Case Report: A Case of Adjustment Disorder with Anxiety
A Case of Adjustment Disorder with Anxiety
A Homeopathic Medicine Case Report
AJHM (Spring 2016 Issue - Volume 110 Number 1) by George Guess, MD, DHt
Abstract: An acute case of adjustment disorder with anxiety is presented that responded to the homeopathic prescription of Vanadium, after the failure of Silicea. Elemental homeopathic analysis using Jan Scholten’s method of analysis provided the guidance to recognize Vanadium as the indicated medicine, the operant theme being that the patient, having committed to and having embarked upon an imposing career as a nurse practitioner, suffered extreme self-doubt and insecurity, questioning whether or not she was capable of performing adequately in that position. Keywords: adjustment disorder with anxiety, performance anxiety, elemental homeopathy, homeopathic medicine, Vanadium
Adjustment disorder with anxiety is characterized by anxiety and other symptoms resulting from a traumatic life event or change. Individuals may suffer intense anxiety, mood and cognition problems, changes in behavior and somatic symptoms, such as insomnia. Conventional treatment includes various forms of psychotherapy and medication (anxiolytics, selective serotonin and/or norepinephrine reuptake inhibitors (SSRIs, SNRIs). Homeopathic medicine, however, has a long track record of quickly alleviating this condition, without the side effects commonly associated with the pharmaceutical treatment of this condition.
On October 17, 2016, this 25 year-old female nurse practitioner consulted with me for anxiety and insomnia originating the previous month when, after having completed her training, she began working as a primary care provider. She had heretofore worked as a nurse and completed her Nurse Practitioner (NP) training without any such problems, having always felt quite confident of her abilities and having performed them admirably. When she first began working in her new position she became overwhelmed with the new charting system and, as she began shadowing her NP superiors, she began worrying that her knowledge of medicine was inadequate to meet the demands of the position and became anxious about being on her own. Her anxiety especially escalated when she was on call and had sole responsibility for the care of her patients.
She felt very insecure. Whenever she returned home from work she would look up information to ensure she’d been correct in her assessments. She could not turn her mind off. She worried as well that others at work would be critical of her. Her anxiety was partially relieved by walks outdoors and exercise. She also was helped by questioning other NPs she worked with, absorbing their experience. However, she felt that she was asking too many questions, questions about topics she should already be familiar with. She commented that she was never on her own before and she always had the support of a preceptor.
Her resulting sleep disturbance took the following pattern: she would initially fall asleep without difficulty, but later waken anxious and restless in bed, tossing and turning for hours. As she lay in bed, her mind raced and her thoughts dwelled on ‘what ifs’—”What if I’m called tonight and don’t know the answer?” “What if I made a mistake with that patient I saw today?” This insecurity would propel her from bed to look up information in her medical texts. In short, she was anxious, insecure, needful of support and overly conscientious.
She did experience some anxiety as a nursing student but studying hard compensated for this; it was the same when she first began working as a nurse in a clinic, though her initial mild anxiety eased after a while. When asked how she felt when having to give public presentations, she admitted to being pretty anxious at the start though her deliveries would go well. With anticipatory anxiety, she experienced some diarrhea and axillary perspiration.
She liked to be organized because it made her feel better when stressed though her follow through could falter when overwhelmed. She was not fastidious. She had a history of being a rather intrepid world traveler, often traveling alone to distant locales. She was not a hurried person. She was normally sympathetic and she had a mild fear of robbers.
Over this time period she’d noted some hair loss and her appetite was reduced from the stress, with consequent weight loss. She was typically a warm-blooded person and often overly warm at night with some mild chest perspiration. Lately, however, she’d become more chilly and sensitive to drafts.
She noted some night sweats, with heat.
She had always craved cheese; more recently, with the stress, she’d begun craving more sweets.
Thirst was unremarkable. Menses were irregular lately, with long cycles of about five weeks; otherwise menses were unremarkable. She noted white spots on her nails and complained of dry scalp and skin.
She had no chronic health issues.
Diagnosis: Adjustment disorder with anxiety of an acute nature. Performance Anxiety.
Treatment: Silicea 200c, liquid attentuation; one dose and wait three days. If no significant reaction is apparent, begin once daily dosing after succussing the remedy bottle 10 times before each dose.
On October 25, 2016, she emailed me complaining that her anxiety was much worse, so much so that she was thinking of quitting her position.
Plan: Discontinue Silicea.. Prescribe Vanadium 200c, liquid attenuation, to be taken in a similar manner as Silicea.
Follow-up: The patient emailed me after one week to report that she was feeling better—less anxious, more confident. After two weeks she felt her confident self; she experienced no anxiety when on call and she had been sleeping quite well. At this point I advised her to begin reducing the frequency of administration of the remedy, gradually extending the number of days between doses and finally stopping altogether, which she has done. To date, she remains well and is functioning well in her new position.
All the usual ‘suspects’ for this sort of performance anxiety were considered for this woman initially—Silicea, Lycopodium, Argentum nitricum, Gelsemium, Carcinosin, Arsenicum album—all strong anticipatory anxiety medicines. Her overall presentation—extreme conscientiousness, anticipatory anxiety, lack of confidence with a strong need for adequate preparation (study) for exams, orderliness, chilliness, and white spots on her fingernails—strongly indicated Silicea; consequently it was prescribed. (No repertorization was performed.) Alas, it only worsened her condition. There remains the possibility that Silicea could be her constitutional remedy at a later date and that she was, at the time, in need of an acute intercurrent remedy.
Subsequent to the obvious failure of Silicea and unhappy with the other usual choices (though Arsenicum album and Carcinosin seemed possible choices), I elected to consider her case in the context of ‘Elemental homeopathy;’ ie, Jan Scholten’s schema of homeopathic analysis based primarily on the mental-emotional characteristics of patients [see Homeopathy and Minerals and Homeopathy and the Elements by Jan Scholten].
Her primary focus appeared to revolve around the competent performance of her work; ie, doing her job well. Admittedly, responsibility (a gold series theme) was involved, as is the case for all health care professionals involved in direct patient care, but her complaint did not reflect a significant concern for meeting her responsibilities. Performance also was, of course, an issue with her, but not in the sense that the Silver series is concerned with - creativity and winning the admiration of others were not her concerns. No, the focus was on competence in the work place, a Ferrum series issue. Performing the task adequately and doing her duty were her central issues.
So, having identified the series, the next prerequisite to applying Scholten’s schema was the identification of her stage. This decision was, for me, difficult, given my infrequent use of Elemental homeopathy. Stages 4 and 5, on the left side of the periodic table—the side pertaining to those who suffer varying degrees of insecurity—appeared most apt. Those two stages suggested two possible remedies— Titanium metallicum and Vanadium. The differences between the two remedies, as described by Scholten, seemed subtle, a major reason I employ Elemental homeopathic analysis infrequently, given the indecision that such subtlety can evoke. Nonetheless, past experience informed me that Scholten’s method can be extremely effective in some cases; so I forged ahead.
Of help was my referring to Rajan Sankaran’s themes for each stage or column in the periodic table. His ideas dovetail quite nicely with Scholten’s own and help to clarify the psychodynamics of each stage. For stage 4/row 4 (Ferrum series: Titanium) he writes, “The doubts about the structure are resolved. There’s no stepping back; one has to do things on one’s own. Will I be able to? Commencing, beginning, inadequate.” (“Rajan’s Column” in “Mineral Maps”—ReferenceWorks). For stage 5 (Vanadium) he writes, “The structure is complete, but the foundation is not strong. Should I go ahead or not? Do I have the ability or not? Trying, unsure, postponing, preparing.” This patient had progressed beyond just beginning; she had accepted that she had to perform on her own, but this decision made her feel insecure and she questioned her ability, even considering quitting when her anxiety was most pronounced. Though the decision was difficult and delicate (to me), I opted for Vanadium.
This case, while not involving significant pathology, is quite revealing of both the impressive efficacy of homeopathy and the utility of Elemental homeopathy. While it is quite possible that one of our tried-and-true homeopathic medicines might have benefited this patient, it’s hard to deny the patient’s positive response to Vanadium, a previously little-known remedy which Phatak describes thusly in his Concise Materia Medica: “Vanadium [Vanad.]: A remedy for degenerative conditions of liver and arteries. Fatty degeneration of heart and liver. Arterio-sclerosis. Deeply pigmented patches on forehead in liver affections. Profound weakness.” None of the angst surrounding one’s performance when embarking on a task, a Stage 4 concern, had heretofore been revealed until Jan Scholten so asserted, with the able assistance of Rajan Sankaran. Their contribution to homeopathy is laudable and extends our pharmacopoeia, adding many effective medicines to our armamentarium.
While acute stress reactions (in this case more ‘subacute’)might not seem like significant pathology, the sufferers of same might beg to differ—the suffering, as in this case, can be immense and affect the very course of their lives. Homeopathy offers a highly effective and safe treatment alternative, avoiding the side effects of anxiolytics and sedatives that are commonly prescribed, and that fail to address the underlying dynamic genesis of these ailments (as opposed to prevailing allopathic concepts of chemical imbalances). Proper homeopathic treatment not only can relieve the anxiety and associated symptoms, but also bolster the psychological foundation of patients, affording a real boost in confidence and an enhanced sense of security when facing an uncertain future.
Lastly, as this case illustrates, it behooves homeopathic physicians to educate themselves about all the many methods of homeopathic analysis, whether so-called classical Hahnemanian analysis, Vithoulkian essence prescribing, Boenninghausen analysis (and associated Polarity Analysis), Elemental homeopathy, Sensation homeopathy (Sankaran), and even Inspirational homeopathy (Tinus Smits). Any one of these methods could prove the key to unlocking a difficult case. While I have only a passing familiarity with some of the aforementioned methods, the several times I have employed some of them, to the extend that I’ve been capable, they have proved invaluable. I would encourage all homeopaths to look into these techniques.
About the Author: George Guess, MD, DHt, practices homeopathy in Crozet, Virginia. (Charlottesville area) He is the previous Editor of the “American Journal of Homeopathic Medicine” and Vice-President of the American Board of Homeotherapeutics. He holds a diploma in homeopathy from the Athenian School of Homeopathy (George Vithoulkas’s instructional program).
Vanadium image info: A high purity (99.95 %) Vanadium disc, EBM remelted, electrical discharge cut, ground, polished and macro etched. Size ca. 35 mm dia., weight ca. 31.5 g. By Alchemist-hp (talk) (www.pse-mendelejew.de) (Own work) [FAL or GFDL 1.2 (http://www.gnu.org/licenses/old-licenses/fdl-1.2.html)], via Wikimedia Commons
Periodic Table from ReferenceWorks, printed with permission from Synergy Homeopathic