Pittaja Unmada: Hyperthyroidism with mania?/Psychotic or irritable mania?

Abstract

“Bhuta vidya” (Ayurvedic psychiatry) is one of the eight branches of Ayurveda (an Indian system of medicine) and it deals with the management of various psychiatric disorders. Unmada (a psychiatric disorder) is characterized by deranged mental functions and it is classified into five types (vataja, pittaja, kaphaja, sannipataja, and agantuja). “Pittaja Unmada” (PU) is one of the five types of unmada described in all major Ayurvedic texts and it comes under “Doshaja Unmada” (psychiatric disorder which occurs due to the aggravation of doshas) category. Scientific literature on PU is scarce and the present study is focused to explore this condition. The etiopathology of PU seems to induce systemic inflammatory sequelae and also autoimmune reactions which again may lead to the manifestation of autoimmune thyroid disease or Graves' disease (GD). Signs and symptoms of PU can be classified into two groups, psychological and physiological. The psychological and physiological features of PU have shown similarity with conditions like manic episode, bipolar disorder (BD), GD, thyrotoxicosis and hyperthyroidism. PU is similar to “psychotic mania” or “mood disorder with psychotic features” or “manic episode due to general medical condition” or “BD comorbid with hyperthyroidism or GD”. PU or “bipolar affective disorder” can be managed successfully by “Virechana” followed by internal medicines.