Sensitivity and likelihood ratio of symptoms in patients with good therapeutic response to Lycopodium, compared to patients with good response to treatment with other homeopathic medicines. Retrospective study

Background and aims: Availability of reliable guiding symptoms in order to accurately prescribe homeopathic medicines is a matter of critical importance. Recent published work has highlighted the likelihood ratio (LR) of symptoms as an objective manner of addressing the question. The aim of the present study is to establish the sensitivity and LR of 35 common symptoms attributed to Lycopodium, comparing good respondents to this medicine to good respondents to other medicines.

Methods: In order to select which symptoms to be evaluated, a survey was conducted with 110 homeopaths -47 from Argentina and 63 from other countries- inquiring on the 10 most important symptoms they use to prescribe Lycopodium in their clinical practice. In a second phase of the study, the presence of selected symptoms was retrospectively assessed in the clinical records of the first visit of patients to the Homeopathic Outpatient Clinic of the Faculty of Medicine of Maimónides University. Patients with one only visit, no homeopathic prescription or more than one prescription, less than 18 or more than 65 years old or acute complaints were excluded. Only patients with good response attributable to the homeopathic treatment were included for analysis. Sensitivity (S) -or prevalence in Lycopodium responding cases- Likelihood Ratio (LR) and their 95% Confidence Intervals were calculated for each symptom.

Results: Twenty five homeopaths answered the survey and 35 symptoms were selected for the study. 875 records were assessed -about one fourth or the archive- and 564 excluded for different reasons. Of the remaining 311, 76.6% were females and 28.6% were prescribed Lycopodium. Females were more frequently prescribed Lycopodium than males (32.8% vs. 15.1%, P 0.003). Good response was seen more frequently in Lycopodium cases than in other medicines cases (75% vs. 62%, P <0.027). 205 good responding cases were included for symptoms analysis. LR of symptoms’ prevalence were calculated between Lycopodium (n=67) and other medicines (n=138) good responding cases.

A group of symptoms emerged as being important pointers to Lycopodium prescription, having high sensitivity and higher than 1 statistically significant LR: anger from (or intolerant of) contradiction (S 50.7%, LR 2.7), dictatorial (S 40.3%, LR 7.9), lack of self-confidence (S 32.8%, LR 3.2), irritability on waking (S 20.9%, LR 4.1), irritability before menses (S 28.2%, LR 3.9), helplessness (S 20.9%, LR 2.2), haughty (S 10.4%, LR 4.8), anticipation (S 31.3%, LR 2.1), conscientious (S 32.8%, LR 1.6), desire of chocolate (S 22.4%, LR 2.1), desire of sweets (S 46.3%, LR 1.6) and abdominal distention after eating (S 34.3%, LR 2.2). The symptom contemptuous had a sensitivity of 7.5%, and it was only found in Lycopodium cases.

A second group of symptoms had a sensitivity between 3 and 12% and LR higher than 1, but statistically non significant: reproaches, egotism, contrary, critical, fear of failure, suspicious, constipation alternating with diarrhoea, lack of vital heat and sensitive to clothing in abdomen.

A third group of symptoms had very low sensitivity (S 1.5): flatterer, hurry, nose obstruction during night, aversion to onions, past or present gallstones and sleeps on abdomen.

Two symptoms had good sensitivity but LR lower than one, though statistically non significant, probably indicating a contraindication of Lycopodium: reserved (S 11.9%, LR 0.7) and desire for open air (S 7.5%, LR 0.4). Finally five symptoms were not recorded in Lycopodium cases but in one or two of the other medicines cases: contemptuous -hard with subordinates and agreeable to superiors-, past or present renal calculi, fear of narrow places, easy satiety and worse at 4 pm.

Conclusions: Retrospective asses of symptoms’ sensitivity and LR could have an important place before performing more accurate prospective research about the same matter.