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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 19  |  Issue : 2  |  Page : 85-86

Mucuna pruriens (Konch Beej) precipitates manic symptoms


Department of Psychiatry, Subharti Medical College, Meerut, Uttar Pradesh, India

Date of Web Publication20-Mar-2015

Correspondence Address:
Supriya Vaish
134, Ram Sadan, Baghpat Road, Meerut, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-8990.153717

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  Abstract 

Owing to the popular misconception that all ayurvedic preparations are completely safe, a vast majority of these are indiscriminately consumed by people procured as over the counter drugs. These preparations are combinations of multiple products that are often unidentified and dangerous and can precipitate various psychiatric symptoms. Hereby, we present a case of adolescent male in acute manic excitement after consumption of ayurvedic preparation containing "konchbeej" (Mucuna pruriens) which is rich in l-3,4 dihydroxyphenyl alanine; precursor of dopamine.

Keywords: l-3,4, dihydroxyphenyl alanine, ayurvedic, konchbeej (Mucuna pruriens), manic excitement, psychiatric


How to cite this article:
Vaish S, Sharma S, Sudarsanan S, Choudhary S, Singh JM, Khosla N. Mucuna pruriens (Konch Beej) precipitates manic symptoms. J Mental Health Hum Behav 2014;19:85-6

How to cite this URL:
Vaish S, Sharma S, Sudarsanan S, Choudhary S, Singh JM, Khosla N. Mucuna pruriens (Konch Beej) precipitates manic symptoms. J Mental Health Hum Behav [serial online] 2014 [cited 2019 Aug 24];19:85-6. Available from: http://www.jmhhb.org/text.asp?2014/19/2/85/153717


  Introduction Top


Mucuna pruriens , commonly known as "cowhage plant" or "kapikacho" or "kevach" in Hindi, is the most popular drug in the Ayurvedic and Unani system of medicine. [1] It is widespread over most of the subcontinent and is found in bushes and hedges throughout the plains of India. [1] The plant/seeds contain the bioactive alkaloids mucunine, mucunadine, mucuadinine, pruriendine and nicotine, besides ß-sitosterol, glutathione, lecithin, oils, venolic, and gallic acids. [2] The seeds show presence of a number of bioactive subtances including tryptamine, alkylamines, steroids etc., and is also a good source of l-3,4 dihydroxyphenyl alanine (L-DOPA). [3] M. prurita has been found to contain L-DOPA, 40 mg/g of the plant that is a significant percentage of plant product. [4] It's different preparations (from the seeds) are used frequently for management of rheumatoid arthritis, diabetes, atherosclerosis, nervous disorders and male infertility. [5] Clinical studies have shown positive outcome in patients with Parkinson's disorder trials in two studies, moreover, in a study 15 g of crude M. pruriens seed powder was found to significantly inhibit the prolactin response to chlorpromazine injection, as effectively as 0.5 g of L-dopa. [6],[7],[8],[9],[10] These clinical studies strongly substantiate the fact that M. pruriens is a good source of L-dopa and thus, increases the levels of dopamine in the brain.


  Case Report Top


We report a case of a 17-year-old adolescent male who presented with florid manic symptomatology including persistent elevated mood, over activity, inflated self-esteem and a decreased need for sleep which appeared abruptly 7 days back which according to family members was and out of character for the patient. On mental status examination, patient appeared excited and overconfident. Lability of affect and grandiose ideas could also be repeatedly observed during the interview with the patient. Further evaluation revealed no significant past or family history. Although, there was no history of substance use, it was however, reported that the patient was taking ayurvedic preparation called "speed height" containing chandrika (170 mg), ashwagandha (60 mg), laksha (10 mg), lavang (10 mg), amarbel (10 mg), bidharikand (50 mg), sitawar (10 mg), karu (10 mg), babool (40 mg), somlata (3 mg), chakramard (32 mg), sonapatha (15 mg), konchbeej (20 mg), lohbhasam (10 mg), which are the herbs used in ayurvedic practice; which as mentioned on the cover are indicated for activation for the growth glands. The patient had been consuming these capsules on the advice of a quack for 7 days two capsules per day.

A diagnosis of Mania without Psychotic Symptoms (F-30.1) was made as per ICD-10. An immediate treatment with injection haloperidol 5 mg and injection phenargen 25 mg was given intramuscularly as the patient was extremely excited at the time of admission. He was evaluated for any underlying possibility of organic mood disorders including complete blood counts, thyroid profile, and magnetic resonance imaging of brain; urinalysis for opioid, cannabis; all investigations were within normal limit. Patient was started on 1000 mg of divalproex, 5 mg of olanzapine and lorazepam 2 mg. Patient started showing improvement within 2 days of hospitalization and was symptom-free within 7 days on the same dosage of medication. Patient was discharged on 10 th day of hospitalization and his lorazepam and olanzapine were gradually tapered off 1 month and divalproex within 3 months. He has been maintaining well for past 1 year without any mood stabilizer or antipsychotic. Patient was counseled to stay in follow-up. Informed consent was sought from the family members at the time of admission and later from the patient under remission for reporting his case.


  Discussion Top


In psychiatric practice, we often come across drug induced psychiatric symptoms and mostly the implicated drugs are steroids, anti-tubercular drugs, antidepressant drugs, anti-parkinsonism drugs like L-dopa and carbidopa, etc. [11] It has been reported that syndopa and carbidopa drugs used in treatment of Parkinson's disease increase the levels of dopamine in the brain and thus improve the symptoms these patients, however, due the same reason they can also precipitate psychotic symptoms in the patients. [11] These drugs contain L-dopa that gets converted into dopamine, a prominent neurotransmitter involved without doubt in the emergence of psychotic symptoms. [11] A large Indian population have a strong faith in Ayurveda and related products. Many of these products are combinations of a number of natural compounds with little or some knowledge about the extent of their chemical and biological changes in the body. The people consume them under the sense of false protection that they are taking so-called natural products and that these products will not harm them. The "Speed Height" capsules, which were being consumed by our patient had many herbal extracts including from "konchbeej" which have been known to have L-dopa in high amounts and thus is often prescribed in patients with sexual dysfunction and also for growth stimulation by herbal prescribers. [5],[10] It has also been observed that many combinations present in ayurvedic medications may have biochemical interactions and alter each other properties precipitating mental disorders not previously reported. An exhaustive review of current literature reveals a dearth of studies conducted on psychiatric sequelae of naturally occurring herbs used in alternative forms of medicine, with just one report of M. pruriens causing toxicity available in November 1989 in the remote district of Memba (Mozambique). District authorities reported 203 cases of acute toxic psychosis over 6-week period where patients were confused, agitated, displayed hallucinatory behavior and paranoid delusions. All patients recovered within 2 weeks, more rapidly after administration of intravenous chlorpromazine. [12] The similarity of presentation in our case and the previously published report further lends credence to our finding that possibly the hyper dopaminergic state due to M. pruriens lead to the development of manic symptoms in our patient.

Thus, to conclude it is important to understand the various alternative medicinal products which may precipitate psychiatric symptoms since a large number people amongst population seems to be consuming them and many of them might go unidentified and be treated as primary psychiatric disorders if the proper history is not elicited. This is of paramount importance that the medical professionals should have insight about the alternate therapies available in their country and how they can affect the mental health. Moreover, the appropriate way of communicating the information to people without hurting their beliefs and sentiments is also a skill that one needs to imbibe.

 
  References Top

1.
Council of Scientific and Industrial Research. New Delhi raw materials. In: The Wealth of India: A Dictionary of Indian Raw Materials and Industrial Products. New Delhi. CSIR; 1962.  Back to cited text no. 1
    
2.
Ghosal S, Singh S, Bhattacharya SK. Alkaloids of Mucuna pruries chemistry and pharmacology. Planta Med 1971;19:280-4.  Back to cited text no. 2
    
3.
Tomita-Yokotani K, Hashimoto H, Fujii Y, Nakamura T, Yamashita M. Distribution of L-DOPA in the root of velvet bean plant (Mucuna pruriens L.) and gravity. Biol Sci Space 2004;18:165-6.  Back to cited text no. 3
    
4.
Daxenbichler ME, VanEtten CH, Earle FR, Tallent WH. L-dopa recovery from Mucuna seed. J Agric Food Chem 1972;20:1046-7.  Back to cited text no. 4
    
5.
Mishra LC, Scientific Basis for Ayurvedic Therapies Florida, US: CRC press LLC; 2004.  Back to cited text no. 5
    
6.
Vaidya AB, Rajagopalan TG, Mankodi NA, Antarkar DS, Tathed PS, Purohit AV, et al. Treatment of Parkinson's disease with the cowhage plant-Mucuna pruriens Bak. Neurol India 1978;26:171-6.  Back to cited text no. 6
    
7.
Katzenschlager R, Evans A, Manson A, Patsalos PN, Ratnaraj N, Watt H, et al. Mucuna pruriens in Parkinson's disease: A double blind clinical and pharmacological study. J Neurol Neurosurg Psychiatry 2004;75:1672-7.  Back to cited text no. 7
    
8.
Lieu CA, Kunselman AR, Manyam BV, Venkiteswaran K, Subramanian T. A water extract of Mucuna pruriens provides long-term amelioration of parkinsonism with reduced risk for dyskinesias. Parkinsonism Relat Disord 2010;16:458-65.  Back to cited text no. 8
    
9.
Manyam BV, Dhanasekaran M, Hare TA. Effect of antiparkinson drug HP-200 (Mucuna pruriens) on the central monoaminergic neurotransmitters. Phytother Res 2004;18:97-101.  Back to cited text no. 9
    
10.
Manyam BV. Paralysis agitans and levodopa in "Ayurveda": Ancient Indian medical treatise. Mov Disord 1990;5:47-8.  Back to cited text no. 10
    
11.
Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia, US: Lippincott Williams & Wilkins; 2009.  Back to cited text no. 11
    
12.
Infante ME, Perez AM, Simao MR, Manda F, Baquete EF, Fernandes AM, et al. Outbreak of acute toxic psychosis attributed to Mucuna pruriens. Lancet 1990;336:1129.  Back to cited text no. 12
    




 

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