Psychosocial aspects

of Health and
Disease
By
Faisal Mehboob

Psychosocial aspects of
Health

Psychosocial aspects of Health

State of complete physical, mental and social well being and not the mere absence of
disease.
Parameters which describe state of health. (DO-POSE)
Dynamism is the different roles and functions of human being, and their changing and
evolving nature.
Optimization is when a person performs most of his roles in an optimum state.
Personal contentment is a despite failures and difficulties and inability to be the
worlds best scientist or best player or best father.
Socially responsible, is a health person who takes responsibility of the roles a duties
assigned by society, starting from his immediate family to his neighborhood and town
and country and to the world at large.
Occupationally effective
Economically effected
Relieved from pain and discomfort
Homeostasis
Defense mechanisms

Defense mechanism
Denial . Blocking anxiety including events or feelings.
Displacement . Discharging pent ups feelings on people less dangerous than those who
initially aroused the emotion.
Dissociation . Handling emotional conflicts or internal or external stressors by a
temporary alternation of consciousness or identity.
Fantasy. Symbolic satisfaction of wishes through non-rational thought.
Identification . Unconsciousness assumption of similarity between oneself and another.
Intellectualization . Separation of an emotion from an idea.
Projection . Attributing ones own unacceptable feelings and thoughts to others.
Rationalization . Falsification of experience through construction through logically
approved explanation of behavior.
Reaction formation. Unacceptable feelings
Repression . Unconsciously keeping unacceptable feelings out of awareness.
Suppression . Consciously keeping unacceptable feelings and thoughts out of awareness.

Reactions of patient to illness and hospitalization

(dadd)
Denial . The event of hospitalization may be perceived as overwhelming
and a challenge to the physical being.
Anger . The state of denial may recede to give way to a state of anger
Depression . A state of resignation , apathy and depression may ensue by
about the third day.
Dependence . The combined effect of the disease, the stress of
hospitalization and the consequent stresses often result in a strong
dependence-hunger.

Psychosocial aspects of
Disease

Psychosocial aspects of disease

Stress due to illness
Change of role
Financial loss
Stigmatization
Loss of self esteem
Fear of being handicapped
Uncertain prognosis

Stress of hospitalization
(Pashtu A)
Loss of privacy
Loss of autonomy

Separation from the dear ones

Need of seeking approval of the
doctors
The issue of handling over his health
matters to a group of total strangers
Threat of social dysfunction of
family
Unsatisfactory information

Psychosocial issues in special hospital settings

In coronary care units
The common psychological
reaction in patient in CCU is, a state
of anxiety, fear, distress, gloom
This lead to clinical depression .
The long term use of
benzodiazepines in cardiac patients
as a routine may also result in
benzodiazepine misuse, abuse and
dependence.

In ICU
Long periods of sensory deprivation
and sensory overload will often give
rise to a state called ICU-Psychosis
or Intensive care syndrome,
characterized by inc wakefulness,
disorientation and visual
hallucination, depression , social
withdrawal, anxiety.

In emergency department
Anger
Frustration
Guilt
Depression
Dependency
Infantilization

In organ transplants
Ethical issues
Legal bindings
Psychosocial bindings
While the recipient is of primary
significance on account of his or
her severe illness, the donor must
never be forgotten.

Pregnancy
Pregnancies which are at risk for the
developing psychosocial
complications
Primigravida, precious pregnancy ,
unwanted pregnancy
Past history of psychiatric illness
Poor marital relationship
History of drug abuse

During puerperium
Postpartum blues. A self limiting
state of low mood, weeping spells and
disturbed sleep that lasts for 10 to
14days.

Puerperal depression. If the

sad mood and disturbed biological
functions lasts for more than 2 weeks,
puerperal depression should be
considered.

Puerperal psychosis .
Characterized by delusions and
hallucinations and gross abnormities
of behavior.

Psychosocial aspects of parenting a

child with disability (CWD)
Denial of childs disability
Anger and guilt about the childs disorder
Blaming others for the disability
Grief
Worry

Common Psychaiatric Disorders

in General Health Settings

 Mixed anxiety and depression

Panic disorders
Unexplained somatic complaints/persistent
complaints
Drug abuse and tobacco use
Delirium
Suicide and deliberate self harm

Suicide

Risk factors for suicide

Individual factors (male gender,
early adult age, physical healthy
problem)
Family related risk factors (being
single or divorced)
Mental health problems (major
depression, bipolar affective
disorder )
Social risk factors (socioeconomic
disadvantage)
Environmental risk factors (easy
access to methods, media cues)

Protective factors of suicide

Sense of connectedness
Having a significant other
Being married
Having children
Personal resilience
Economic security
Good health
Restricted access to methods.

Stress

Stress
the rate of wear and tear in the body
Types . Physiological stresses (like temp, noise, hunger
, disease, smoking, drinking. ) Psychological stress
(low self esteem, social factors)]
Management.
Physical manifestations of stress (cardiovascular,
neurologic, Gastrointestinal, Musculoskeletal,
Pulmonary, Hormonal , Dermatologic, Immunity)
Emotional manifestations to stress (coping with
stress, managing the stressor, manage your behavior
,manage your time, manage your stress, exercise and
nutrition, relaxation ,social support )

Examples of physical conditions having

psychological problems
Cardiovascular (hypertension , angina, tachycardia, arrhythmia etc)
Gastrointestinal (irritable bowel syndrome, Gastric ulcer, Duodonal
ulcer )
Hormonal (hypoglycemic , Diabetes mellitus)
Immune (allergic disorders , Cancer, autoimmune disorders like SLE.)
Integumentary (neurodermatitis, pruritis, psoriasis, warts )
Neuromuscular (chronic pain, headache, sacroiliac pain)
Respiratory (asthma, TB)

Guideline for progressive muscle relaxation

Each muscle or group of muscle is tensed for 5 to 7 sec and then
relaxed for 20 to 30sec . REPEAT THE CYCLE
Four major muscle groups are covered in this order
1. Hands , forearm and biceps
2. Head, face, throat and shoulders
3. Chest , abdomen and lower back
4. Thighs , buttocks, calves and feet using this procedure.

Non-pharmacological interventions for reducing

stress

Improve time management

Improve sense of humor
Pursue personal and vocational activities
Explore meaning of life
Engage in spiritual activities
Clarify values
Cultivate social support network
Increase assertiveness
Reduce exposure to unnecessary stressors
Help others

Psychotrauma

Psychotrauma
Also known as psychological trauma , it is the result of extraordinarily stressful
events that shatters a persons sense of security, making him fell helpless and
vulnerable in a dangerous world..
Common reactions to trauma.
Guilt and self blame
Anxiety
Mood swings and irritability
Feeling numb
Insomnia
Social withdrawal
Loss of appetite
Feeling sad

Pain

Psychosocial aspects of pain

Types
Acute pain
Chronic pain
Psychological symptoms in chronic pain
Psychogenic pain disorder
Pain behavior (sick role )

Steps of pain Management

Psychological assessment
Establish primary cause of pain
Define the exact role of psychological factors (psychodynamic or
cognitive)
Make an assessment of the various environmental factor.

Cognitive strategies
These are divided into two
categories .
Dealing with stress
Modifying pain related
cognitions

Coping strategies approach

Active coping
Engaging in physical exercise or
physical therapy clearing your mind
of bothersome thoughts or worries.

Passive coping
Restricting or cancelling your
social activities. Taking
medications for purposes of
immediate pain relief.

Sleep

Psychosocial aspects of sleep and awareness

Normal sleep. Normal sleep cycle is divided into REM (Rapid eye
movement ) sleep and Non-rapid eye movement sleep.
Stages of sleep.
Stage 1. lightest stage, with theta waves on EEG and is characterized
by a sense of calmness, slow pulse, respiration and a decrease in blood
pressure. This constitute 5% of sleep cycle.
Stage 2. shows sleep spindles and K complex on EEG and occupies
45% of sleep cycle making it the largest %age of sleep time.
Stage 3 and 4 are characterized by delta waves or slow wave sleep and is
deepest and most relaxed stage of sleep. Many sleep disorders such as
night terrors, sleep walking and bed wetting occur during this stage.

Sleep disorders
Primary disorders are those sleep
disorders occurring as a direct result
of disturbances in the sleep wake
cycle. Further divided into dyssomnia
and parasomnias.
Secondary sleep disorders are a
consequences of other mental
disorders such as depression or due
to a general medical condition or
substance abuse.

Intervention for improving sleep

Inc physical activity
Cool room
A light bed time snack
Stress reduction
Avoid napping during day.
Avoid caffeine in evening .
Avoid abuse of drugs .

 For more notes.

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