1. 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.

2. P Death of the parents at age of 7
S P
Late birth
Y Alone child S
ORAL STAGE FIXATION Y
C SENSITIZATION
C
H TOBACCO CHEWING H
O O
CIGARETTE SMOKING
S Late birth D
Alone child
O Y
M N
Over caring FATHER
A AF:
Over caring HUSBAND A
INJU
M
T RY
Insecurity +3 I
I OA
KNEE C
C
Weather I can do my job or not??

3. Diagnostic Net

4. 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.

5. • 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…

6. 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.

7. Psychological plane…
1. Thoughts include orientation, perception, memory,
thinking, decision-making, judgment.
2. Emotions and attitudes which include all the affective
elements of the mind
3. Values, motivation, drive etc.
4. Speech, gestures and in general communication
skills
5. Motor control
6. Social sensitivity and social perception
7. Habits, coping techniques etc.
8. Behavior, which is an observable manifestation.

8. The social plane…
• The social systems in which the
individual functions assume importance.
1. Interpersonal system
2. Family system
3. Other social support system
4. Medical system
5. Other institutional systems

9. 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.

10. 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.

11. 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.

12. 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.

13. The maintaining causes…
• Perhaps the most difficult task.
• Precipitating factors also work as
maintaining.
• The disturbed marital situation which
precipitate also maintain the stress.

14. • Over a period of time,
• The balance of forces may change and a
reassessment and a fresh diagnostic net
would be called for.

15. PREDISPOSING PRECIPITATING MAINTAINING PATTERN OF RESPONSE
P Family history ? a/f FALL FROM < walking OA KNEE
H Any genetic BIKE < standing from
Y predisposition? sitting position
S < bending knee jt
I
C < winter URTICARIA
A < dinner ALLERGIC URTI
L < dust
< open air
P •Hard working < DISEASE SELF Anticipation •Anxious future about
S •Irritable < DISEASE WIFE •Anxious health about
Y •Sensitive •Habits – tobacco 1-2
C pckt/20yrs
H •High self esteem
O •Independent childhood < contradiction •Cigarette smoking 4m – 2
L •Fastidious < reprimands per day
O •High M W D •Anger shouts
G
I
C
A
L
S •Early death of parents •Late birth of his •Supervisor
O •Loves his wife & son a lot son •Stop medication
C •Only son • over caring HUSBAND &
I FATHER
A
L •Workers do not • suppression of anger at
work properly work ?

16. Thank you
Dr. Dharmesh Bhadja