Psychodynamic interpretation• Dominant defense mechanism• The trauma or the cause• The stage at which pt become fixed.• the nature of inner conflict give rise to the problem.• The relative strengths and weakness of the person.
P Death of the parents at age of 7S P Late birthY Alone child S ORAL STAGE FIXATION YC SENSITIZATION CH TOBACCO CHEWING HO O CIGARETTE SMOKINGS Late birth D Alone childO YM N Over caring FATHERA AF: Over caring HUSBAND A INJU MT RY Insecurity +3 II OA KNEE CC Weather I can do my job or not??
The purpose…• During filling the columns, student becomes aware of the missing data for whole and comprehensive study of the pt. the enquiry can be extended in the desired direction. Lacunae in the net indicate the understanding arrived by the physician which ma have been well taken, but generates many questions in mind of learner …EDUCATIONAL PURPOSE.• This tool allow us to plan the mode of treatment, by applying various factors via understanding their strength in particular case with better chances to succeed since all factors would have been taken into account …THERAPEUTIC PURPOSE.
• The human being is a complex bio- psycho-social organism.• Physician will have to reorient his understanding of the pt to fit in with the actual complexity that is present.• So divided into three planes…
The physical plane…• Comprise of – Peripheral biosystems • PERIPHERAL-Molecular, cellular, organ, systems as in electrolyte disturbances, hepatitis or diabetes mellitus respectively. – Central biosystems • CENTRAL- autonomic, neroendocrine, subcortical as in diabetic neuropathy, thyrotoxicosis and encephalopathy.
Psychological plane…1. Thoughts include orientation, perception, memory, thinking, decision-making, judgment.2. Emotions and attitudes which include all the affective elements of the mind3. Values, motivation, drive etc.4. Speech, gestures and in general communication skills5. Motor control6. Social sensitivity and social perception7. Habits, coping techniques etc.8. Behavior, which is an observable manifestation.
The social plane…• The social systems in which the individual functions assume importance.1. Interpersonal system2. Family system3. Other social support system4. Medical system5. Other institutional systems
Construction• The vertical grid… gives us the idea of the functioning of the human being on different levels i.e. physical, psychological and social.• The horizontal grid… gives us an analysis of causal factors while the last column of this grid allows us to view the end results that the pt is afflicted with.
Operation…• Identify the pattern of response…• As alcoholic suffering from gastritis is having hallucination and is unemployed.• Last column thus would be filled up with the respective problems of gastritis, hallucinations and work unemployment.
The precipitating factors…• Easy if sudden onset after a particular event.• Easy for physical, slightly difficult on psychological plane and can be difficult on social plane.• Prolong alcohol can precipitated the gastritis but what for hallucinosis and the unemployment.• the break up of marriage and Grief of loss of parent may pushed him into depression and into alcohol dependence. Two different precipitating factors at different time. The psychological factor of loss of parent and the social factor of marriage break-up leading to alcohol dependence and the hallucinosis.
The predisposing causes…• Would compromised of both the attributes as well as the established defense mechanisms evolved by the pt.• These have been placed before the onset of illness.• So they are combination of the healthy and the not- so-healthy patterns of coping but which nave stood him in good stead till illness takes over.• Genetic predisposition in form of depressive illness in one of the parents.• Psychologically he would have had a pampered childhood, be impulsive, demanding, having poor communicating skills.• At social level, family stress in form of a broken home, an alcoholic fa.
The maintaining causes…• Perhaps the most difficult task.• Precipitating factors also work as maintaining.• The disturbed marital situation which precipitate also maintain the stress.
• Over a period of time,• The balance of forces may change and a reassessment and a fresh diagnostic net would be called for.
PREDISPOSING PRECIPITATING MAINTAINING PATTERN OF RESPONSEP Family history ? a/f FALL FROM < walking OA KNEEH Any genetic BIKE < standing fromY predisposition? sitting positionS < bending knee jtIC < winter URTICARIAA < dinner ALLERGIC URTIL < dust < open airP •Hard working < DISEASE SELF Anticipation •Anxious future aboutS •Irritable < DISEASE WIFE •Anxious health aboutY •Sensitive •Habits – tobacco 1-2C pckt/20yrsH •High self esteemO •Independent childhood < contradiction •Cigarette smoking 4m – 2L •Fastidious < reprimands per dayO •High M W D •Anger shoutsGICALS •Early death of parents •Late birth of his •SupervisorO •Loves his wife & son a lot son •Stop medicationC •Only son • over caring HUSBAND &I FATHERAL •Workers do not • suppression of anger at work properly work ?