Thursday, March 24, 2011


 OSTEOARTHRITIS -HOMOEOPATHIY MANAGEMENT

DEFINITION
        Osteoarthritis" is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although the "itis" of osteo arthritis is somewhat of a misnomer inflammation is not a conspicuous feature of the disease.
       Osteoarthritis is defined as the non-inflammatory condition of synovial joints characterized by focal loss of articular hyaline cartilage with proliferation of new bone and remodeling of joint contour.

Causes
1.  Genetic predisposition
2.  Age (women above 45yrs)
3.  Major trauma
4.  Repetitive joint use
5.  Female sex
6.  Race
7.  Obesity
8.  Congenital or developmental defects
9.  Prior inflammatory joint diseases

JOINT INVOLVEMENT
1.  OA is more common in weight bearing joints.
2.  Pattern of joint involvement in OA is also influenced by prior vocational or a vocational overload.

CLASSIFICATION OF OA

I.           Idiopathic OA

A.  Localized OA
1)  Hands
2)  Feet
3)  Knee – a. Medial compartment
   b. Lateral compartment
   c. Patellofemoral compartment
4)  Hip –   a. Eccentric
                  b. Concentric
             c. Diffuse
5)  Spine – a. Apophyseal joints
                   b. Intervertebral joints
              c. Spondylosis
              d. Ligamentous
6)  Other singular sites – a. Glenohumeral
                          b. Acromio clavicular
                            c. Tibiotalar
                            d. Sacroiliac
                            e. Temporomandibular

II.         Secondary OA

A.  Trauma
1)  Acute
2)  Chronic (sports, occupation)
B.  Congenital or developmental disorders
1)  Localized diseases.
a.   Legg – Calve – Perthes disease
b.  Congenital hip dislocation
c.   Slipped epiphysis
2)  Mechanical factors
a.   Unequal lower extremity length
b.  Valgus or varus deformity
c.   Hyper mobility syndromes
3)  Bone dysplasia’s
a.   Epiphyseal dysplasia
b.  Spondyloepiphyseal dysplasia
c.   Osteonychon dystrophy.

C) Metabolic disorders
        1. Ochronosis
        2. Hemochromatosis
        3. Wilson’s disease
        4. Gaucher’s disease

D) Calcium deposition diseases

1.  Calcium pyrophosphate dihydrate deposition
2.  Apatite arthropathy.

E) Other bone and joint diseases

1.  Localized  – Fracture
- A vascular necrosis
- Infection
- Gout
2.  Diffuse      – Rheumatoid arthritis
- Paget’s disease
- Osteopetrosis
- Osteochondritis

F. Neuropathic

G. Endemic

1.  Kashin – Beck
2.  Mseleni


H. Miscellaneous

1.  Frost bite
2.  Caisson’s disease
3.  Hemoglobinopathies

PATHOLOGY
        Proliferation of chondrocytes to form clones in early stages. Biochemical changes – Water content of matrix increase and the concentration of proteoglycans decreases Vertical and horizontal fibrillation and cracking of the matrix as the superficial layers of cartilage are degraded.
        Granular articular surface becomes softer then normal. Full thickness portions of the cartilage are sloughed and the exposed sub chondral bone plate becomes the new articular surface. Friction smoothes and burnishes the exposed bone giving polished ivory appearance.

        Rebuttressing and sclerosis of underlying cancellous bone. Small fractures and dislodged pieces of cartilage and subchondral bone tumble into joint forming loose bodies, Fracture gaps allow synovial fluid to be forced into the subchondral regions in a one-way ball-value mechanism.

        The loculated fluid collection increases in size forming fibrous walled cysts. Mushroom shaped osteophytes  develop at the margins of the articular surface and are capped by fibro cartilage and hyaline cartilage that gradually ossify.
        Minimal synovial alterations. In severe disease, fibrous synovial pannus covers the peripheral portion of articular surface.

CLINICAL FEATURES

Joint pain
Deep ache localized to the involved joint. 
Aggravated by joint use and relieved by rest
Later becomes persistant.
Nocturnal pain interfering with sleep in advanced hipOA.
Stiffness     
After rising in morning or after a period of inactivity.
Lasts less than 20 min
No systemic manifestations.


PHYSICAL EXAMINATION:
Localized tenderness
Bony or soft tissue swelling
Bony crepitus
Synovial effusion
Warmth in early stages
 Periarticular muscle atrophy due to joint disuse.

IN ADVANCED STAGES
Bony hypertrophy
Subluxation
Marked loss of joint motion.

DIFFERENTIAL DIAGNOSIS:
        Soft tissue rheumatism
        Radiculopathy
        Referral pain
        Entrapment neuropathy 
        Vascular disease
        Crystal – induced synovitis
        Septic arthritis
        Rheumatoid arthritis.
INVESTIGATIONS
        X – Ray
                    Normal in early stages
-         Narrowing of joint space
-         Subchondral bone sclerosis
-         Subchondral cysts
-         Osteophytosis
-         Change in joint contour.
 - Erythrocyte Sedimentation rate – Normal
 - Serum chemistry determination - Normal
 -  Blood counts - Normal
 - Urinalysis - Normal

 - Synovial fluid analysis – Mild leukocytosis
-         To rule out other conditions

 - Arthroscopy – Invasive procedure to diagnose OA prior to radiographic changes
       
INTERPHALANGEAL JOINTS:                                        
Heberden’s nodes – Distal inter-phalangeal joint Bouchard’s nodes – Proximal inter-phalangeal                                        joints
EROSIVE OSTEO ARTHRITIS
           More destructive
            Mostly involves interphalangeal joint
            Leads to collapse of subchondral plate and bony                     ankylosis.
           Joint deformity and functional impairment may               be severe.
            Episodic pain and tenderness.
            Synovium more extensively infiltrated with                              mononuclear cells.

GENERALIZED OSTEO ARTHRITIS
          Involvement of three or more joints or groups of joints.
          Heberden’s and bouchard’s nodes are prominent.
          Episodic “Flare Ups” with inflammation marked by soft tissue swelling, redness and warmth.
          ESR elevated.
          Serum RA factor negative

HIP OSTEO ARTHRITIS
        Due to congenital or developmental defects such as
                - Acetabular dysplasia.
                - Legg – Calve – Perthes disease
                - Slipped capital epiphysis.
-         Bilateral involvement in 20%
-         Pain in hip referred to buttock, inguinal area and proximal thigh, rarely to knee joints.
-         Various range of motion causes pain.
       - Flexion is painless, internal rotation exacerbates pain.
-         Loss of internal rotation occurs followed by loss of extension, abduction and flexion due to fibrosis and buttressing osteophytes.

KNEE OSTEO ARTHRITIS

-         Involves medial or lateral femorotibial compartments or the patellofemoral compartment.
-         Bony hypertrophy and tenderness on palpation.
-         Small effusions may be present.
-         Bony crepitus on joint movement.
-         OA in medial compartment – Varus deformity (Bow leg).
-         OA in lateral compartment – Valgus deformity (Knock knee)
-         Patellofemoral OA – positive “shrug” sign.

SPINAL OSTEO ARTHRITIS
-         Degeneration of apophyseal joints, intervertebral disc and paraspinous ligaments occur.
-         Localized pain and stiffness.
-         Nerve root compression by osteophytes, prolopse of a degenerated disc, Subluxation of apophyseal joint causes radicular pain and motor weakness.

TREATMENT:
        Aims to reduce pain maintain mobility and minimize disability.               
GENERAL MANAGEMENT
      -      Reduction of joint loading.                                    
-         Correction of poor posture.
-         Support for excessive lumbar lordosis
-         Avoid prolonged standing, kneeling and squatting. 
-         Lose weight in obese patients.
-         Take rest periods during day.
-          

PHYSICAL THERAPY

-         Application of heat
-         Application of  ice
-         Exercise programmes
ORTHOPEDIC SURGERY
-         Joint replacement surgery in advanced OA.
-         Severe pain (walking limited up to 10min, severe rest or night pain)
-         Age (Preferred in old age; life span of prosthesis is 15 yrs).
-         Fitness for surgery and anesthesia (Lung and heart diseases)
-         Exclusion of patients with an unacceptable risk of complications

 
HOMOEOPATHIC MANAGEMENT


o   Angustura Vera
o   Arnica Montana
o   Aurum metallicum
o   Benzoic acid
o   Bryonia alba
o   Calcarea carbonica
o   Calcarea phosphorica
o   Causticum
o   Cinchona officinalis
o   Cocculus indicus
o   Colchicum autumnale
o   Colocynthis
o   Granatum
o   Guaiacum
o   Kali bichromicum
o   Kali carbonicum
o   Kali  iodum
o   Kalmia latifolia
o   Lactic acidum
o   Lathyrus sativus
o   Ledum pal
o   Natrum phosphoricum
o   Pulsatilla
o   Radium
o   Rhododendron
o   Rhus toxicodendron
o   Syphilinum








Friday, March 18, 2011

ATTENTION DEFICIT HYPERACTIVITY DISORDER - HOMOEOPATHIC MANAGEMENT



ATTENTION DEFICIT HYPERACTIVITY DISORDER

INTRODUCTION:
        Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).
        Neurobehavioral disorder comes under DSH4 classification.

TYPES
PREDOMINANTLY HYPERACTIVE-IMPULSIVE
·        Most symptoms (six or more) are in the hyperactivity impulsivity categories.

·        Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.


PREDOMINANTLY INATTENTIVE
·        The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.

·        Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.

COMBINED HYPERACTIVE-IMPULSIVE AND INATTENTIVE
·        Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present. 

·     Most children have the combined type of ADHD.

        Treatments can relieve many of the disorder's symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.
        3-4 times common in males  5 to 12 years.

Symptoms of ADHD in children
        Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.

Children who have symptoms of inattention may:

·        Be easily distracted, miss details, forget things, and frequently switch from one activity to another 

·        Have difficulty focusing on one thing 

·        Become bored with a task after only a few minutes, unless they are doing something enjoyable 

·        Have difficulty focusing attention on organizing and completing a task or learning something new 

·        Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities 

·        Not seem to listen when spoken to 

·        Daydream, become easily confused, and move slowly 

·        Have difficulty processing information as quickly and accurately as others 

·        Struggle to follow instructions.


Children who have symptoms of hyperactivity may:

1.  Fidget and squirm in their seats
2.  Talk nonstop
3.  Dash around, touching or playing with anything and everything in sight
4.  Have trouble sitting still during dinner, school, and story time
5.  Be constantly in motion
6.  Have difficulty doing quiet tasks or activities.

Children who have symptoms of impulsivity may:
1.  Be very impatient
2.  Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
3.  Have difficulty waiting for things they want or waiting their turns in games
4.  Often interrupt conversations or others' activities.

ADHD CAN BE MISTAKEN FOR OTHER PROBLEMS

        Parents and teachers can miss the fact that children with symptoms of inattention have the disorder because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, compared with those with the other subtypes, who tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive subtypes just have emotional or disciplinary problems.

CAUSES  FOR ADHD
        Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.
        Genes. Inherited from our parents, genes are the "blueprints" for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder. Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments. Defect in dopamine transporter (D4 receptor gene) and human thyroid β gene.
        Children with ADHD who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This NIMH research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.
        Environmental factors. Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children. In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, may have a higher risk of developing ADHD.
        Brain injuries. Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.
        Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it. In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute.Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results.
        In another study, children who were considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as Nutrasweet. Although all the children got aspartame, half their mothers were told their children were given sugar, and the other half were told their children were given aspartame. The mothers who thought their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers who thought their children received aspartame.
        Food additives. Recent British research indicates a possible link between consumption of certain food additives like artificial colors or preservatives, and an increase in activity.11 Research is under way to confirm the findings and to learn more about how food additives may affect hyperactivity.


ADHD DIAGNOSIS:
        Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose.
        Parents may first notice that their child loses interest in things sooner than other children, or seems constantly "out of control." Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently "spaces out" in the classroom or on the playground.
        No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child's pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood mental disorders such as ADHD.
         The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.

Between them, the referring pediatrician and specialist will determine if a child:
1.  Is experiencing undetected seizures that could be associated with other medical conditions
2.  Has a middle ear infection that is causing hearing problems
3.  Has any undetected hearing or vision problems
4.  Has any medical problems that affect thinking and behavior
5.  Has any learning disabilities
6.  Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
7.  Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent's job loss.
        A specialist will also check school and medical records for clues, to see if the child's home or school settings appear unusually stressful or disrupted, and gather information from the child's parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.

The specialist also will ask:
1.  Are the behaviors excessive and long-term, and do they affect all aspects of the child's life?
2.  Do they happen more often in this child compared with the child's peers?
3.  Are the behaviors a continuous problem or a response to a temporary situation?
4.  Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?

        The specialist pays close attention to the child's behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment.
        A child also may be evaluated to see how he or she acts in social situations, and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.
        Finally, if after gathering all this information the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.

TREATMENT
        Currently available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education or training, or a combination of treatments.
MEDICATIONS
        A list of medications and the approved age for use follows. ADHD can be diagnosed and medications prescribed by M.D.s (usually a psychiatrist) and in some states also by clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists. Check with your state's licensing agency for specifics.
Trade Name
Generic Name
Approved Age
Adderall
amphetamine
3 and older
Adderall XR
amphetamine (extended release)
6 and older
Concerta
methylphenidate (long acting)
6 and older
Daytrana
methylphenidate patch
6 and older
Desoxyn
methamphetamine hydrochloride
6 and older
Dexedrine
dextroamphetamine
3 and older
Dextrostat
dextroamphetamine
3 and older
Focalin
dexmethylphenidate
6 and older
Focalin XR
dexmethylphenidate (extended release)
6 and older
Metadate ER
methylphenidate (extended release)
6 and older
Metadate CD
methylphenidate (extended release)
6 and older
Methylin
methylphenidate (oral solution and chewable tablets)
6 and older
Ritalin
methylphenidate
6 and older
Ritalin SR
methylphenidate (extended release)
6 and older
Ritalin LA
methylphenidate (long acting)
6 and older
Strattera
atomoxetine
6 and older
Vyvanse
lisdexamfetamine dimesylate
6 and older

Psychotherapy
        Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events.
        Behavioral therapy also teaches a child how to monitor his or her own behavior. Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy.
         Parents and teachers also can give positive or negative feedback for certain behaviors. In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.
        Therapists may teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.
How can parents help?
        Children with ADHD need guidance and understanding from their parents and teachers to reach their full potential and to succeed in school. Before a child is diagnosed, frustration, blame, and anger may have built up within a family. Parents and children may need special help to overcome bad feelings. Mental health professionals can educate parents about ADHD and how it impacts a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.
        Parenting skills training helps parents learn how to use a system of rewards and consequences to change a child's behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors they want to discourage. In some cases, the use of "time-outs" may be used when the child's behavior gets out of control. In a time-out, the child is removed from the upsetting situation and sits alone for a short time to calm down.
        Parents are also encouraged to share a pleasant or relaxing activity with the child, to notice and point out what the child does well, and to praise the child's strengths and abilities. They may also learn to structure situations in more positive ways. For example, they may restrict the number of playmates to one or two, so that their child does not become over stimulated. Or, if the child has trouble completing tasks, parents can help their child divide large tasks into smaller, more manageable steps. Also, parents may benefit from learning stress-management techniques to increase their own ability to deal with frustration, so that they can respond calmly to their child's behavior.
        Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle disruptive behaviors and to encourage behavior changes. Finally, support groups help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.
Tips to Help Kids Stay Organized and Follow Directions
        Schedule. Keep the same routine every day, from wake-up time to bedtime. Include time for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
        Organize everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
Use homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
Be clear and consistent. Children with ADHD need consistent rules they can understand and follow.
Give praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
What conditions can coexist with ADHD?
        Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:
1.  A learning disability. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and math.

2.  Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.

3.  Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.


4.  Anxiety and depression. Treating ADHD may help to decrease anxiety or some forms of depression.

5.  Bipolar disorder. Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.

6.  Tourette syndrome. Very few children have this brain disorder, but among those who do, many also have ADHD. Some people with Tourette syndrome have nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or grimacing. Others clear their throats, snort, or sniff frequently, or bark out words inappropriately. These behaviors can be controlled with medication.
        ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or other disorders or illnesses.





          REPERTORY FOR ADHD

HOMOEOPATHIC MEDICAL REPERTORY- ROBIN MURPHY
RUBRIC           :       gestures
SUB RUBRIC   :       clapping the hands
2 marks           :       belladona, stramonium

RUBRIC           :       Gestures
SUB RUBRIC   :       Grasping bystanders, at
3 Marks           :       ANT-T.
1 Mark             :       ars., bell., phos.,
RUBRIC           :       Gestures
SUB RUBRIC   :       Indicates his desire by
2 Mark             :       stram.,

RUBRIC           :       Gestures
SUB RUBRIC   :       Automatic
1 Mark             :       anac., calc., cann-i., hell., hyos., nux-m.,
                                phos., tab., zinc.,

RUBRIC           :       Hyperactive children
3 Marks           :       CARC., HYOS., MED., STRAM., TUB.,
2 Marks           :       ars., cina., iod., tarent., verat.,
1 Mark             :       anac., calc-p., coff., nux-v., thuj.,

RUBRIC           :       CONCENTRATION
SUB RUBRIC   :       Difficult
SUB RUBRIC   :       Children in,
3Marks            :       BAR.C.,
2 Marks           :       aethu., phos.,
3 Marks           :       am-c., graph.,lach., ph-ac., sil., zinc.,

                        SYNTHESIS       

SECTION         :       MIND
RUBRIC           :       Heedless
2 Marks           :       Alum., Anac., Bell., Caust.,cham., Gels.,
                                Hell., Hyos.,Lach., Lyc., Merc., Nux-v., Op.,
                                Phos.,
1 mark             :       bies-c., agar., agn.m ail., alum-p., am-c.
                                Ambr., amphet-s.,apis.,asaf., aur-m., bov.,
                                Calad., cann-i., cann-s., canth., carl., cic.,
                                Clem., coff., croc., cupr.,daph., euon., ham.,
                                Ign., ind., kali-c., kali-sil., laur., m-arct.,
                                Nux-c., plat., puls., rhod., rhus-t., rib-ac.,
                                ruta., sabad.,sep., sil., spig., staph., tarax.,


SECTION         :       MIND
RUBRIC           :       Mental exertion
Sub rubric       :       impossible
3 Marks           :       Nat-c
2 marks           :       Alum., Ambr.,Anac., Arg-met., Bapt.,
                                Calc.,Carb-v.,Con.,Ferr., Gels.,Hell.,Kali-br.,
                                kali-p.,Nat-m.,Petr.,Ph-ac.,Phos.,Rhus-t.,Sumb
                                Thuj.,Zinc
1 Mark             :       acon., agar.,am-c.,ammc.,anh.,arn.,ars.,
                                ars-s-f.,asar.,astra-e.,aur.,bar-c.,berb.,borx
                                brom.,buth-a.,cadm-met.,calad.,calc-ar.,
                                caps.,carb-ac.,caust.,cere-s.,chel.,chin.,coff.,
                                cycl.,dig.,dulc.,fago.,form.,glon.,graph.,grat.,
                                haem.,ham.,hyos.,ign.,ind.,kalm.,mang.,
                                merc.,naja.,sel.,sep.,sieg.,stann.,tab.,thal.,

SECTION         :       MIND
RUBRIC           :       Forgetful
3Marks            :       Ambr.,Anac.,Bar-c.,Both.,Carbn-s.,Cocc.,
                                Colch.,Lyc.,Merc.,Mur-ac.,Petr.,Ph-ac.,
                                Phos.,Plat.,Zinc-p.
2Marks            :       Acon.,Aeth.,Agn.,Alum.,Anh.,Arg-n.,Arn.,
                                Aur.,Bell.,Calc.,Calc-p.,Cann-i.,Carb-an.,
                                Carb-v.,Chel.,Con.,Corn.,Croc.,Dig.,Ferr-p.,
                                Fl-ac.,Gels.,Glon.,Graph.,Guaj.,Guare.,Kali
                                Kali-p.,Lac-c.,Mag-p.,Nux-m.,Nux-v.,Pic-ac
                                Sulph.,Thuja
1Mark              :       abot.,absin.,acet-ac.,agar.,ail.,alum.,am-c.,
                                Apis.,arg-met.,arum-t.,aur-ar.,arg-met.,ars.,
                                bapt.,bar-ac.,brom.,bry.,borx.,camph., carc.,
                                clem.,coff.,coloc.,cupr.,cycl.,ham.,hell.,iod.,
                                nat-c.,nat-s.,plb.,sep.,sil.,staph.,stram.,zing

SECTION         :       MIND
RUBRIC           :       Loquacity          
3 Marks           :       Lach., Dulc.,Hyos.,Ran-b.,Stram.
2 Marks           :       Arg-met., Aur., Bell., Camph., Cann-i., Carl.,
                                Cimic., Cocc., Croc., Crot-c., cupr., Gels.,
                                Lachn., Mosch., Mur-ac., Nat-c., Op., Par.,
                                Phos., Pyrog., Verat.,
1 Mark             :       abrot., acon., agar., agn., aloe., alum.,am-c.,
                                arn., ars., bapt., bar-c., bar-i., borx., bov.,
                                bry.,calad., calc., caust., cham., chin.,chel.,
                                graph., ign., kali-c., onos., parth., ph-ac.,
                                stap.,sulph., tab., tarax., zinc.,

SECTION         :       MIND
RUBRIC           :       Gestures
SUBRUBRIC    :       Repeating the same action
3Marks            :       verat.,
2 Marks           :       Syph., zinc.,
1Marks            :       Chen-a., lach., plat., tub.,

SECTION         :       MIND
RUBRIC           :       Libertinism
4Marks            :       MORPH.,
3 Marks           :       op.,
2 Marks           :       syph., verat.,
1 Mark             :       alco., arg-met., arg-n., calc., calc-p., carb-v.,
                                Coca., lyc., med., merc., nux-v., plat., sep.,
                                Sil.,staph., sulph., tarent., thuj.,

SECTION         :       MIND
RUBRIC           :       Self – esteem
SUBRUBRIC    :       Low(see confidence- want)
4 Marks           :       BAR-C.,
3 Marks           :       Anac.,sil.,
2 Marks           :       Am-br., Aur., Bry., Calc-p.,Bry., Calc-p.,
                                Carc.,Chin., Kali-c., Kali-sil., Med., Pall.,
                                Petr., Puls., Rhus-t.,
1 Mark             :       agn., aloe., alum., ambr., anan., ang., ars.,
                                Bell., calc., canth., con., dros., graph.,
                                hyos., ign.,lach., mag-m., op., ruta., sumb.,
                                thuj., tub., verb., zinc.

SECTION         :       MIND
RUBRIC           :       Disorganied( chaotic)
2Marks            :       Ars., Bell.,Merc.,Ph-ac.,Phos.,Rhod.,Seneg.,
1Mark              :       agar., am-c., anac., bry., euphr., ip., lach.,
                                mag-m., mex., nat-c., nux-v., puls., rhus-t.,
                                stram.,sul-ac., sulph., syph., thuj., zinc.