pathophysiology and psychodynamics of disease causation

PRESENTED BY:
BHAWANPREET KAUR

 The study of pathophysiology (or patho biology)
considers the changes that happen to normal
anatomy and physiology due to illness and disease.
 Any cellular change or damage can affect the
whole body. Injury, malnutrition or invasion by
pathogens can all disrupt homeostasis. Cells check
for such imbalances during the cell cycle and
replication and usually adapt successfully in
response to such stresses.
 However, sometimes the cell cycle fails to detect
unwanted changes and the resulting mutation may
cause disease.

 Pathology is the branch of medical sciences that
treats the essential nature of disease, especially the
changes of structure and function in tissues and
organs of the body that cause or are caused by
disease.Pathophysiology involves the study of
functional or physiologic changes in the body that
result from disease processes.
 This builds on knowledge of the normal structure,
and function of the human body. As a disease
develops, the changes in the normal anatomy and/or
physiology of the body may be obvious or maybe
hidden, occurring at the cellular level.

 Subclinical Condition
When not associated with clinical features, the
disease is called a “subclinical condition”.
 Carrier
A person with subclinical infectious disease who can
transmit the disease to others is called carrier.
 Disability
The inability to carry out the activities of daily
living like bathing, combing, cooking, dressing is
called disability.
 Handicap
When the disability prevents the individual from
engaging in his vocation, it is called handicap.

 Health
Health is a state of complete physical, mental and
social well being and not merely the absence of
disease or infirmity.
 Disease
Disease is just the opposite of the health “Disease is
a condition in which body health is impaired, a
departure from the state of health, an alteration
of human body interrupting the performance of
vital functions”.
 Pathophysiology The term combines pathology
and physiology. Pathology deals with the study of
study of structural and functional changes in
physiology deals with the functions of the human
body.

 BIOLOGICAL DETERMINANTS
 BEHAVIORALAND SOCIO-CULTURAL
CONDITIONS
 ENVIRONMENT
 SOCIO-ECONOMIC CONDITIONS
 Major importance of Socio-Economic Conditions
 Economic status
 Education
 Occupation
 Political System
 Health Services
 Aging of the Population
 Gender
 Other Factors

PSYCHODYNAMICS
The term psychodynamics implies that
psychic, or mental, processes are dynamic as
opposed to static they involve movement and
force.
A psychodynamic interpretation always
contains the idea that an individual’s behavior
and subjective experience are the outcome of a
conflict, usually largely unconscious, between
opposing forces in the mind.

 Physiological Factors
 Germ Theory Of Disease
 Genetic Disorders
 Autosomal dominant
 Achondroplasia
 Adult Polycystic Kidney Disease
 Huntington’s Chorea
 Hyper Cholestrerolemia
 Marfan’s Syndrome
 Multiple Neurofibromatosis
 Osteogenesis Imperfect
 Spherocytosis
 Von Willebrand’s Disease

 Autosomal Recessive
 Colour Blindness
 Cystic Fibrosis
 Glycogen Storage Diseases
 Oculocutaneous Albinism
 Phenylketonuria(PKU)
 Renal Glycosuria
 Sickle Cell Disease
 Tay- Sachs Diseases
 Wilson’s Disease
 (Sex – Linked ) X- Linked Recessive
 Bruton- Type Agammaglobilinemia
 Classic Haemophilia A
 Duchenne- Type Muscular Dystrophy

Chromosomal Disorders
Chromosome disorders involve a
change in chromosome number or
structure that results in damage to
sensitive genetic mechanism or in
reproductive disorders.
Trisiomy 21 (Down’s syndrome)
Monosomy X (Turner’s syndrome)
Poly somy X (Klinefelter’s syndrome)

 The Triangle has three corners (called vertices):
 Agent, or microbe that causes the
disease.
(The “what” of the Triangle)
 Host, or organism harboring
the disease.
(The “who” of the Tri-
angle)
 Environment, or those
external factors that cause or allow disease transmission
(The “where” of the Triangle)
AGENT
ENVIRONMENTHOST

The Agent—“What”
 Bacteria
Virus
Fungi
The
Protozoa
The Host—“Who”
The Environment—“Where”
 Physical environmental
Biological environmental

 THE Steady State
 The person as a living system has both an internal and an
external environment. There are four concepts for that :
 1.) CONSTANCY 2.) HOMEOSTASIS
 a) Physiological Homeostasis
 b) Psychological Homeostasis
 3.) STRESS
 Types of stressors:
 1. Physical — cold, heat and chemical agent
 2. Physiological — pain and fatigue
 3. Psychosocial — fear
 4. Normal life transition
 5. Others: frustration, war and terrorism, marriage, divorce,
retirement etc.
DYNAMIC BALANCE

 It is modification of cell morphology and function to
achieve a new steady but altered state, preserving the
viability of cells, which includes Atrophy, Hypertrophy,
Hyperplasia, Metaplasia and Dysplasia.
 ATROPHY
 HYPERTROPHY
 HYPERPLASIA
 a) Physiologic Hyperplasia
 b) Compensatory-Hyperplasia
 c) Pathologic Hyperplasia
 METAPLASIA
 DYSPLASIA

 1. Normal body substances (lipids, proteins)
 2. Abnormal endogenous products ( metabolism)
 3. Exogenous products (environmental agents)
 CAUSES OF CELL INJURY
 Physical agents, Electricity , Radiation, Chemical,
 Biologic agents , Mechanical forces
 Extremes of temperature
 Injury from nutritional imbalances
 Infectious
 Immunologic agents, Genetic defects, Aging.
 Oxygen Deprivation (Hypoxia, due to restriction of
blood “ischemia”),

1. REVERSIBLE CELL INJURY
 Cell swelling Cloudy swelling and hydropic
degeneration, Fatty changes
 Occurs in organs rich in mitochondria e.g. renal tubules,
cardiac muscles and hepatocytes.
 Organ is enlarged, soft, pale with tense capsule and
rounded borders.
 Swollen cells with granular cytoplasm - Nucleus is
normal.
 Hydropic degeneration renal tubules Hydropic
degeneration liver.
 Hydropic degeneration:- A severe form of cloudy
swelling. Cytoplasm accumulates vacuoles of water in
the liver; it may be caused by alcohol, viral hepatitis.

 It is single cell death in the middle of living tissue due to
activation of internal “suicide” program with characteristic
morphology (cell shrinkage) that does not cause tissue
disruption or inflammation. It occurs in:
1) Embryogenesis, organogenesis,& developmental involution
2) Hormone-dependent physiologic involution.
3) Cell deletion in proliferating populations, such as intestinal
crypt epithelium, or cell death in tumors.
4) Deletion of auto reactive T cells in the thymus.
5) Deletion of virally infected cells.
6) Mild injury (heat, radiation, cytotoxic cancer drugs, etc.) that
cause irreparable DNA damage (e.g., via the tumor suppressor
protein)

 Necrosis is the death of a group of cells within
living organism.
 Types of Necrosis
1. Coagulative (most common) necrosis
 It implies preservation of the basic structural outline
of the cell or tissue for a span of days. The injury or
the subsequent increasing acidosis denatures not
only the structural proteins but also the enzyme
proteins, thus blocking cellular proteolysis. The
process of Coagulative necrosis, with preservation
of the general tissue architecture, is characteristic of
hypoxic death of cells in all tissues except the brain.
 Infarction is Coagulative necrosis resulting from
hypoxia.

2. Liquefactive Necrosis
It’s characteristic of focal bacterial or fungal
infections, due to accumulation of white
cells, and hypoxic death within the central
nervous system. Liquefaction completely
digests the dead cells.
3. Caseous Necrosis
The term "Caseous" is derived from the cheesy,
white gross appearance of the central necrotic
area. The necrotic focus is composed of structure
less, amorphous granular debris within a ring of
granulomatous inflammation. The tissue
architecture is completely lost.

4. Fat Necrosis
In this focal areas of fat destruction, typically
occurring after pancreatic injury > release of
activated pancreatic enzymes into adjacent
parenchyma or the peritoneal cavity. The released
fatty acids combine with calcium to produce
grossly visible chalky white areas (fat
saponification).
5. Gangrenous Necrosis
It is ischemic Coagulative necrosis (frequently of a
limb> dry gangrene); when there is superimposed
infection with a Liquefactive component, the
lesion is called "wet gangrene”. Gangrenous tissue
must be removed surgically.

4. Gangrene
It is the death of tissues in your body. It may be caused
by a lack of blood flow to a part of the body or by a
bacterial infection. Blood helps the distribution of
nutrients, oxygen and to the body parts. It also carries
toxins and waste materials to the liver and kidneys to
be removed from your body. When body flow is
blocked the body suffers and tissue dies. If they don’t
get the nutrients and oxygen by the blood then health
problems like gangrene can develop.
Types: There are two main types:
 Dry gangrene: This is caused by disease, which
affects the blood circulation.
 Wet gangrene: This is caused by a wound infected
with bacteria.

1. Nor epinephrine - Excitatory or inhibitory
2. Dopamine - Excitatory
3. Serotonin - inhibitory
4. Melatonin - Sleep walk cycle
5. Acetylcholine - Excitatory or inhibitory
6. Gamma-amino butyric acid- inhibitory

1. Sympathetic nervous system response:
Its response is rapid and short-lived. Increase
heart rate, Peripheral vasoconstriction, raising
blood pressure, blood glucose is increased,
pupils dilated.
2. Sympathetic-adrenal-medullar response:
 Release of the hormones epinephrine and nor
epinephrine.
 Increase blood glucose increase metabolic rate.
 Mental acuity
 Increased ventilation
 This effect is called “fight-or-flight” response.

This is the body’s response to perceived threat or
danger.
During this reaction, certain hormones like
adrenalin and cortisol are released, speeding the
heart rate, slowing digestion, shunting blood flow
to major muscle groups, and changing various other
autonomic nervous functions, giving the body a
burst of energy and strength.
The fight-or-flight response, also known as the
acute stress response, refers to a psychological
reaction that occurs in the presence of something
that is terrifying, either mentally or physically.

 In response to acute stress, the body's sympathetic
nervous system is activated due to the sudden
release of hormones.
 The sympathetic nervous system stimulates the
adrenal glands triggering the release of
catecholamine's, which include adrenaline and
noradrenalin.
 This results in an increase in heart rate, blood
pressure and breathing rate.
 After the threat is gone, it takes between 20 to 60
minutes for the body to return to its pre-arousal
levels.

Sigmund Freud believed in theory of libido
development. Libido derived from Latin
word for wish or desire-as a non specific
sensual drive for bodily gratification.
THE ORAL STAGE
THE ANAL STAGE
THE PHALLIC STAGE ( OEDIPUS
COMPLEX) ( ELECTRA COMPLEX)
THE LATENCY STAGE
THE GENITAL/PUBERTY STAGE

It is earliest stage of development .
The goal is immediate gratification of needs,
a sense of security & ability to trust others.
Relief from anxiety through oral gratification
of needs &pleasure is obtained through
stimulation of mouth as in thumb sucking.
It consists of two phases:-
1.) Receptive phase-chewing
2.) Sadistic phase -Biting

In this stage major tasks are gaining
independence & control with particular focus on
excretory function. Gratification is obtained
through holding & expelling feaces. The manner
in which parents approach the task of toilet
training may have long term effects child in
terms of valves and personality characteristics, It
consists of two phases:-
The destructive expulsive phase—child enjoys
excretion
The mastering phase---child enjoys sphincter
control

 In this stage the focus of energy shifts to genital
area. Children display considerable sexual
interest. Discovery of differences between genders
results in a heightened interest in sexuality of self
& others.
 This interest may be manifested in sexual self
exploratory play. Development of Oedipus
complex occurs during this stage of development
(desire to eliminate parent of same sex & to
possess parent of opposite sex) guilt feelings result
with emergence of superego during these years.

It is regarded as phase of sexual latency and
the focus changes to group activities,
learning, socialization.
The preference is homosexuals groups i.e.
gang formation.
 Children of same age show distinct
preferences for same sex relationships even
rejecting members of opposite sex.

It is initiated by puberty and leads to
reawaking of sexual interest that is now
conscious, increasing desire to achieve
adult status. Sexual arousal occur
through memories and sensation from
earlier childhood periods, physical
manipulation of genitals and hormonal
secretions.
 Heterosexual interests appear and focus
on relationships with members of
opposite sex.

 Id- The id is the part of our mind where the drives are
represented. These are intimately connected with the physical
body and its functions. According to Freud the Id operates on
the pleasure principle. E.g. baby is crying for milk, he want
milk in any condition ,he can compromise.
 Ego-It operates on the reality principle. Ego considers the
consequences of our actions. Ego is based on id as well as of
reality. It is set of conscious, intellectual & self preservation
functions. E.g. School going kid want new bag but he know
his father cannot buy, he will compromise.
 Superego-Within the ego there is substructure called the
superego. It is the part of the ego, which the identification
with our parents and their authority. It is called perfection
principle. It is mainly unconscious. The superego
corresponds closely to the conscience which is a set of
positive values and moral ideals. E.g. a person always obey
rules because of strict discipline at home.

 Mental Health:
Mental health in a narrow sense, it is describe as
a health mind. But it can’t be described without
physical, social and spiritual health. Therefore
mental is a part of general health. It requires a
balance between the body, mind, spirit and
environment in which a person lives.
Illness and other conditions upset the previously learned
functions of the child for e.g. secure bladder control or revert
babyish eating. This is described as regression.

Illness:
Illness is a subjective state of the person who
feels aware of not being well.
Meaning Of Illness:
Illness are also individualized to each person,
who experience an alternation in health. So illness
is the responses, the person has, to a disease; it is
an abnormal process in which the person’s level
of functioning is changed compared with a
previous level.
The response is different for each person, and is
influenced by self-perceptions; other perceptions,
the effects of changes and body, structure and
functions, the effects of those changes on roles
and relationships and cultural and spiritual values
and beliefs.

 Mental illness occurs when a state of physical,
mental, social and spiritual well-being is
disturbed. Personality of a person and use of
various defense mechanism, help the individual
to adjust to various stressful situation of life.
 When the capacity to adjustment of the
individual is not able to adjust to the situation,
he may develop maladaptive behaviour and
become mental ill.

1. ORGANIC CONDITIONS
2. HEREDITY
3. SOCIAL PATHOLOGICAL CAUSES
4. ENVIRONMENTAL FACTORS (Toxic
substances, Psychotropic drugs,
Nutritional factors, Minerals Infective
agents, Traumatic factors, Radiation)

 INTRODUCTION
 Models of why and how individuals carry out
behaviours to promote health and prevent illness are
useful in helping healthcare providers understand
health-related behaviours and adapt care to people
from diverse economic and cultural backgrounds.
 This knowledge can be used to overcome barriers to
health from disparities in care resulting from such
factors as:
 1. The increasing number of people without health
insurance.
 2. Predicted upward trend in minority populations.
 3. Lack of accessible and essential healthcare services
for low-income and rural populations.

The health belief model is concerned with
what people perceive, or believe, to be
true about themselves in relation to their
health.
This model is based on three components
of individual perceptions of threat of a
disease:
(1) Perceived susceptibility to a disease,
(2) Perceived seriousness of a disease,
(3) Perceived benefits of action.

1. Perceived susceptibility to a disease:
 It is the belief that one either will or will not
contract a disease. It ranges from being afraid of
contracting a disease to completely denying that
certain behaviours will result in illness.
2. Perceived seriousness of a disease:
 This component is related to how much the person
knows about the disease and can result in a
change in health behaviour.
3. Perceived benefits of action:
 Is concerned with how effective the individual
believes measures will be in preventing illness.

Cues to action are also modifying
factors and are provided by activities
such as:
1. Others' advice,
2. Mass-media campaigns,
3. Literature,
4. Appointment-reminder telephone calls
or postcards,
5. Illness of a significant other.

 The health–illness continuum is one way to measure a
person's level of health. This model views health as a
constantly changing state, with high-level wellness and
death.
 The continuum illustrates the ever-changing state of
health person adapts to changes in the internal and
external environments to maintain a state of well-being.
 Health is a common theme in most culture. In fact all
communities have their concepts of health as a part of
their culture.
 Health and illness are defined according to the values
of society to which a person belongs. When a person is
able to adjust and adapt to his environment he is said to
be healthy. A person with good mental health functions
comfortably with society. He is satisfied with himself
and achievements.

 Health and disease lie along a continuum and there is no
single cut-off point. The lowest point on the health and
disease spectrum is death and highest point corresponds to
the WHO definition of positive Health. It is thus obvious
that health fluctuates within a range of optimum well being
to various levels of dysfunction, namely the death.
 The transition from optimum health to ill health is often
gradual, and where state ends and the other begin is a
matter of judgment. So the spectral concept of health of an
individual is not static. It is a dynamic phenomenon and a
process of continuous change, subject to frequent stable
variations.
 That is a person may function at maximum level of health
today and diminished level of health tomorrow.

 It implies that health is a state not to be attained once
and for all, but ever to be renewed. There are degrees
or ‘levels of health ‘as there are degrees or severity of
illness. As long as we are alive there is some degree of
health in us.
 According to R. Dubois views health as adaptation, a
function of adjustment. He believes a utopian state of
health can never be so perfectly adapted to the
environment that life will not involve struggle, failure
and suffering. Human can adapt to environment but
each new adaptation procedures new problems that
demand new solutions.

 H. S. Sullivan defines mental or emotional illness as
inappropriate interpersonal behavior or behavior that
is inadequate for the social context. Sullivan believes
that each person has some small degree of illness.
Physical or emotional even when he or she feels and
looks well.
 The illness may be minor aches, temper flares,
inappropriate forgetfulness, or over use of certain
defense mechanisms such as rationalization or
forgetfulness. Similarly the emotionally ill person
manifests some degree of health. Some appropriate
thinking and behavior.

Halberd, Dunn (1961) described the model of high
level wellness as functioning to one’s maximum
potential while maintaining balance and
purposeful direction in the environment.
Concept Of High Level Wellness Model
It can be applied to the individual, family,
community, environment and society. Dunn,
model is holistic, allowing the nurse care for the
total persons with regards for all dimensional
factors affecting the person’s state of being as he
or she strives to reach maximum potential. For
example, intellectual dimension, social
dimension, emotional dimension and spiritual
dimension.

(1) Direction in progress forward and
upwards towards a higher potential of
functioning.
(2) An open-ended and ever-expanding
tomorrow with its challenge to live at a
fuller potential.
(3) The integration of the whole being of
the total individual—body, mind, and
spirit—in the functioning process.

1. Willingness to face inconsistencies in our thinking.
2. Willingness to hear and examine the other fellow's
viewpoints with an open mind.
3. Willingness to encourage freedom of expression of
those around us.
4. Willingness to adjust our own views.
5. Willingness to make time for unhurried contacts with
others when such relationships are essential.
6. Willingness and determination to give credit and
recognition to others when it is due them.
7. Eagerness and determination to serve others as
opportunities arise.
8. Willingness to give freedom to those we love.

EMOTIONAL
PHYSICAL
VOCATIONAL
SPIRITUAL
INTELLECTUAL
SOCIAL

(a) High self-esteem and a positive outlook;
(b) A foundation philosophy and a sense of purpose;
(c) Strong sense of personal responsibility;
(d) Good sense of humour and plenty of fun in life;
(e) Concern for others and a respect for the environment;
(f) Conscious commitment to personal excellence;
(g) Sense of balance and an integrated lifestyle;
(h) Freedom from addictive behaviours of a negative or health-
inhibiting nature;
(i) Capacity to cope with whatever life presents and to continue to
learn;
(j) grounded in reality;
(k) Highly conditioned and physically fit;
(l) Capacity to love and an ability to nurture;
(m) Capacity to manage life demands and communicate effectively.

 Park's Textbook of Preventive and Social Medicine, 19th Edition, Bhanot, pp.
29-36, 80-82.
 Gupta Pixyish and Ghai O.P., "Textbook of Preventive and Social Medicine"
2nd Edition, C.B.S. Publishers & Distributors, New Delhi, pp 10-11
 Dr. Rao Sridhar, "Principles of Community Medicine" 4th Edition, Aitbs
Publishers, New Delhi, pp 1-5.
 Brunner, Sudharath, "Text Book of Medical Surgical Nursing" 11th edition,
William Wilkins Lippincott.
 Harrison's, "Principles of Internal Medicine", 17th Edition, Vol. I, Mac Grew
Hill, pp. 19-22.
 Davidson's, "Principles and Practice of Medicines", 18th Edition, Churchill
Living Stone ELBS, pp 45-56.
 K.Park. “Text book of preventive and social medicine”. 17th ed.2002.
Banarasidas bharath.Jabalpur.Pp 16-32, and 582- 581.
 Potter.A.Patricia and Perry Anne Griffins “fundamentals of nursing” 6thy
ed.2005.Mosby.St.louis Missouri. Pp 91 – 103.
 Niraj ahuja. “A short textbook of Psychiatry “. 1st edition.1995.Jaypee brothers.
New Delhi. Pp –1-2,
4.
 Stuart.Gail.W.Laria.Michele.T. Principles and practice of psychiatric
nursing.8th edition.2007.Mosby: St. Louis.Pp 445 – 472.

pathophysiology and psychodynamics of disease causation

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pathophysiology and psychodynamics of disease causation