Changes

The ''unmada'' covers a wide range of major mental disorders and is considered synonymous with  madness and mental derangement, in which a person loses his/her contact from reality and loses the ability to regulate his/her actions and conduct according to norms of the society. In ''unmada'' there is upward movement of ''doshas'' leading to disturbance in the functions of ''manas'' causing ''mada'' ( delusional/ intoxicated state ) in an individual. The factual clinical picture of the mental status of psychotic patients is vividly described. This description suggests that a patient of ''unmada'' develops derangement of all the activities of ''manas'' (mind), ''buddhi''(intellect), ''ahamkara'' (conceit of self-individuality) and ''indriyas'' (senses). He develops thought disturbances in the form of abnormalities of ''chintana'' (thinking), ''vichara''(discrimination) and ''uhya'' (analysis), derangement of memory in the form of ''smriti nasha'' (loss of memory) and ''smriti bramsha'' (impairment of memory), behavioral, social and emotional disturbances in the form of abnormalities of ''achara'' (behaviour), ''dharma'' (eternal duties) and ''bhavas'' (mental factors) along with functional derangement of ''indriyas'' which is manifested clinically as disturbed speech and its various presentations like incoherence (''abaddha vakyama''), thought blocking (''hridaya shunyata'' ), loosening of associations, neologism, echolalia etc. and various psycho-motor disturbances .

The ''unmada'' covers a wide range of major mental disorders and is considered synonymous with  madness and mental derangement, in which a person loses his/her contact from reality and loses the ability to regulate his/her actions and conduct according to norms of the society. In ''unmada'' there is upward movement of ''doshas'' leading to disturbance in the functions of ''manas'' causing ''mada'' ( delusional/ intoxicated state ) in an individual. The factual clinical picture of the mental status of psychotic patients is vividly described. This description suggests that a patient of ''unmada'' develops derangement of all the activities of ''manas'' (mind), ''buddhi''(intellect), ''ahamkara'' (conceit of self-individuality) and ''indriyas'' (senses). He develops thought disturbances in the form of abnormalities of ''chintana'' (thinking), ''vichara''(discrimination) and ''uhya'' (analysis), derangement of memory in the form of ''smriti nasha'' (loss of memory) and ''smriti bramsha'' (impairment of memory), behavioral, social and emotional disturbances in the form of abnormalities of ''achara'' (behaviour), ''dharma'' (eternal duties) and ''bhavas'' (mental factors) along with functional derangement of ''indriyas'' which is manifested clinically as disturbed speech and its various presentations like incoherence (''abaddha vakyama''), thought blocking (''hridaya shunyata'' ), loosening of associations, neologism, echolalia etc. and various psycho-motor disturbances .

Thus, ''unmada'' is not a lone clinical entity comparable to a single modern diagnostic category, rather it is a syndrome describing a group of psychotic disorders. It is a common and broader entity, which provides guidance to the line of management for almost all psychiatric disorders in Ayurveda. In this ailment, the intellect, mind and memory get perverted. ''Unmada'' can be described as the disordered state of mind, in which an individual loses the ability of regulating his/her actions and conduct according to the rules of society.  As the psychotic disorders  cover  almost all the major mental illnesses, the different types and sub-types of ''unmada'' can be  separately correlated with different psychotic disorders. The clinical features of the different types of ''unmada'' resemble various types of schizophrenia, manic psychosis, psychotic depression / major depressive disorder. ''Unmada'' is divided into two broad categories – (1) ''Nija''- those caused by internal imbalance of body humors i.e. ''vata, pitta, kapha'' and the ''sannipataja'' and the (2) ''Agantunimitta''- those caused by exogenous factors.  

Thus, ''unmada'' is not a lone clinical entity comparable to a single modern diagnostic category, rather it is a syndrome describing a group of psychotic disorders. It is a common and broader entity, which provides guidance to the line of management for almost all psychiatric disorders in [[Ayurveda]]. In this ailment, the intellect, mind and memory get perverted. ''Unmada'' can be described as the disordered state of mind, in which an individual loses the ability of regulating his/her actions and conduct according to the rules of society.  As the psychotic disorders  cover  almost all the major mental illnesses, the different types and sub-types of ''unmada'' can be  separately correlated with different psychotic disorders. The clinical features of the different types of ''unmada'' resemble various types of schizophrenia, manic psychosis, psychotic depression / major depressive disorder. ''Unmada'' is divided into two broad categories – (1) ''Nija''- those caused by internal imbalance of body humors i.e. ''vata, pitta, kapha'' and the ''sannipataja'' and the (2) ''Agantunimitta''- those caused by exogenous factors.  

The medicated ''ghrita'', the most preferred dosage form for the management, enhances intellect, memory and plays an important role in the treatment of ''unmada''. Hence many ''ghrita'' formulations have been described for the management. ''Anjana'' and ''nasya'' are other treatment modalities indicated in ''unmada''. Vagbhata emphasizes upon their importance by saying that if all medications for ''unmada'' like ''vamana, virechana'' etc. fail, one should do ''teekshna anjana'' and ''nasya karma''.

The medicated ''ghrita'', the most preferred dosage form for the management, enhances intellect, memory and plays an important role in the treatment of ''unmada''. Hence many ''ghrita'' formulations have been described for the management. ''Anjana'' and ''nasya'' are other treatment modalities indicated in ''unmada''. Vagbhata emphasizes upon their importance by saying that if all medications for ''unmada'' like ''vamana, virechana'' etc. fail, one should do ''teekshna anjana'' and ''nasya karma''.

#Various psychoses due to possession of ''grahas'' and ''bhutas'' (supernatural beings) are included under ''agantuja unmada'', which should be regarded as suffering from paranoid schizophrenia, paranoia and various other paranoid states. Paranoid schizophrenia is characterized by predominance of delusions.

#Various psychoses due to possession of ''grahas'' and ''bhutas'' (supernatural beings) are included under ''agantuja unmada'', which should be regarded as suffering from paranoid schizophrenia, paranoia and various other paranoid states. Paranoid schizophrenia is characterized by predominance of delusions.

#It is important to mention that ''grahas'' have been christened only on the basis of the resemblance of the clinical features of the afflicted individual with the activities of those grahas e.g. gods, gandharvas etc. It is not that these have entered into the the body of the afflicted individual. This is just the way of presentation and the writing style in Ayurveda to personify an event/process. This form of presentation is somewhat similar to syndromic classification in conventional modern medicine. Because of similarity of clinical symptoms, the patients are said to be suffering from some ''graha.'' These individual syndromes can also be correlated to a single disease entity from modern perspective.

#It is important to mention that ''grahas'' have been christened only on the basis of the resemblance of the clinical features of the afflicted individual with the activities of those grahas e.g. gods, gandharvas etc. It is not that these have entered into the the body of the afflicted individual. This is just the way of presentation and the writing style in [[Ayurveda]] to personify an event/process. This form of presentation is somewhat similar to syndromic classification in conventional modern medicine. Because of similarity of clinical symptoms, the patients are said to be suffering from some ''graha.'' These individual syndromes can also be correlated to a single disease entity from modern perspective.

==== Management of ''unmada'' ====

==== Management of ''unmada'' ====

===== ''Satvavajaya'' =====

===== ''Satvavajaya'' =====

The methods of yuktivyapasraya treatment have been prescribed in the treatment of mental diseases. But in the derailment of manasika doshas, it is  essential that the line of treatment of mental diseases should be specific and  based on the theory of balancing the mental doshas (rajas and tamas). Taking into consideration all these factors, most probably in Ayurveda a separate classification of satvavajaya treatment has been specially mentioned. Charak defines it as a mind control therapy in which stress will be laid on restraining the mind from unwholesome arthas (objects). Certain techniques have been mentioned for this therapy.  

The methods of yuktivyapasraya treatment have been prescribed in the treatment of mental diseases. But in the derailment of manasika doshas, it is  essential that the line of treatment of mental diseases should be specific and  based on the theory of balancing the mental doshas (rajas and tamas). Taking into consideration all these factors, most probably in [[Ayurveda]] a separate classification of satvavajaya treatment has been specially mentioned. Charak defines it as a mind control therapy in which stress will be laid on restraining the mind from unwholesome arthas (objects). Certain techniques have been mentioned for this therapy.  

The inclusion of satvavajaya chikitsa, within these primary classifications of treatment of diseases, clearly indicates that this therapy of mano-nigraha was adopted in those days as a practical therapy to over come the psychological and psychosomatic diseases. While describing the principles of treatment, Charak prescribes the following methods of treatment for mental diseases:

The inclusion of satvavajaya chikitsa, within these primary classifications of treatment of diseases, clearly indicates that this therapy of mano-nigraha was adopted in those days as a practical therapy to over come the psychological and psychosomatic diseases. While describing the principles of treatment, Charak prescribes the following methods of treatment for mental diseases:

#Bhavamishra, Bhavaprakasha. Hindi commentary by Bhishagratna pandit sir Brahma Shankar Mishra. Chaukambha Sanskrit bhavan edition 2010, madhyama khanda,pp 770 , page no.214  

#Bhavamishra, Bhavaprakasha. Hindi commentary by Bhishagratna pandit sir Brahma Shankar Mishra. Chaukambha Sanskrit bhavan edition 2010, madhyama khanda,pp 770 , page no.214  

#Chabanur Sunil kumar. A Clinical Study on Shireeshadi Yoga in the Management of Kaphaja Unmada w.s.r.to Depressive Disorders RGUHS, Karnataka, 2010.

#Chabanur Sunil kumar. A Clinical Study on Shireeshadi Yoga in the Management of Kaphaja Unmada w.s.r.to Depressive Disorders RGUHS, Karnataka, 2010.

#Deole Y.S. Chandola H.M. Clinico- experimental study on effect of Brahmi ghrita on depressive illness, M.D. dissertation submitted to Gujarat Ayurveda University Jamnagar-2008  

#Deole Y.S. Chandola H.M. Clinico- experimental study on effect of Brahmi ghrita on depressive illness, M.D. dissertation submitted to Gujarat [[Ayurveda]] University Jamnagar-2008  

#The national clinical coding standards ICD-10 4th edition(www.connectingforhealth.nhs.uk/.../icd1...)

#The national clinical coding standards ICD-10 4th edition(www.connectingforhealth.nhs.uk/.../icd1...)

#Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62

#Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62

#Charak Samhita Vol. I (1976): Eng. Translation of R. K. Sharma and V. Bhagawan Dash - Chowkhamba Sanskrit Series Office, Varanasi.

#Charak Samhita Vol. I (1976): Eng. Translation of R. K. Sharma and V. Bhagawan Dash - Chowkhamba Sanskrit Series Office, Varanasi.

#Charak Samhita Volume III (1988): Eng. Translation By R. K. Sharma and V. Bhagwan Dash - Chowkhamba Sanskrit Series Office, Varanasi.

#Charak Samhita Volume III (1988): Eng. Translation By R. K. Sharma and V. Bhagwan Dash - Chowkhamba Sanskrit Series Office, Varanasi.

#David Frawley; Ayurveda and the mind; The Healing of Consciousness; Motilal Banarasidas Publishers Private Limited; Delhi.

#David Frawley; [[Ayurveda]] and the mind; The Healing of Consciousness; Motilal Banarasidas Publishers Private Limited; Delhi.

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#Murthy A.R.V. & R.H. Singh; Non Pharmachological approach to the management of IBS with special reference to group Sattvavajaya; 1986.

#Murthy A.R.V. & R.H. Singh; Non Pharmachological approach to the management of IBS with special reference to group Sattvavajaya; 1986.

#Shukla Punam Rani : Supportive Psychotherapy in stress related diseases report submitted to teachers reorientation training programme held at Department of Kayachikitsa, Faculty of Ayurveda, IMS, BHU. 2000.

#Shukla Punam Rani : Supportive Psychotherapy in stress related diseases report submitted to teachers reorientation training programme held at Department of Kayachikitsa, Faculty of [[Ayurveda]], IMS, BHU. 2000.

#Singh R.H. (1986): Ayurvediya manasa vignana, chaukamba Amarabarati Prakasan. Varanasi.

#Singh R.H. (1986): Ayurvediya manasa vignana, chaukamba Amarabarati Prakasan. Varanasi.

#Tripathi J.S.: Dimensions of sattvavajaya chikitsa  (Ayurvedic -Psychotherapy) and their clinical applications,Annals of Ayurvedic Medicine,vol. 1 Issue 1&2,Jan-June,2012,ISSN-2277-4092 .

#Tripathi J.S.: Dimensions of sattvavajaya chikitsa  (Ayurvedic -Psychotherapy) and their clinical applications,Annals of Ayurvedic Medicine,vol. 1 Issue 1&2,Jan-June,2012,ISSN-2277-4092 .