PATHOPHYSIOLOGY AND

PSYCHODYNAMICS OF DISEASE
CAUSATION

BY: MS. GRACE WILLIAM

MSC. NURSING 1ST YEAR
GCON, RAIPUR
INTRODUCTION

 The study of pathophysiology (or pathobiology)

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 imbalance during the cell cycle
and replication and usually adapt successfully in
response to such stresses.
DEFINITION

 Health:-
 Health is a state of complete physical, mental,
and social well being and not merely the absence
of disease or infirmity.-WHO
 Pathophysiology
 It is the physiology of altered health. The term
combines pathology and physiology. Pathology
deals with the study of structural and functional
changes and physiology deals with the functions
of the human body
DEFINITION
 Psychodynamics
 It is a systematized study and theory of the psychological
forces that underlie human behaviour, emphasizing the
interplay between conscious & unconscious motivation and
the functional significance of emotion.
 It is defined as human behaviour, either external or internal
which can lead to its state of health or disease.
 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” .
DETERMINANTS OF HEALTH
 Human biology:-
 Genetic inheritance and physiological factors:- Physical
conditions such as being pregnant or overweight place an
increased risk of stress on physiological system increasing
susceptibility to illness in that area.
 Hereditary or genetic predisposition-A family history of
diabetes mellitus is at risk of developing disease later in life.
Other genetic risk factors include family history of cancer,
heart disease or mental illness.
 Age :Age increases or decreases susceptibility to get illness.
E.g. an infant born prematurely and neonates are more
susceptible to infection. The risk of heart disease increases
with age for both sexes.
DETERMINANTS OF HEALTH
 Environment:-
 Micro-environment: Refers to immediate environment or personal
environment usually include home environment, occupational
environment, and socio-cultural environment.
 Macro – environment: External environment which is outside the home
environment.
 Physical environment: It includes housing; building structures and wide
variety of physical substances which directly or indirectly regulate body
mechanism and effect health.
 Social environment: It includes other people and social institutions, socio-
cultural events, religious beliefs, moral and ethical values and social rules
and regulations pertaining to living in the society. The individuals develop
certain practices which will have positive and negative impact on health.
 Biological environment:- It comprised of plant and animal kingdom which
help in maintaining the ecosystem and thereby health of people.
DETERMINANTS OF HEALTH

 Lifestyle:-
 Life style refers to the people’s ways of living
which is reflective of their knowledge,
attitude and practices. It is composite of daily
living activities, behavioral and cultural
practices including customs and traditions
e.g. unhygienic practices, nutritional
deficiencies, smoking, alcoholism etc.
 Health and health allied resources:-
 Socio-economic conditions:-
 It includes economic status, education, occupation and living
standard.
 Political system:-
 It has a very strong role in promotion of people in the country.
The health care delivery system is determined by the political
system through there is constitutional control.
 Health related services:-
 It includes education, food and agriculture, industry, rural and
urban development, social welfare and manpower
development, communication and broadcasting and
transportation etc.
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.
 Genetics and physiological factors
 Age
 Environment
 Lifestyle
ETIOLOGY
 It is defined as a specific part of the disease which act as a main
cause for the occurrence of the disease. There may be sometimes
only one or the group of etiology which causes the disease.
Sometimes the etiology may be unidentified or idiopathic
 Hereditary
 Congenital
 Inflammatory
 Degenerative
 Infection
 Deficiency
 Metabolic
 Neoplastic
 Traumatic
CONCEPT OF DISEASE CAUSATION

 It includes:
 Theories of disease causation
 Pathogenesis
 Iceberg phenomenon
 Theories of disease causation:-
 Old theories
 Germ theory of disease
 Biomedical model
 Theory of multi-factorial causation
 Epidemiological triad
 Lazarus theories of stress response
 Wolff’s theory of stress, organ mal-adaptation and
disease
 Holmes and Rahe’s theory of life change and the
onset of illness.
 Old theories:-
 Old theories- till the end of 18th century, various
theories were in vogue, e.g. supernatural theory
of disease (e.g. curse of God, an evil eye)
 The Ayurveda considers that the disease is due to
imbalance of the “tridoshas”. These are Vata (air),
Pita(bile), Kapha(mucus)
 The Chinese medicine believes that the disease is
caused due to imbalance of male principle (yang)
and female principles (yin)
 Germ theory:-
 The discoveries in microbiology became a turning point in the
etiological concept of disease.
 Louis Pasteur(1860) demonstrate the presence of bacteria in the
air.
 Robert Koch (1877) showed the anthrax was caused by bacteria.
 These theories of Pasteur and Koch confirmed the germ theory of
disease
 Thus the emphasis has shifted from empirical causes (like bad air
as cause in malaria)of the old theories to microbes of Germ
theory.
 But now, it is recognized that a disease is rarely caused by a single
agent alone, but depends upon a number of contributory factors.
 Biomedical model:-
 This model explains disease as a result of
malfunctioning organs or cells .e.g. diabetes
is caused by malfunctioning of pancreas.
 But the drawback with it is that it focuses on
cause and effect relationships, tends to
ignore the psychosocial component of the
disease.
 Theory of multi-factorial causation:-
 This theory of multifactorial causation was put forth by Pettenkofer
Munich (1819-1901).
 Disease is not caused by an organism but predisposed by many
factors contributing to its occurrence, specially “modern diseases”
of civilization
 These predisposing factors are:-social, economic, cultural, genetic,
psychological factors, etc.(including poverty, illiteracy, ignorance,
poor living condition, over-crowed)
 This theory de-emphasizes the “Germ theory” (or single cause
idea).
 It is now known that most of these factors are so much linked to
life-style and human behavior, that they are considered as “Risk-
factors”, in the web of causation of the disease.
 Web of causation:-
 It was suggested by MACMAHON and PUGH.
 This model is ideally suited in study of chronic
diseases where disease agent is not known
but is outcome of interaction of multiple
factors.
 It considers all predisposing factors of any
type and there interrelationship with each
other. E.g Myocardial infarction
 Epidemiological triad:-
 The triangle has three corners (called
vertices):
 Agent, or microbe that causes the disease
 (The “what” of triangle)
 Host or organism harboring the disease.
 (The “who” of the triangle)
 Environment, or those external factors that
cause or allow disease transmission
 Lazarus’s theory of stress response :-
 According to him, in the process of coping , the individual shapes as
well as responds to a demand or stress which can have an impact on
the client’s resistance to disease
 Wolff’s theory of stress, organ mal-adaptation and disease:
 He studied people’s responses to chronic stressors, like a frustrating
job or an unhappy home life. He believed that a person’s total life
situation, profoundly affects a person’s susceptibility to disease
 Holme’s and Rahe’s theory of life change and the onset of
illness:-
 They explored the relationship between the amount if change in a
person’s life and subsequent illness.
 They discovered that the higher a person’s life change score, the
greater the likelihood that an illness would develop
PATHOGENIES OF THE DISEASE

 Prepathogenesis phase
 Pathogenesis phase
 PREPATHOGENESIS PHASE
 This phase refers to the period before the
onset of disease. During this phase,
interaction is taking place among the three
components of epidemiological triad namely
agent, host and environment, each
representing the angle of triangle respectively.
 PATHOGENESIS PHASE
 The pathogenesis phase begins with the entry of the
disease "agent" in the susceptible human host
 ICEBERG PHENOMENON
 To this disease can be closely related with an iceberg. The
floating tip of iceberg represents what physician sees in
the community i.e clinical cases.
 The vast submerge portion of the iceberg represents the
hidden mass of disease i.e latent, unapparent,
presymptomatic and undiagnosed cases and carrier in the
community. The waterline represents the demarcation
between apparent and unapparent diseases.
BODY- DYNAMIC BALANCE- A
STEADY STATE:
 The person, as a living system, has both an
internal and an external environment.
 Information and matter are continuously
exchanged between the environment.Within
the internal environment each organ tissue
and cell is also a system or a subsystem of the
whole each with its own internal and external
environment exchanging information
 The goal of the interaction of body
subsystem is to produce a dynamic balance
or a steady state so that the subsystem are in
harmony with each other.
 Four concepts
 Constancy
 Homeostasis
 Stress
 Adaptation
CONSTANCY

 Claude Bernard,19th century french

physiologist, develop the biological principle
that for life their must be constancy despite
changes in the external environment The
constancy was the balance internal
statement by physiologic and biochemical
process
HOMEOSTATIC MECHNAISMS OF
BODY
 Homeostatic mechanisms control a property of all living
things called homeostasis. Homeostasis is a built-in,
automated, and essential property of living systems.
Breathing is an example of a homeostatic property.
Homeostatic mechanisms are self-regulating mechanisms
that function to keep a system in the steady state needed
for survival. These mechanisms counteract the influences
that drive physiological properties towards a more
unbalanced state Conditions that are regulated in
homeostasis include blood glucose level, temperature,
water content of the body, and the amount of carbon
dioxide and urea being carried by the blood.
DEFINITION

 Homeostasis, from the Greek words for

"same" and "steady," refers to any process
that living things use to actively maintain
fairly stable conditions necessary for survival.
INTERNAL COMPONENTS OF
HOMEOSTASIS:
 Concentration of oxygen and carbon dioxide
 pH of the internal environment
 Concentration of nutrients and waste
products
 Concentration of salt and other electrolytes
 Volume and pressure of extracellular fluid
 Control Systems of homeostasis
 Extrinsic
The nervous system depends on sensors in the skin or sensory organs
to receive stimuli and transmit a message to the spinal cord or brain.
Sensory input is processed and a signal is sent to an effector system,
such as muscles or glands, that effects the response to the stimulus.
The endocrine system is the second type of extrinsic control, and
involves a chemical component to the reflex. Sensors detect a
change within the body and send a message to an endocrine
effector (parathyroid), which makes PTH. PTH is released into the
blood when blood calcium levels are low. PTH causes bone to
release calcium into the bloodstream, raising the blood calcium
levels and shutting down the production of PTH.
 Some reflexes have a combination of nervous
and endocrine response. The thyroid gland
secretes thyroxin (which controls the metabolic
rate) into the bloodstream. Falling levels of
thyroxin stimulate receptors in the brain to
signal the hypothalamus to release a hormone
that acts on the pituitary gland to release
thyroid-stimulating hormone (TSH) into the
blood. TSH acts on the thyroid, causing it to
increase production of thyroxin.
 Intrinsic
 Local, or intrinsic, controls usually involve
only one organ or tissue. When muscles use
more oxygen, and also produce more carbon
dioxide, intrinsic controls cause dilation of
the blood vessels allowing more blood into
those active areas of the muscles. Eventually
the vessels will return to "normal".
Feedback Systems in Homeostasis

 NEGATIVE FEEDBACK MECHANISM

 These are used by most of the body's
systems, and are called negative because the
information caused by the feedback causes a
reverse of the response. Negative feedback
mechanism consists of reducing the output or
activity of any organ or system back to its
normal range of functioning.
 A good example of this is regulating blood pressure.
Blood vessels can sense resistance of blood flow against
the walls when blood pressure increases.,The blood
vessels act as the receptors and they relay this message
to the brain. The brain then sends a message to the
heart and blood vessels, both of which are the effectors.
The heart rate would decrease as the blood vessels
increase in diameter (or vasodilation). This change
would cause the blood pressure to fall back to its
normal range. The opposite would happen when blood
pressure decreases, and would cause vasoconstriction.
POSITIVE FEEDBACK MECHANISM

 It is designed to accelerate or enhance the output

created by a stimulus that has already been activated.
Input increases or accelerates the response. During
uterine contractions, oxytocin is produced. Oxytocin
causes an increase in frequency and strength of
uterine contractions. This in turn causes further
production of oxytocin, etc. Unlike negative feedback
mechanisms that initiate to maintain or regulate
physiological functions within a set and narrow range,
the positive feedback mechanisms are designed to
push levels out of normal ranges
HOMEOSTATIC IMBALANCE

 Many diseases are a result of disturbances of homeostatic,

a condition known as Homeostatic imbalance.
 As it ages, every organism will lose efficiency in its control
system. The inefficiency gradually results in an unstable
internal environment that increases the risk for illness.
 In addition, homeostasis imbalance is also responsible for
the physical changes associated with aging.
 Heart failure has been seen where nominal negative
feedback mechanism become over whelmed and
destructive positive mechanism take over.
 Role of nurse in prevention of disease
 Participation in early diagnosis and
treatment.
 Notification of certain specific diseases
 Identification of source of infection and
method of spread
 Health education of people.
 Control of communicable diseases.