ABSTRACT
The COVID-19 epidemic brought about many unforeseen changes in people's social and personal life, putting the world in a new and challenging period. Adjustment disorder is defined as the inability to adjust to a stressful experience to a degree that is disproportionate to the stressor's severity or intensity. Undoubtedly, this has affected the most vulnerable children's survival systems. This article focuses on the MYMOP scale's assessment of children's physical and emotional well-being, as well as how different age groups of children exhibit different symptomatology and the homoeopathic medicine that corresponds with it.
KEYWORDS
Adjustment disorder, Post-pandemic period Covid-19, Homoeopathy, children, Lock down, Schooling
INTRODUCTION
“Adaptability is being able to adjust any situation at any given time”
- John Wooden
Adjustment disorder (AjD) is recognized as a stress-response syndrome, which is defined as a maladaptive reaction to an identifiable stressor(1) Stress is ubiquitous, and a person learns to deal with stress over time. However, when coping mechanisms fail to ameliorate stress effectively, adjustment disorder is precipitated. The key points of the ICD-11 AjD definition are as follows:
Identifiable stressor(s), maladaptive reactions that occur within 1 month after exposure to the stressor and tend to resolve within 6 months if the stressor has ended,
Symptoms of preoccupation and failure to adapt related to the identified stressor. It was also specified that symptoms do not justify another mental or behavioural disorder(2)
COVID-19, a highly contagious illness that resembles pneumonia, was discovered for the first time in December 2019. Nearly 14,000 individuals died as a result of this illness, also known as Coronavirus-2019, which afflicted about 334,000 people worldwide (WHO, 2020).(3)The COVID-19 lockdown measures may have more of an effect on children and adolescents' lifestyle choices and general well-being than the virus itself, according to some research. (4) The impact of COVID-19 varies among nations, in part because of the different steps each nation has taken to contain the epidemic. With the first patient reported on January 30, 2020, COVID-19 instances were also sharply increasing in India (Ministry of Health, 2020). On March 24, 2020, India's government implemented a nationwide lockdown that lasted until May 3, 2020. A complete shutdown of all businesses was ensured throughout this lockdown, including those in stores, banks, industries, schools, colleges, parks, theatre’s, gymnasiums, etc. After that, due to a second wave that devastated the nation in 2021, a second lockdown was implemented (state-wise). (1)
Many parents have seen personality changes in their children during this time of social restraint, including stranger phobia, anxiety, lack of focus and concentration, mood swings, boredom, and restlessness. There may also be times when stress levels are higher for both parents and children. Many young children around the world have been impacted by lockdown because they are unable to keep up with their grades in numerous disciplines. Additionally, these stresses people out and is bad for kids. Due to the closing of parks, clubs, swimming pools, and other kid-friendly activities, children have been losing out on a variety of physical activities and motor skills in addition to their academic performance in school. Robinson (2020) highlighted that children have been displaying greater intellectual development delays as a result of lockdown, particularly as a result of a lack of activities like music lessons, summer camps, library visits, and other such activities. (3)
Over 90% of respondents reported a negative impact on mental health, including worse behavior, mood, fitness, and social and learning regression. In general, respondents reported negative effects of lockdown restrictions, with 61% reporting a reduction in physical activity levels. (5). only 36.3% of respondents said the relationship had not changed, while a sum of 24.7% claimed there had been a negative influence. Additionally, a subtotal of 32.9% of respondents noticed the child's health getting worse. (6) I used a self-made questionnaire to screen participants in my study, which was done in a government homeopathic medical college and hospital, as well as surrounding schools and outlying camps, and I discovered that 10% of children between the ages of 5 and 18 had adjustment disorder.
Homoeopathy is a medical science in which medications are attributed to people rather than diseases. It is a therapeutic medical system based on the principle "Similia Similibus Curentur," which states that disease symptoms are comparable to the symptoms of a remedy capable of producing similar disease symptoms in a healthy human being. It not only treats patients holistically but also takes into consideration the individual's unique features.
The adjustment disorder after the COVID-19 pandemic period will come under mostly mental diseases of doubtful origin (3rd type), where it is not certain that the mental disease arose from physical illness rather than from "faults in education, bad practices, corrupt morals, superstition, or ignorance", See if it can be improved by "friendly exhortations, consolatory arguments, serious representations, and sensible advice." In the future, there will be possibilities of forming a mental disease (4th type: psychosomatic), where one’s emotional illnesses will, if left alone, destroy the physical health due to emotional factors like anxiety, worry, and vexation. (7)
1. STUDY SETTING
· Study Area: Government Homoeopathic Medical College and Hospital, Bhopal
· Study Population-
1. OPD of Government Homoeopathic Medical College and Hospital, Bhopal
2. Peripheral unit
3. Frequently organized camps and schools.
· Study period -1 year
2. SELECTION OF SAMPLE:
· The subjects for the study were selected from OPD of Government Homoeopathic Medical College and Hospital, Bhopal and Peripheral unit, Villages, frequently organized camps and schools.
· A self-made screening questionnaire done to patients came in the OPD and camps then selected 61 patients from them ,then among them 36 patients were selected on the basis of inclusion criteria and exclusion criteria . The effect and sample size sample size we assumed it moderate(0.5).Fixing α as 0.05 and power (1-β) as 80%, to detect a significant difference between two dependent means of MYMOP score (8)(matched pairs) by paired t test, we require a sample size of 34.Alllowing a provision for 5% drop-outs, the target sample size becomes 36.
· Detailed case history was taken by interview as per the proforma prepared for the topic. All patients for study were selected by Purposive sampling method, where the children which were registered between the periods of April 2022 to 2023 . All cases were followed up for minimum period of 6 months.
3. INCLUTION CRITERIA:
1. Children of aged 5-18 years and diagnosed under Adjustment disorder.
2. Patient of all religions
3. Patient of both sexes and irrespective of socio-economic status
4. Patient who are willing to participate in the study.
5. Patient who are coming for regular follow ups
4. EXCLUTION CRITERIA:
1. Patient who already diagnosed to other psychiatric disorder and critical illness
2. Patient who is under treatment of other mode of treatment for adjustment disorder
3. Children below 5 years
4. Children who are already socially withdrawal (introvert) by nature before covid 19 pandemic.
5. STUDY DESIGN
Prospective, non- randomized, non- controlled, single arm, pre-post comparison, open label observational study design.
6. INTERVENTION
1. Proper case taking.
2. Selection of medicine.
3. Intervention was planned as administering indicated homoeopathic medicines in centesimal potency. In this scale each dose shall consist of a single drop of the indicated medicine (preserved in 90% v/v ethanol) in 5 ml of distilled water, to be taken orally with empty stomach; dosage and repetition depending upon the individual requirement of the cases. All medicines will be procured from a Good Manufacturing Practice (GMP)-certified firm.
4. Proper follow up of the case:
5. Duration of therapy: 3 to 6 months.
6. Thinking about second prescription where needed.
7. SELECTION OF TOOLS
1. Case taking in standard case taking preform provided by Govt. Homoeopathic Medical College and Hospital, Bhopal.
2. Repertorization sheet.
3. Drugs prepared under centesimal scale at Govt. Homoeopathic Medical College and Hospital, Bhopal.
4. Potency: Depending on the case.
5. Dose: As per strict homoeopathic principles.
6. Diet & regimen: As directed by Master Hahnemann in Organ on of Medicine' & Chronic Disease'.
7. Severity and improvement of Patient's complaints i.e., before and after treatment was assessed by MYMOP Scale
8. Severity of the patient's illness, before & after treatment, was assessed on MYMOP Scale
9. Patient's improvement after treatment shall be assessed on LIKERT -5 Point scale
8. OUT COME ASSESMENT
Follow up of cases is done once in 15-30 days interval, consecutive for3-6 months
Primary:
MYMOP Scale
A broad patient-specific outcome instrument to evaluate general health is the Measure Yourself Medical Outcome Profile (MYMOP) tool(8),(9)Throughout the study period, the MYMOP2 Scale was tested each month. Each scale has 4 elements and 6 points, for a total of 24 possible scores.