UNIT-5 BIO PSYCHOSOCIAL PATHOLOGY

PATHOPHYSIOLOGY AND PSYCHODYNAMIC OF DISEASE CAUSATION

INTRODUCTION:
Disease is a dynamic process and it is just opposite to the health. Health denotes
perfect harmony and normal functioning of all the body system or state of complete wellness
whereas disease denotes disharmony and deviation from normal functioning of various
bodies functioning system.
DEFINITIONS:
HEALTH:
 Health is a state of complete physical, mental and social wellbeing and not merely the
absence of disease or infirmity. -WHO
 Health is an absence of disease and the ability to use one is power to the fullest.
-FLORENCE NIGHTINGALE.
ILLNESSS:
 Illness is defined as ‘’ a state in which a person is physical, emotional, intellectual,
social, developmental or spiritual functioning is diminished or impaired with previous
experience.
DISEASE:
 Disease is a condition of body or some part of body or organ of body in which its
function is disrupted. -OXFORD ENGLISH DICTIONARY
 Disease is a condition in which body health is impaired, a departure from state of
health, an alteration of human body function and interruption the performance of vital
function. -WEBSTER
PATHOPHYSIOLOGY:
 It is the study of the disordered physiological processes that cause, result from, or are
otherwise associated with a disease or injury.
PSYCHODYNAMICS:
 It is the psychology of mental or emotional forces or processes developing especially
in early childhood and their effect on behavior and mental states. - MERRIAM
WEBSTER DICTIONARY
RISK FACTORS:
A risk factors is any situation, habit, social or environmental condition physiological or
psychological condition, developmental or intellectual condition or spiritual or other variable
that increases the vulnerability of an individual or group to an illness or accident.
The presence of risk factors do not mean that a disease will develop, risk factors increases the
chances that the individual will experience a particular disease or dysfunction. The risk
factors can be divided into:
 I. Genetic and physiologic factors
II. Age
III. Environment
IV. Life style
GENETIC AND PHYSIOLOGIC FACTORS:
 Physiological risk factors involve the physical functions of the body. Certain physical
condition such as being pregnant or overweight place increased stress on
physiological system (e.g., circulatory system) increasing susceptibility to illness in
those areas.
 Heredity or genetic predisposition to specific illness is a major physical risk factor.
E.g.: A person with a family history of diabetes mellitus is at risk for developing the
disease later in life. Other genetic risk factor includes family histories of cancer, heart
disease or mental illness.
AGE:
 Age increases or decreases susceptibility to get illness. E.g.: Am infant born
prematurely and neonates are more susceptible to infection. The risk of heart disease
increases with age for both sex. The risk factors are often closely associated with
other risk factors such as family history and personal habits.
ENVIRONMENT:
 Where we live and the condition of that area (its air water and soil) determines how
we live, what the we eat, the disease agents to which we exposed, our state of health
and our ability to adapt. The physical environment in which a person works or lives
increase likelihood that certain illness will occur. E.g., some type of cancer and
diseases are more prevalent in industrial works.
LIFE STYLE:
 Many activities, habits and practices involve risk factors. Life style practices can be
positive or negative effect on health. Lifestyle with potential negative effects are
sedentary life style, over eating or poor nutrition, insufficient rest and sleep, poor
personal hygiene. Other habit process negative effects are use of tobacco, alcohol,
drug, abuse, unsafe sex, multiple sex partners etc.
ETIOLOGY:
It is defined as a specific part of the disease which act as the main cause for the
occurrence of the disease, Etiology along with risk factors and other triggering mechanism of
the body as well as the environment causes a disease.
There are specific etiological features for every disease. There may be some times
only one or the group of etiology which causes the disease, Sometimes the etiology may be
unidentified or idiopathic.
I. Hereditary
II. Congenital
III. Inflammatory
 IV. Degenerative
V. Infection
VI. Deficiency
VII. Metabolic
VIII. Neoplastic
IX. Traumatic
HEREDITARY:
 This is the disease-causing features that come from parents. The disease like diabetes
mellitus, hyper tension etc. can be identified as hereditary if the parents are having the
disease, then there is a higher chance to get them for their children. E.g., sickle cell
anemia, hemophilia, color blindness etc.
CONGENTIAL:
 It is mostly not related with the chromosomal or the genetic features which causes the
disease. The X-linked hemophilia and other congenital birth anomalies are the best
examples. They appear at birth or shortly thereafter birth and not caused by genetic
abnormalities. These are results from some failure in development during pregnancy
for first two months of pregnancy. Contributing factors are alcohol, drugs etc.
INFLAMMATORY:
 Inflammatory diseases are the causative factors for the many diseases. The cell wall
destruction or any inflammation occurring to the cell acts as the disease origin. Here
the body reacts to the causative agents with an inflammatory response e.g.,
Pharyngitis or bronchitis.
DEGENTATIVE:
 This is the destruction of the specific activity or the power of group of cells, the
degeneration of group of cells results in disease e.g., Osteoarthritis.
INFECTION:
 Infectious diseases are caused by invasion of specific pathogens or bacteria into the
human body. The infections are caused mainly because of bacteria, virus, fungus etc.
e.g., AIDS, Tuberculosis etc.
DEFICUIENCY:
 Deficiency results from a specific lack of a group of proteins, carbohydrates, minerals
or lack of food constitutions in the nutrition of the human body.
METABOLIC:
 Metabolic causes of the disease are the disturbance in the normal function of the body
or the specific routine. It is caused by a dysfunction, that result in a loss of metabolic
control of homeostasis of the body.
NEOPLASTIC:
 It occurs because of the increased number of cell division or any abnormal cell
growth. Neoplasm is the causation of cancer. It may be benign or malignant.
Malignant neoplasm is a serious threat to health.

TRAUMATIC:
 This is caused by the externa l environment or any force which act or overcome the
body function and results to the later disorientation e.g., accidents. It can be both
physical and emotional trauma. e.g., loss of loved ones
THEORIES OF DISEASE CAUSATION:
INTROCUTION:
Before the rise of modern medicine, disease was attributes to a variety of spiritual or
mechanical forces. It was interpreted as a punishment by God for sinful behavior or the
result of an imbalance in body elements. Greeks related disease to the natural environment or
the way in which human populations lived and worked. Then the idea that disease could be
passed from person to person arose in the Middle Ages and convincing evidence proved that
the disease was spread by water contaminated by the excretions of cholera victims. In those
times, the body was viewed as a machine to be corrected when things go wrong, by
procedures designed to neutralize specific agents or modify the physical processes causing
disease.
Before the discovery of the micro-organism (bacteria by louis’ pasture in 1822-1895)
several theories explaining the cause of disease were put forward time to time:
I. Divers epidemiological model
II. Web of causation
III. Multi-factorial causation theory
IV. Epidemiological triad
V. Germ theory
GERM THEORY:
 According to this theory, there is one single cause of every disease. This refers to one
to one relationship between the causative agent and disease.
WEB OF CAUSATION:
 According to Macmohan and Pugh, Disease never depends upon single isolated cause
rather it develops from a chain of causation in which each link itself is a result of
complete interaction of preceding events this chain of causation which may be the
fraction of the whole complex is known as web pf causation.
MULTI-FACTORIAL CAUSATION THEORY:
 Epidemiological theory is not applicable for non-infectious and chronic disease like
coronary artery disease etc., because it has many causes or multiple factors.
  This theory helps to understand the various associated causative factors, prioritize and
plan preventive and plan measures to control the disease.
DIVERS EPIDEMIOLOGICAL MODEL:
 Divers epidemiological model talk about socio environment approach. The socio-
environmental approach is not so mush concerned with the causes of disease, rather it
focuses to identify the main factors that make and keep people healthy. This model is
composed of four major categories of factors
I. Life style factors include daily living activities, customs, traditions, health
habits etc.
II. Human biological- epidemiological triad and include genetic inheritance,
complex, physiological system, factors related to maturation and ageing.
III. Health care system factors include availability, accessibility, adequacy and
use of health care services at all levels.
IV. Environmental factors include physical, biological, social and spiritual
components.
 All these factors influence health status positively or negatively.
THEORY OF EPIDEMIOLOGICAL TRIAD
 According to this theory, every one exposed to disease agent did not contract the
disease. This means it is not only the causative agent that is responsible for disease
but there are another factors also , related to man and environment which contribute to
disease.
I. AGENT- Bacteria, Viruses, Fungi, Amoeba
II. HOST- Genetic makeup, Age, Sex, Health, Immunity, Behavior
III. ENVIRONMENT- Sanitation, Water, Air, Noise, Customs

S THEORY DISEASE CAUSATION

L.
N
O
I. Devers Four major categories of factors causing disease:
epidemiolo a) Life style
gical model b) Human biological
c) Health care system factors
d) Environmental factors

II. Web of Not depends upon single isolated cause but on web of causes
causation

III. Multi- Many causes or multiple factors

factorial
causation
 IV. Epidemiolo
gical triad

AGENT

ENVIRNMENT HOST

V. Germ One single specific cause of every disease

theory Germ (Causative agent) Man disease

SPECTRUM OF DISEASE
 Spectrum of disease is the graphical representation of variation in the manifestations
of disease.
 At one end of disease spectrum are subclinical infections which are not ordinarily
identified and at the other end are fatal illness. In the middle of the spectrum lies
illness ranging in severity from mild to severe.

Subclinical Mild, Fatal

infection moderate, illness
severe cases

Spectrum of disease

Pre-pathological
Pathogenesis period
period

Disability
Agent
Death
Recovery
Early Advance Convales- Chronic
disease d cence state
Early
Host Environment pathogenesis

Natural history of disease

  Natural history of disease refers to the progress of a disease process in an individual
over time, in the absence of intervention. The process begins with exposure to or
accumulation of factors capable of causing disease. Without intervention, the process
ends with recovery, disability or death.

Good Health
Health Outcomes
Cure
Control
Disease Symptoms Care Diagnosis Therapy Disability
Seeking Death

Natural history and Spectrum of disease

ICEBERG PHENOMENON OF DISEASES

 Iceberg phenomenon of disease gives a picture of the spectrum of diseases in a
community. The visible part of the iceberg denotes the clinically apparent cases of
disease in the community. The floating tip of the iceberg represents what the
physician sees in the community.i.e., clinical cases. The vast submerge portion of the
iceberg represents the hidden mass of diseases .i.e. latent, unapparent, pre-
symptomatic and undiagnosed cases and carrier in the community. The waterline
represents the demarcation between apparent and unapparent disease.
 The phenomenon describe a situation in which large percentage of a problem is
subclinical, unreported, or otherwise hidden from view. Thus, only the ‘’tip of the
iceberg’’ is apparent to the epidemiologist.

Diagnosed
disease

Undiagnosed or
wrongly
diagnosed

PATHOPHYSIOLOGY OR PHYSIOPATHOLOGY:
 Is a convergence of pathology with physiology, pathology is the medical discipline
that describe conditions typically observed during a disease state, where as physiology
is the biological discipline that describe processes or mechanisms operating within an
organism. Pathology describes the abnormal or undesired condition, whereupon
 pathophysiology seeks to explain the physiological process or mechanisms whereby
such condition develops and progresses.
 Pathophysiology can also mean the functional changes associated with or resulting
from disease or injury. Another definition is the functional changes that accompany a
particular disease.
PATHOLOGY PHYSIOLOGY
Medical discipline Biological discipline
Deals with the study and diagnosis of Deals with the normal functions of living
disease organism and their parts.

USES:
 Pathophysiology is a required area of study for nearly all healthcare professional
school programs (medical, dental, physician assistant, occupational therapy, physical
therapy , nurse practitioner, radiation therapists, pharmacy, nursing, radiologic
science, chiropractic and paramedic programs) in the united states, Canada and other
countries.
PSYCHODYNAMICS:
 Psychodynamics also known as dynamic psychology, in its broadest sense, is an
approach to psychology that emphasizes systematic study of the psychological forces
that underline human behavior, feelings and emotions and how they might relate to
early experience. It is especially interested in the dynamic relations between
conscious motivation and unconscious motivation.
 The term psychodynamic theory or psychodynamics doesn’t refer to a single theory,
rather it references a number of different psychological theories that makeup the
psychodynamic perspective, there theories collectively suggest that the individual
personality is a combination of early childhood experiences and unconscious impulses
or desires.
 Emerging from Europe during the 19th century, the psychodynamic approach gained
considerable attention through the work of the Austrian neurologist Sigmund Freud.
The term psycho-dynamics is also used by some to refer specifically to the
psychoanalytical approach developed by Sigmund Freud (1856-1939) and his
followers. Freud was inspired by the theory of thermodynamics and used the term
psychodynamics to describe the processes of the mind as flows of psychological
energy (libido) in an organically complex brain. Freud is widely regarded as a
pioneer is the area of psychodynamics.
According to Freud, human personalities are made up of three parts:
 Id is the part of the brain that operates unconsciously based on ‘pleasure principles,
driven by instant gratification and pleasure, while avoiding anything that would cause
discomfort or pain.
 Ego is the part of the personality that negotiates between the id and the real world.
The ego exists to provide some balance for the id, which is purely motivated by self-
interest.
  Super ego, the most conscious part of the personality which exists to keep a person
from deviating from social expectations or engaging in amoral behavior. The super
ego adheres to all of the things that children learn in the very early part of their lives,
such as social or cultural standards.
In the treatment of psychological distress, psycho dynamic psychotherapy
tends to be a less intensive, once or twice weekly modality than the classical Freudian
Psychoanalysis treatment of 3-5 sessions per week. Psychodynamic therapies depend
upon a theory of inner conflict, wherein repressed behaviors and emotions surface
into the patient’s consciousness, generally, one’s conflict is subconscious.
ROLE OF NURSE:
PATHOPHYSIOLOGY OF DISEASE CAUSATION:
CARE GIVER:
 As a care giver, the nurse helps client to regain health through healing process.
 Nurse address the holistic health care needs of client.
 She helps the client and families to set goals and meets those goals.
 She preserves dignity of client.
 She accepts client as person not merely as mechanical beings.
CLINICAL AND ETHICAL DECISION MAKER:
 Nurse uses critical thinking skills throughout the nursing process to provide effective
care.
 Nurse makes decision in collaboration with client and family.
 She also collaborates and consults with other health professionals.
PROTECTORS AND ADVOCATE:
 She provides a safe conductive environment to the client.
 She takes step to prevent injury to client.
 She protects the client from every possible adverse effects of treatment.
 She asks about any allergy to medicine or food.
 She provides immunization against disease.
AS ADVOCATE:
 She protects client’s human and legal rights and provides assistance in asserting those
rights if the need arises.
 She advocates the client by keeping in mind the client’s religion and culture.
 Nurses defends the clients right in general way by speaking out against policies that
might endanger their well-being.
MANAGER:
 As a manager, nurse co-ordinates the activities of other members of health care team.
 She manages the nursing care of not only one client but also of families and in
communities.
  She delegates the nursing activities to auxiliary workers and other nurses.
COMMUNICATOR:
 Effective communication is an essential element of all professions including nursing.
 Nursing involves communication with clients and families other nurses, health care
professionals, resource person and the community.
 As a communicator, nurse provides information to other health team members about
the planned and unplanned nursing care.
 She conveys information verbally as well as through documentation
 Nurse communicates verbally at change of shift.
 She reports while shifting the client from one unit to another.
COMFORTER:
 The role of comforter is a traditional and historical one in nursing and has continues
to be important as nurses have assumed new roles.
 As a comforter, nurse provides comforts to the client by considering him as an
individual with unique feeling and needs.
 She motivated clients to reach therapeutic goals.
 She promotes comforts to client by staying near the patient.
LEADER:
 Nursing leadership is defines as a mutual process of interpersonal influence through
which nurse helps client in making decisions for establishing and achieving the goals
to improve the clients wellbeing. As a leader, she influence the client to make
decisions regarding health.
COUNSELLOR:
 Nurse helps the client to recognize and cope with stressful, psychologic or social
problems.
 She assists the client for developing good interpersonal relationship.
 Nurse counsel primary healthy individuals with normal adjustment difficulties.
 Nurse helps the person to develop new attitudes feeling and behaviors.
REHABILITATOR:
 Rehabilitation is the process by which individuals returns to maximal levels of
functioning after illness, accident or other events.
 Nurse helps the clients to adapt as fully as possible who experience physical or
emotional impairment that changes their lives.
 Rehabilitative and restorative care activities range from teaching clients to walk with
crutches to help the client cope with lifestyle changes often associated with chronic
illness.
TEACHER/EDUCATOR:
 Teaching refers to the activities by which the teacher helps the learner to learn. As a
teacher.
  She determines that the client fully understood.
 She also evaluates clients progress in learning,
 She also incorporates other resources such as family, in teaching plans.
 She gives health education on diet, about preventive measures of disease,
RESEARCHER:
 Nurse investigates problems in order to improve nursing care and expand the scope of
nursing practice. She does many qualitative and quantitative researches. Based upon
these findings, they practice nursing care in hospital as well as clinical settings. For
example: investigating various ways to resolve client’s pain.
PSYCHODYNAMICS OF DISEASE CAUSATION:
PATIENT CARE:
 The common role of psychiatric mental health nurse includes following physician’s
orders, assessment and making diagnosis, assisting the family members in dealing
with a member’s mental disorder and assisting with counselling and interventions.
 Focuses on helping a client to develop new attitudes feeling and behaviors rather than
promoting intellectual growth.
 She provides emotional, intellectual and psychological support.
 Ensuring the correct administration of medication, including injections and
monitoring the results of treatment.
 Responding to distressed patient in a non-threating manner and attempting to
understand the source of distress; applying the ‘de-escalation’ approach to help people
manage their emotions and behavior.
 Carry out mental status examination and mini mental status examinations to formulate
diagnosis.
 Preparing and participating in group and /or one-to-one therapy sessions, both
individually and with health professionals.
 Encouraging patients to take part in art, drama or occupational therapy where
appropriate.
EDUCATIONA DN SUPERVISION:
 Mental health nurses also play an important role in health educational and promotion,
seeking the general public to recognize and appreciate the beneficial and harmful
effects of stress.
 Psychiatric mental health nurse may also be found in education settings where their
primary role is to teach the public or other mental health care providers about mental
health and psychological disorders
 Mental health nurse teaches patients and their families how to manage their mental
illness or psychological injury, including post-treatment home care needs, diet and
exercise programs, and self-administration of medication and physical therapy.
 Helps the students in changing the misconceptions of the client and family member’s
regarding mental health and mental illness.
 Mental health nurses interprets information to the client.
  They assist in teaching and supervising nursing students.
 Participate in teaching a client and family members regarding the disease condition
and home care.
 Plans various staff development programs based on the needs of society and staff.
INTERPERSONAL RELATIONSHIP AND COMMUNICATION:
 Develops good relationship with client and other significant members.
 Encourages patient for participating in group activities.
 Mental health nurses helps to socialize the patient,
 Communicate with other mental health team members to coordinate the services.
 Develops healthy relation with other health care professionals.
 Share the knowledge about community resources which can be utilized by the client
and family members.
 Identify potentials and capabilities of the client in meeting their needs.
 She also works as a liaison/ mediator between family members and health care team
members.
WARD MANAGEMENT:
 Nurse manager makes decisions, coordinates activities of others, allocates resources,
evaluates care and personnel.
 Nurse manager plans, gives directions, develops staff, monitors activities, gives the
rewards fairly and represents both staff and administrations as needed.
 Nurse will look after the cleanliness of the ward.
 Nurses participate in evaluating the services of other nurses and supporting staff.
 Maintain records and reports of the units and patient’s records.
 Evaluate the care provided to the client.
 Hands over and takes over during shift duties.
 Accompanies multidisciplinary team during their rounds and report the observation
made by nurses.
CONCLUSION:
Physiologic mechanism must be understood in the context of the body as a whole. Each
person, as a living system has both internal and external environment between which
information and matter are continuously exchanged. Within the internal environment each
organ, tissue and cell is also a system or subsystem of the whole, each with its own internal
and external environment, each exchange information and matter. The goal of the interaction
of the body subsystems is to produce a dynamic balance or study state. So that all
subsystems will be in harmony with each other.
BOOK REFERNCE:
 Shebeer. P.Basheer, S. Yaseen Khan, A concise textbook of advanced nursing
practice, EMMESS medical publishers, 1st edition-2012, page no. 190-194.
 Neelam Kumari, Pee Vee book of advanced nursing practice, S. Vikas & company
medical publishers, edition 2018, page no. 329-334
  Ram Kumar Gupta, A textbook of mental health nursing (PV), S. Vikas & company
medical publishers, edition 2016, page no. 31-34
 R Sreevani, A guide to mental health and psychiatric nursing, Jaypee brothers medical
publisher, 4ht edition 2018, page no. 59,60
 Dr. S. K. Mangal, Psychology for nursing, Avichal publishing company, 1st edition
2012 (reprint 2017), page no. 314,315
 Lakhwinder kaur, Maninder Kaur, A textbook of nursing foundations, PV book, S.
Vikas and company medical publishers India, 2015 edition, page no. 47-49
NET REFERNCE:
 https://en.wikipedia.org/wiki/Pathophysiology
 https://fdocuments.in/document/pathophysiology-and-psychodynamics-of-disease-
causation-html
 https://www.slideshare.net/PreetKaur91/pathophysiology-and-psychodynamics-of-
disease-causation
 https://en.wikipedia.org/wiki/Psychodynamics
 https://www.slideshare.net/Amrindersaini2/133835244-diseasecausation
JOURNAL REFERENCE:
 Theories of Disease Causation: An Overview, Published by Dharmashree Satyarup,
Manish Kumar, Radha Prasanna Dalai, Sharmistha Mohanty, Karishma R. Rathor,
Published on dec 2020.