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I

Name Age Sex

Religion H [ ] M [ ] S [ ] Ch [ ] Others [ ]

Merital status M [ ] UM [ ] D [ ] W [ ]

Occupation HW [ ] B [ ] S [ ] L [ ]

Education UE [ ] P [ ] M [ ] HS [ ] G [ ] PG [ ] P.hd. [ ]

Socio-Economical Status VP [ ] LM [ ] M [ ] UM [ ] R [ ]

Address

Ph. No.

OPD No. IPD No.

Date of Commencement Date of Completion

Group A Group B

BMI

Desha Jangala Anoopa Sadharana

Jatah

Samvriddhah

Vyadhitah

Parameter B.T. A.T.

Height

Weight

B.M.I.

Institute of Post Graduate Teaching Research in Ayurveda

Gujarat Ayurved University - Jamnagar.

Dept: Roga Nidana & Vikriti Vijnana

TTiittllee:: RRoollee ooff OOmmeeggaa 33 ffaattttyy aacciidd ddeeffiicciieennccyy iinn eettiiooppaatthhooggeenneessiiss ooff DDeepprreessssiioonn &&

eevvaalluuaattiioonn ooff AAttaassii ((LLiinnuumm uussiittaaiittiissssiimmuumm)) aass aaddjjuuvvaanntt ttoo

AAsshhwwaaggaannddhhaaddyyaarriisshhttaa iinn iittss mmaannaaggeemmeenntt

Co-guide

Prof. Rajesh Kumar

M.D. (Psychiatry)

Associate Professor of Psychiatry

M. P. Shah Medical College & GGH

Scholar

Dr. Ila Tanna

Guide

Prof. H. M. Chandola M.D. (Ayu), Ph.D.

Professor & Head – Kayachikitsa

IPGT & RA, GAU, Jamnagar

II

DIAGNOSTIC CRITERIA DSM – IV for Major Depressive Disorder

Five or more of the following symptoms, one of which should be depressed mood or anhedonia must be present for

at least two weeks:

No. Symptom Present Duration

1 Depressed mood

2 Loss of pleasure in usual activities (Anhedonia)

3 Feelings of worthlessness or inappropriate guilt

4 Inability to concentrate

5 Fatigue or loss of energy

6 Insomnia or Hypersomnia

7 Psychomotor agitation or retardation

8 Significant weight loss or gain

9 Recurrent thoughts of death or suicide

10 Clinically significant distress / impairment in social, occupational or other

important areas of functioning.

11 No any direct physiological effect of a substance (e.g. drug abuse,

medication) or general medical condition (e.g. hypothyroidism).

Chief Complaints

Chief complaints B.T. During Treatment A.T. Follow up

15th

day 30th

day 45th

day 60th

day 1st wk 2

nd wk

1 Dukhtvam

2 Asiddhi Bhaya

3 Atmana Ashaktatam

4 Kheda

5 Avasannata

6 Karmesu Apravriti

7 Dourbalyam

8 Thought of death/suicide

9 Arochaka

10 Alpa Ahara

11 Alpa Cheshta

12 Alpa Vakyata

13 Viviktapriyata

14 Atinidrata

15 Sadana

16 Mano vibhrama

17 Anavasthit Chittatvam

18 Kshudha

Mandya/aadhikya

19 Vibandha

20 Nidrabhramsh /

Nidralpta/Nidradhikya

http://www.medindia.net/education/familymedicine/PshyciatricDisorders-DSMIV.htm



III

HISTORY OF PRESENT ILLNESS:

Duration of onset:

Medication Running: Yes / No Ayurvedic:

Allopathy:

Aggravating factor and season

Any history of Hypomania or Manic Episod Yes / No

Any history of previous Depressive episode Yes / No

Internal between previous Episode and Current Episode ________________________

HISTORY OF PAST ILLNESS WITH DURATION :

Medical History __________________________________

Psychological / Psychiatric History _____________________________________

Legal History ______________________________________

FAMILY HISTORY :

Any major illness in family __________________________

Emotional makeup of family members :

Anxious / Tensive / Irritable / Depressed / Unsatisfied / Sad / Cheerful / Supportive

BIRTH & CHILDHOOD HOSTORY

Developmental History:

Behavioral Problems:

EDUCATIONAL HISTORY

School Performance: Excellent / Moderate / Average / Poor

Qualification

OCCUPATIONAL HISTORY

Attitude towards job : Satisfactory / Unsatisfactory / Dissatisfactory

Competence / future ambitions Yes / No

Any punishment / suspension / constant break in job Yes / No

IV

MARITAL HISTORY

Married Years / Duration ______________

Occupation of spouce _________________

Harmony: Yes / No

Problem:

MENSTUAL HISTORY

Menarche / Menopause

Regular / Irregular

Disturbance: Amenorrhoea / Dysmenorrhoea / Menorrhagia / Others

Whether the complaints aggravating during / before / after menstrual period: Yes / No

MENTAL ILLNESS IN THE FAMILY:

Suicide / Alcoholism / Neurological problems / Mental illness

PERSONAL HISTORY:

1. Aaharaja (Dietary Habits)

Type of diet - Veg. / Mix

Dominance of Rasa in Diet - M / A / L / Kt. / T. / KS

Dominant Guna in diet - G / L / St. / U / Sn. / R

Dietary habits - Samashana / Adhyashana / Vishamashana / Reg. / Irreg.

Supplementary diets - Tea / Coffee / Cold drinks / Others

Quantity

Addiction - Tobacco / Smoking / Chewing / Alcohol / Sedative / others

Quantity

Nature of work : Heavy / Standing / Sitting / Travelling / Labour

Physical or mental : Satisfied with work : Y / N / P

2. Viharaja (Life Style)

Exercise - Reg. / Irreg. / No / Less / Proper / Excess

Rest hrs / day hrs / night

Abhyanga - Yes / No

V

Snana - Daily / Irreg.

Nidra - Samyaka / Asamyaka; Alpa / Prabhuta / Khandita

hrs / day; hrs / night

Dinacharya Palana - Yes / No, Reg. / Irreg.

Ritucharya Palana - Yes / No, Reg. / Irreg.

Ratricharya Palana - Yes / No, Reg. / Irreg.

Sadvrita Palana - Yes / No, Reg. / Irreg.

Sanshodhana - Yes / No, Reg. / Irreg.

3. Interest or hobbies

4. Kostha (Bowel Habit)

Santushta / Asantushta; Sama / Nirama

Kathina / Drava / Sakashtam / Vivarana / Alpa / Muhurmuhah

Frequency time / day

Kostha - Mridu / Madhyama / Krura

5. Mootra Pravritti - (Micturition)

Samyaka / Kruchha / Vaivarya / Daaha / Alpa Prabhuta /

Freq. / days; / night

6. Artava Pravritti - (Menstrual history) : Reg / Irreg.

7. Prasava - (Obstetric history)

No. Delivery /Abortion / Miscarriage

Dashavidha Pariksha

1. Prakriti

2. Vikriti Balavan [ ] Madhyama bala [ ] Alpabala [ ]

Nidana - Purvarupa - Rupa –

Chronicity - Age -

VI

3. Sara Pravara [ ] Madhyama [ ] Avara [ ]

4. Samhanana Pravara [ ] Madhyama [ ] Avara [ ]

5. Pramana Pravara [ ] Madhyama [ ] Avara [ ]

6. Satmya Pravara [ ] Madhyama [ ] Avara [ ]

7. Satva Pravara [ ] Madhyama [ ] Avara [ ]

8. Ahara Shakti

Uttama Madhyama Hina

Ruchi

Abhyavaharana Shakti

Jarana Shakti

9. Vyayama shakti Pravara [ ] Madhyama [ ] Avara [ ]

10. Vaya Bala [ ] Madhya [ ] Jirna [ ]

ROGA BALA PARIKSHA

Dosha Pariksha

Vata

Kshaya Vriddhi Prakopa

Manda chesta, Alpa Wakatwa,

Apraharsha, Mudha Sangyata.

Vakaparushyam, Karshyam,

Karshanyam, Gatra sphurana,

Ushnakamita, Nidranasha,

Alpabala, Gadha, Varchastwam

Khanjata, Kubjata, Aakshepa,

Toda, Bheda, Moha, Pralap, Loma

harsha.

Pitta


Manda Ushma, Mada Agnita,

Nishprabhatwa

Pitaavabhasata, Santap, Shita

Kamitwa, Alpa Nidra,

Murchchha, Balahani, Endirya

daurbalya, Pita - vid, mutra, natra.

Sweda, Kleda, Koth, Paka, Srava.

Kapha


Rukshta, Antardah, Shleshmashay

shanyata, Sandhi Shaithilya,

Trishna, Daurbalya, Prajagaran

Shouklyam, Shaityam, Sthairyam,

Gauravam, Avasad, Tandra,

Nidra, Sandhi, Wishlesha,

Asthivishlesha

Kandu, Uplep, Aalsya Klaibya

VII

DHATU PARIKSHA :

Dhatu Vriddhi BT AT Kshaya BT AT

Rasa Hridayotkleda Rukshata

Praseka Shrama

Shosha – Trishna

Glani

Shabda-asahishnuta

Hriddravatva

Hridshula

Tama

Kampa

Rakta Raktanga-akshita Amla priti

Sira purnatvam Shishira priti

Sira shaithilya

Rukshata

Parusha – sfutita- mlana twak

Mamsa Sphik – ganda- uru-

aushtha- upastha-

bahu- jangha vridhdhi

Shikgrivodara shushkata

Sandhivedana

Raukshya

Gurugatrata Toda

Gatra sada

Dhamani shaithilya

Meda Snigdhangata Sandhi sfutana

Udara-parshva vriddhi Netra glani

Kasa Udara tanutvam

Shwasa Krishangata

Daurgandhya Pliha vriddhi

Kati svapa

Sandhi shunyata

Raukshya

Meduramamsa prarthana

Asthi Adhyasthi Kasha-loma-smashru prapatana

Adhidanta Dwija – nakha prapatana

Sandhi shaithilya

Asthi shula-toda

Raukshya

VIII

Majja Sarvanga gaurava Asthi shirnata

Netra gaurava Asthi durbalata

Asthi laghuta

Vata roga

Asthi saushirya

Bhrama

Timira darshana

Alpa shukrata

Parvabheda

Asthi shunyata

Asthi nistoda

Shukra Shukra-atipravritti Daurbalya

Shukrashmari Mukhashosha

Pandutva

Sadanam

Shrama

Klaibya

Shukra-avisarga

Oja Ojo visramasha Murchchha-vijnana indriya

nirodhah

Sandhi vishlesha Mamsa kshaya

Gatra sada Pralapa

Dosha chyavanam Moha- vaichityam

Kriya sannirodha

Ojo vyapad

Stabdha guru gatrata

Varna bheda

Glani

Tandra

Nidra

MALA PARIKSHA :

Mutra Vriddhi Mutravriddhi / Muhurmuhur Pravriti / Bastitoda / Adhmana

Kshaya Mutrakruchha / Mutravaivarnya / Pipasa / Mukhshosha / Bastitoda

Purisha Vriddhi Atopa / Kukshishula

Kshaya Antrapidana / Urdhvavayu / Thyam Hridparshva Pida

Sweda Vriddhi Stabdharomkupata / Twakshosha / Sparsh Vaigunya / Swednasha

Kshaya Twak Daurgandhya Kandu

IX

Srotas Parikshana

Srotas

Srotodushti

Hetu

Srotodushti Lakshana B.T.

Pranavaha

Srotas

Kshya

Sandharana

Ruksha

Vyayama

Kshudhita

Uchchhavas –

Prakupitam

Alpalpam

Sashabda

Sashula

Udakavaha

Srotas

Ushna

Ama

Bhaya

Madyapana

Atishushkanna

Trushnayah

Atipidanat

Shosha – Jihva

Talu

Oshtha

Kantha

Kantha

Kloma

Atipravriddha Pipasa

Annavaha

Srotas

Atimatra

Bhojana

Akala Bhaojana

Ahiata Bhojana

Pavaka

vaigunya

Anannabhilashanam

Arochaka

Avipaka

Chhardi

Rasavaha

Srotas

Ashana – Guru

Shita

Atisnigdha

Atimatra

Samashana

Chintyanam

Atichintanat

Ashraddha

Aruchi

Asyavairasya

Arsagyata

Angamarda

Jvara

Tandra

Hrillasa

Gaurava

Tama

Pandutvam

Srotorodha

Klaibya

Sada

Krishangata

Agninasha

Ayathakala –

Valaya

Palita

Raktavaha

Srotas

Annapanani –

Vidahi

Snigdha

Ushna

Drava

Atapa Sevana

Anala Sevana

Pidaka

Raktapitta

Asyapaka

Pliha roga

Gulma

Kamala

Vyanga

X

Medovaha

Srotas

Avyayama

Divaswapna

Medya

Atibhakshana

Varuni

Atisevana

Kesheshu Jatilibhava

Asyamadhurya

Karapadasuptata

Karapadadaha

Angeshu paridaha

Angeshu suptata

Mukha talu kantha shosha

Pipasa

Alasya

Kaye malam

Kayachhidreshu upadeham

Mutadosha

Visra shariragandha

Sarvakala Nidra

Sarvakala Tandra

Majjavaha

Srotas

Utpeshana

Ati

Abhishyanda

Abhighata

Prapidana

Viruddha

sevana

Parvanam ruk

Bhrama

Murchha

Tamodarshana

Parvanam Sthulamula

Arunshika

Mutravaha

Srotas

Mutrita –

Udaka

Bhakshana

Strisevana

Mutra

nigrahana

Kshina

Atikrisha

Mutrapravrutti –

Atisrushtam

Atibaddham

Kupitam

Alpalpam

Abhikshnam

Bahalam

Sashulam

Purishavaha

Srotas

Vidharana

Atyashana

Ajirnashana

Adhyashana

Durbalagni

Krisha

Purisha pravritti –

Kruchchhhrena

Alpalpam

Sashulam

Atidrava

Atigrathira

Kuthita

Atibahu

Swedovaha

Srotas

Ativyayama

Atisankshobha

Akrma

shitoshnasevana

Krodha

Shoka

Bhaya

Aswedanam

Atiswedanam

Parushyam

Atishlakshanata

Paridaha

Lomaharsha

XI

MANAS VIBHRAMA PARIKSHA :

MANAS VIBHRAMA BT During treatment AT

15th day 30

th day 45

th day 60

th day

1. Mana Vibhrama

2. Buddhi Vibhrama

3. Sandnya Vibhrama

4. Smriti Vibhrama

5. Bhakti Vibrama

6. Shila Vibhrama

7. Chesta Vibrama

8. Aachara Vibrama

Gradations : Absent-0; Occasional-1; Often-2; Always-3

MANAS PARIKSHA BHAVA

General Health Questionnaire (GHQ) – 12

No. Feelings Not at

all Same

as usual

Less than usual

Much more than usual

1 Been able to concentrate on whatever you’re doing? 2 Lost much sleep over worry? 3 Felt you were playing a useful part in things? 4 Felt capable about making decisions about things? 5 Felt constantly under strain? 6 Felt you couldn’t overcome your difficulties? 7 Been able to enjoy your normal day-to-day activities? 8 Been able to face up to your problems? 9 Been feeling unhappy and depressed?

10 Been losing confidence in yourself? 11 Been thinking of yourself as a worthless person? 12 Been feeling reasonably happy, all things considered?

Negative Emotions

B.T. DT A.T. Positive Emotions

B.T. DT A.T.

15th

D 30th

D 45th

D 60th

D 15th

D 30th

D 45th

D 60th

D

Bhaya Dhairyam

Krodha Dhriti

Shoka Harsha

Dwesha Priti

Rajah Virya

Manasa Shraddha

Chinta Medha

Avasthana

Upadhi

Vijnana

Shila

Samgya

Smriti

XII

MENTAL STATE EXAMINATION

Indriyabhigraha

(perception & motor control)

Hallucination

Illusion

Intact / Partially Impaired / Grossly Impaired

Manonigraha (Mental control) Present/ Absent / Occasionally absent /

Frequently absent

Ooham (Guess) Intact / Partially Impaired / Grossly Impaired

Vichara (Thought)

Flight of ideas

Blocking of thoughts

Thought broadcasting

Thought control by others

Obsession and fixed ideas

Sudden strange ideas / Pseudo-

religious ideas


Present / Absent

Present / Absent

Present / Absent

Present / Absent

Present / Absent

Present / Absent

Buddhi (Intellectual capacity)

Mental deficiency

General information

Immature Behaviour

Imitation of Different sounds

Insight

Judgement

Delusions


Mild / Moderate / Severe / Absent

Good / Bad

Present / Absent

Present / Absent

Present / Absent

Present / Absent

Grandeur / Persecution / Hypochondrias /

Melancholia

Samjnajnanam (Consciousness /

Orientation / Responsiveness)

Orientation of place

Orientation of time

Orientation of person

Attention

Concentration

Intact / Impaired / Partially Impaired



Present / Absent / Occasionally Absent


XIII

Smriti (Memory)

Remote memory

Recent memory

Immediate memory




Bhakti Vibhrama (Desire)

Desire for food

Desire in relation to dress

Desire for sex

Desire for entertainment

Normal / More / Less / Perverted

Normal / Dirty and shabby / Careless

Normal / More / Less

Normal / More / Less

Sheela Vibhrama (Habits, Temperaments)

Sleep

Desire for solitude

Smoking / Tobacco chewing /

Narcotics / Snuff / Alcohol

addiction / other addiction

Antisocial behaviours like stealing

etc.

Sound / Disturbed / Insomnia

Present / Absent

Present / Absent

Present / Absent

Cheshta Vibhrama (Psychomotor activity)

Speech

Spontaneous / Non spontaneous

Relevant / Non relevant

Verbal output

Volume

Dysphasia / Aphasia / other

Achara

Personal standards

Neglect of daily routine and work

Hating cleanliness

Social standards

Nudity

Modesty

Others

Present / Absent

Present / Absent

Present / Absent

Present / Absent

XIV

Holmes & Rahe’s Stress Rating Scale

Events Value Score Death of spouse 100 Divorce 60 Menopause 60 Separation from living partner 60 Jail term or probation 60 Death of close family member other than spouse 60 Serious personal injury or illness 45 Marriage or establishing life partnership 45 Fired at work 45 Marital or relationship reconciliation 40 Retirement 40 Change in health of immediate family member 40 Work more than 40 hours per week 35 Pregnancy or causing pregnancy 35 Sex difficulties 35 Gain of new family member 35 Business or work role change 35 Change in financial state 35 Death of a close friend (not a family member) 30 Change in number of arguments with spouse or life partner 30 Mortgage or loan for a major purpose 25 Foreclosure of mortgage or loan 25 Sleep less than 8 hours per night 25 Change in responsibilities at work 25 Trouble with in-laws,or with children 25 Outstanding personal achievement 25 Spouse begins or stops work 20 Begin or end school 20

Change in living conditions (visitors in the home, change in roommates,

remodeling house) 20

Change in personal habits (diet, exercise, smoking, etc.) 20 Chronic allergies 20 Trouble with boss 20 Change in work hours or conditions 15 Moving to new residence 15 Presently in pre-menstrual period 15 Change in schools 15 Change in religious activities 15 Change in social activities (more or less than before) 15 Minor financial loan 10 Change in frequency of family get-togethers 10 Vacation 10 Presently in winter holiday season 10 Minor violation of the law 5

Total Score

XV

HAMILTON ANXIETY RATING SCALE :

Range: 0-4; Gradations : 0-None, 1. Mild, 2. Moderate; 3. Severe, 4. Very severe

HAMILTON DEPRESSION RATING SCALE :

Symptoms BT DT AT Symptoms BT DT AT

15th D 30th D 45th D 60th D 15th D 30th D 45th D 60th D

Anxious Mood Somatic (Sensory)

Tension Cardiovascular Symptoms

Fears Respiratory Symptoms

Insomnia Gastro-intestinal Symptoms

Intellectual (cognitive) Genito Urinary Symptoms

Depressed Mood Autonomic Symptoms

Somatic (Muscular) Behaviour at Interview

Symptoms B.T. DT A.T. Symptoms B.T. DT A.T.

15th

D

30th

D

45th

D

60th

D

15th

D

30th

D

45th

D

60th

D

Depressed Mood Somatic

Gastrointestinal

Guilt Genital

Suicide Hypochondriasis

Insomnia Initial Insight

Insomnia Middle Loss of Weight

Insomnia delayed Diurnal variation

Work Interest Depersonalization

Retardation Paranoid symptoms

Agitation Obsessional -

compulsive

symptoms

Anxiety(Psyche) Helplessness

Anxiety(Somatic) Hopelessness

Somatic General Worthlessness

XVI

Montgomery Asberg Depression Rating Scale

Beck Depression Inventory



Apparent sadness Concentration difficulties

Reported sadness Lassitude

Inner tension Inability to feel

Reduced sleep Pessimistic thoughts

Reduced appetite Suicidal thoughts



Sadness Loss of interest

Pessimism Indecisiveness

Past failure Worthlessness

Loss of pleasure Loss of energy

Guilt feelings Changes in sleep pattern

Punishment feelings Irritability

Self dislike Changes in appetite

Self criticalness Concentration difficulty

Suicidal thoughts or

wishes

Tiredness or Fatigue

Crying Loss of interest in sex

Agitation

XVII

DAS S 21

Name:

Please read each statement and circle a number 0, 1, 2 or 3 which indicates how much the statement applied to you

over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

The rating scale is as follows:

0 Did not apply to me at all

1 Applied to me to some degree, or some of the time

2 Applied to me to a considerable degree, or a good part of time

3 Applied to me very much, or most of the time

BT DT AT

15th

D 30th

D 45th

D 60th

D

1 S I found it hard to wind down

2 A I was aware of dryness of my mouth

3 D I couldn't seem to experience any positive feeling at all

4 A

I experienced breathing difficulty (eg, excessively rapid breathing,

breathlessness in the absence of physical exertion)

5 D I found it difficult to work up the initiative to do things

6 S I tended to over-react to situations

7 A I experienced trembling (eg, in the hands)

8 S I felt that I was using a lot of nervous energy

9 A

I was worried about situations in which I might panic and make

a fool of myself

10 D I felt that I had nothing to look forward to

11 S I found myself getting agitated

12 S I found it difficult to relax

13 D I felt down-hearted and blue

14 S

I was intolerant of anything that kept me from getting on with

what I was doing

15 A I felt I was close to panic

16 D I was unable to become enthusiastic about anything

17 D I felt I wasn't worth much as a person

18 S I felt that I was rather touchy

19 A

I was aware of the action of my heart in the absence of physical

exertion (eg, sense of heart rate increase, heart missing a beat)

20 A I felt scared without any good reason

21 D I felt that life was meaningless

XVIII

MAANASA PRAKRITI ASSESSMENT ON THE BASIS OF TRIGUNAAS

0 Never true

1 Rarely true /True in certain conditions only

2 Sometimes true / True in favourable conditions only

3 Often true / True in most of the conditions

4 Always true / True in all conditions

Guna Qualities 0 1 2 3 4

Sattva Bhoota hita vachah

Yathavachah

Kshama

Medha

Smiriti

Buddhi

Samvibhagaruchita

Dharma

Dhriti

Aanrushamsyam

Jnanam

Aastikya

Rajah Krodha

Harsha

Kaama

Maana

Dambha

Ahamkara

Aanrutikatvam

Atanasheelata

Adhriti

Akaarunyam

Dukhabahulata

Tamas Buddhinirodha

Nidraluta

Adharmasheelata

Vishaditvam

Ahamkarashilata

Durmedhastvam

Nastikya

Ajnana

Signature of Scholar Signature of Guide

Dr. Ila Tanna Prof. H. M. Chandola

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