into problems and self-motivation to change
Reference:
•1. Stevens L,Rodin I. Psychiatry:An illustrated colour text,Churchill Livingstone 2001
•2. Steple D. Oxford Handbook of Psychiatry,Oxford University Press,2006
•3. Guthrie E &Creed F. Seminars in Liaison Psychiatry. Royal college of Psychiatrist 2007
•4. World Health Organization (WHO). ICD-10 Classification of mental and behavioural disorders. Churchill Livingstone
•5. American Psychiatric Association (APA). DSM-IV-TR. Fourth Edition Text Revision. APA Publication
•6. King D. Seminars in clinical psychopharmacology. Second Edition 2004. Royal College of Psychiatrists
•7. Smith G et al. Key topics in Psychiatry. Bios scientific publisher limited,1996.
•8. Boyle D,Davies S. Psychiatry,Mosby’s crash course 2002
About the Author
Prof. Saoud Al Mualla (M.B,MSC,M.D,Dip,MRCPsych)
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Help! Help! with my strange hair?
I have severe hair loss as I live in the gulf (UAE). I eat almonds everyday but of no use. I also eat gooseberries but no use. Some1 suggested me Provillus but im scared to have it as it may cause side effects. I also used almond oil on my hair but it made it more oily and i loose more hair. PLEASEEEEEEEEE HELP!!!!
Also I heard amla powder( gooseberry)is good. please help!!!
One of my golfing buddies started loosing his hair at an early age. After several types of herbal,homebrew,and crazy stuff from the Internet,he finally decided to visit a hair loss center. At first he was afraid to go becasue he was scared it would cost too much,but he learned a lot from the consultations. After 9 months he is finally starting to regrow some hair. I wish I know exactly what treatment he is using,but maybe you could contact a local clinic. http://www.hairlossandtreatment.com
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Hair Falling | Hair loss | Homeopathic treatment and Homeopathy remedy
Each hair grows in cycles?it grows,rests,and then falls out. Usually,this cycle repeats approximately yearly. At any time,about ninety percent of a person’s scalp hair is growing,a phase that lasts between two and six years. Ten percent of the scalp hair is in a resting phase that lasts between two and three months. At the end of its resting stage,the hair goes through a shedding phase Symptoms.
Causes-
Childbirth. When a woman is pregnant,her hair continues to grow. The usual 50 to 100 hairs per day are not shed. However,after she delivers her baby,many hairs enter the resting stage of the hair cycle at once. Within two to three months after delivery,these hairs may all fall out together and be seen as large amounts of hair coming out in their brushes and combs.
High fever,severe infection,major surgery,significant life stressor. From four weeks to three months after a person has a high fever,severe infection,major surgery,or significant life stressor such as death in the family,he or she may be shocked to see a lot of hair falling out. This condition usually corrects itself but may require treatment.
Thyroid disease. Both an overactive and under active thyroid can cause hair loss. The hair loss associated with thyroid disease can be reversed with proper treatment.
Inadequate protein in diet. Some vegetarians,people who go on crash diets that exclude protein,and those with severely abnormal
eating habits,may develop protein malnutrition. When this happens,a person’s body will help to save protein by shifting growing hairs into the resting phase. Massive hair shedding can occur two to three months later. Hair can then be pulled out by the roots. This condition can be reversed by eating the proper amount of protein.
Medications. Prescription drugs can cause temporary hair shedding in a small percentage of people. Examples of such drugs are blood thinners,some drugs used to treat gout and arthritis,acne,or psoriasis,and some medications for heart problems.
Cancer treatment drugs. Most drugs used in chemotherapy will cause hair cells to stop dividing. Hair shafts become thin and breakoff as they exit the scalp. This can occur one to three weeks after beginning chemotherapy. The patient may lose all of his hair,but this will usually re-grow after treatment ends.
Birth control pills. Women who lose their hair when taking birth control pills usually have an inherited tendency towards hair thinning.
Low serum iron. Iron deficiency sometimes produces hair loss. Low iron can be detected by laboratory tests and corrected with iron pills.
Symptoms-
1. Hair loss can occur as thinning,in which you may not notice hair falling out,or as shedding,in which clumps of hair fall out.
2. In the most common type of hair loss,inherited hair loss (androgenetic alopecia),men tend to lose hair on the front hairline and forehead and on top of the head. Eventually,only hair around the ears,the sides,and back of the head remains. Women with this condition typically have gradual thinning throughout the scalp.
3. Other causes of hair loss may also show distinct patterns. For example,conditions such as trichotillomania (compulsively pulling at the hair) or alopecia areata (in which the immune system attacks hair follicles) result in obvious patches of hair loss,while stress and some medications result in clumps of hair falling out.
4. Because hair is an important part of appearance,hair loss can also result in loss of self-esteem and feeling unattractive,especially in women and teens.
Remedies-
Hair-loss is again just an indicator that there is something not well in your body. The hairs may fall due to a local infection or due to a systemic disorder or deficiency. The treatment also varies accordingly. The following homeopathic medicines are often found indicated in cases of hair fall:
1. Vinca Minor:
Vinca Minor is a remedy for skin affections,eczema,and especially plica polonica (matting of hair together). Spots are present on scalp with oozing moisture and matting hair together. There is Corrosive itching on scalp. Finally producing a bald spots on head. There is an Irresistible desire to scratch.
2. Thallium Metallicum:
Thallium Met is almost a specific for hair loss especially after debilitating,exhaustive acute illness. It is mainly indicated in cases of endocrine disorders especially thyroid and adrenalin disorders.
3. Fluoricum Acidum:
Especially adapted to chronic diseases with syphilitic and mercurial history. Mainly adapted to people who are Indifferent towards loved ones and they are unable to realize their responsibility towards everyone;buoyancy. Mentally they are elated and gay. Mainly indicated for Alopecia and hair loss.
4. Selenium:
Selenium is a constant constituent of bones,hair and teeth. Mainly indicated for hair fall from debiliting diseases.
5. Lycopodium Clavatum:
Lyco is best adapted to persons who are intellectually keen,but physically weak due to lack of muscular power. Lyco patients are thin,withered,full of gas and dry. They lack vital heat;has poor circulation and cold extremities. They have great falling out of hair. Eczema which is moist and oozing on scalp behind ears. Deep furrows on forehead. Premature baldness and gray hair.
6. Phosphorus:
Phos mainly indicated in tall,slender persons,narrow chested,with thin,transparent skin,weakened by loss of animal fluids,with great nervous debility,emaciation and amative tendencies. Great susceptibility to external impressions,to light,sound,odors,touch,electrical changes,thunder-storms is also marked. In scalp skin of forehead feels too tight. Itching of scalp,dandruff,falling out of hair in large bunches.
7. Thuja Occidentalis:
The main action of Thuja is on the skin with ill effects from vaccinations. Thuja has white,scaly dandruff;hair dry and falling out in bunches. Emotionally sensitive with fixed ideas for every thing.
More informations:http://www.homeopathyonline.in
About the Author
Dr Harshad Raval MD[hom] Honorary consultant homeopathy physician to his Excellency governors of Gujarat India. Qualified MD consultant homeopath ,International Homeopathy adviser,books writer and columnist. Specialist in kidney,cancer,psoriasis,leucoderma ,Infertility,male infertility,low sperm count,oligospermia ,nil sperm count,or azoospermia teatment,and other chronic disease,www.homeopathyonline.in ,www.oligospermiatreatment.com ,email:info@homeopathyonline.in
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