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Therapeutic File
Clinical Theme
Clinical Theme
Eating disorders in adolescents
Adolescents and addictions
Adolescent Acne
Teaching Clinical Homeopathy
CEDH magazine C O N T I N U I N G M E D I C A L E D U C AT I O N C E D H M A G A Z I N E • J U N E 2 0 1 6 • N U M B E R 4 1
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EDITORIAL
CEDH is deeply committed to the training of physicians Yves Lévêque, MD Editor in Chief
C
EDH is involved in the sharing of knowledge and the will to progress
together, in order to answer the needs of patients and healthcare professionals. CEDH is committed to bringing a therapeutic response to problems that are frequently encountered in our society. The articles presented here on acne, eating disorders and addictions are a perfect illustration. CEDH is committed to offering modern and varied learning tools. We now have an online version of the CEDH Magazine available at the following address: CEDH is involved at an international level to promote the largest diffusion of clinical homeopathy education. The international CEDH 2016 Chicago conference is part of this international approach, with 16 nationalities represented, 15 speakers and 185 participants, showing the will to share homeopathic knowledge and confront clinical experiences among physicians. CEDH is committed to debating and engaging in reflections to promote a greater ■
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place of clinical homeopathy in our society.
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SUMMARY
CEDH magazine 3 EDITORIAL ,
Yves Lévêque, MD, 05
41 N°
Published by CEDH, 38, rue des Mathurins, 75008 Paris - www.cedh.org Editor in Chief : Yves Lévêque, MD Editorial board : Yves Lévêque, MD Frédéric Voirin, MD Contributors for this issue : Antoine Demonceaux, MD Marine Guinet-Demonceaux, Sonia Pecastaing, MD Patrick Vachette, MD
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Production : Logomotif, Lyon Editing : Élodie Ther Translator : Benedict Clement Illustrations : Fotolia, Logomotif Printing : ISSN : 1950-8832 Legal mention : 0516 T 88691 Publication date : June 2016.
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5 THERAPEUTIC FILE EATING DISORDERS IN ADOLESCENTS Patrick Vachette, MD, 07
23 CLINICAL THEME Adolescents and addictions Marine Guinet-Demonceaux Antoine Demonceaux, MD, 23
Adolescent Acne Sonia Pecastaing, MD, 29
T
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THERAPEUTIC
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Eating disorders Patrick Vachette, MD Avignon, France
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oday most magazines or so called “medical” TV shows always talk about well-being. In our consultations, especially with adolescents, we hear this unrelenting complaint: “I don’t feel good about myself. What can you do for
me?” Feeling good about oneself is most often based on two things, first an adequacy between one’s ideal body and one’s real body, and second that family, friends and society in general do not trigger stress or complexes in the adolescent.
TWO EXTREMES: TWO PATHWAYS FOR REFLEXION ■ OBESE PATIENTS are forced to escape their body because of its extra weight. They will become overly empathic because they can only feel appreciated by others that way. It helps them get away from their unpleasant body. On a social level they present themselves as fun-loving, full of life individuals. ■ THIN PATIENTS, on the contrary to obese patients, they no longer want to have a body. Only the mind is important. Being fat means being weak. Being thin means being strong and intelligent. Thin patients are focused on themselves and become hyper narcissist. They like to show off their body. Their favorite activities are focused on the body: i.e. weight lifting, running, dancing, horse-riding. They become egocentric, hard on themselves and on others, dried up emotionally.
All these patients, victims of a society that promotes thinness, idealized bodies and youth, alternate between the pleasure of eating, which is frown upon, taboo and guilt ridden, and the dictate of the different diets they force upon themselves, valorizing them and weakening them at the same time. Today religious and social rites have greatly decreased, conversely society and medical rules promote the notion of eating well and drinking well, and individuals who stray from these paths are meant to feel guilty.
WHY NOT FOLLOW VOLTAIRE WHO SAID “I decided to be happy because it is good for my health”?
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Between these two extremes, there are multifactorial pathologies that require a global care management and multidisciplinary approach. Here are other situations on which we can act effectively:
• Adolescents who alternatively lose weight and gain weight (yo-yo dieting); • Adolescents snacking constantly; • Big eaters who risk becoming overweight, with related dangerous consequences; • Those who flirt with anorexia and bulimia without ever falling completely into it, or loosing themselves into it.
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Eating disorders
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Statistics ■ Eating disorders affect mostly women: there are 20 women suffering from bulimia for 1 man. ■ The risk of anorexia nervosa is 10 times higher in girls than in boys, and mortality remains important: 5% ■ In France, 3 children out of 10 are obese. 80% will remain this way unless they receive adequate care.
Four classes of homeopathic medicines can be proposed for their action on: • Physical symptoms; • Emotional sphere; • Etiology • Sensitive type and reactional mode.
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Homeopathic treatment of hyperphagia MEDICINES USED IN HYPERPHAGIC PATIENTS
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Place of the homeopathic treatment HOMEOPATHIC MEDICINES FOR THE SENSITIVE TYPE
HYPERPHAGIC PATIENTS WHO GAIN WEIGHT
CALCAREA CARBONICA We know that this medicine acts on the general metabolism. It is useful at all ages of life.
OR CONSTITUTIONAL TYPE present morphological
particularities, a specific emotional reaction and different physical symptoms, organ per organ, allowing us to individualize and prescribe them to improve the eating disorders in these adolescents.
REGARDING THE REACTIONAL MODE: Tuberculinic patients are thin, lanky adolescents who can “flirt” with anorexia or bulimia. Psoric patients alternate between opposite eating habits. They play yo-yo with their weight. Sycotic patients develop weight-related pathologies leading to complications because of their obesity.
NEWBORNS: Stocky morphology. Birth weight is higher than normal, they will develop digestive disorders very early on – lactose intolerance, alternation of diarrhea and constipation, as soon as food diversification begins, they will be attracted to hard-to-digest foods. They like eggs, sweets, ice cream. Dairy products are often poorly tolerated. CHILDREN: Slow but steady acquisitions. It will be necessary early on to limit sweets, provide a balanced diet and monitor the child's weight to height ratio.
ETIOLOGY IS IMPORTANT because in adolescents,
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emotional stress, related to friends or family, can trigger or worsen an eating disorder (moving house, parents separating or getting a divorce, grief, family or interpersonal conflict). A patient might not correspond to only one medicine, and the progression of his/her clinical history will require to update the prescription.
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HOW TO PROCEED Conduct a complete homeopathic interview. If necessary prescribe additional examinations and request the advice of specialists.
This medicine corresponds both to the Psoric and Sycotic Reactional Modes. Children are still reactive and can, with a good life hygiene, stabilize their weight, but once they become adults, Sycosis sets in and weight loss is compromised.
DOSAGE ■ To be used in 15C or 30C, 5 pellets per day at the beginning of the treatment, followed by 10 pellets once a week.
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Eating disorders SULPHUR Very close to Calcarea carbonica. Sulphur can be used in association or in alternation with it. Sulphur patients are fun-loving and enjoy the good things in life, including food! Right from a young age they will try any type of food proposed. They like everything but mostly sweets and spicy foods. Sulphur children and young adults, will eliminate quite well in spite of food excesses, then they will progressively develop weightrelated pathologies: high blood pressure, diabetes, acute attack of gout, lipid metabolism disorder, atherosclerosis and arteriosclerosis. Sulphur patients do not accept nor follow any diet rules, what matters are the joy of eating and good things in life. They will have cravings, often at 11 am. Often complaining of dyspeptic disorders: • Abdominal bloating; • Diarrhea, especially in the morning upon waking up, alternating with periods of constipation that can be complicated by burning and pruritic hemorrhoids; • Sensation of emptiness in the epigastric notch at the end of the morning, improved when eating; • Colitis episodes.
DOSAGE ■ To be used in 15C or 30C, 5 pellets per day at the beginning of the treatment, followed by 10 pellets once a week.
ALLIUM SATIVUM
DOSAGE ■ 5 pellets in 6C, twice a day.
(Not available in the US)
In low dilutions, this plant stimulates the appetite. In high dilutions (15C), it helps patients reach satiation more quickly.
DOSAGE ■ To be used in 15C, 5 pellets twice a day.
HYPERPHAGIC PATIENTS WHO LOSE WEIGHT
NATRUM MURIATICUM Sodium chloride is an essential component of the body. It is actively involved in the regulation of transmembrane bionic exchanges and contributes to maintaining the intra- and extracellular electrolyte fluid balance, explaining the characteristic symptoms that are sometimes quite contradictory. • Loses weight while eating well; • Weight loss especially in the upper body with cellulites retention at waist level; • Thirst or absence of thirst; • Craving or aversion for salty foods; • Dryness or water infiltration of the mucous membranes; • Can develop binge eating episodes; • Alternation of asthenic and agitation periods. These adolescents often present with thyroid dysfunction issues. They have a low self-esteem. They are lonely and have an erroneous perception of their body image. Easily depressed, they will develop a tendency to binge eating attacks. Some amenorrhea. Binge eating attacks crises occur mid-morning, around 10 am.
DOSAGE ■ To be used in 15C or 30C, 5 pellets per day at the beginning of the treatment, followed by 10 pellets once a week.
IODUM Hyperthyroid type. Thin patients who are always hungry. Eating relieves their fatigue, anxiety, epigastric pain. They are tired and easily fatigued, with palpitations and tachycardia at the slightest effort.
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Useful medicine in dyspeptic patients with flatulence, large appetite, gluttons, who present with acid burns and hypersalivation. They eat a lot of meat.
FOENUM GRAECUM
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Eating disorders LOOK FOR: • Anxious agitation; • The need to move around with constant agitation to prevent anxiety; • Intolerance to heat; • Improvement when heating; • Intolerance to cow’s milk; • Medicine more adapted to women.
DOSAGE ■ To be used in 15C or 30C, 5 pellets per day at the beginning of the treatment, followed by 10 pellets once a week.
PETROLEUM Interesting medicine in patients who are always hungry, with nighttime snacking, but who do not digest anything (dyspepsia, diarrhea). They will have a tendency to lose weight. They like beer and sauerkraut, which they cannot tolerate (diarrhea). These patients are prone to motion sickness and, in spite of their constant nauseous state they keep eating.
DOSAGE ■ 5 pellets in 9C, once or twice per day.
STAPHYSAGRIA We have to think about it when faced with adolescents with eating disorders who snack after unresolved relational conflicts: moral and/or school bullying, friendships that turn sour. These patients will turn to “comfort” food to compensate: chocolate, cakes, sweets. They have a contained inner anger that will trigger symptoms. This medicine corresponds to psychosomatic symptoms. In fact the preferential pathogenic symptoms correspond to organs particularly sensitive to psychogenic influences. DURING THE INTERVIEW, WE MUST LOOK FOR THE FOLLOWING KEY POINTS: • Oppression, palpitations, restrosternal chest pain; • Sleep disorders with intense dreaming; • Erratic pruritus when scratching; • UTI with clean urines; • Recurrent sties.
DOSAGE ■ 5 pellets once to twice per day in 15C or 30C, in the presence of behavioral disorders. It is then quite close to Ignatia amara and Colocynthis.
PHOSPHORUS Tall and lanky, with an intense and tiring life, these emotional, sensitive and elegant intellectuals exhibit a voracious hunger. They are never satiated, even at the end of a meal. They wake up in the middle of the night to eat. They crave spicy and salty foods (except fish and oysters). They are always thirsty, especially for cold water. They like to eat cold foods.
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DOSAGE ■ To be used in 15C or 30C, 5 pellets per day at the beginning of the treatment, followed by 10 pellets once a week.
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HYPERPHAGIC PATIENTS WHO COMPENSATE
THEY COMPENSATE THEIR FRUSTRATION
THEY COMPENSATE THEIR FATIGUE
ANACARDIUM ORIENTALE The desire to eat is triggered by intense intellectual fatigue with memory loss. Patients forget the names of people and of the most common things. Patients are indecisive. They are afraid to fail what they’ve started. The only thing that makes them feel better is eating. IT IS IMPORTANT TO LOOK FOR DIGESTIVE SYMPTOMS: • Sensation of emptiness at the pit of the stomach; • Epigastralgia after meals, improved by eating. One should think about prescribing the medicine under two circumstances frequently encountered in our clinical practice • Students studying for their exams who
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Eating disorders compensate their state of fatigue by eating; • Ambivalent patients who are prone to contradictory and opposite impulses. Anacardium Orientale patients have “an angel on their right shoulder and a demon on the left one”.
DOSAGE ■ 15C, 5 pellets around 10 am and 5 pm, to be repeated in case of snacking or food cravings.
KALIUM PHOSPHORICUM The more tired these patients are the more irritated and irritable they get. Disorders will start when they have to face an intense intellectual task:
THEY WILL THEN COMPLAIN ABOUT: • Headaches, with sensation of pressure in the occipital region (back of the head), nape of the neck or sinuses; • Sensation of lump in the throat (Ignatia amara); • Sensation of empty stomach, improved when eating; • Hypersensitive to noise; • Insomnia (with night frights or sleep-walking in children and adolescents). This medicine is quite well indicated for tall and lanky “Phosphoric” patients, who are emotional, hypersensitive, very performant on an intellectual level but quickly tired. Fatigue makes them irritable.
DOSAGE ■ 9C or 15C, 5 pellets twice a day.
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The risk of anorexia nervosa is 10 times higher in girls than in boys, and mortality remains important: 5%
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Eating disorders HYPERPHAGIC PATIENTS WHO HAVE A HARD TIME DIGESTIVE DISORDERS
• In the presence of behavioral disorders: stress in a school environment; • In an insomniac patient.
NUX VOMICA The perfect prototype of adolescents intoxicated by the stress of life in today’s world. They will bear with this life by compensating with: • Food, alcohol, tobacco and illegal substances excesses; • Prescription drugs excesses to fight off stress (anxiolytics and hypnotics); • Excesses of caffeine and high-energy drinks to keep up with the work; • Intense exercises for a patient who is quite sedentary by nature.
ANTIMONIUM CRUDUM Hyperphagia medicine relevant in adolescents who: • Eat too much food; • Eat too fast. wolfing down food; • Are attracted to low-quality, hard-to-digest food: fatty food, acid food, cured meat, cakes, bad alcohol. THIS EATING BEHAVIOR WILL TRIGGER THE FOLLOWING
This medicine is not a sensitive type medicine, but rather related to a specific context or circumstance. It is the intense way of life, multiple solicitations, family and work stress that trigger the symptoms justifying the prescription of this medicine. BEFORE PRESCRIBING THE MEDICINE, LOOK FOR THE DIGESTIVE SYMPTOMS THAT MUST BE PRESENT: • posterior part of the tongue is coated; • nausea in the morning, especially when brushing their teeth; • painful sensation of hunger with dyspepsia, improved when eating; • sleepiness after meals, improved by a short nap; false urges to have a bowel movement; • alternation of diarrhea and constipation; • spastic colitis; • hemorrhoids aggravated by excessive alcohol intake, too many spicy meals and improved by immersing them in cold water.
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ALSO LOOK FOR POTENTIAL SLEEP DISORDERS: • Insomnia when falling asleep; brain hyperactivity; • Wakes up between 2 and 3 am: prepares the day ahead in his/her mind; • Insomnia at the end of the night. Falls back asleep right before the alarm goes off, making him/her in a very bad mood.
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DOSAGE ■ 9C, 5 pellets per day, for digestive symptoms or to systematically detox a patient with multiple addictions (alcohol, illegal substances, prescription drugs, coffee) ■ 15C, 5 pellets in the evening:
DIGESTIVE SYMPTOMS:
• Tongue is covered with a thick, white coating; • Eructation tasting like previously eaten food (Pulsatilla); • Diarrhea and/or vomiting of undigested food. Patients have a temper, with no table manners. They can be rude and touchy. YOU NEED TO LOOK FOR TWO CONCOMITANT SYMPTOMS THAT ARE FREQUENTLY ASSOCIATED: • Impetigo-like rash around the mouth, and skin inflammation at the corner of the lips; • Hyperkeratosis of the palms and sole of the feet, hyperkeratotic warts.
DOSAGE ■ 9C, one hour before the main meals allowing patients to limit their food intake during meals. . HEPATIC DISORDERS
LYCOPODIUM CLAVATUM These irritable adolescents have a temper, are intolerant to contradiction, intelligent but lack self-confidence, and exhibit a very peculiar eating behavior. • They sit down at the table and eat very small quantities of food and are quickly satiated. • Tend to snack between meals. • Need to eat at regular times.
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Eating disorders • Cannot evaluate the right quantity of food, overestimate their appetite. • They can be very hungry if meal times are respected.
similar circumstances 2. a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
The quickly satiated sensation can be explained by being prone to having a bloated abdomen and air in the colon.
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
On the other hand these patients present with a weak hepatobiliary tract. They are prone to indigestion, stomach burns and hepatic headaches. They love sweets (Argentum nitricum, Sulphur, Kali carbonicum) and very hot food. They like oysters but cannot tolerate them. Onions and garlic are also poorly tolerated. BEFORE PRESCRIBING, LOOK FOR THESE SENSATIONS: • Quickly satiated hunger; • Gastric plenitude right from eating the first bites; • Bloating under the abdominal belt. LOOK FOR THE MODALITIES: • Aggravation between 4 pm and 8 pm; • Improvement by hot food and drinks.
PRESCRIBE THIS MEDICINE ■ Either in 9C around 5 pm, to stimulate the hepatic and digestive functions; ■ or in 6C before meals, in case of bloating after meals; ■ or in 15C or 30C, in the presence of the sensitive type, 5 pellets per day at the beginning of the treatment, followed by 10 pellets once per week.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months. • Self-evaluation is unduly influenced by body shape and weight. • The disturbance does not occur exclusively during episodes of Anorexia Nervosa. 1. PURGING TYPE: during the current episode of Bulimia Nervosa, the person has regularly engaged in selfinduced vomiting or the misuse of laxatives, diuretics, or enemas 2. NONPURGING TYPE: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, (e.g. fasting, excessive exercising). To approach this severe eating disorder, some precautions are essential. A homeopathic treatment must be necessarily associated with medical and psychological support, since this disorder can be life-threatening. Some type of patients, when they exhibit their pathological side, can develop an eating disorder behavior with bulimia symptoms.
THE HOMEOPATHIC TREATMENT BULIMIA: AT-RISK PROFILES
BULIMIA DIAGNOSTIC CRITERIA ACCORDING TO THE DSM - 4
NATRUM MURIATICUM This patient suffers from body dysmorphic disorder (BDD). She is never satisfied of her body image, finds herself too thin in the upper body and too fat around her waist. She has a strong appetite and the way she looks at herself makes her use laxatives, diuretics, she also vomits and exercises too much thus reinforcing her isolation.
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• Recurrent episodes of binge eating; an episode of binge eating is characterized by both of the following: 1. eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under
These medicines should be used in high dilutions, and be associated with psychological and therapeutic support and follow-up.
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Eating disorders She is a loner who has very few friends and a sentimental betrayal or deception can lead her to this type of binge eating crisis.
SEPIA OFFICINALIS One can look at her as an aggravated Natrum muriaticum as such. In this context she presents with bulimic behaviors associated with severe depression with a very low self-esteem, gives up on maintaining social ties, does not care about herself or others. She can only exist in a violent manner. Any relational intrusion feels like an assault. She only exists via excessive reactions: hyperactivity, violent and extreme sports. This medicine is at the frontier between bulimia and anorexia.
PLATINA This patient also suffers from body dysmorphic disorder, she is proud and has a high self-esteem and can have the feeling that some parts of her body are swelling up. She hides her weakness by protecting herself by being overly feminine: extravagant clothes and jewelry, bold make up.
SILICEA Interesting medicine in an asthenic young girl, physically and intellectually exhausted. She looks frail and worries us because she has a delayed growth and does not weigh enough. Intelligent and observant she lacks selfconfidence. She is constantly afraid of failure and of feeling misunderstood. She is afraid of no longer being loved and all these personality traits can lead to a bulimic behavior.
SEROTONINUM MURIATICUM (Not available in the US) The only therapeutic class of antidepressant treatments that have an action on bulimia are serotoninergics, especially Zoloft® (Sertraline Hlc).
THUS IT MIGHT BE RELEVANT TO USE LOW DILUTIONS OF SEROTONIN: ■ Serotoninum muriaticum 5C, 5 pellets per day.
ARGENTUM NITRICUM Her feverish agitation, precipitation and anxiety can trigger pathological eating disorders, she becomes unaware of the quantity of food ingested. What matters is filling up a void and calm the anxiety. In this patient binge eating is contingent on multiple phobias.
GELSEMIUM During the attack, the patient puts herself inside an emotional fog with slowing down of her mental functions and tremors.
ARSENICUM ALBUM
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Her eating disorders are based on rituals. She will prepare her binge episodes in a meticulous, repetitive and organized manner. She cleans out every trace of the binging episode since everything must be clean and flawless.
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ANTIMONIUM CRUDUM She eats too much, low-quality food and too fast. During the binging episode she is in a very foul mood, vicious and touchy.
ABROTANUM We can think of it in adolescents who have a sudden drop in their weight and height curve. These patients present with diarrhea and vomiting episodes in spite of excessive hunger. It is a good complementary medicine of Natrum muriaticum. LOOK FOR: laxatives abuse.
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Homeopathic treatment for loss of appetite For adolescents who show a very clear diminution of their appetite with or without weight loss, we must proceed with a rigorous clinical examination and eventually prescribe additional examinations, because this symptoms can be part of:
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Eating disorders the following clinical symptoms: - Asthenia; - Cold-sensitivity; - Weight gain; - Constipation.
THIS PATIENT’S METABOLISM IS SLOWED DOWN:
- AN ENDOCRINE PATHOLOGY: thyroid dysfunction; - ORGANIC DISEASE: beginning of neoplasia; - PSYCHIATRIC PATHOLOGY: depression, bipolar disorders, eating phobia, compulsiveobsessive disorders, anorexia nervosa. The homeopathic treatment for eating disorders will have to be a complementary therapeutic, within the global care management of the person, in partnership with competent specialists.
WE ENCOUNTER TWO TYPES OF PATIENTS - PATIENTS WITH HYPOPHAGIA WHO GAIN WEIGHT: The homeopathic treatment in itself is enough, with appropriate dietary advice. - PATIENTS WITH HYPOPHAGIA WHO LOSE WEIGHT: Homeopathy is interesting with the precautions listed above. So be careful!
PATIENTS WITH HYPOPHAGIA WHO GAIN WEIGHT “Doctor, I swear I am sticking to my diet. But I cannot eliminate everything that I eat, it gets stuck here!” And in fact we observe at the clinical examination, some cellulite with retention disorders.
THE PATIENT IS SLOWED DOWN ON A PSYCHOLOGICAL LEVEL: - slow in her thinking and taking decisions, so irresolute; - anxious and fearful, with exaggerated sentimentality. Graphites is a frontier medicine between the Psoric reactional mode (patient is an aggravated and slowed down Calcarea carbonica) and Sycotic reactional mode (slowed-down metabolism, retentions, prone to depression).
DOSAGE ■ We can prescribe it either in 15C or 30C, 5 pellets per day at the beginning of the treatment, followed by 10 pellets per week when we have the Sensitive Type and the main pathogenic targets. ■ either in 9C pellets, to stimulate the eliminating organs (especially constipation and skin).
THUJA OCCIDENTALIS It is the central medicine of Sycosis. This patient has water retention, cellulitis, and fat excesses on the upper leg, abdomen and buttocks. She eats little but gains weight.
GRAPHITES When you think of this medicine, one should look for hypothyroidism, especially if we find
This patient is an obsessional phobic, even suffers from cancer phobia, which makes her depressive and ambivalent.
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SOME MEDICINES CAN HELP THESE PATIENTS:
- ON A DIGESTIVE LEVEL: the patient is bloated and constipated presenting with epigastric pain, such as stomach burns or cramps, which are improved by hot foods or drinks, even though she is not attracted by them. She has an aversion for sweets, meat, cooked and hot foods; - ON A GENITAL LEVEL: long menstrual cycles, slight menstrual flow, even some amenorrhea, lack of sexual desire; - ON SKIN LEVEL: skin is coarse, dry and thick, with typical oozing episodes.
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Eating disorders She can have somatic-psychological sensations: prone to fixed beliefs, cenesthesic disorders. There is an indication for this medicine in patients who became Sycotic by taking prescription drugs: birthcontrol pill, corticoids. They will gain weight without having eating disorders.
PRESCRIPTION ■ Thuja occidentalis must be prescribed in 15C or 30C, 5 pellets per day at the beginning of the treatment, followed by 10 pellets, once a week.
PULSATILLA Her weight gain can be explained by venous insufficiency, with congestion and stasis both phenomena are aggravated by heat and long periods of standing still. Pulsatilla adolescents have hypomenorrhea with long menstrual cycles (Graphites). We will need to look for the following digestive symptoms: - Slow digestion with bloating, eructation that tastes like previously ingested foods (Antimonium crudum); - Can’t stand fatty foods; - Fruits, pastries and ice cream are poorly tolerated and trigger diarrhea episodes. - Craving for spicy foods. These patients are emotionally dependent and they can become depressed and develop eating disorders when they are confronted to their separation anxiety and their fear of not being recognized and loved. “ PULSATILLA LOVES TO BE LOVED ”
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DOSAGE ■ Low dilutions will improve local disorders (digestive, circulatory and genital disorders). ■ High dilutions will calm their separation anxiety.
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NATRUM SULPHURICUM These patients are heavy set with body adiposity. All tissues are infiltrated (skin, conjunctive tissue, fibrous tissue) and the lymphatic circulation is slowed down. They eat little and have a slow digestion, are flatulent
and constipated (in spite of the classic diarrhea after breakfast). These patients are very sensitive to the gray and damp weather, brutal barometric decrease, which triggers apathy, fatigue and depression. This Sycotic medicine can also be very interesting, just like Thuja occidentalis, in patients who regularly takes prescription drugs (corticoids, birth control pill).
DOSAGE ■ To be used in 15C or 30C, 5 pellets per day at the beginning of the treatment, followed by 10 pellets per week.
PATIENTS WITH HYPOPHAGIA WHO LOSE WEIGHT CALCAREA PHOSPHORICA We find its indication in children or adolescents tired by their life rhythm and studies, triggering a decrease in appetite at the end of each school term. These patients are tall and lanky, with growth spurts, are thin and often develop kyphoscoliosis. They tend to be physically and mentally tired, which makes them nervous and aggressive. They eat little, except for cured meats and fish.
TO PRESCRIBE ■ To be used in 15C or 30C, 5 pellets per day at the beginning of the treatment, followed by 10 pellets once a week.
IGNATIA AMARA This patient is anxious, emotional, paradoxical, the somatic expression of her anxiety are spasms located in different places over time and space. Her lack of appetite is due to uncomfortable spasm-like sensations in the throat and/or stomach She often complains of chest oppression. Her speech is punctuated with sighs and yawns.
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Eating disorders Paradoxically, hard-to-digest foods are well digested and a low-calorie, fat-free diet, is not! She can’t stand coffee or alcohol, and is hypersensitive to odors. With its anti-anxiolytic and anti-spasmodic action, this medicine should be prescribed in patients with strong emotional weakness translating among other things, by difficulties in managing a logic eating behavior. Being improved by distraction, these patients will eat better when they are with others or if they do something else while eating.
DOSAGE ■ Each Ignatia amara patient has its preferential dilution. LET THEM MANAGE THEIR MEDICINE!
SEPIA OFFICINALIS Sepia officinalis will not be interested by food when she is depressed and will disinvest her relationship with herself and others. She no longer wants to cook, cannot stand cooking odors, and could only eat acid and spicy food (vinegar, lemon, pickles). This disinvestment can lead her to more severe eating disorders, like anorexia nervosa. We will speak about it later on. When Sepia officinalis is balanced, she will develop a real lack of appetite because of ptosis in multiple parts of her body due to the poor quality of the connective support tissues. - AT STOMACH LEVEL, she has the sensation of a stone or weight at the pit of her stomach. - AT GALLBLADDER LEVEL, she develops biliary dyskinesia, with or without lithiasis or slow biliary elimination. - AT THE LEVEL OF THE INTESTINAL TRACT, she is prone to constipation with rectal ptosis that can be complicated by prolapsed hemorrhoids.
DIAGNOTIC CRITERIA OF ANOREXIA NERVOSA ACCORDING TO THE DSM-4 - Refusal to maintain body weight at or above a minimally normal weight for age and height; - Intense fear of gaining weight or becoming fat, even though underweight; - Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.; - In postmenarcheal females, amenorrhea, i.e. the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g. estrogen, administration.); - Restricting type: During current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior; - Binge-eating/purging type: During the current episode of Anorexia Nervosa the person has regularly engaged in binge-eating or purging behavior
THREE CHARACTERISTIC SYMPTOMS - Weight loss of more than 25% of the total body weight, and masking all feminine forms; - amenorrhea > 6 months; - alteration of the perceived weight and body shape. This pathology affects predominantly women: 90%. Some patients alternate in their lifetime periods of anorexia nervosa and bulimia.
BMI When you suspect anorexia nervosa in a patients, think that thinness is the most specific criteria and the foremost symptom of the disease. It is at the core of the diagnosis and treatment. It is necessary to assess the Body Mass Index: BMI is equal to weight (in kilos) divided by height (in meters) multiplied by itself.
> BMI = W/(H X H) For example an adolescent girl who is 1.62 meter high and weighs 44 kilos. Her BMI = 44/2.624 = 16.8.
THIS WILL HELP YOU FOLLOW THE EVOLUTION OF YOUR PATIENT.
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DOSAGE ■ 9C, to stimulate the appetite. ■ 15 to 30C, when there is an associated depression.
ANOREXIA – AT-RISK PROFILES
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THERAPEUTIC
FILE
Eating disorders 23 22 21
Normal weight
20 19 18
Diagnostic criterion of anorexia
17 16
Necessary care
15
Hospitalization
14
Forced Hospitalization
13
Intensive care is needed
12
Death is possible
Table I: Severity of anorexia nervosa according to BMI
POSSIBILITIES AND LIMITS OF HOMEOPATHY This pathology cannot be treated solely with homeopathic medicines. Our therapeutic can only accompany our patients and be part of a comprehensive care. Anorexia care management is difficult because the anorexic patient denies she is sick because she feels elated and proud of being thin. In one third of cases, it is the first step to schizophrenia. To accompany these patients in their fight against the disease some medicines can be helpful, either because they are structurally similar to the anorexic Sensitive Type, or because they will decrease the physical symptoms and emotions triggered by this pathology.
NATRUM MURIATICUM
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Her body never meets her expectations. Either she feels she is too skinny in the upper body, or she is obsessed by her hips that are not narrow enough. An ambiguous and ambivalent internal battle starts. We are faced with Natrum muriaticum in its duality or the succession of the pathologies anorexia nervosa and binge eating.
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Natrum muriaticum seeks isolation and her isolation gets worse when she loses an exclusive friendship, because she privileges a lone and intense relationship rather than multiple superficial relationships. When in her anorexia phase, she will develop physical symptoms that will become more and more alarming:
low blood pressure, fainting due to low blood sugar around 10 am, hyperventilation, hydroelectrolytic disturbances aggravated by the intake of diuretics, laxatives or excessive exercising, especially running and longdistance races.
SEPIA OFFICINALIS In my opinion, it is an aggravation of Natrum muriaticum. She goes from isolation to disinvestment. Sepia officinalis is not concerned about others or herself. The only way to stay within her body is to practice violent sports: aerobics, step, intense dancing by herself all night long among others. Any type of contact is violently rebuked. Her body becomes painful: epigastralgia with sensation of weight in the stomach, multiple urinary tract infections and/or gynecological infections, constipation with hemorrhoids. She is locking doors, doesn’t want to be desired or to desire anyone.
PLATINA It is the hysterical version of the anorexic patient. She protects herself by accentuating her feminine side. She is almost a caricature: too much jewelry, too much make-up. We can find these type of patients in certain social groups such as punks, goths, models and persons who have an issue with their sexual identity. There is in Platina a pride, apparent high self-esteem with contempt for others. She looks at the world from above. Behind this very provocative feminine mask, the true depressive nature of Platina is hidden. Indifferent, cold, she has retreated within herself and is afraid of death, sometimes with suicide impulses. In their sexual behavior, behind this very hysterical nymphomaniac-like mask, the patient cannot be fulfilled in her emotional relationships with others. This can be translated into vaginism and pain during intercourse. Platina often expresses her unhappiness via hyperventilation, with spasms and cramps. Platina cannot evaluate her body image, she sees herself as bigger than she really is. She is unaware of her weight loss.
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THERAPEUTIC
FILE
Eating disorders ARSENICUM ALBUM With the alternations of anxious agitation and depressive asthenia, Arsenicum album is a meticulous obsessive person with intense rituals. She will be extremely refined when preparing meals for others with high esthetics, the plate’s decorum becoming similar to art. She loves watching other people eat.
GELSEMIUM She is scared of the scale. The idea of being confronted to the reality of her thinness triggers a real panic with shaking, abdominal pain, emotional diarrhea, pollakiuria. The patient puts herself in a state of avoidance, translated by an emotional blur with slowed down intellectual capabilities.
IN CONCLUSION The medicines presented can effectively accompany these adolescent girls throughout the difficult battler with eating disorders along with multidisciplinary medical support. The mortality rate in this pathology is 5%. According to the different studies, the chronicity rate is around 30%.
CLINICAL CASES MARY
HOW DOES MARY EXPRESS HER SUFFERING? Mary was referred to me by a colleague in 2005, when she was 18, for bulimia that started three years before. In her personal history we can note an episode of anorexia nervosa that lasted two years with amenorrhea. At the age of 17 she weighed 42 kg for 1.69 m. At the first consultation she weighed 54 kg and found herself too fat, she developed a bulimic attitude with vomiting. IN THE FACTORS THAT PROMOTE THE CRISIS WE NOTE: - Fatigue; - Stress before exams: Mary is a brilliant student in a preparatory class to enter a prestigious business school; - Emotional frustrations: fear of not being loved, fear of disappointing a father that she idealizes, but who is always absent, she anticipates emotional breakups because she feels neither desired nor desirable. The only time when she can manage her eating disorders is when she is in a stable emotional relationship or after passing her exams, which she always does brilliantly, she is unable to truly assess her abilities. Mary is not very self-possessed. She doubts her intellectual potential as much as her physical attributes. She is very dependent on what others think of her. Since she always sets unattainable goals, she irremediably fails. She keeps saying before a crisis that she needs to “fill a void”.
THIS IS THE TYPE OF LETTERS SHE SENT ME THAT VERY WELL SUMS UP THE COMPLEXITY OF HER PATHOLOGY:
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“I am not trying to annihilate my femininity. On the contrary, I like people to find me pretty. I am very conscious that a woman should be desirable. A woman can be admired for her forms, but mostly for her looks, her eyes, charm, what she exudes. A woman can be beautiful and full-figured, the
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THERAPEUTIC
FILE
Eating disorders contrary seems difficult. I prefer to look at women with some roundness to them than the contrary, because when shapeless it seems to me that the woman is suffering and might not be able to have children….
- TOO MUCH PRESENCE, AFFECTION FROM THE MOTHER: “When I am the only link remaining of my parents’ doomed relationship.”
COMMENTS Bulimia is not a way to erase my femininity. I have my binging episodes when I feel like a failure, when I have thoughts that bear no relations to the bulimic act. But the more I think about it, the more I understand that I tried to make myself feel ugly. Too much femininity kills femininity, as you had previously explained. I think that this is part of the clue. When I have a attack, I feel ugly and stupid, the exact opposite of the image I usually project. It is as if I was trying to show that all is fake, that I am not always refined and that I can also be quite common. I told you one day that I was a paradox. When I speak of protection, I am also seeking my freedom and a type of solitude”.
CIRCUMSTANCES TRIGGERING THE ATTACKS These circumstances helped me determine the medicines. - SITTING DOWN AT THE TABLE: “I sit down at the table alone and I get bored, but then the idea of vomiting comes up and it reassures me because I will not get fat. This scares me because I can hurt myself” (irritation and inflammation of the oropharynx, alteration of the tooth enamel and multiple tooth decays, hypertrophy of the parotids and angulo-maxillary glands). - SEEING SOMEONE EATING IN FRONT OF HER: “This can trigger a binging episode I have denied myself for too long the food that I like (chocolate, cookies…). I can be disgusted if this person eats bad food or too much food”
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- A BORING ACTIVITY: “when the activity is repetitive, I feel that it is not interesting and that I am not learning anything.”
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- LACK OF LOVE: “this scares me. I have to fill up otherwise I get into a attack, even if I know that I will feel a huge void afterwards.” - TOO MUCH LOVE: “when I meet boys that are too forward.”
Mary’s behavior is ambivalent, paradoxical, irrational, which led me to prescribe the three following medicines.
ANACARDIUM ORIENTALE - Contradictory and opposite impulses; - Intellectual fatigue improved when eating; - Imperious need to eat when she is tired.
NATRUM MURIATICUM - When she gains weight it is around the buttocks, - When she loses weight, she annihilates her femininity on the upper body.
IGNATIA AMARA - Bulimic episodes are preceded by a sensation of having a lump stuck in her throat. - She is oppressed. - Improved by distraction (taking a bath, making a phone call, getting out of the house to avoid bulimic episodes). - There is the irrational and paradoxical side of her emotions.
THE CAUSES FOR HER ANOREXIA EPISODES: .E. FATIGUE AND STRESS BEFORE EXAMS, SOLITUDE, FRUSTRATION, BROUGHT UP THE FOLLOWING MEDICINES: CALCAREA PHOSPHORICA - Mary is in fact easily fatigued on a physical and intellectual level. - She is tall and lanky. - She has frontal headaches, aggravated in periods of exams.
KALI PHOSPHORICUM - Irritable asthenia aggravated by any intellectual effort.
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THERAPEUTIC
FILE
Eating disorders I OFTEN PRESCRIBE DURING HER SEVERE ANOREXIA EPISODES: SEPIA OFFICINALIS - Sensation of having a weight or heaviness at the pit of her stomach or sensation of void before or having the episodes; - Isolation, sadness, withdrawal.
ARGENTUM NITRICUM During the binging episodes, Mary is agitated, feverish. Mary eats very quickly and it is associated with great anxiety. Bloating, diarrhea, vomiting.
STAPHYSAGRIA She compensates, by eating and vomiting, either her emotional or sexual frustrations or her eating frustrations (“when I see someone eating chocolate and cakes, which I deprive myself of in order not to gain weight”).
CONCLUSION Mary is feeling better. She still has a hard time detaching herself from her family and her relationship with her mother is still too fusional. She still suffers from eating disorders episodes when questions her emotional life or intellectual abilities.
MARY DESCRIBES HER BINGING EPISODES IN A PRECISE AND INSTRUCTIVE MANNER: “Now I only purge myself at the end of a meal, when I am tired or when I feel lonely. The image of my deformed body comes to my mind and I know that I will need to vomit. When I start I continue because I know I have to empty myself. I go quite far, I need to feel pain in my chest, because if there is not enough pain, I know I will try again the next day. The pain I feel leads to fatigue, and is justified at the same time. After the vomiting episode I try not to think about anything and the next day I focus on something else. I still need to work on two things with you:
PRESCRIPTION Two types of prescriptions accompanied Mary in our work.
- I am still in a codependent relationship with my mother. I need her (need to fill up) and she smothers me (need to purge).
DURING PERIODS OF SEVERE BINGING EPISODES ■ Sepia officinalis 15C, Calcarea phosphorica 15C, ■ Anacardium orientale 30C, 10 pellets once a week of each medicine.
- My father never tells me that he is proud of me. He never does it spontaneously. My mother has to ask him.”
With: ■ Ignatia amara 9C, 5 pellets in the morning; ■ Kali phosphoricum 9C, 5 pellets in the afternoon; ■ Argentum nitricum 15C, 5 pellets in the evening at bedtime.
JULIE, FAMILY LOYALTY Julie was referred to me by a colleague in February 2005, for eating disorders that started at the beginning of the year 2004. She alternates periods where she eats too much, and I learn during the interview that she makes herself throw up from times to times, with periods where she eats very little.
WHEN SHE MANAGES HER EPISODES AND RESUMES HER SOCIAL ACTIVITIES:
IN HER PERSONAL AND FAMILY HISTORY Her father died in 2003 during the heatwave, he died from depression and alcoholism. He let himself die. She had not seen her father since the age of 7, and was unable to grieve properly (it is quite frequent for an adolescent that age to experience an altered or delayed grief).
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■ Natrum muriaticum 15C, 10 pellets on Sundays. With: ■ Ignatia amara 9C, 5 pellets in the morning; ■ Staphysagria 15 C, 5 pellets at bedtime.
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THERAPEUTIC
FILE
Eating disorders Her mother has met someone that she has been living with for the past four years, and there are major conflicting issues with this man (“nobody hears me, I feel judged all the time”).
INTERVIEW
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NATRUM MURIATICUM Julie presents with BDD. When she gains weight it goes right to her hips and thighs, which she finds unacceptable.
Julie is a sophomore in high school, she is a brilliant student (top of her class) and wants to be a veterinarian. She is very intense about her school achievements, she always wants to be the best, she has a hard time self-assessing her abilities and accepting that her excellent school results are really hers.
She has lengthy menstrual cycles with little blood flow. She is an introvert, a loner and has extended periods of sadness. She doesn’t have many friends;
Horse-riding is her passion. She describes herself as a loner and explains to me that her eating disorder is more frequent during the week but that she manages better during the weekend. She prefers chocolate and acid foods, eats too much and too fast (“I wolf things down”, she says). She has no sensation of satiety.
Her binging episodes are more frequent during the week, when she is alone, and when she is confronted to unresolved interpersonal conflicts. She “craves chocolate” (comfort food).
Her menstrual cycles are lengthy (forty days). She suffers from insomnia in the middle of the night. Julie works a lot. She has very few friends, except in her horse-riding club, she has no love interest (“the more I know men, the more I prefer my horse…”). She feels sad sometimes. She misses her father. She has very fond memories of her childhood with her parents, unfortunately she has no relationships with her father’s family and tells me that four of her father’s brothers died of alcoholism.
Complementary medicine of Natrum muriaticum, with a craving for acid foods, in a patient with low self-esteem and periods of sadness that are hard to verbalize.
STAPHYSAGRIA
SEPIA OFFICINALIS
FOENUM GRAECUM (Not available in the US) For its action on satiety.
NUX VOMICA
The first interview ended by a sentence that Julie said and that explains all her difficulties: “I recently learned that Dad wanted to be a veterinarian and failed during his first year”.
For the insomnia in the middle of the night related to stress linked to preparing her exams.
Julie is probably trying to symbolically repair her father’s failure.
EVOLUTION
TREATMENT GIVEN AFTER THE FIRST INTERVIEW
20
COMMENTS ON THE MEDICINES PRESCRIBED
■ Natrum muriaticum 15C, 10 pellets on Sundays. ■ Staphysagria 15C, 10 pellets on Wednesdays. With: ■ Sepia officinalis 9C, 5 pellets in the morning; ■ Foenum graecum 15C, 5 pellets one hour before the main meals (Not available in the US) ; ■ Nux vomica 9C, 5 pellets at bedtime.
I see her more often now that she started university and is getting ready for her exams to get into Veterinary School. Besides graduating high school as a Valedictorian, she still feels that she is competing with students that she believes are more brilliant than she is. Again, she has a low body image because she no longer has time to go horse-riding, but she is no longer tempting to purge herself by vomiting.
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THERAPEUTIC
FILE
Eating disorders She leaves my office with this sentence on the poor relationship that is left to resolve with her father “failing is being like dad who also tried to become a veterinarian”.
THE HOMEOPATHIC TREATMENT It will be centered on the preparation of her exams: ■ Natrum muriaticum 9C, 10 pellets on Sundays ■ Calcarea phosphorica 9C, 10 pellets on Wednesdays With: ■ Kali phosphoricum 9C, 5 pellets in the morning; ■ Sepia officinalis 9C, 5 pellets in the afternoon; ■ Gelsemium 15C, 5 pellets at bedtime.
trigger a binging episode. Our role is to help them find the proper balance to adapt to these relationships. ■
COMMENTS REFERENCES CALCAREA PHOSPHORICA Intellectual fatigue with irritability and headaches.
KALI PHOSPHORICUM Irritable asthenia; the worst the intellectual fatigue the greater the irritability, which can become unmanageable.
GELSEMIUM Stage fright by anticipation, inhibition, helmetlike headaches, difficulties concentrating. I have to see her once again before her final exams.
CONCLUSION
We are either in the too much or the not enough. If they don’t have enough, they feel frustrated and when they have too much, they feel smothered. These are factors that can
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We often find in bulimic patients these difficulties in establishing balanced interpersonal relationships.
APFELDORFER G., Je mange, donc je suis, Petite Bibliothèque Payot, Paris, 2006. APFELDORFER G., Mangez en paix ! Odile Jacob, Paris, 2008. BARBENCEY J., Pratique homéopathique en psychopathologie, Tome 2, Similia, 1995. CHEFDEVILLE F. & AL., Mémento homéopathique, du symptôme à la matière médicale, CEDH International, 2004. CUNGI CH., Faire face aux dépendances, Retz, Paris, 2003. CUNGI CH., L’Alliance thérapeutique, Retz, Paris, 2006. DEMARQUE D., JOUANNY J., POITEVIN B., SAINT-JEAN Y., Pharmacologie & matière médicale homéopathique, 3e édition, CEDH, Paris, 2003. DSM-4, Diagnostic criteria for anorexia nervosa and bulimia. GRANIER E., Petit guide de thérapie comportementale et cognitive à l’usage des patients, Laboratoire Glaxo-Smith Kline, 2003. GUELFI J.D., ROUILLON F., Manuel de psychiatrie, Masson, Paris, 2007. LATHOUD J. A., Études de matière médicale homéopathique, Boiron, Lyon, 1998. MILLER W. R., ROLLNICK S., L’Entretien motivationnel, Interéditions, 2006. MIRABEL-SARRON C., Bien manger, Bayard, Paris, 1999. NEF Y., SIMON Y., Comment sortir de l’anorexie, Odile Jacob, Paris, 2001. PERROUD A., Faire face à l’anorexie, Retz, Paris, 2001. PERROUD A., Faire face à la boulimie, Retz, Paris, 2003. VOISIN H., Matière médicale du praticien homéopathe, 2e édition, Maloine & Les laboratoires homéopathiques de France, 1984. VOISIN H., Thérapeutique et répertoire homéopathiques du praticien, 2e édition, Maloine & Les laboratoires homéopathiques de France, 1981.
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CLINICAL
THEME
Adolescents and addictions Marine Guinet-Demonceaux Clinical psychologist, referent in addiction disorders for the Champagne-Ardennes region, France. Antoine Demonceaux, MD Primary care physician, homeopath and psychanalyst, Reims, France.
A
dolescence is a phase of the physical and mental human development occurring generally between puberty and adulthood, following childhood. Aside from physical changes, which are sometimes hard to cope with, such
as changed facial traits, acne, maturation of genital organs and more body hair, the psychological transformation is at the forefront of the development.
1
Psychological changes Adolescence is considered as a normal period of selfaffirmation, where conflicts are necessary for the person’s balance. It is a time of maturation made of permanent evolution allowing the person to become autonomous, find his/her own identity and gain access to adult reality. If education and parental model retain a significant impact, adolescents necessarily identify to people of their age group, famous people or feel the need to belong to a group. Love and emotional relationships start to take a big part of an adolescent’s life, with its overwhelming consequences, such as breakups and the onset of sexual awakening. Limitless and permanent communication possibilities (iPads, cell phones) generate a heightened emotionality and trigger important difficulties in managing their frustration. It is the generation of “everything right away”.
2
Addiction and dependence Addiction and dependence are based on the same mechanisms. They include the maladapted use and abuse of psychotoxic substances. This behavior is based on a recurrent and irrepressible desire for these substances. There are numerous sources of addiction: illegal drugs, alcohol, tobacco, risk behaviors, excessive exercising, eating disorders (anorexia, bulimia), gambling, and communications (text messages). The notion of a drug-free dependence, called behavioral addiction, is becoming more important in adolescents.
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What starts as a debate with an adult often becomes conflictual and many adolescents feel “misunderstood” or not trusted by adults. All this can become a source of imbalance, of poorly controlled emotional states and veiled depression, which might all become causes for addictive behaviors.
Issues encountered by adolescents – managing frustration, life difficulties, relationship issues with adults (parents, teachers, coaches), sentimental breakups – will represent risk factors for addictive behaviors. Adolescent pathologies (depression, mood disorders) can remain unresolved and continue into adulthood. The adolescent is “in between”.
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CLINICAL
THEME
Adolescents and addictions
3
Objects of addiction ILLEGAL SUBSTANCES
CANNABIS There are several ways of using it, smoking it (joint), inhaling it with a water pipe for a quicker effect, or mixing it with food to eat it. Today, levels of Cannabinol are a hundred times higher than 10 years ago. Dangerous consequences are mostly long-term brain numbness with concentration disorders and memory loss. A regular consumption often leads to dropping out of school. It also affects in a very dangerous manner their driving abilities.
very short time, the consequences are disastrous (alcohol-induced coma, deadly accidents) especially as it is often associated with cannabis and amphetamine use. A new habit consists in challenging others to binge drinking “parties”, filming them and posting them on social networks. It is becoming more common to see some students presenting with chronic alcohol abuse, leading to a pathology that used to be called alcoholism. Some even need to go to rehab in order to stop drinking.
To overcome these addictions it is essential to consult a healthcare professional, with regular follow-up and the detox must be progressive.
COCAINE It has become more common than it used to be some years back, because of its popularity and decreased cost. Cocaine leads to a quick dependence (a few takes) and the withdrawal process is very complicated. Related risks are dependence, brain and cardiovascular damages.
VIDEO GAMES AND GAMBLING
Injected or inhaled, its dependence is almost instantaneous and triggers a quick physical and mental deterioration. We can put in this same category Ketamine and all morphine substitutes or derivatives.
An alternative to “getting high”, video games are often an expression of childhood regression “I want to play”. Online gaming is often associated to behavioral and eating disorders. It is easier to make “friends” without ever meeting them face to face. Gaming is often a sign of problematic relationships with others.
They have been used for a long time, especially in the context of competitive sports, we can note that they are becoming more popular because of their stimulant effect and low cost. Pills, powder to be sniffed, smoked or injected, these substances come in different forms. The withdrawal process is easier than with the previously listed substances. Of note, the important neurotoxicity with a high risk of psychotic breakdown in the presence of associated risk factors.
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With the arrival of the electronic cigarette, we more often see true nicotine addicts.
HEROIN
AMPHETAMINS (ECSTASY, MDMA)
24
TOBACCO
ALCOHOL The two main problems with alcohol are its trivialization as a toxic and its diverted use. The most common practice among adolescents is binge drinking, consisting in consuming large quantities of alcohol in a
You can play with the entire world 24/7: with no ending in sight. It is often a question of performance (boys) like in sports, without physical fatigue to stop. Compulsive gamers compensate online their lack of self-esteem. War games are an outlet for aggressive impulses, which are common in many adults, but quite exacerbated in adolescents. Often less problematic in terms of care management, they do require a specific focus in young adults with psychotic disorders. Gambling is highly addictive. Adolescents are often attracted to poker, which has a good image in the media, since some actors and singers are involved in poker tournaments.
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THÈMES
CLINIQUES
Adolescents et addiction
“
Drug addictions can trigger a deep depression.
“ Adolescents are attracted by potential substantial money gains. This time-consuming activity isolates the adolescent.
4
Adolescent-specific pathologies Addictions are even harder to treat when the adolescent has an underlying pathology. The most frequent ones are veiled depression and schizophrenia. Drug addictions can trigger a deep depression.
Illegal substances, video games and gambling trigger high peaks in neurotransmitter levels,
6
Psycho-emotional challenges WE CAN LIST WHAT ADOLESCENTS ARE TRYING TO ACHIEVE WITH
THIS ADDICTIVE BEHAVIOR:
• Calm their anxiety. • Look for a powerful and exciting, limitless effect. • Break one’s limits. • Forget. • Disinhibition • Make up for lack of emotional support. • Cope with lack of self-esteem. • Belonging to a community (values, affect, and sensation of safety).
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5
Brain chemistry
so when these decrease the withdrawal syndrome sets in with its afferent symptoms: anxiety, pain, spams, especially seen with chemical substances.
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CLINICAL
THEME
Adolescents and addictions
7
What can we do? Several actions should be done to help the adolescent stop using addictive substances in a progressive manner and with adapted therapeutic support.
HOWEVER SOME NOTIONS ARE ESSENTIAL: • Restoring the rules: strong parental authority or putting the adolescent in a secure rehab facility. • Fix some limits. The consultation must be planned in a set timeframe and require mutual respect: i.e.: behave as an adult. • Listen without judging to restore the adolescent’s self-esteem. • Be able to recognize an underlying pathology. • Refer the young patient to a specific addiction consultation for adolescents.
8
LYCOPODIUM CLAVATUM Less frequent, it will be prescribed based on the digestive disorders (bloating, alternation of diarrhea/constipation) and the notion of lack of self-esteem.
COLOCYNTHIS Medicine related to anger, it will lead to violent spasms, improved when compressing the abdomen. Very useful to deal with the withdrawal syndrome.
STAPHYSAGRIA After poorly managed frustrations and inner anger, which is the daily life of an adolescent (but not just). When there is an associated pruritus (very frequently seen in heroin addicts), or cystalgia, this medicine will be very effective.
What about homeopathy? EXCITATION
If the psychological and human support is essential, homeopathy will be a very relevant complementary therapeutic. Homeopathic medicines will be prescribed in high dilutions.
AGGRESSIVENESS, ANGER NUX VOMICA The most frequently encountered because of the common aggressiveness of addicts, especially to stimulants. One needs to look for the usual signs of Nux vomica such as waking up at 3 am and its characteristic coated tongue.
COFFEA CRUDA Coffee dilution corresponds perfectly to these intense states of excitement related to video games, amphetamines and cocaine. The brain is overloaded and cannot slow down.
OPIUM If Opium makes patients sleepy, it also intensely stimulates the brain, triggering full insomnia with hyperacusis. Useful to manage the withdrawal syndrome.
CIMICIFUGA RACEMOSA CHAMOMILLA VULGARIS
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Aggressiveness and intolerance to pain, often seen in opioid withdrawal.
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Medicine associating a highly disparate and unstructured logorrhea with muscle pain in the upper back. There is often an aggravation during menstruation.
AURUM METALLICUM Related to amphetamines and its derivatives that frequently trigger high blood pressure with arrhythmia. Anger is also a frequent component of the clinical picture.
LACHESIS MUTUS It used to be dedicated to alcohol-related disorders, this medicine is in fact a good fit for any addict presenting with major mental
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CLINICAL
THEME
Adolescents and addictions excitement with logorrhea, pathological jealousy and cardiovascular congestion.
IGNATIA AMARA Oversensitivity that will make the withdrawal process quite difficult. To be prescribed without moderation.
ANGUISH, ANXIETY, FEAR PHOSPHORUS ACONITUM NAPELLUS Addicts often have acute anxiety attacks with tingling, tachycardia and sudden fear of dying. We could complement Aconitum napellus with Arsenicum album in the presence of an intense and overwhelming fear of death.
GELSEMIUM Medicine for anxiety with inhibition, we are aware of its action on the gabaergic1 system.
ARGENTUM NITRICUM Medicine of stage fright by anticipation, it mixes anxiety, dizziness and hastiness. It will very often be prescribed in patients addicted to stimulants.
Often lost in his/her imaginary world and sometimes exhibiting a borderline behavior. This adolescent will look for hallucinogenic substances, with the risks of awakening an underlying psychiatric pathology. His/her history of acute inflammation (lung inflammation, pyelonephritis, hepatitis) can guide the prescription. This list is not exhaustive. It can help you build the right prescription for the comprehensive care management of these addict patients.
A well-refined approach, empathic listening, judgement free, associated with the medicine of the person determined based on the patient’s sensitive type, will be the pillars of this difficult care management of these adolescents with addictive personalities.
CALCAREA CARBONICA Fear is at the forefront of the symptoms. We will also find eating disorders associated with important weight gain.
AFFECT, EMOTIONS PULSATILLA Emotional dependence is so important that the link to a group and compensating with various addictions can fill a void. Let’s note venous disorders and a tendency to lingering bronchitis episodes.
NATRUM MURIATICUM
PHOSPHORICUM ACIDUM This medicine fits perfectly the full depressive phase that can occur during the withdrawal period. This depressive state is characterized by a total lack of will or initiative, major intellectual and physical asthenia. It is quite similar to Natrum muriaticum.
KALI PHOSPHORICUM Intellectual depression with forgetfulness, difficulty memorizing and headaches located at the back of the skull. Particularly indicated in cannabis smokers.
ACETICUM ACIDUM Intense fatigue with weight loss. To be prescribed in heroin addicts who have decompensated.
SEPIA OFFICINALIS Pessimisms, disinterest, solitude, disinvesting social and affective relationships. These words characterize
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Very sensitive to separation, any history of breakups or ruptures, whether with the parents or affecting the adolescent himself/herself will be dramatic. Withdrawn, silent, aggressive and touchy, we find all the symptoms of a cannabis addict.
DEPRESSION
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CLINICAL
THEME
Adolescents and addictions the person who is sensitive to Sepia officinalis. Quite improved by violent sports, the person exercises intensely. Despondency, affective indifference and refusal to cope are often seen in adolescents with addictions.
BRAIN CHEMISTRY It is possible to envision to use dilutions of neurotransmitters (dopamine, serotonin). I believe that Opium is part of this context. The dilution will be adapted according to the targeted action: low dilutions to stimulate the receptors and high dilutions to inhibit them.
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Sophie’s case SOPHIE IS 17 and comes to the consultation forced by her parents who believe she has an excessive cannabis use. She doesn’t talk much so it is difficult to learn more during the first consultation. I gather that she uses several times a day and that it started 2 years ago when her parents got divorced. In her medical history we will note several rhinopharyngitis episodes in her childhood, severe acne especially in the T-zone and forehead associated with some asthma in the springtime. She had a phase where she exhibited anorexic behavior at the beginning of her parents’ relationship issues and she lost 5 kg.
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She dropped out of high school, she goes from groups to groups and is looking to start a hairdressing course. She tells me that she is overly emotional and it bothers her.
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TREATMENT An association of ■ Ignatia amara 15C, 3 three times per day and ■ 10 pellets per week of Natrum muriaticum 30C, allowed Sophie to relax, which in turn facilitated the withdrawal process.
NOTES 1
Fundam Clin Pharmacol. 2012 Dec ;26(6):751-60. doi:10.1111/j.14728206.2011.00993.x. Epub 2011 Sep 28. Effect of Gelsemium 5 CH and 15 CH on anticipatory anxiety : a phase III, single-centre, randomized, placebo-controlled study. ■
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CLINICAL
THEME
Adolescent acne Sonia Pecastaing, MD Toulouse, France
A
cne is an affection of the pilosebaceous follicles related to an excessive sebum production, keratinization disorders and inflammation leading to the formation of blackheads. 80 % of adolescents are affected and 15% of them present with severe
acne. An affection without blackheads or signs of hyperandrogenism must benefit from a complete endocrinology and sometimes gynecological evaluation.
1
Pathophysiology Excessive sebum production and blackhead formation are induced by dihydrotestosterone (DHT), an inflammation related to the presence of the gram-positive human skin commensal Propionobacterium acnes. Stress, sun exposure, heavy make-up (foundation especially), menstruations are all risk factors promoting acne flare ups. Allopathic treatment associated with topical care, consists, according to the severity of the acne, of antiseptics and/or antibiotics and topical retinoids, oral administration of antibiotics and retinoids, which have many adverse effects. Homeopathy is thus quite indicated as a first line treatment to manage this bothersome, yet temporary, pathology.
The etiologic treatment will be based on dilutions of androgenic hormones: DHA-S 30C or Acetate of testosterone 30C, 5 pellets per day (not available in the US)
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2
Toolbox
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CLINICAL
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Adolescent acne THE SYMPTOMATIC TREATMENT WILL INCLUDE IN A NON EXHAUSTIVE MANNER: ■ For excessive sebum production: Kali bromatum, Kali iodatum, Selenium, Natrum muriaticum… ■ For blackheads: Eugenia jambosa, Selenium… ■ For inflammation, superinfection: Sulphur iodatum, Hepar sulphuris calcareum, Calcarea sulphurica, Arnica montana ■ To prevent scarring: Graphites, Causticum, Tuberculinum residuum.
To determine the sensitive type, one will take into account the location of acne lesions (Natrum muriaticum, Pulsatilla), stage of the lesions (e.g. excessive sebum production, Lycopodium clavatum; inflammation Sulphur; nodules Thuja occidentalis). The Chronic Reactional Mode medicines will most often be Psoric-Tuberculinic ones.
3
Clinical Cases
■ Etiologic treatment DHA-S 30C, 5 pellets in the evening; ■ Symptomatic treatment Eugenia jambosa 9C, 5 pellets twice a day;
Treatment for 3 months.
JENNIFER JENNIFER, 16 YEARS OLD, started an oral contraception (birth control pill) 3 months ago. This aggravated her acne located at the hairline, it bothers her as she feels it is very unsightly. The acne is made of micro cysts and blackheads on an oily skin.
■ Etiologic treatment DHA-S 30C, 5 pellets in the evening; ( +/- Folliculinum if no improvement is noted after 3 months); ■ Symptomatic treatment Selenium 15C, 5 pellets twice a day; ■ Sensitive type treatment Natrum muriaticum 15C, 10 pellets per week;
JACOB
JACOB, 14 YEARS OLD, can’t stop touching the pens on my desk, his acne located on the face and back with inflamed pustules and blackheads bothers him.
■ Etiologic treatment DHA-S 30C, 5 pellets in the evening; ■ Symptomatic treatment for excessive sebum production, blackheads, inflammation Kali bromatum 15C (hand agitation) 5 pellets twice a day; ■ Symptomatic treatment of the infection Hepar sulphuris calcareum 15C, 5 pellets twice a day.
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Treatment for 3 months.
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CINDY CINDY, 12 YEARS OLD, comes to the consultation for a sore throat. At the end of the consultation she asks for a treatment for the beginning of an acne, limited to a few micro cysts.
Treatment for 3 months.
REFERENCES - Prise en charge de l’acné, Société Française de Dermatologie, juin 2015 validée par l’HAS le 10 juin 2015. - Recommandations de bonne pratique, Traitement de l’acné par voie locale et générale, AFSSAPS 2007. - R. TOURAINE, J. REVUZ, Dermatologie clinique et Vénérologie, Masson. - D.DEMARQUE, J. JOUANNY, B.POITEVIN, Y. SAINTJEAN, Pharmacologie et matière médicale homéopathique, CEDH. - M. GUERMONPREZ, Homéopathie Principes, Clinique, Techniques, CEDH. ■
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