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Dementia, Delirium & Neuropsychiatric conditions in Charaka indriya sthana

Authors:
  • 15.59
  • SKS AYURVEDIC MEDICAL COLLEGE & HOSPITAL
  • 15.75
  • SKS Ayurvedic Medical College & Hospital

Abstract

Charaka Samhita is the oldest and most authentic treatise on Ayurveda (an ancient Indian system of medicine). Indriya sthana (prognostic medicine) is one among the eight sections of Charaka samhita and it deals with prognostic aspects. Arishta lakshanas are the signs and symptoms which indicates imminent death. Various psychiatric and neuropsychiatric conditions are mentioned throughout ‘Charaka Indriya sthana’ in a scattered form. Dementia and delirium are commonly seen at terminal stages or at the end-of-life. As indriya sthana deals with terminal illnesses or end-of-life stages, there is a hypothesis that description of conditions like dementia and delirium may be traceable in ‘Charaka indriya sthana’. The present study attempts to screen various references pertaining to psychiatric and neuropsychiatric conditions of ‘Charaka Indriya sthana’ and explore their rationality, clinical and prognostic significance in present era. Dementia, Delirium and neuropsychiatric conditions of ‘Charaka Indriya sthana’ have been explored in the present study. ‘Dementia’ and ‘Delirium’ are the two most common conditions found through out ‘Charaka indriya sthana’. Various references related to other psychiatric and neuropsychiatric conditions like, ‘Hallucinations’, ‘Trichotillomania’, ‘Bruxism’, ‘Nail biting’, ‘Impulse control disorders’, ‘Major depressive disorder’, ‘Catatonia’ and ‘Negative symptoms of Schizophrenia’. The psychiatric/neuropsychiatric conditions mentioned in ‘Charaka Indriya sthana’ are characterized by poor prognosis, having irreversible underlying pathology, chronic, progressive and debilitating in nature and commonly found in dying patients or at the endof-life stages. It seems that psychiatric conditions mentioned in ‘Charaka Indriya sthana’ have clinical applicability and prognostic significance in present era also. Further studies are required to substantiate the clinical findings described in ‘Charaka Indriya sthana’. Keywords: Charaka samhita, delirium, dementia, Indriya sthana, neuropsychiatric disorders, scizhophrenia
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Abbreviations: CSD, cognitive spectrum disorder; MCI,
mild cognitive impairment; BPSD, behavioural and psychological
symptoms of dementia; DSM-V, diagnostic and statistical manual
of mental disorders-5th edition; NCD, neurocognitive disorder;
AD, alzheimer’s disease/alzheimer’s dementia; VaD, vascular
dementia; DLB, dementia with Lewy bodies; FTLD, frontotemporal
lobar dementia; HD, huntington’s disease; CJD, creutzfeldt-Jakob
disease; HIV, human immunodeciency virus; AIDS, acquired
immunodeciency syndrome; MS, multiple sclerosis; MSA, multiple
system atrophy; PD, parkinson’s disease; PWS, prader-willi syndrome;
ESP, extrasensroy perception; NDs, neurodegenerative diseases; PSP,
progressive supranuclear palsy; ALS, amyotrophic lateral sclerosis;
PCA, posterior cortical atrophy; TBI, trauamatic brain injury; TIA,
transient ischemic attack; VCI, vascular cognitive impairment;
FTD, frontotemporal dementia; VP, vascular parkinsonism; CBD,
corticobasal degeneration; OGC, oculogyric crisis; PDD, parkinson’s
disease dementia; CP, cancer pain; CIBP, cancer induced bone pain;
CNS, central nervous system; SD, seborrheic dermatitis; CBS, charles
bonnet syndrome; OBS, organic brain syndrome; MDD, major
depressive disorder; CS, cotard’s syndrome; TTM, trichotillomania;
TS, tourette’s syndrome; OCD, obsessive compulsive disorder;
BFRB, body focused repetitive behaviours; ADHD, attention-decit/
hyperactivity disorder; SIB, self injurious behaviour; MRI, magnetic
resonance imaging; KBS, kluver-bucy syndrome; ICU, intesive care
unit
Introduction
Charaka Samhita is the oldest and most authentic treatise on
Ayurveda (an ancient Indian system of medicine).1 Indriya sthana
(prognostic medicine) is one among the eight sections of Charaka
samhita and it deals with prognostic aspects. Indriya sthana contains
12 chapters and various ‘Arishta lakshanas’ are explained in ‘Indriya
sthana’. Arishta lakshanas are the signs and symptoms which indicates
imminent death. Conditions which are having poor prognosis, having
irreversible underlying pathology, conditions which are refractory to
treatment, chronic, debilitating and progressive conditions, diseases
having higher mortality risks, conditions which are commonly found
during end-of-life stages and conditions which require hospice or
palliative care etc are explained in ‘Indriya sthana’.2
Physician should be alert to identify the arishta lakshanas
whenever they appear, incorporate them in calculating remaining life
expectancy and also in clinical decision making.2 Various psychiatric
and neuropsychiatric conditions are mentioned throughout ‘Charaka
Indriya sthana’ in a scattered form.3-14 Various concepts of ‘Charka
samhita’ were untouched or unexplored till date. The present study
attempts to screen various references pertaining to psychiatric and
neuropsychiatric conditions of ‘Charaka Indriya sthana’ and explore
their rationality, clinical and prognostic signicance in present era.
Dementia, Delirium (Table 1) and neuropsychiatric conditions (Table
2) of ‘Charaka Indriya sthana’ have been explored in the following
sections.
Pharm Pharmacol Int J. 2020;8(5):297310. 297
©2020 Gupta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which
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Dementia, delirium & neuropsychiatric conditions in
Charaka indriya sthana
Volume 8 Issue 5 - 2020
Kshama Gupta, Prasad Mamidi
Professor, Department of Kayachikitsa, SKS Ayurvedic Medical
College & Hospital, India
Correspondence: Kshama Gupta, Professor, Dept of
Kayachikitsa, SKS Ayurvedic Medical College & Hospital,
Mathura, Uttar Pradesh, India, Tel 7567222309,
Email
Received: September 16, 2020 | Published: October 12, 2020
Abstract
Charaka Samhita is the oldest and most authentic treatise on Ayurveda (an ancient Indian
system of medicine). Indriya sthana (prognostic medicine) is one among the eight sections
of Charaka samhita and it deals with prognostic aspects. Arishta lakshanas are the signs
and symptoms which indicates imminent death. Various psychiatric and neuropsychiatric
conditions are mentioned throughout ‘Charaka Indriya sthana’ in a scattered form.
Dementia and delirium are commonly seen at terminal stages or at the end-of-life. As
indriya sthana deals with terminal illnesses or end-of-life stages, there is a hypothesis that
description of conditions like dementia and delirium may be traceable in ‘Charaka indriya
sthana’. The present study attempts to screen various references pertaining to psychiatric
and neuropsychiatric conditions of ‘Charaka Indriya sthana’ and explore their rationality,
clinical and prognostic signicance in present era. Dementia, Delirium and neuropsychiatric
conditions of ‘Charaka Indriya sthana’ have been explored in the present study. ‘Dementia’
and ‘Delirium’ are the two most common conditions found through out ‘Charaka indriya
sthana’. Various references related to other psychiatric and neuropsychiatric conditions like,
‘Hallucinations’, ‘Trichotillomania’, ‘Bruxism’, ‘Nail biting’, ‘Impulse control disorders’,
‘Major depressive disorder’, ‘Catatonia’ and ‘Negative symptoms of Schizophrenia’.
The psychiatric/neuropsychiatric conditions mentioned in ‘Charaka Indriya sthana
are characterized by poor prognosis, having irreversible underlying pathology, chronic,
progressive and debilitating in nature and commonly found in dying patients or at the end-
of-life stages. It seems that psychiatric conditions mentioned in ‘Charaka Indriya sthana
have clinical applicability and prognostic signicance in present era also. Further studies
are required to substantiate the clinical ndings described in ‘Charaka Indriya sthana’.
Keywords: Charaka samhita, delirium, dementia, Indriya sthana, neuropsychiatric
disorders, scizhophrenia
Pharmacy & Pharmacology International Journal
Review Article Open Access
Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana 298
Copyright:
©2020 Gupta et al.
Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
Table 1 Dementia & Delirium in Charaka indriya sthana
References in Charaka indriya
sthana ‘Dementia’ or ‘Delirium’
‘Heena balavarnendriyeshu -- kshayasya’
(Ch. I. 1 / 12) Changes in skin colour in senile dementia patients at the end-of-life stages;
‘Sweda stambha’ (Anhidrosis)
(Ch. I. 3 / 4) Dementia with Lewy bodies (DLB);
‘Darshanamaayaati maruto’
(Ch. I. 4 / 8) Visual hallucinations in Dementia and Delirium;
‘Jaagruta pashyati -- vividhani cha’
(Ch. I. 4 / 10) Complex visual hallucinations seen in delirium tremens and Dementia;
‘Yo agnim neelam -- pashyati nishprabham’
(Ch. I. 4 / 11) Achromatopsia in focal dementia;
‘Naktam suryam -- va nishprabhau’
(Ch. I. 4 / 15) Visual hallucinations in delirium; Achromatopsia in focal dementia;
‘Ashabdasya yaha cha shrota’
(Ch. I. 4 / 19) Auditory verbal hallucinations (AVH) in dementia;
‘Indriyai adhikam pashyan’
(Ch. I. 4 / 24) Delirium tremens, Lewy body dementia; Extrasensory perception (ESP);
‘Swastha pragna -- vaikrutam’
(Ch. I. 4 / 26)
Neurocognitive disorders (NCDs) like Dementia, Delirium, Alzheimer's disease (AD), Frontotemporal lobar
degeneration, Lewy body disease, Huntington's disease, Prion disease etc;
‘Krodhanam trasa bahulam -- unmadena’
(Ch. I. 5 / 20) Metabolic encephalopathy in Delirium;
‘Dhyaanaayasau tatha -- sambhava
(Ch. I. 5 / 18)
Clouding of consciousness, restlessness, agitation, perseveration, illusions, disorientation, increased
psychomotor activity, stupor and anxiety etc seen in delirium;
‘Balam vignanamarogyam -- kshipram’
(Ch. I. 6 / 23) Cachexia in advanced dementia; Delirium;
‘Arogyam heeyate prakrutim pariheeyate’
(Ch. I. 6 / 24) Dementia; Delirium;
‘Traya prakupita dosha kashtabhilakshita’
(Ch. I. 6 / 17) Delirium;
‘Taamyati ayachhante -- vindati’
(Ch. I. 6 / 21) Delirium;
‘Hraswam cha -- spandate cha’
(Ch. I. 7 / 25) Hyperactive subtype of delirium; Parkinson’s dementia;
‘Urdhwagre nayane -- kampane’
(Ch. I. 7 / 27) Familial Parkinson’s dementia syndrome;
‘Muhurhasan muhurkshvedan -- hanti’
(Ch. I. 8 / 20) Lyme borreliosis with dementia (Neuropsychiatric Lyme borreliosis); Hyperactive subtype of delirium;
‘Swarasya durbali bhavam -- bala varnayo’
(Ch. I. 9 / 12) Delirium; Advanced dementia;
‘Nissangna parisushkasya --
vyadhibhishcha’
(Ch. I. 9 / 4)
Delirium; Severe dementia;
‘Apaswaram bhashamanam --
apashabdasya’
(Ch. I. 9 / 14)
Alzheimer’s dementia; Dementia; Delirium;
‘Anujyoti anekagro -- ratim na labhate’
(Ch. I. 11 / 3)
Behavioral and psychological symptoms (BPSD) of Dementia; Delirium; Neurocognitive disorders (NCDs)
like Alzheimer’s dementia, VaD, Dementia with Lewy body (DLB), and Frontotemporal lobar degeneration;
‘Bhakti sheelam --
buddhirbalamahetukam’
(Ch. I. 11 / 7)
Alzheimer’s disease and related dementias (ADRD); BPSD;
‘Shareera kampa -- mattasyeva’
(Ch. I. 11 / 10) DLB with Parkinsonism features;
‘Aahvayastham -- janameva’
(Ch. I. 11 / 21) Dementia; Acute confusional states or Delirium;
‘Ayogam atiyogam -- bhishak’
(Ch. I. 11 / 22) Terminal agitation in Delirium; DLB; Neurodegenerative diseases;
‘Atipravruddha -- bala kshayaat’
(Ch. I. 11 / 23) Dementia; Delirium
‘Varna swaragni -- bhavati va na va’
(Ch. I. 11 / 24) Dementia; Delirium
‘Sambhramo atipralapo -- ati daruna’
(Ch. I. 11 / 16) Bone metastasis causing delirium;
‘Yasya gomaya choornaabham -- jayate’
(Ch. I. 12 / 3) Seborrheic dermatitis (SD) seen in AD patients;
‘Vignaanam uparudhyate’
(Ch. I. 12 / 46) Delirium; Demenita;
Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana 299
Copyright:
©2020 Gupta et al.
Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
References in Charaka indriya
sthana ‘Dementia’ or ‘Delirium’
‘Indriyani vinashyanit -- bhajate satvam’
(Ch. I. 12 / 47) Dementia; Delirium;
‘Smriti tyajati -- chapasarpata’
(Ch. I. 12 / 48) FTD; AD;
‘Shabda sparsho -- ashubhani eva’
(Ch. I. 12 / 58) Senile dementia; BPSD;
(Ch. I. XX / YY): Ch - Charaka samhita; I - Indriya sthana; XX - Chapter number; YY - Verse number
Table continue
Review methodology
Ayurvedic literature regarding ‘Indriya sthana has been collected
from Charaka samhita, including ‘Ayurveda dipika commentary
by Chakrapani. Electronic databases ‘Google’ and ‘Google scholar’
have been searched to nd out the relevant studies and reviews
based on dementia, delirium, psychiatric and neuropsychiatric
conditions published till ‘August 2020’, irrespective of their
appearance/publication year. The key words used for search were,
Charka samhita’, ‘Indriya sthana’, ‘Charaka indriya sthana’,
‘Neuropsychiatric disorders’, ‘Dementia’, ‘Delirium’, ‘Catatonia’,
‘Negative symptoms of schizophrenia’, ‘Anxiety’, ‘Depression’,
‘Bruxism’, ‘Impulse control disorders’, ‘Trichotillomania’,
‘Neurocognitive disorders’ ‘Health psychology’, ‘Positive
psychology’, ‘Psychoneuroimmunology’, ‘Personality factors’,
‘Visual allucinations’, ‘Auditory hallucinations’, ‘Cognitive
distortions’, ‘Cognitive bias’, ‘Cognitive errors’, ‘Parkinsonism’, and
other relevant terms. Abstracts, full texts and open access articles in
‘English language’ were only considered.
Psychiatric conditions
‘Dementia’ and ‘Delirium’ are the two most common conditions
found through out ‘Charaka indriya sthana’ (Table 1). Various
references related to other psychiatric and neuropsychiatric conditions
like, ‘Hallucinations’, ‘Trichotillomania’, ‘Bruxism’, ‘Nail biting’,
‘Impulse control disorders’, ‘Major depressive disorder’, ‘Catatonia’.
‘Negative symptoms of Schizophrenia’ are also mentioned in ‘Charaka
Indriya sthana’ (Table 2). Dementia, Delirium and neuropsychiatric
conditions are explored in the following sections.
Table 2 Psychological & Psychiatric conditions in Charaka indriya sthana
References in Charaka indriya sthana Relevant psychopathology
Psychological concepts:
‘Sattvam, bhakti, shaucham, sheelam, achara, smrti, medha, harsha, tandra & Swapna
darshana (Ch. I. 1 / 3)
Various psychological or psychiatric factors having signicance
in clinical prognostication;
‘Jati prasakta, Kula prasakta, desha, kaala vayo anupatini & Pratyatma niyata (Ch. I. 1 / 5) Various factors which inuences the development of
personality;
‘Mithyadrushtam -- pragnaaparadhajam’(Ch. I. 2 / 6) Cognitive distortions, Cognitive errors, Cognitive biases;
‘Manovahaanaam -- shubham phalam’(Ch. I. 5 / 41-46) Physiology and classication of dreams;
‘Svaachaaram, hrushtam, avyangam & Avyagram’ (Ch. I. 12 / 67-70) Positive attributes of a caregiver;
‘Sattva lakshana -- shubha lakshana’(Ch. I. 12 / 87-88) Health psychology; Positive psychology;
Hallucinations:
‘Swasthebhyo vikrutam -- maranasya tat’(Ch. I. 4 / 5) Hallucinations; Illusions;
‘Ghaneebhutamiva -- marana mruchhati’(Ch. I. 4 / 7) Visual hallucinations; Visual illusions;
‘Yasya darshanam -- kshayamaadishet’(Ch. I. 4 / 8) Visual hallucinations;
‘Jagruta pashyati -- jeevitu marhati’(Ch. I. 4 / 10) Visual hallucinations;
‘Mareechi nasato -- marana mruchhati’(Ch. I. 4 / 12) Visual hallucinations;
‘Aparvani yada -- tasya jeevitam’(Ch. I. 4 / 14) Visual hallucinations;
‘Naktam suryam -- marana mruchhati’ (Ch. I. 4 / 15) Visual hallucinations;
‘Ashabdasya cha -- vijaanataa’ (Ch. I. 4 / 16-19) Auditory hallucinations;
‘Indriyai adhikam pashyan’ (Ch. I. 4 / 24) Hallucinations;
‘Indriyaanaamrute -- na sa jeevati’ (Ch. I. 4 / 25) Hallucinations;
‘Laksha rakta -- neeyate’ (Ch. I. 5 / 10) Visual hallucinations;
‘Apaswaram bhashamaanam -- parivarjayet’ (Ch. I. 9 / 14) Auditory hallucinations;
‘Ayogam atiyogam va -- naavachaarayet’ (Ch. I. 11 / 22) Visual hallucinations;
Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana 300
Copyright:
©2020 Gupta et al.
Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
References in Charaka indriya sthana Relevant psychopathology
Psychological concepts:
Catatonia & Schizophrenia:
‘Ahara dveshinam -- ati paatinaa’ (Ch. I. 5 / 19) Catatonia;
‘Yairvindati pura -- maranamaadishet’ (Ch. I. 8 / 21) Negative symptoms of Schizophrenia; Major depressive
disorder; Cotard syndrome;
Bruxism & Trichotillomania:
‘Dantai chhindanti -- parimuchyate’ (Ch. I. 8 / 18) Trichotillomania; Nail biting;
‘Dantaan khaadati -- vimuchyate’ (Ch. I. 8 / 19) Bruxism;
‘Pramuhya lunchayet -- kaalachodita’ (Ch. I. 11 / 17) Trichotillomania;
Nightmares:
‘Drushyante daaruna -- udeeryate’ (Ch. I. 12 / 59) Nightmares;
(Ch. I. XX / YY): Ch - Charaka samhita; I - Indriya sthana; XX - Chapter number; YY - Verse number
Table continue
Dementia & delirium
Dementia and delirium are two major causes for cognitive
impairment in later years of life. Though these two conditions are
distinct, mutually exclusive entities, it can be dicult at times to
dierentiate between them. Delirium in late life is often superimposed
on pre-existing dementia and dementia is the leading risk factor for
delirium in older persons. Occurrence of delirium in turn is a risk
factor for subsequent development of dementia in older people
without pre-existing dementia. [15] People with various individual
‘Cognitive spectrum disorders’ (CSDs) (dementia, delirium, delirium
superimposed on dementia and unspecied cognitive impairment)
have been shown to have a high mortality in many studies
internationally. Mortality post-admission is high in older people with
CSD. Immediate risk is highest in those with delirium, while dementia
or unspecied cognitive impairment is associated with medium- to
long-term risk.16
Dementia is a clinical syndrome characterized by progressive
decline of cognition that interferes with the ability to function
independently. Symptoms of dementia are gradual, persistent and
progressive in nature. Patients with dementia experience changes
in cognition, function and behaviour. The clinical presentation of
dementia is variable among individuals, and the cognitive decits
it causes can present as memory loss, communication and language
impairments, agnosia, apraxia and impaired executive function such
as reasoning, judgement and planning. Patients with mild decits
who do not meet the criteria for dementia are considered to have
mild cognitive impairment (MCI). Behavioural and psychological
symptoms of dementia (BPSD) are complications of dementia.
Wandering, hoarding, inappropriate behaviours such as sexual
disinhibition and eating inappropriate objects, repetitive behaviour
and restlessness etc comes under BPSD which do not respond
well to treatment. In the most recent ‘Diagnostic and Statistical
Manual of Mental Disorders (DSM-V)’, the term ‘Neurocognitive
disorder’ (NCD) was introduced and replaced the term ‘Dementia’.
The NCD is classied as mild or major, (based on the severity of
symptoms).17 The most common types of dementia are Alzheimer’s
disease (AD), vascular dementia (VaD), dementia with Lewy bodies
(DLB) and frontotemporal lobar dementia (FTLD). Less common
causes of dementia include Huntingdon’s disease (HD), Creutzfeldt-
Jakob disease (CJD), Human immunodeciency virus (HIV) /
Acquired immunodeciency syndrome (AIDS) and multiple sclerosis
(MS).18
Delirium is an acute, transient and usually reversible
neuropsychiatric syndrome, seen in medical-surgical set-ups. It is
considered as a serious problem in acute care settings and it reects
decompensation of cerebral functions due to the result of one or more
underlying pathophysiological processes.19 The clinical presentation
of delirium is variable and it is classied broadly into three
subtypes, hypoactive, hyperactive and mixed (based on psychomotor
behavior). Patients with hyperactive delirium demonstrate features of
restlessness, agitation, hyper vigilance, hallucinations and delusions.
Patients with hypoactive delirium present with lethargy and sedation,
respond slowly to questioning, and show little spontaneous movement.
Patients with mixed delirium demonstrate both hyperactive and
hypoactive features.20 A variety of terms have been used in the
literature to describe delirium, such as “acute confusional state,”
“acute brain syndrome,” “acute cerebral insuciency,” and “toxic-
metabolic encephalopathy”. Delirium is characterized by a rapid onset
of symptoms, uctuating course and an altered level of consciousness,
global disturbance of cognition or perceptual abnormalities, and
evidence of a physical cause.21
References of Dementia & Delirium in Charaka indriya
sthana
‘Heena balavarna --- kshayasya bhavati’ (Verse 12)3
According to the above verse, reduced energy, body complexion
and performance of sensory organs denote imminent death. Lack of
self esteem, Apathy (diminished interest), slowing and lack of energy
(heena bala) and anhedonia (lost of interest in previous pleasurable
stimuli) etc emotional disturbances can be seen in dementia patients.22
Hearing loss, visual impairment, olfactory loss, and dual sensory
impairments (heena indriyeshu) are related to cognitive declination
and neurodegenerative disorders. Sensorineural organ impairment
(heena indriyeshu) is a predictive factor for mild cognitive impairment
Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana 301
Copyright:
©2020 Gupta et al.
Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
and neurodegenerative disorders (dementia) in the elderly.23 Vital
power decline, body weight reduction (heena bala) and changes in
skin colour (heena varna) are some of the signs and symptoms of
impending death in end-of-life (ayusha kshayasya) senile dementia
patients.24
‘Sweda stambha’ (Verse 4)5
The above condition denotes ‘Anhidrosis’. Anhidrosis (sweda
stambha) is more widespread in ‘Multiple system atrophy’ (MSA) than
in ‘Parkinson’s disease’ (PD). DLB is another form of synucleinopathy
that usually presents as distal anhidrosis (sweda stambha). Apart form
degenerative diseases, structural lesions such as stroke, MS, tumors,
and infection can also cause anhidrosis (sweda stambha) when they
involve autonomic pathways.25
‘Darshanamaayaati maruto’ (Verse 8)6
According to the above verse, visualization of the ow of wind (in
the absence of ophthalmic pathology) denotes imminent death. Visual
hallucinations (darshanam maruto) are the most common type of
hallucination seen in delirium patients. A strong positive correlation
between visual hallucinations and the number of active somatic
diagnoses has been established. Delirium from alcohol withdrawal (i.e.,
delirium tremens) or stimulant intoxication is typically accompanied
by visual hallucinations. The visual hallucinations in DLB involve
seeing objects move when they are actually still (darshanam maruto)
and seeing complex scenarios of people and items that are not present.
Visual hallucinations are an important clinical clue indicating DLB
rather than with another subtype of dementia. Posterior cortical
atrophy is another neurodegenerative syndrome associated with visual
hallucinations (darshanam maruto).26
‘Jaagruta pashyati --- sa jeevitumarhati’ (Verse 10)6
The above verse denotes ‘Complex visual hallucinations’. Visual
hallucinations (jaagruta pashyati) in delirium tremens typically
involve dierent types of animals (dogs, cats, snakes, insects, rats)
or signs and shapes (multicolored patterns, chalk writing on slate).
Tactile, auditory, musical and lilliputian hallucinations (anyad vaa
api adbhutam) may also occur in delirium tremens. Hallucinations
in AD are visual (jaagruta pashyati), although auditory, tactile and
olfactory hallucinations have also been observed. Well-formed
visual hallucinations (jaagruta pashyati) are seen in DLB patients.
The hallucinatory experiences in PD patients may include sensations
of presence of people or animals (jaagruta pashyati) and feeling of
oating (anyad vaa api adbhutam).27
‘Yo agnim prakruti --- vrajati saptameem’ (Verse 11)6
The above verse denotes ‘Achromatopsia’ or ‘Dyschromatopsia’.
Dysfunction in dierent tasks of vision and visual cognition, decreased
visual acuity (pashyati nishprabham), visuospatial disorientation,
decits in visual motion perception, contrast sensitivity disturbances
and incomplete achromatopsia (krishnam va shuklam va pashyati) etc
are the pathological alterations of the visual system caused by AD.
Dementia, including AD, is a major disorder, leading to several ocular
manifestations amongst the elderly population.28
‘Naktam suryam --- maranamruchhanti’ (Verse 15)6
The above verse indicates visual illusions, hallucinations and
achromatopsia. ‘A perception without an object’ is the classic
denition of a hallucination and a visual hallucination is experienced
when one sees something where nothing actually exists (anagnau
dhoomamuthitam). Patients with dementia with Lewy bodies
frequently experience a variety of visual illusions as well as visual
hallucinations (naktam suryam pashyati aha chandram). Various
visuoperceptual dysfunctions like visual illusions and hallucinations
etc are seen in AD and DLB.29 Visual hallucinations can be seen in
occipital seizures, migraines, ocular pathology, Charles Bonnet
syndrome (CBS), narcolepsy, psychosis, and delirium.30
‘Ashabdasya yaha --- vijaanataa’ (Verse 19)6
The above verse denotes ‘Auditory hallucinations’ and ‘Auditory
agnosia’. Auditory agnosia (shabdaan yascha na budhyate) can be
seen in various neurodegenerative diseases such as AD.31 Auditory
agnosia or word defaness and cortical defaness (shabdaan yascha
na budhyate) are seen in dementia patients. Patients with semantic
dementia develop decits of nonverbal sound recognition (auditory
associative agnosia) (shabdaan yascha na budhyate). Impaired
recognition of familiar voices (shabdaan yascha na budhyate) may
be a salient symptom of right temporal lobe degeneration. Elementary
auditory hallucinations (ashabdasya yaha cha shrota) are seen in
‘Semantic dementia’. Hallucinations of ‘mued’ sounds or voices
(Ashabdasya yaha cha shrota) are seen in DLB patients.32 ‘Shabdaan
yascha na budhyate’ or auditory agnosia is similar to ‘Shroto buddhi
vibhrama’.33
‘Indriyai adhikam --- adhigachhati’ (Verse 24)6
The above verse denotes ‘Hallucinations’ or ‘Extrasensory
perception’. Conditions causing interference with or damage to the
peripheral sensory pathways can produce hallucinations (indriyai
adhikam pashyan). Hallucinations can also be seen in conditions
like thyroid dysfunctions, Hashimoto disease, deciencies in vitamin
D and B12, Prader–Willi syndrome (PWS), autoimmune disorders,
HIV/AIDS, narcolepsy, tumors, traumatic brain injuries, epilepsy,
cardiovascular events involving the brainstem regions and temporal,
occipital, or temporo-parietal pathways, neurodegenerative conditions
such as PD and DLB.34 The ESP (extrasensory perception) (indriyai
adhikam pashyan) or paranormal experiences include ‘telepathy’
(communication between two geographically separated persons,
outside the range of sensory organs), ‘clairvoyance’ (knowledge of
hidden objects or events occurring outside the physical reach of the
person) and ‘precognition’ (knowledge of future events that can not
be predicted or inferred from the available information).35 Achieving
ESP in the absence of ‘Yogic practices’ denotes imminent death as per
the above verse.
‘Swastha pragna --- maranamaadishet’ (Verse 26)6
The above verse denotes cognitive alterations or disturbances or
distortions due to an underlying pathology. Cognitive disturbances
or alterations (pragna viparyaya) are seen in ‘Neurodegenerative
diseases’ (NDs) such as AD, DLB, FTLD, PD and other neurological
conditions like progressive supranuclear palsy (PSP), amyotrophic
lateral sclerosis (ALS), posterior cortical atrophy (PCA), corticobasal
syndrome, ischemic or hemorrhagic stroke, transient ischemic
attack (TIA) and traumatic brain injury (TBI) etc.36 Vascular
cognitive impairment (VCI) denes alterations in cognition (pragna
viparyaya), ranging from subtle decits to full-blown dementia, due
to cerebrovascular causes. Mixed vascular and neurodegenerative
dementia comorbid with AD has emerged as the leading cause of age-
related cognitive impairment.37
‘Krodhanam --- unmado sharirinaam’ (Verse 20)7
Panic attacks are characterized by severe apprehension (trasa
bahulam), dizziness (murcha), chest discomfort, palpitations, or fear
of “losing control.” Intermittent loss of consciousness (murcha) may
suggest ‘Syncope’ which occurs due to global cerebral hypoperfusion.38
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Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
Agitation, restlessness, hypervigilance (traasa bahulam), delusions,
hallucinations, disturbance of consciousness (murcha), dehydration
(due to intercurrent illness) (pipaasa bahulam), and behavioral
changes (krodhana & prahasitaanana) can be seen in delirium.20 The
above verse denotes delirium.
‘Dhyaanaayasau --- unmada purvaka’ (Verse 18)7
The etiologies of delirium are diverse and multi-factorial, and they
often reect the pathophysiological consequences of an acute medical
illness. Delirium develops through a complex interaction between
dierent risk factors. Hypervigilance (dhyaana), emotional distress
(aayaasa), agitation (udvega), restlessness (arati), disturbance of
consciousness (moha), and energy deprivation (due to metabolic
derangements) (bala haani) etc are seen in delirium.20 The above verse
indicates delirium.
‘Balam vignanam --- kshipram sa hanyate’ (Verse 23)8
Cachexia is a complex metabolic process associated with
underlying terminal illnesses (sa hanyate) and it is characterized
by anorexia (ksheeyante grahani) and loss of fat and muscle mass
(ksheena mamsa). Loss of body weight and reduced energy levels
(bala haani) are also found in cachexia. Cachexia is known to be
associated with advanced dementia (vignanam ksheeyate). The
natural history of dementia spans over 10 years, and the later stages
of the disease are marked by substantial unintentional weight loss
(bala haani), malnutrition (ksheeyante grahani), sarcopenia (ksheena
mamsa), anorexia (ksheeyante grahani), lethargy (bala haani), altered
immune function (ksheeyante arogyam), and cachexia.39 The above
verse indicates cachexia in advanced dementia patients.
‘Arogyam heeyate --- harati jeevitam’ (Verse 24)8
Psychological symptoms and behavioral abnormalities (prakrutim
pariheeyate) such as depression, anxiety psychosis, agitation,
aggression, disinhibition, and sleep disturbances etc are common and
prominent characteristics of dementia. Personality changes (prakrutim
pariheeyate) are most common in AD. Early loss of personal and
social awareness, early decline in social interpersonal conduct, early
loss of insight, and emotional blunting are characteristic features of
‘Frontotemporal dementia’ (FTD) (prakrutim pariheeyate). Health
related quality of life and ability to perform activities of daily living
(arogyam heeyate) are also impaired in dementia patients.40 The above
verse denotes advanced stages of dementia or delirium.
‘Traya prakupita --- nasti tasya chikitsitam’ (Verse 17)8
Delirium is common in the last weeks of life (nasti tasya
chikitsitam), occurring in 26% to 44% of people with advanced cancer
in hospital, and in up to 88% of people with terminal illness in the last
days of life (nasti tasya chikitsitam). Delirium is part of a wide range
of organic mental disorders that includes dementia, organic mood
disorder, and organic anxiety disorder. The prognosis of terminal
illness (traya prakupita dosha kashtabhilakshita) is worsened by
delirium.41 The above verse denotes chronic, debilitating, fatal, and
terminal illness which leads to delirium and death.
‘Taamyati ayachhante --- achiraannara’ (Verse 21)8
The above verse denotes delirium due to an underlying terminal
illness or delirium superimposed on advanced dementia patients
with cachexia. Disturbance or clouding of consciousness (taamyati),
agitation (sharma na vindati kinchidapi), restlessness (sharma na
vindati kinchidapi) and increased psychomotor activity (aayachhate)
are seen in delirium.20 During last days of life patients often experience
progressive functional decline and worsening symptom burden. Many
symptoms such as anorexia-cachexia (ksheena ahara & ksheena
mamsa), weight loss (ksheena bala), decreased quality of life and
delirium can be found in last days of life.42
‘Hraswam cha --- punarvasu’ (Verse 25)9
The above verse denotes either delirium (hyperactive subtype) or
seizures. Respiratory impairment (hraswam prashvasati) can be found
in delirium patients. Delirium can be accompanied by overactivity
of the autonomic system, producing sweating, pupil dilatation, and
tremor (vyaviddham spandate). Delirium may carry a high morbidity
and mortality (mrutameva tam). Seizures (vyaviddham spandate)
may present with ictal, interictal, or postictal delirium. Many of the
conditions resulting in delirium may also induce seizures (vyaviddham
spandate) such as hepatic and renal failure, electrolyte and metabolic
abnormalities, drug intoxications, intracranial infections, and acute
cerebrovascular events.43
‘Urdhwagre nayane --- na sa jeevati’ (Verse 27)9
Vascular parkinsonism (VP) is a condition which presents with
the clinical features of parkinsonism that are presumably caused by
cerebrovascular disease. Diagnosis is supported by the history of prior
stroke and vascular risk factors such as hypertension, diabetes mellitus,
hypercholesterolemia, or carotid stenosis (manya arata kampane?).44
The parkinsonian syndromes include idiopathic PD, PSP, MSA,
corticobasal degeneration (CBD) and VP.45 Oculogyric crises (OGC)
(urdhwagre nayane yasya) are dened as spasmodic movements of
the eyeballs into a xed position, usually upwards. OGC (urdhwagre
nayane yasya) can be seen secondary to dierent neurological
conditions such as neurotransmitter disorders, disorders aecting
certain parts of the brainstem, multiple sclerosis and encephalitis.46
OGC (urdhwagre nayane yasya) can be seen in ‘Postencephalitic
parkinsonism’.47 Balaheena (fatigue), shushkaasya (dry mouth), and
pipaasa (excessive thirst) indicates dehydration or hypovolemia. The
above verse denotes a condition of OGC with an underlying stroke or
cerebrovascular pathology.
‘Muhurhasan --- na sa jeevati’ (Verse 20)10
BPSD also termed as ‘Neuropsychiatric symptoms’, occur in
most patients with dementia. They describes the heterogeneous group
of signs and symptoms of disturbed perception, thought content,
mood (muhurhasan) or behaviour that frequently occur in patients
with dementia.48 Aggressive behaviours such as verbal agression
(screaming and cursing), physical aggression (hitting, biting, kicking,
scratching and grabbing) (shayyaan paadena hanti), mannersisms
(uchhai chhidraani vimrushyan), mood disturbances (anger outbursts,
irritability, anxiety and depression), delusions, hallucinations
and illusions etc are the common behavioural disturbances seen
in dementia patients. Late-life dementias are associated with
delusions and hallucinations (muhurhasan). Disruptive vocalization
(muhurkshvedan) tends to occur along with various other agitated
behaviors.49 Emotional disturbances (muhurhasan), such as anxiety,
fear, irritability, anger, depression, and euphoria are seen in delirium
patients. Delirium patients show features such as hyper-vigilance,
restlessness, agitation, aggression (shayyaan paadena hanti),
mood lability (muhurhasan), and in some cases, hallucinations and
delusions. Behaviors are frequently disruptive (e.g., shouting or
resisting, pulling out the IV tubing) or potentially harmful (shayyaan
paadena hanti).21 The above verse denotes BPSD features of dementia
or hyperactive subtype of delirium.
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DOI: 10.15406/ppij.2020.08.00309
Swarasya durbali --- maranamaadishet’ (Verse 12)11
Decline in vital power (bala haani), changes in skin colour (skin
becomes deadly pale, earth like colour, and turns white) (varna haani),
and weight loss etc are the signs and symptoms of death in end-of-life
(maranam) senile dementia patients.24 Hypophonia (swarasya durbali
bhaava) is seen in late stage PD.50 Delirium is a common and serious
disorder with high morbidity and mortality.51 Delirium is prevalent at
the end of life (maranam), particularly during the nal 24–48 hours.
Delirium is characterised by rapidly emerging (rogavriddhi ayuktya)
disturbance of consciousness and a change in cognition with
uctuating symptoms and evidence of organic aetiology.52 The above
verse denotes terminal illnesses, advanced dementia and delirium.
‘Nissangna --- dheera parivarjayet’ (Verse 4)11
Disturbances or clouding of consciousness (nissangna) is one of
the characteristic features of delirium. Delirium is highly prevalent in
the elderly and those with serious or advanced medical illnesses
(samruddho vyadhibhishcha). It is associated with many adverse
consequences (uparuddha ayusham). Delirium often leads to
increased need for higher levels of care, functional decline, increased
mortality, and decreased life expectancy (uparuddha ayusham).53
Delirium is multifactorial in origin, and precipitating or contributory
factors include dehydration and hypovolemia (parisushkasya).54 The
above verse denotes delirium with hypovoemia.
Apaswaram --- doorata parivarjayet’ (Verse 14)11
The above verse denotes abnormal vocalizations or speech and
auditory hallucinations seen in PD, dementias, and in delirium.
Auditory hallucinations (shrotaaram ashabdasya) are common
neuropsychiatric symptoms in DLB.55 Vocalizations (apaswaram
bhashamanam) consist of excessively loud and repetitive verbal
utterances, such as single words or phrases, nonsensical sounds,
screaming, moaning, and constant requests for attention. Nearly all
disruptive vocalizations are related to a form of brain injury; most
have dementia due to AD or cerebrovascular disease.56 Auditory
hallucinations (shrotaaram ashabdasya) can be seen in AD patients.57
‘Anujyoti anekagro --- samaantaram’ (Verse 3)13
BPSD include agitation (anekagro), aberrant motor behavior,
anxiety (anekagro), elation, irritability (durmana), depression, apathy,
disinhibition, delusions, hallucinations, and sleep or appetite changes
(anu jyoti). BPSD is associated with poor outcomes (yaati paralokam),
and distress (durmana) to patients.22 Changes in skin colour (skin
becomes deadly pale, earth like colour, and turns white) (dushchhaya)
is one of the the signs and symptoms of death in end-of-life (yaati
paralokam) senile dementia patients.24 Reduced appetite (anu jyoti)
is one of the sickness features caused by inammatory response in
delirium patients.58 Delirium patients show features such as hyper-
vigilance (anekagro), restlessness (ratim na labhate), agitation,
aggression (durmana), mood lability (durmana), and in some cases,
hallucinations and delusions (durmana).21 The above verse denotes
dementia or delirium.
‘Bhakti sheelam --- marishyata’ (Verse 7)13
AIthough cognitive decline (buddhi & smriti nivartante) and decits
in social competence (sheelam or bhakti nivartante) are the hallmarks
of progressive neuro-degeneration, behavioral abnormalities (sheelam
or bhakti nivartante) are common and important characteristics of
dementia. Personality changes such as disinterest (bhakti nivartante),
in environment or inappropriate social behavior (sheelam nivartante)
are most common in AD. Various behavioural and personality changes
and BPSD features (bhakti, smriti, buddhi & sheelam etc nivartante)
can be seen in AD, FTD, DLB and other dementia syndromes.40 The
above verse denotes various dementia syndromes.
‘Shareera kampa --- masam na jeevati’ (Verse 10)13
The above verse indicates PD dementia (PDD) or delirium
superimposed on preexisting dementia. The classical motor features
of PD include rigidity, resting tremor (kampa), bradykinesia and
postural instability (mattasyeva gati). Language abnormalities
(mattasyeva vachana) are also seen in dementia. ‘Associated clinical
features’ of PDD are dened along four primary cognitive domains
(attention, memory, executive and visuo-spatial functions) (sammoha)
and a spectrum of behavioural disorders.59 Confusion (sammoha),
gait instability (mattasyeva gati), language decits (although
most commonly seen in AD) (mattasyeva vachana) and cognitive
deterioration are seen in PDD.60
‘Aahvayastham --- na pashyati’ (Verse 21)13
The above verse denotes dementia or delirium. Cognitive symptoms
(mahamohavruta mana) in AD include memory loss (poor recall,
losing items), aphasia, agnosia (pashyannapi na pashyati), apraxia,
disorientation features such as impaired perception of time and unable
to recognize familiar people (pashyannapi na pashyati) and impaired
visuospatial function and executive function.17 Face recognition is
signicantly aected (swajanam janameva pashyannapi na pashyati)
in patients with FTD. Prosopagnosia in AD is of visuospatial nature
and hence can recognize the individual when named or spoken to,
but in FTD, it is multimodal and hence cannot be recognized by any
mode (pashyannapi na pashyati).61 Synonymous equivalents of the
term delirium are, “acute brain syndrome,” “organic brain syndrome,”
“acute cerebral insuciency,” “acute confusional state,” “disorders of
consciousness,” “transitional syndrome,” and “confusional syndrome”
(mahamohavruta mana).62
‘Ayogam atiyogam --- naavachaarayet’ (Verse 22)13
The above verse denotes ‘Sensory impairments’, ‘Agnosia’, and
‘Hallucinations’ seen in dementia and delirium. Agnosia (ayogam),
communication and language impairments and hallucinations
(atiyogam) can be seen in various sub types of dementia such as AD,
DLB, FTD and VaD.17 Sensory impairments (ayoga) are one of the
potential modiable risk factor for delirium. Patients with hyperactive
subtype of delirium often experience delusions and hallucinations
(atiyoga).20
‘Atipravruddha --- deha sangnakam’ (Verse 23)13
The above verse denotes delirium or advanced dementia. Patients
at the end of life (vaasamutsrujati) develop a number of distressing
symptoms. Delirium is one of the most common neuropsychiatric
problems (manasashcha balakshayaat) in patients with advanced
cancer and other terminal illnesses (atipravruddha rogaanaam).52
Dementias are progressive and incurable diseases (atipravruddha
rogaanaam). People with advanced dementia develop apraxia,
dysphagia, and decreased mobility, thus increasing the risk of
infection, malnutrition, and other adverse outcomes (atipravruddha
rogaanaam). Therefore, advanced dementia (manasashcha
balakshayaat) should be considered a terminal illness, particularly at
the very severe or end-stage state (vaasamutsrujati).63
‘Varna swaragni --- va na va’ (Verse 24)13
Delirium is an acute and uctuating disturbance of consciousness
and cognition, is a common manifestation of acute brain dysfunction
Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana 304
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Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
(heeyate manobalam) in critically ill patients (aasu kshaye), occurring
in up to 80% of the sickest intensive care unit (ICU) populations
(aasu kshaye). Altered level of consciousness, inattentiveness,
disorientation, psychosis, psychomotor agitation or retardation
(heeyate manobalam), inappropriate speech (heeyate vaak balam) or
mood and sleep-wake cycle disturbances (sleeping < 4 hours / day or
waking at night or sleeping all day) (nidraa nityaa va na va) are seen in
delirium in ICU patients.64 Breathing disorder, consciousness decline,
vital power decline (heeyate bala), reduced oral intake (heeyate agni),
feces disorder, calm and peaceful character, blood pressure decline,
change in skin color (heeyate varna), patient odor, edema, preagonal
vital power, body temperature decline, bedsore/wound deterioration,
body weight reduction (heeyate bala), cyanosis, and oliguria are the
signs and symptoms of impending death in end of life (aasu kshaye)
senile dementia (heeyate vaagindriya manobalam) patients.24 The
above verse denotes delirium or dementia.
‘Sambhramo --- pravartate’ (Verse 16)13
Bone metastasis and advanced cancer can act as predisposing
risk factors for delirium.65 Cancer pain remains a signicant clinical
problem worldwide. Causes of cancer pain are multifactorial and
complex and are likely to vary with an array of tumor-related and
host-related factors and processes.A good example of the emerging
theory of ‘Cancer pain’ (CP) is cancer-induced bone pain (CIBP),
which now is understood as a complex pain state with nociceptive but
also inammatory and neuropathic characteristics.66 Bone metastases
often result in breakthrough pain episodes.67 Incoherent speech and
rambling or irrelevant conversation, or unclear or illogical ow of
ideas along with altered level of consciousness can be seen in delirium
patients.21 The above verse denotes a condition of delirium associated
with bone pain due to bone metastases.
‘Yasya gomaya --- tasya jeevitam’ (Verse 3)14
Seborrheic Dermatitis (SD) and dandru are common
dermatological problems that aect the seborrheic areas of the
body. Dandru is restricted to the scalp (murdhani jaayate), and
involves itchy, aking skin (bhrashyate chaiva) without visible
inammation. SD aects the scalp (murdhani jaayate) as well as
face, retro-auricular area and upper chest, causing aking, scaling,
inammation and pruritus, and erythema. Flaking (bhrashyate
chaiva) in SD and dandru is usually white-to-yellowish (gomaya
choornaabham), and may be oily (sa sneham) or dry.68 Previous studies
suspect that fungal infections might be involved in central nervous
system (CNS) diseases including AD, ALS, MS and schizophrenia.
SD is a benign dermatological condition caused by over proliferation
of Malassezia on the skin and it is strongly associated with PD.
Recent studies have found Malassezia DNA in the CNS of MS and
AD patients.69 The above verse denotes SD or dandru in dementia
patients.
‘Vignaanam uparudhyate’ (Verse 46)14
Dementia and delirium are the two most common causes of
cognitive impairment (vignaanam uparudhyate) in older populations.
Dementia, an insidious neurodegenerative condition, is characterised
by chronic and progressive cognitive decline (vignaanam
uparudhyate) from a previous level of performance in one or more
cognitive domains (vignaanam uparudhyate). Delirium is a syndrome
manifesting as an acute change in mental status that is characterised
by inattention and disturbance in cognition (vignaanam uparudhyate)
that develops over a short period of time and tends to uctuate.70 The
above verse denotes cognitive impairment seen in dementia and
delirium etc conditions.
‘Indriyaani vinashyanti --- bheeraavishatyapi’ (Verse 47)14
Along with cognitive decline and sensory impairments (indriyaani
vinashyanti), various non-cognitive symptoms can be seen in dementia
such as delusions, hallucinations, anxiety (cheto bheeraavishatyapi),
agitation (autsukyam bhajate sattvam) and aggressive behavior.15
Sensory and cognitive impairments (indriyaani vinashyanti) is one
of the risk factors for the development of delirium. Severe agitation
(autsukyam bhajate sattvam), restlessness (autsukyam bhajate
sattvam) and severe anxiety (cheto bheeraavishatyapi) can be seen
in delirium.19 The above verse denotes conditions like dementia or
delirium.
‘Smriti tyajati --- nashyati’ (Verse 48)14
Dementia is characterized clinically by progressive memory
(smriti tyajati) & orientation loss and other cognitive decits (medha
tyajati). These are typically accompanied by various neuropsychiatric
symptoms (i.e. depression, apathy, anxiety, agitation, delusions &
hallucinations). Disinhibition (hree apasarpati) is one of the features
of BPSD in AD.71 Older age, multimorbidity (upaplavante paapmana)
and dementia are all strongly correlated with adverse health outcomes
as well as a proxy for loss of independent living.72 Many modications
of immune system (ojashcha nashyati) have been reported in patients
aected by AD.73 Delirium is a complex neurocognitive manifestation
(smriti tyajati medha cha) due to an underlying medical abnormality
such as organ failure, infection or drug eects (upaplavante
paapmana). It occurs frequently in palliative and supportive care, in
patients with advanced cancer and in the terminal phase of the illness.
Disturbances in cognition (medha tyajati) and memory decits (smriti
tyajati) are seen in delirium.74 Disinhibition (hree apasarpati) is also
one of the features of delirium.21 The above verse denotes advanced
stages of dementia, BPSD features of dementia especially FTD and
delirium in ICU patients.
‘Shabda sparsho --- pravruttishu’ (Verse 58)14
Sensory impairments such as visual impairment (rupa), hearing
loss (shabda), poor smell (gandha) and touch insensitivity (sparsha)
are common in older adults and also associated with increased risk
of mortality and dementia. Sensory impairment may be a marker
of underlying neurodegeneration. Multisensory impairment was
strongly associated with increased risk of dementia.75 Presence of
hallucinations (utpadyante ashubhaaneva) is selectively associated
with more rapid cognitive decline in Alzheimer’s disease.76 The
above verse denotes multisensory impairments, BPSD features and
hallucinations seen in the patients of senile dementia and dementia
superimposed on delirium.
Other psychiatric / neuropsychiatric
conditions
Psychiatric and neuropsychiatric conditions are explained
under the domain of ‘Unmada’ (a broad disease consists of various
psychiatric and neuropsychiatric conditions) in various Ayurvedic
classical texts. Unmada is explained in ‘Nidana sthana’ (section
which deals with etiopatholgoy) and ‘Chikitsa sthana’ (section which
deals with treatment) in various Ayurvedic classical texts. Dierent
types of unmada have shown similarity with various psychiatric/
neuropsychiatric conditions according to the previous works.77-94
Apart
from ‘Unmada’, description of various psychiatric/neuropsychiatric
conditions can also be found in ‘Charaka indriya sthana’.3-14 The
exploration of various references pertaining to psychological concepts
and psychiatric / neuropsychiatric conditions in ‘Charaka indriya
sthana’ has been done in following sections.
Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana 305
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Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
Psychological concepts in Charaka indriya sthana
‘Sattvam, bhakti --- jignaasamaanena bhishajaa’ (Verse 3)3
The above verse denotes varoius psychological factors such
as ‘Sattvam’ (mind), ‘Bhakti (interests), ‘Shaucham (hygiene),
Sheelam’ (character/personality), ‘Achara (conduct), ‘Smriti
(memory), ‘Medha’ (intellect), ‘Harsha (positive mood/elation),
Tandra’ (fatigue/hypersomnia), and ‘Swapna darshana (dreams) etc
which can be used clinically to prognosticate life expectancy or to
assess survival time frame in those patients who are at end of life stages
or suering with terminal illnesses or receiving palliative or hospice
care. Various questionnaires, scales and other measuring instruments
based on the above factors are available for clinical prognostication.3
‘Tatra prakruti --- visheshaa bhavanti’ (Verse 5)3
The above verse denotes various factors which inuences
the formation and development of human personality (prakruti).
Various factors such as ‘Jaati’ (community/cultural), ‘Kula (caste/
cultural), ‘Desha’ (geographical/environmental), ‘Kala (generational
dierences/environmental), Vaya (age) and ‘Pratyatma niyata
(individualized or genetic) etc inuences the formation and
development of personality or personality traits. Personality traits
(prakruti) are commonly dened as relatively stable patterns of
thoughts, feelings, and actions in which one individual diers from
others (pratyatma niyata). Several studies have found that individual
dierences in personality traits are substantially genetically (jaati,
kula and pratyatma niyata) inuenced. Personality can change at
every age (vaya) throughout the life span. Environmental factors
(desha/kala), life events (major changes in life circumstances and
social roles), cultural inuences (jaati/kula), social factors (jaati/
kula), and biological factors (vaya/pratyatma niyata) etc all can
inuence the personality. [95]
‘Mithyadrushtam --- pragnaaparadhajam’ (Verse 6)4
The above verse denotes cognitive distortions or cognitive errors
or cognitive biases made by the physician while prognosticating.
Cognitive biases (mithyadrushtam) and personality traits of the
physiciain may aect clinical reasoning processes which may lead
to errors in the diagnosis, management, or treatment of medical
conditions. Misdiagnosis, mismanagement, and mistreatment
(ajaanataa) are frequently associated with poorer outcomes.
Cognitive biases (i.e., anchoring and framing eects, information
biases) and personality traits (e.g. tolerance to uncertainty, aversion to
ambiguity) (asambuddha) are the most commonly reported cognitive
biases which may potentially aect physicians’ decisions.96 Cognitive
errors (pragnaaparadhajam) can be derived from 3 sources,
knowledge decits, cognitive bias and clinician attitude problems.
Cognitive errors (mithyadrushtam) are the most frequent in the eld
of ‘Emergency medicine’.97 ‘Type 1’ thinking is a fast, intuitive,
pattern recognition driven method of problem solving, which places
a low cognitive burden on the user, and allows one to make fast and
accurate decisions rapidly (pragnaaparadhajam). However, this type
1, rapid decision was poor at predicting diagnosis or aiding further
prognostication (pragnaaparadhajam).98 The above verse warns the
physician to be hypervigilant and to minimize or avoid cognitive
biases or errors while prognosticating especially in emergency wards.
‘Manovahaanaam -- shubham phalam’ (Verse 41-46)7
The above verses describe the physiology, classication and
consequences (positive & negative) of dreams. Oneirology is the
scientic study of dreams. Ancient Indian scholars have used swapna
(dreams) as a tool to diagnose a disease, to assess the prognosis of
a condition, for personality assessment and also to know the life
expectancy. The dream has been described from physiological,
pathological, diagnostic, prognostic and therapeutic point of view
in Ayurvedic texts. Ayurvedic texts have described the concepts like
‘Analysis or interpretation of dreams’ and also usage of dreams as a
tool to prognosticate or diagnose the underlying hidden conditions.7
‘Svaachaaram --- avyagram’ (Verse 67-70)14
The above verse denotes various positive personality traits
required for a caregiver. Tranquility (avyagram), empathy, courage
(avyangam), warmth, commitment, patience (avyagram), joyfulness
(hrushtam), kind-heartedness (svaachaaram), thoughtfulness,
mutually-orientedness (svaachaaram) and helpfulness (svaachaaram)
are considered as positive attributes of a caregiver. Patients appreciated
caregivers who gave ecient help which was well thought out and
reasonable. Caregivers support and assistance give patients the power
and strength to move on with their lives.99
‘Sattva lakshana --- shubha lakshana’ (Verse 87-88)14
The above verse denotes positive personality attributes or health
psychology or positive psychology. Health psychology focuses on the
interplay among biological dispositions, behaviour, and social context.
A biopsychosocial model considers health as the complex interplay
among biological disposition, behaviour, and social conditions.100
Positive psychology is the scientic study of a healthy and ourishing
life. Positive psychology (sattva lakshana samyogo) is concerned with
positive psychological states (eg, happiness), positive psychological
traits (eg, talents, interests, strengths of character) (purusha shubha
lakshana), positive relationships, and positive institutions (ishtaam cha
aparaan bhaavaan). Evidence is accumulating that a happy, engaged,
and fullling psychological and social life leads people to live a
healthy and long life.101 The new science of psychoneuroimmunology
(PNI) has more than validated age-old human wisdom about the unity
of mind and body, showing that the emotion-processing centres of the
brain are inextricably linked with the nervous system, the immune
system, and the hormonal apparatus. PNI studies the interactions
between the sciences of immunology, endocrinology, and psychology/
neuroscience.102 The above verse is realted to the various concepts like
‘Health psychology’, ‘Positive psychology’ and PNI.
Psychiatric conditions in Charaka indriya sthana
Hallucinations
Hallucinations are perceptions in the absence of an external
stimulus and are accompanied by a compelling sense of their
reality.103 The term “organic” applied to psychosis is meant to convey
the emergence of hallucinations or delusions in a patient with a
recently acquired disturbance of brain function. Organic or secondary
psychosis can be seen in diverse conditions such as toxic or metabolic
disorders, neurodegenerative disease, and stroke.104 Various references
found in ‘Charaka indriya sthana’ denotes hallucinations of organic
or secondary origin (having some underlying brain pathology).
‘Swasthebhyo --- maranasya tat’ (Verse 5)6
In the fouth chapter of ‘Charaka indriya sthana’ (indriyaneekam
indriyam), ‘Acharya Charaka’ states that, ‘the perception pertaining
to the sensory organs which is abnormal and arisen without any
apparent cause indicates imminent death’.105 The above verse denotes
hallucination (vikrutam yasya gnaanam) due to secondary or organic
origin without having pathology (animittena) at the level of sensory
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Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
organs. The above verse also denotes perceptual distortions or
agnosia or and other sensory impairments due to an underlying brain
pathology.6
‘Ghaneebhutamiva --- marana mruchhati’ (Verse 7)6
As per the above verse, ‘the patient who sees the sky as solidied
like earth or sees the earth like the sky, or both in contradiction attains
death’.105 The above verse denotes visual hallucinations105 or visual
perceptual distortions.6
‘Yasya darshanam --- kshayam aadishet’ (Verse 8)6
According to the above verse, ‘one who sees air moving in the sky
but does not visualize the burning re should be taken for lost’. This
verse also denotes visual hallucinations.105
‘Jagruta --- jeevitu marhati’ (Verse 10)6
The above verse indicates that, ‘while awake, if one visualizes
ghosts and various demons or some other bizarre things, he/she is
unable to live’. This verse also denotes visual hallucinations.105
‘Mareechi --- marana mruchhati’ (Verse 12)6
Above verse demonstrates that, ‘If one sees rays of light without
clouds, if one sees clouds in the sky though not there or if one sees
lightning when there are no clouds, he/she attains death’. This verse
denotes visual hallucinations.105
‘Aparvani --- tasya jeevitam’ (Verse 14)6
As per the above verse, ‘If a diseased person or healthy person
visualizes solar eclipse or lunar eclipse though it is not there, it indicates
death’. The above verse denotes either ‘Visual hallucinations’105 or
‘Achromatopsia’ or ‘Scierneuropsia’ or ‘Hemeralopia’.6
‘Naktam suryam --- mruchhati’ (Verse 15)6
According to the above verse, ‘If one sees the sun during the night
and moon during daytime, smoke rising without re or lusterless re
in the night, he/she is going to die’. The above verse denotes either
visual hallucinations105 or Achromatopsia.6
‘Yashcha pashyati adrushyaan’ (Verse 18)6
The above vese demonstrates that, ‘if a person sees nonvisible
objects or does not see the visible ones, he/she dies soon’. This verse
also denotes visual hallucinations105 or ‘Visual anosognosia’.6
‘Ashabdasya cha --- vijaanataa’ (Verse 19)6
According to the above verse, ‘one who hears sounds when there
is none or does not perceive the real sound should be considered to be
dead’. This verse indicates ‘Auditory hallucniations’105 or ‘Auditory
agnosia’.6
‘Viparyayena --- vigataayusham’ (Verse 21)6
According to the above verse, ‘if one perceives good smell and bad
smell in contrary, or does not perceive the smell entirely should be
considered to have completed his/her life span’. This verse indicates
‘Olfactory hallucniations’105 or ‘Anosmia’ or ‘Parosmia’ or ‘Cacosmia’
or ‘Dysosmia’.6
Yo rasaanna --- kushala naram’ (Verse 22)6
According to the above verse, ‘if one does not perceive the taste
even in the absence of any kind of inammation in the mouth or
perceives altered taste, he/she should be considered to die soon’.
This verse indicates ‘Gustatory hallucniations’105 or ‘Ageusia’ or
‘Pargeusia’ or ‘Dysgeusia’ or ‘Hypogeusia’.6
‘Ushnaan cha --- steshu manyate’ (Verse 23)6
As per the above verse, ‘if one perceives touch sensations such as
hot-cold, coarse-smooth, and soft-hard in an opposite way (contrarily),
he/she is about to die’. This verse indicates ‘Tactile hallucniations’105
or ‘Allodynia’ or ‘Paresthesia’ or ‘Dysesthesia’ or ‘Lack of tactile
discrimination ability’.6
‘Indriyai adhikam pashyan’ (Verse 24)6
As per the above verse, ‘super sensory perceptions without any
rigorous penance (tapas) or methodical yoga, indicate death’.105 The
above verse indicates ‘Visual hallucinations’ or ‘ESP’.6
‘Indriyaanaamrute --- na sa jeevati’ (Verse 25)6
The above verse demonstrates that, ‘if one perceives all senses
correctly in spite of incapability of sense organs, it indicates
death’.105 Charles Bonnet syndrome (CBS) is characterized by visual
hallucinations (naro pashyati ya) in patients without mental illness
(indriyaarthan adoshajaan). Patients with CBS have shown history
of diminished visual acuity or visual eld loss (indriyaanaamrute).
Patients of CBS do not have any signicant metabolic derangements or
impaired sensorium that would otherwise explain their symptoms. The
currently accepted theory suggests that vision loss (ndriyaanaamrute)
leads to visual sensory de-aerentation, causing disinhibition,
and later spontaneous ring, of the visual cortical regions in CBS
patients.106 The above verse denotes various conditions like, ‘Mental
imagery’, ‘Phantom perception’, ‘Neuroplasticity’, ‘Synesthesia’,
CBS and ‘Hallucinations’ etc.
‘Swasthaa --- marana maadishet’ (Verse 26)6
The above verse demonstrates that, ‘if a healthy person contrary
to his intellect repeatedly perceives abnormal sensations though
there is no object of stimulus, it indicates death’.105 Diseases of the
brain are frequently manifested by psychiatric symptomatology, a
condition conventionally termed ‘Organic Brain Syndrome’ (OBS).
Symptoms suggestive of cognitive impairment (pragnaaviparyaya)
in OBS may even persist in a proportion of cases long after the initial
episode, especially when the cerebral insult is irreversible (marana
maadishet).107 NCDs are referred as ‘organic’, implying that they
manifest due to known structural brain disease. AD, cerebrovascular
disease, FTLD, DLB, HD, TBI, HIV disease, prion disease and
substance-use-associated disease etc comes under the category of
NCDs. The term “neurocognitive” describes cognitive functions
are closely linked to the function of particular brain regions, neural
pathways, or cortical/subcortical networks in the brain.108 The above
verse denotes cognitive distoritions seen in OBS or NCDs.
‘Laksha rakta --- antaaya neeyate’ (Verse 10)7
As per the above verse, ‘one who sees his/her clothers as dyed with
red ‘Lac’, he/she will die by getting aicted with bleeding disorder’.
Seeing everything as red colored denotes visual hallucinations or
vascular neuro-ophthalmological condition or vascular dementia or
hypertensive encephalopathy.6
‘Apaswaram --- parivarjayet’ (Verse 14)11
The above verse denotes abnormal vocalizations or speech
and auditory hallucinations seen in various conditions such as PD,
dementias, and delirium. Auditory hallucinations (shrotaaram
ashabdasya) can be seen in AD and DLB patients.57
Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana 307
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©2020 Gupta et al.
Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
‘Ayogam atiyogam --- naavachaarayet’ (Verse 22)13
The above verse denotes ‘Sensory impairments’, ‘Agnosia’, and
‘Hallucinations’ seen in dementia and delirium. Agnosia (ayogam),
communication and language impairments and hallucinations
(atiyogam) can be seen in various sub types of dementia such as AD,
DLB, FTD and VaD.17 All the above references discussed under the
section of ‘Hallucinations’ denotes OBS or NCDs.
Catatonia & Schizophrenia
Ahara dveshinam --- ati paatinaa’ (Verse 19)7
Catatonia of the retarded type is associated with signs reecting
a paucity of movement, including immobility, staring, mutism (lupta
chittam), rigidity, withdrawal and refusal to eat (aahaara dveshinam),
posturing, grimacing, negativism, waxy exibility, echolalia or
echopraxia, stereotypy, verbigeration, and automatic obedience.109
Blunted aect (diminished facial and emotional expression) (lupta
chittam), alogia (decrease in verbal output or verbal expressiveness)
(lupta chittam), asociality (lack of involvement in social relationships
of various kinds), avolition (a subjective reduction in interests, desires,
and goals and a behavioral reduction of self-initiated and purposeful
acts), and anhedonia (inability to experience pleasure from positive
stimuli) are considered as negative symptoms of schizophrenia
(lupta chittam).110 Major depressive disorder (MDD) (lupta chittam)
is a leading cause of chronic disability and mortality (mumurshu).
Decreased appetite (aahaara dveshinam) is the fature of MDD.111 The
above verse denotes catatonia or negative symptoms of schizophrenia
or MDD.
‘Yairvindati --- maranamaadishet’ (Verse 21)10
The above verse denotes ‘Anhedonia’. Depressed mood and
anhedonia are the cardinal features of MDD. Anhedonia is dened
as a ‘markedly diminished interest or pleasure in all, or almost all,
activities of the day’ (taireva aramamaanasya glaasno) suggesting
pleasure experiences in anhedonia are at and blunted.112 The term
‘Cotard’s syndrome’ (CS) is used to describe a number of clinical
features, mostly hypochondriac and nihilistic delusions (taireva
aramamaanasya glaasno). Besides, anxious and depressed mood
(taireva aramamaanasya glaasno), delusions of damnation,
possession and immortality, suicidal and self-mutilating behavior
(maranamaadishet) are also the features of CS.113 The above verse
indicates conditions like MDD or CS or Mood disorder.
Bruxism & Trichotillomania
‘Dantaichhindan --- parimuchyate’ (Verse 18)10
The above verse denotes ‘Nail biting’, ‘Trichotillomania’ and
‘Mannerisms or stereotypies’. Trichotillomania (TTM), or hair-
pulling disorder (nakhaichhindaan shiroruhaan), is characterized
by the repeated removal (or pulling) of hair from the body, resulting
in signicant hair loss. Most commonly, the hands, particularly the
thumb and forenger, (nakhaichhindaan) are used to remove the
hair. The most common site from which pulling occurs is the scalp
(shiroruhaan). Along with TTM disruption of control mechanisms
have also been found with varying degrees of motor dysfunction in
conditions like ‘Tourette’s syndrome’ (TS) and ‘Obsessive compulsive
disorder’ (OCD). BFRBs (body focused repetitive behaviours) such as
skin picking, nail biting (dantaichhindan nakhaagraani), and cheek
biting etc are frequently comorbid with TTM. TTM is comorbid with
various other conditions like, OCD, anxiety disorders, mood disorders,
tic disorder and attention-decit/hyperactivity disorder (ADHD).114
TTM can also be seen in FTD. Various self injurious behaviors
(SIB) are seen in children with autism and mental retardation. Major
stereotypies (kaashtena bhumim vilikhan) shown by children with
pervasive developmental disorders (PDD) are repetitive, compulsive,
stereotypical, and rhythmic behaviors such as self-biting, face/head
banging or hitting, handshaking, body rocking, mouthing of objects,
picking at skin or body orices, hair pulling (nakhaichhindaan
shiroruhaan), breath holding, and swallowing (aerophagia).115 The
literature indicates that simple motor stereotypy such as skin-picking,
head rocking, and lip pursing and complex motor stereotypy like
hair-pulling, skin-picking, hand apping, and wriggling with leg
movement (kaashtena bhumim vilikhan) involve frontostriatal disease
or dysfunction.116 The above verse denotes stereotypic movement
disorder or TTM or BFRBs due to various underlying neurological
syndromes.
‘Dantaan khaadati --- vimuchyate’ (Verse 19)10
FTD is a neurodegenerative disorder occurs due to frontal
and temporal lobar atrophy and it is characterized by troubling &
progressive changes in behavior, personality, judgment, language, and
cognition. Decreased response to pain (dukham na vijaanaati) is seen
in ‘Apathetic subtype of FTD’. FTD patients have shown signicant
impairment in emotion recognition for the fear and sad lm clips
(virudhan hasan). Magnetic resonance imaging (MRI) volumetrics
revealed that decits in emotion recognition were associated with
decreased frontal and temporal lobar volumes seen in FTD patients.117
Awake bruxism is dened as an oral parafunctional activity that
includes clenching and grinding of teeth during wakefulness (dantaan
khaadati yo jaagruta). Awake bruxism (dantaan khaadati yo jaagruta)
is seen in the patients of FTD, AD, PD and Stroke.118 The above verse
denotes a condition of ‘Awake bruxism in FTD’ patients.
‘Pramuhya --- kaalachodita’ (Verse 17)13
The above verse denotes TTM or Agitation. Patient with
FTD may present with TTM (lunchayet keshaan), agitation
(lunchayet keshaan), anger, disinhibitory behavior, food faddism
(nara swasthavat aahaaram) and apathy (abala?). The main
neuropsychiatric manifestations of FTD include disinhibition,
apathy, obsessive-compulsive behavior, and Kluver–Bucy syndrome
(KBS).115 Hyperoralitly (nara swasthavat aahaaram), increased
preference for sweet foods (nara swasthavat aahaaram) and poor
insight (pramuhya) are found in FTD patients.117 Despite having
hyperorality and food faddisms (nara swasthavat aahaaram) etc,
FTD patients show features like apathy (abala). The above verse
indicates TTM in FTD patients.
Nightmares
‘Drushyante --- pretaakrutirudeeryate’ (Verse 59)14
Nightmares (drushyante daaruna swapna) are common in intensive
care unit (ICU) patients. Nightmares may have been interpreted
by patients as an extremely unpleasant (dauraatmyamupajaayate)
dream.119 Critically ill patients reported a high incidence of recall
for unpleasant events (dauraatmyamupajaayate), and the patients
who stayed longer than 24 hours at the ICU, indicated vivid memory
for nightmares and hallucinations.120 Post-traumatic stress disorder
(PTSD) and resultant nightmares are well-recognized complications
(dauraatmyamupajaayate) of severe illness that have been described
in ICU patients after multiple trauma, burns, myocardial infarction,
acute respiratory distress syndrome or septic shock.121 Sleep
disturbances in critically ill patients are associated with poorer long-
term clinical outcomes (pretaakrutirudeeryate) and quality of life.122
The above verse denotes nightmares commonly seen in ICU patients
and indicate poor prognosis.
Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana 308
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©2020 Gupta et al.
Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
Conclusion
Charaka Samhita is the ancient and most authentic treatise on
Ayurveda. Indriya sthana of Charaka samhita deals with prognostic
aspects. Various psychiatric and neuropsychiatric disorders are
mentioned throughout ‘Charaka indriya sthana’ in a scattered form.
‘Dementia’ and ‘Delirium’ are the two most common conditions
found through out ‘Charaka indriya sthana’. Various references
related to other psychiatric and neuropsychiatric conditions like,
‘Hallucinations’, ‘Trichotillomania’, ‘Awake bruxism’, ‘Impulse
control disorders’, ‘Major depressive disorder’, ‘Catatonia’. ‘Negative
symptoms of Schizophrenia’ are also mentioned in ‘Charaka
indriya sthana’. Most of the psychiatric conditions of ‘Charaka
indriya sthana’ are ‘organic’ or ‘secondary’ in nature and they are
characterized by having poor prognosis and commonly found in dying
patients or at the end-of-life stages. The contemporary perspective of
ancient psychiatric concepts mentioned in ‘Charaka indriya sthana’
as demonstrated in the present article provides new insights and paves
way further studies and also the psychiatric conditions mentioned in
it have clinical applicability and prognostic signicance in present era
also.
Acknowledgments
None.
Conicts of interest
Authors declare that there is no conict of interest.
References
1. Bhavana KR, Shreevathsa. Medical geography in Charaka Samhita. Ayu.
2014;35(4):371–377.
2. Nipane MS, Chouagade B, Chouragade N, et al. Relevance of indriya
sthan in the prognosis of diseases: A review. Int J Res Ayurveda Pharm.
2018;9(1):9–12.
3. Mamidi P, Gupta K. Varna swareeyam of Charaka Indriya sthana - An
explorative study. Int J Ayu Alt Med. 2019;7(5):152–175.
4. Gupta K, Mamidi P. Pushpitakam of Charaka Indriya sthana - An
explorative study. Int J Ayu Alt Med. 2019;7(5):176–182.
5. Mamidi P, Gupta K. Parimarshaneeyam of Charaka Indriya sthana - An
explorative study. Int J Ayu Alt Med. 2019;7(5):183–191.
6. Gupta K, Mamidi P. Indriyaaneekam of Charaka Indriya sthana - An
explorative study. Int J Ayu Alt Med. 2019;7(5):192–202.
7. Mamidi P, Gupta K. Purvarupeeyam of Charaka Indriya sthana - An
explorative study. Int J Ayu Alt Med. 2019;7(5):203–212.
8. Gupta K, Mamidi P. Katamani shaririyam of Charaka Indriya sthana -
An explorative study. Int J Ayu Alt Med. 2019;7(5):213–222.
9. Mamidi P, Gupta K. Panna rupeeyam of Charaka Indriya sthana - An
explorative study. Int J Ayu Alt Med. 2019;7(6):223–235.
10. Gupta K, Mamidi P. Avaak shirasiyam of Charaka Indriya sthana - An
explorative study. Int J Ayu Alt Med. 2019;7(6):236–251.
11. Mamidi P, Gupta K. Yasya shyaava nimitteeyam of Charaka Indriya
sthana - An explorative study. Int J Ayu Alt Med. 2019;7 (6):252–263.
12. Gupta K, Mamidi P. Sadyo maraneeyam of Charaka Indriya sthana - An
explorative study. Int J Ayu Alt Med. 2019;7(6):264–273.
13. Mamidi P, Gupta K. Anu jyoteeyam of Charaka Indriya sthana - An
explorative study. Int J Ayu Alt Med. 2019;7(6):274–287.
14. Gupta K, Mamidi P. Gomaya choorneeyam of Charaka Indriya sthana -
An explorative study. Int J Ayu Alt Med. 2019;7(6):288–306.
15. Shaji KS, Sivakumar PT, Rao GP, et al. Clinical Practice Guidelines
for Management of Dementia. Indian J Psychiatry. 2018;60(Suppl
3):S312–S328.
16. Hapca S, Guthrie B, Cvoro V, et al. Mortality in people with dementia,
delirium, and unspecied cognitive impairment in the general hospital:
prospective cohort study of 6,724 patients with 2 years follow-up. Clin
Epidemiol. 2018;10:1743–1753.
17. Duong S, Patel T, Chang F. Dementia: What pharmacists need to know.
Can Pharm J (Ott). 2017;150(2):118–129.
18. Cunningham EL, McGuinness B, Herron B, et al. Dementia. Ulster Med
J. 2015;84(2):79–87.
19. Grover S, Avasthi A. Clinical Practice Guidelines for Management of
Delirium in Elderly. Indian J Psychiatry. 2018;60(Suppl 3):S329–S340.
20. Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis,
prevention and treatment. Nat Rev Neurol. 2009;5(4):210–220.
21. Martins S, Fernandes L. Delirium in elderly people: a review. Front
Neurol. 2012;3:101.
22. Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. Behavioral and
psychological symptoms of dementia. Front Neurol. 2012;3:73.
23. Wongrakpanich S, Petchlorlian A, Rosenzweig A. Sensorineural Organs
Dysfunction and Cognitive Decline: A Review Article. Aging Dis.
2016;7(6):763–769.
24. Hirakawa Y, Uemura K. Signs and Symptoms of Impending Death in End-
of-life Elderly Dementia Suerers: Point of View of Formal Caregivers
in Rural Areas: A Qualitative Study. J Rural Med. 2012;7(2):59–64.
25. Park KH, Park KJ. Neurological aspects of anhidrosis: dierential
diagnoses and diagnostic tools. Ann Clin Neurophysiol. 2019;21(1):1–6.
26. Teeple RC, Caplan JP, Stern TA. Visual hallucinations: dierential
diagnosis and treatment. Prim Care Companion J Clin Psychiatry.
2009;11(1):26–32.
27. Chaudhury S. Hallucinations: Clinical aspects and management. Ind
Psychiatry J. 2010;19(1):5–12.
28. Colligris P, Perez de Lara MJ, Colligris B, et al. Ocular Manifestations
of Alzheimer’s and Other Neurodegenerative Diseases: The Prospect
of the Eye as a Tool for the Early Diagnosis of Alzheimer’s Disease. J
Ophthalmol. 2018;2018:8538573.
29. Uchiyama M, Nishio Y, Yokoi K, et al. Pareidolias: complex visual
illusions in dementia with Lewy bodies. Brain. 2012;135(Pt 8):2458–
2469.
30. Taylor I, Scheer IE, Berkovic SF. Occipital epilepsies: identication of
specic and newly recognized syndromes. Brain. 2003;126(4):753–769.
31. Johnson JK, Chow ML. Hearing and music in dementia. Handb Clin
Neurol. 2015;129:667–687.
32. Hardy CJ, Marshall CR, Golden HL, et al. Hearing and dementia. J
Neurol. 2016;263(11):2339–2354.
33. Gupta K, Mamidi P. Pancha Indriya Buddhi: Association cortices. Int J
Yoga - Philosop Psychol Parapsychol. 2018;6(2):61–65.
34. Waters F, Fernyhough C. Hallucinations: A systematic review of points
of similarity and dierence across diagnostic classes. Schizophr Bull.
2017;43(1):32–43.
35. Pasricha SK. Relevance of para-psychology in psychiatric practice.
Indian J Psychiatry. 2011;53(1):4–8.
36. Trojsi F, Christidi F, Migliaccio R, et al. Behavioural and Cognitive
Changes in Neurodegenerative Diseases and Brain Injury. Behav Neurol.
2018;2018:4935915.
Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana 309
Copyright:
©2020 Gupta et al.
Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
37. Iadecola C. The pathobiology of vascular dementia. Neuron.
2013;80(4):844–866.
38. Good DC. Episodic Neurologic Symptoms. In: Walker HK, Hall
WD, Hurst JW, editors. Clinical Methods: The History, Physical, and
Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990.
39. Minaglia C, Giannotti C, Boccardi V, et al. Cachexia and advanced
dementia. J Cachexia Sarcopenia Muscle. 2019;10(2):263–277.
40. Müller-Spahn F. Behavioral disturbances in dementia. Dialogues Clin
Neurosci. 2003;5(1):49–59.
41. Keeley PW. Delirium at the end of life. BMJ Clin Evid. 2009;2009:2405.
42. Hui D, Dev R, Bruera E. The last days of life: symptom burden and
impact on nutrition and hydration in cancer patients. Curr Opin Support
Palliat Care. 2015;9(4):346–354.
43. Kaplan PW. Delirium and epilepsy. Dialogues Clin Neurosci.
2003;5(2):187–200.
44. Udagedara TB, Dhananjalee Alahakoon AM, Goonaratna IK. Vascular
Parkinsonism: A Review on Management updates. Ann Indian Acad
Neurol. 2019;22(1):17–20.
45. Williams DR, Litvan I. Parkinsonian syndromes. Continuum (Minneap
Minn). 2013;19(5):1189–1212.
46. Solberg M, Koht J. Oculogyric Crises. Tremor Other Hyperkinet Mov
(N Y). 2017;7:491.
47. Barow E, Schneider SA, Bhatia KP, et al. Oculogyric crises: Etiology,
pathophysiology and therapeutic approaches. Parkinsonism Relat
Disord. 2017;36:3–9.
48. Tible OP, Riese F, Savaskan E, et al. Best practice in the management of
behavioural and psychological symptoms of dementia. Ther Adv Neurol
Disord. 2017;10(8):297–309.
49. Desai AK, Grossberg GT. Recognition and Management of Behavioral
Disturbances in Dementia. Prim Care Companion J Clin Psychiatry.
2001;3(3):93–109.
50. Ali S, Patel M, Jabeen S, et al. Insight into delirium. Innov Clin Neurosci.
2011;8(10):25–34.
51. Varanese S, Birnbaum Z, Rossi R, et al. Treatment of advanced
Parkinson’s disease. Parkinsons Dis. 2011;2010:480260.
52. Harris D. Delirium in advanced disease. Postgrad Med J.
2007;83(982):525–528.
53. Irwin SA, Pirrello RD, Hirst JM, et al. Clarifying delirium management:
practical, evidenced-based, expert recommendations for clinical
practice. J Palliat Med. 2013;16(4):423–435.
54. Lawlor PG. Delirium and dehydration: some uid for thought? Support
Care Cancer. 2002;10(6):445–454.
55. Tsunoda N, Hashimoto M, Ishikawa T, et al. Clinical Features of
Auditory Hallucinations in Patients With Dementia With Lewy
Bodies: A Soundtrack of Visual Hallucinations. J Clin Psychiatry.
2018;79(3):17m11623.
56. Yusupov A, Galvin JE. Vocalization in dementia: A case report and
review of the literature. Case Rep Neurol. 2014;6(1):126–133.
57. El Haj M, Roche J, Jardri R, et al. Clinical and neurocognitive aspects
of hallucinations in Alzheimer’s disease. Neurosci Biobehav Rev.
2017;83:713–720.
58. Maclullich AM, Ferguson KJ, Miller T, et al. Unravelling the
pathophysiology of delirium: a focus on the role of aberrant stress
responses. J Psychosom Res. 2008;65(3):229–238.
59. Poewe W, Gauthier S, Aarsland D, et al. Diagnosis and management of
Parkinson’s disease dementia. Int J Clin Pract. 2008;62(10):1581–1587.
60. Meireles J, Massano J. Cognitive impairment and dementia in
Parkinson’s disease: clinical features, diagnosis, and management. Front
Neurol. 2012;3:88.
61. Chandra SR, Patwardhan K, Pai AR. Problems of Face Recognition in
Patients with Behavioral Variant Frontotemporal Dementia. Indian J
Psychol Med. 2017;39(5):653–658.
62. Lorenzl S, Füsgen I, Noachtar S. Acute confusional States in the elderly-
-diagnosis and treatment. Dtsch Arztebl Int. 2012;109(21):391–399.
63. Arcand M. End-of-life issues in advanced dementia: Part 1: goals of care,
decision-making process, and family education. Can Fam Physician.
2015;61(4):330–334.
64. Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care
unit. Crit Care. 2008;12(Suppl 3):S3.
65. Nolan C, DeAngelis LM. The confused oncologic patient: a rational
clinical approach. Curr Opin Neurol. 2016;29(6):789–796.
66. Chwistek M. Recent advances in understanding and managing cancer
pain. F1000Res. 2017;6:945.
67. Schneider G, Voltz R, Gaertner J. Cancer Pain Management and
Bone Metastases: An Update for the Clinician. Breast Care (Basel).
2012;7(2):113–120.
68. Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and
Dandru: A Comprehensive Review. J Clin Investig Dermatol.
2015;3(2):10.13188/2373-1044.1000019.
69. Laurence M, Benito-León J, Calon F. Malassezia and Parkinson’s
disease. Front Neurol. 2019;10:758.
70. Fong TG, Davis D, Growdon ME, et al. The interface between delirium
and dementia in elderly adults. Lancet Neurol. 2015;14(8):823–832.
71. Yiannopoulou KG, Papageorgiou SG. Current and future treatments for
Alzheimer’s disease. Ther Adv Neurol Disord. 2013;6(1):19–33.
72. Tonelli M, Wiebe N, Straus S, et al. Multimorbidity, dementia and health
care in older people:a population-based cohort study. CMAJ Open.
2017;5(3):E623–E631.
73. Martorana A, Bulati M, Bua S, et al. Immunosenescence, inammation
and Alzheimer’s disease. Longev Healthspan. 2012;1:8.
74. Lawlor PG, Bush SH. Delirium diagnosis, screening and management.
Curr Opin Support Palliat Care. 2014;8(3):286–295.
75. Brenowitz WD, Kaup AR, Lin FR, et al. Multiple Sensory Impairment
Is Associated With Increased Risk of Dementia Among Black and White
Older Adults. J Gerontol A Biol Sci Med Sci. 2019;74(6):890–896.
76. Wilson RS, Gilley DW, Bennett DA, et al. Hallucinations, delusions,
and cognitive decline in Alzheimer’s disease. J Neurol Neurosurg
Psychiatry. 2000;69(2):172–177.
77. Prasad Mamidi, Kshama Gupta. Obsessive compulsive disorder–
‘Sangama graha’: An Ayurvedic view. J Pharm Sci Innov. 2015;4(3):156–
164.
78. Mamidi P, Gupta K. Pittaja Unmada: Hyperthyroidism with mania? /
Psychotic or irritable mania? Int J Yoga - Philosop Psychol Parapsychol.
2020;8(2):47–57.
79. Gupta K, Mamidi P. Vataja Unmada: Schizophrenia or dementia or mood
disorder with psychosis? Int J Yoga - Philosop Psychol Parapsychol.
2020;8(2):75–86.
80. Gupta K, Mamidi P. Kaphaja unmada: Myxedema psychosis? Int J Yoga
- Philosop Psychol Parapsychol. 2015;3(2):31–39.
81. Mamidi P, Gupta K. Guru, vriddha, rishi and siddha grahonmaada:
Geschwind syndrome? Int J Yoga–Philosop Psychol Parapsychol.
2015;3(2):40–45.
Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana 310
Copyright:
©2020 Gupta et al.
Citation: Gupta K, Mamidi P. Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana . Pharm Pharmacol Int J. 2020;8(5):297310.
DOI: 10.15406/ppij.2020.08.00309
82. Gupta K, Mamidi P. Gandharva grahonmada: Bipolar disorder with
obsessive-compulsive disorder/mania? Int J Yoga - Philosop Psychol
Parapsychol. 2017;5(1):6–13.
83. Mamidi P, Gupta K. Vetaala Grahonmada: Parkinson’s disease
with obsessive-compulsive disorder?/Autoimmune neuropsychiatric
disorder? Int J Yoga - Philosop Psychol Parapsychol. 2017;5(2):35–41.
84. Gupta K, Mamidi P. Deva shatru/Daitya/Asura grahonmada: Antisocial/
Narcissistic/Borderline personality disorder? Int J Yoga - Philosop
Psychol Parapsychol. 2018;6(1):10–15.
85. Gupta K, Mamidi P. Yaksha grahonmada: Bipolar disorder with
obsessive-compulsive disorder? Int J Yoga - Philosop Psychol
Parapsychol. 2018;6(1):16–23.
86. Gupta K, Mamidi P. Deva grahonmada: Interictal behavior syndrome of
temporal lobe epilepsy? / Obsessive-compulsive disorder with mania?
Int J Yoga - Philosop Psychol Parapsychol. 2018;6(1):41–50.
87. Mamidi P, Gupta K. Rakshasa grahonmada: Antisocial personality
disorder with psychotic mania? Int J Yoga - Philosop Psychol
Parapsychol. 2018;6(1):24–31.
88. Mamidi P, Gupta K. Brahma rakshasa grahonmada: Borderline
personality disorder? / tourette syndrome – plus? Int J Yoga - Philosop
Psychol Parapsychol. 2018;6(1):32–40.
89. Gupta K, Mamidi P. Nishaada grahonmada: Behavioral and
Pscyhological symptoms of dementia? / Frontotemporal dementia? /
Hebephrenia? J Neuro Behav Sci. 2018;5(2):97–101.
90. Mamidi P, Gupta K. Uraga grahonmada: Extrapyramidal movement
disorder?/Tourette syndrome-Plus? Indian J Health Sci Biomed Res.
2018;11(3):215–221.
91. Gupta K, Mamidi P. Preta grahonmada - Catatonia? Med J DY Patil
Vidyapeeth. 2018;11(6):461–465.
92. Mamidi P, Gupta K. Maukirana grahonmada – Psychiatric manifestations
of Graves’ hyperthyroidism and ophthalmopathy?. Med J DY Patil
Vidyapeeth. 2018;11(6):466–470.
93. Gupta K, Mamidi P. Kushmanda grahonmada - Paraneoplastic
neurological syndrome with testicular cancer? J Neuro Behav Sci.
2018;5(3):172–176.
94. Gupta K, Mamidi P. Bhutonmada’s of Harita samhita-An explorative
study. Int J Yoga-Philosop Psychol Parapsychol. 2020;8(1):3–12.
95. Kandler C, Bleidorn W. The Genetic and Environmental Contributions
to Personality Dierences and Development. In Wright JD (ed). The
international encyclopaedia of social and behavioural sciences (2nd ed).
884-890 p.
96. Saposnik G, Redelmeier D, Ru CC, et al. Cognitive biases associated
with medical decisions: a systematic review. BMC Med Inform Decis
Mak. 2016;16(1):138.
97. Esteban-Zubero E, Valdivia-Grandez MA, Alatorre-Jiménez MA, et al.
Diagnosis Bias and its Revelance During the Diagnosis Process. Arch
Clin Med Case Rep. 2017;1(1):24–30.
98. O’Sullivan ED, Schoeld SJ. Cognitive bias in clinical medicine. J R
Coll Physicians Edinb. 2018;48(3):225–232.
99. Snellman I, Gustafsson C, Gustafsson LK. Patients’ and caregivers’
attributes in a meaningful care encounter: similarities and notable
dierences. ISRN Nurs. 2012;2012:320145.
100. Kaplan RM. Health psychology: where are we and where do we go from
here? Mens Sana Monogr. 2009;7(1):3–9.
101. Park N, Peterson C, Szvarca D, et al. Positive Psychology and Physical
Health: Research and Applications. Am J Lifestyle Med. 2014;10(3):200–
206.
102. Maté G. The science of psychoneuroimmunology. Can Fam Physician.
2005;51(4):489.
103. Boksa P. On the neurobiology of hallucinations. J Psychiatry Neurosci.
2009;34(4):260–262.
104. Joyce EM. Organic psychosis: The pathobiology and treatment of
delusions. CNS Neurosci Ther. 2018;24(7):598–603.
105. Balsavar A, Deshpande SN. Hallucinations in the classical Indian system
of Ayurveda: A brief overview. Indian J Psychiatry. 2014;56(4):325–
329.
106. Jan T, Del Castillo J. Visual hallucinations: charles bonnet syndrome.
West J Emerg Med. 2012;13(6):544–547.
107. Chandrasekaran PK, Jambunathan ST, Zainal NZ. Characteristics of
patients with organic brain syndromes: A cross-sectional 2-year follow-
up study in Kuala Lumpur, Malaysia. Ann Gen Psychiatry. 2005;4(1):9.
108. Ganguli M, Blacker D, Blazer DG, et al. Classication of neurocognitive
disorders in DSM-5: a work in progress. Am J Geriatr Psychiatry.
2011;19(3):205–210.
109. Rasmussen SA, Mazurek MF, Rosebush PI. Catatonia: Our current
understanding of its diagnosis, treatment and pathophysiology. World J
Psychiatry. 2016;6(4):391–398.
110. Mitra S, Mahintamani T, Kavoor AR, et al. Negative symptoms in
schizophrenia. Ind Psychiatry J. 2016;25(2):135–144.
111. Simmons WK, Burrows K, Avery JA, et al. Depression-Related
Increases and Decreases in Appetite: Dissociable Patterns of Aberrant
Activity in Reward and Interoceptive Neurocircuitry. Am J Psychiatry.
2016;173(4):418–428.
112. Heininga VE, Dejonckheere E, Houben M, et al. The dynamical
signature of anhedonia in major depressive disorder: positive emotion
dynamics, reactivity, and recovery. BMC Psychiatry. 2019;19(1):59.
113. Moschopoulos NP, Kaprinis S, Nimatoudis J. Cotard’s syndrome: Case
report and a brief review of literature. Psychiatriki. 2016;27(4):296–302.
114. Woods DW, Houghton DC. Diagnosis, evaluation, and management of
trichotillomania. Psychiatr Clin North Am. 2014;37(3):301–317.
115. Issac TG, Telang AV, Chandra SR. Trichotillomania Ranging from
“Ritual to Illness” and as a Rare Clinical Manifestation of Frontotemporal
Dementia: Review of Literature and Case Report. Int J Trichology.
2018;10(2):84–88.
116. Paholpak P, Mendez MF. Trichotillomania as a Manifestation of
Dementia. Case Rep Psychiatry. 2016;2016:9782702.
117. Wittenberg D, Possin KL, Rascovsky K, et al. The early
neuropsychological and behavioral characteristics of frontotemporal
dementia. Neuropsychol Rev. 2008;18(1):91–102.
118. Kwak YT, Han IW, Lee PH, et al. Associated conditions and clinical
signicance of awake bruxism. Geriatr Gerontol Int. 2009;9(4):382–
390.
119. Guttormson JL. Releasing a lot of poisons from my mind”: patients’
delusional memories of intensive care. Heart Lung. 2014;43(5):427–
431.
120. Rundshagen I, Schnabel K, Wegner C, et al. Incidence of recall,
nightmares, and hallucinations during analgosedation in intensive care.
Intensive Care Med. 2002;28(1):38–43.
121. Matthews EE. Sleep disturbances and fatigue in critically ill patients.
AACN Adv Crit Care. 2011;22(3):204–224.
122. Wang S, Meeker JW, Perkins AJ, et al. Psychiatric symptoms and their
association with sleep disturbances in intensive care unit survivors. Int J
Gen Med. 2019;12:125–130.
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