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==([[Chikitsa Sthana]] Chapter 9, Chapter on the Management of Mental Disorders) ==

==([[Chikitsa Sthana]] Chapter 9, Chapter on the Management of Mental Disorders) ==

Abstract

=== Abstract ===

 

“Unmada Chikitsita” describes the management of unmada (insanity). The approach to the management of  individual  types of unmada have been elaborately described. The  uniqueness of the chapter lies in the broad description of  all three  forms of therapies described in Ayurvedic System  i.e. yukti-vyapashraya (rational treatment) to daiva- vyapashraya ( spiritual therapy) & sattvavajaya chikitsa (psychotherapy) for the management. Apart from these three types, the fourth type of therapy, called upayabhipluta (consolation, mental support) chikitsa, which incorporates a variety of non–pharmacological methods of treatment has also been described. Unmada is the only disease entity in the entire classical Ayurvedic literature, which requires such an extensive & broad spectrum of management principles, techniques, drugs, counselling, psychotherapy & therapeutic modalities, which are to be judiciously utilized by the clinicians based on their  specific indications and the state of the disease.

“Unmada Chikitsita” describes the management of unmada (insanity). The approach to the management of  individual  types of unmada have been elaborately described. The  uniqueness of the chapter lies in the broad description of  all three  forms of therapies described in Ayurvedic System  i.e. yukti-vyapashraya (rational treatment) to daiva- vyapashraya ( spiritual therapy) & sattvavajaya chikitsa (psychotherapy) for the management. Apart from these three types, the fourth type of therapy, called upayabhipluta (consolation, mental support) chikitsa, which incorporates a variety of non–pharmacological methods of treatment has also been described. Unmada is the only disease entity in the entire classical Ayurvedic literature, which requires such an extensive & broad spectrum of management principles, techniques, drugs, counselling, psychotherapy & therapeutic modalities, which are to be judiciously utilized by the clinicians based on their  specific indications and the state of the disease.

Key Words: Unmada, Manas, Schizophrenia, Manic Psychosis, Psychotic Depression / Major Depressive disorder, Treatment of psychiatric disorders   

'''Keywords''': Unmada, Manas, Schizophrenia, Manic Psychosis, Psychotic Depression / Major Depressive disorder, Treatment of psychiatric disorders   

Introduction

=== Introduction ===

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 & 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 (impairement of memory), behavioral, social and emotional disturbances in the form of abnormalities of achar (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 vakyam), thought blocking (hridaya shunyata ), loosening of associations, neologism, echolalia etc. and various psychomotor 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 & 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 (impairement of memory), behavioral, social and emotional disturbances in the form of abnormalities of achar (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 vakyam), thought blocking (hridaya shunyata ), loosening of associations, neologism, echolalia etc. and various psychomotor 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 & 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 & the sannipataj 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 & 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 & the sannipataj 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 & nasya are other treatment modalities indicated in unmada. Acharya Vagbhata emphasises their importance by saying that if all medications for unmada like vamana, virechana etc. fail, one should do teekshna anjana & 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 & nasya are other treatment modalities indicated in unmada. Acharya Vagbhata emphasises their importance by saying that if all medications for unmada like vamana, virechana etc. fail, one should do teekshna anjana & nasya karma.