Etiology CausationDiathesis and Stress

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Etiology -Causation-Diathesis and Stress
ROTP IN PSYCHIATRY MLDMHI

• DR. SUNIL D. BHALINGE, MD(HOM.)
• Director, Study Groups Academics
• INSTITUTE OF CLINICAL RESEARCH, MUMBAI
• Reader, Dept Of Organon Hom. Philosophy
• MLDMHI ,Palghar

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To understand a Phenomenon natural and disease
(Mental)

• What to study the form (complaints in evolution
  )
• Why to study comprehend the diagnosis clinical
  and homoeopathic
• How to study by analysis of symptoms (C-C-A)
  psychiatry and homoeopathic

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Homoeopathic Totality

• Symptoms state disposition
• Pre-disposition
• Diathesis
• Cause exciting , precipitating, maintaining
• Modalities
• Sensations general and particulars

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HEALTH
A STATE OF DYNAMIC STABLE EQUILIBRIUM IN WHICH AN
INDIVIDUAL IS AT PEACE WITH HIMSELF AS WELL AS
WITH THE WORLD. HE HAS NO COMPLAINTS
STRUCTURAL INTEGRITY
IN PROPORTION TO TIME
EFFICIENT FUNCTIONING
BALANCED EXPRESSION
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DISEASE
AN UNSTABLE STATE OF DISEQUILIBRIUM. IT REFLECTS
FAILURE OF ADAPTATION OF AN INDIVIDUAL TO HIS
ENVIRONMENT. THIS REFLECTS AS COMPLAINTS
STRUCTURAL ALTERATION
DISPROPORTION TO TIME
INEFFICIENT FUNCTIONING
SIGNS SYMPTOMS
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CONFLICT EXPRESSION
(1) Disturbed Imagination when the individual
indulges in Dreams day and night, Fancies and
Fantasies
(2) Altered Physiological Functions e.g.
Appetite, Digestion, Elimination, Sexual
functions and Sleep disturbances (including
dreams).
(3) Drop in Performance and Efficiency At
school college, play and work.
(4) Disturbed Intellectual Performance
Confusion and Aberrations of Perception and
Thinking. Impaired thinking, memory (Rote and
Logical or Associative), discrimination,
judgement and decision.
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(5) Emotional Disturbances Overt display of
Emotions with their inherent, complex, and
mutually reinforcing potential, the chief
amongst them being
Anger Sadness Love Hate
Envy, Jealousy, Suspicion Anxiety, Fear, Fright,
Guilt.
These give rise to various neurotic and psychotic
syndromes.
(6) Altered Psycho-Physiological Functioning
resulting from Suppressed / Repressed Emotions
Symbolization of Emotional Conflicts, as in
Organ Neurosis.
(7) Structural (Psycho-Physiological)
Alterations Resulting from Suppressed /
Repressed Emotions Somatization of Emotional
Conflicts, as in Psychosomatic Disorders.
(8) Altered Behaviour Speech, Gesturers and
Actions.
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ENVIRONMENTAL CAUSES HUMAN ORGANISM IS
SUSCEPTIBLE TO
1. Physical Electrical, Magnetic, Lunar, Solar,
Planetary, Radiation.
Position and Balance in Space Time Periodicity
Epochs in Life.
Sensory Inputs Pain Thermal
Meteriological Temperature weather,
Seasons, humidity.
Skin Touch, Pressure, Jar (Vibration),
Rubbing
Ears Noise, Music
Eyes Light, Vision
Tongues Taste, Desires and Aversions.
Nose Odours
Addictions Sex Reproduction.
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Emotional
Chemical Drugs, Heavy Metals, Fumes and
Gases. Occupational Hazards Odours
Biological Germs, Viruses, Parasites,
Fungi Prophylactic Vaccinations and
Inoculations and Sera, as well as
Therapeutic.
Socio-Cultural, Religious, Spiritual
Economico-Political Milieu
Sleep Dreams
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WHAT IS A CAUSE ?

• If one knows the WHY he can understand the
  HOW
• Is CAUSE a unitary factor or a multifactorial
  phenomenon?
• We need to understand various factors affecting
  the person time to time, passing through the
  entire process which leads to the present picture
  of illness.

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• If one considers organisms as a cause of any
  condition, the mode of treatment has a central
  idea to finish the organisms.
• While if one consider the all the responsible
  factors, as example organisms as well as miasms,
  as the causative factors then he has to deal with
  both in order to established the cure. Thus
  therapeutic action is determined at removing the
  Cause.

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CAUSE-EFFECT-PHENOMENON

• Etiology is the identification and collection of
  all causative factors and understanding their
  effects in development of disease. Thus
  establishing the phenomenological sequence of
  cause - effect relationship in a given case is
  essential in management of any illness.
• Thus establishing the phenomenological sequence
  of cause - effect relationship in a given case is
  essential in management of any illness.

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• Causality denotes a necessary relationship
  between one event (called cause) and another
  event (called effect) which is the direct
  consequence (result) of the first.

• Etiology is the identification and collection of
  all causative factors and understanding their
  effects in development of disease

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Etiology

• concerns itself with the synthesis of causative
  factors in the pathogenesis of a disease to
  enable one to form a comprehensive picture of the
  development of the disease in all its stages.
• Concept of Etiology is changing and evolving time
  to time from ancient to recent era

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History of Medicine

• Natural forces e.g. thunderstorms, lightning,
  earthquakes, eclipses, waning and waxing of moon,
  high and low tides, storms, etc.
• Supernatural concept of disease existed like the
  devil, demons and ghosts as reasons for
  sickness..
• HIPPOCRATES-Diseases as a Phenomenon
• Sydenham - disease as a definite clinical entity
  grafted on the host. He considered disease is
  something comes from out, not from within.
• Virchow - Cellular pathology and shifted the
  concept from organs and tissues to cell as a
  unit. And the cause of disease lied in the cell.
• Koch- bacteriology

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OTHER FACTORS

• Personal
• Familial
• Social
• Economic
• Religious
• Cultural
• Immunological
• Genetic and
• Psychological Factors

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CONCEPT Time as a Cause

• An Event is a recognizable unitary expression of
  a moment (frozen time).
• Our Mind interprets this sequential order of
  Events in Nature as Causation.
• All Events take place in the Time Continuum
  (Past, Present and the Future being regarded as a
  continuous sequence)
• The Field is defined as the four-dimensional
  Space (Time serving as the fourth dimension) in
  which the Phenomenon occurs.

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Natural Diseases as imprint on Time

• Clinical Evolution and Expression of Disease give
  us a clinically useful Standard of Time.
• Correlated with the operations of the
  environmental factors.
• Interpret all these observations in relation to
  the Hahnemannian Theory of Miasms and Dyscrasia.
  And these can be generalized as Time-Expression.

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• Form Identify objects through their external
  qualities
• Function The use to which an object is put,
• Structure The reason for this why?
• How does it arise?
• From What does it arise?

WE NEED TO DISCOVER THE BUILDING BLOCKS
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HEREDITY-SUSCEPTIBILITY-EVOLUTION

• All Forms and Expressions, is due to
  Susceptibility a fundamental property of the
  Living World.
• Susceptibility is responsible for the response to
  the various inputs it receives from the
  Environment.
• The Genetic Code determines the Susceptibility,
• The System evolves through specialization as
  well as organization and thereby improves the
  capacity to dominate the surroundings through an
  appropriate response.
• The sophisticated control systems the
  Psycho-Neuro-Endocrine and the Reticulo-Endothetia
  l Systemshelp to maintain effective harmony over
  a wide range of environmental circumstance.

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ROLE OF OBSERVER

• The Structure steadily keeps on evolving from
  infancy, keeping pace with the processes of
  maturation till a steady state is reached at the
  end of the period of adolescence.
• This evolution is reflected outside as a changing
  Form and Responses.
• These together constitute the only evidence
  available to the observer for the derivation of
  the structure which is a mere Concept not a fact
  of experience.

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• CASE MR S.N.P
• DISCUSSION

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Hahnemann - the Real Pioneer of Psychiatry
 
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Plato in the fifth century BC, echoed by
Hahnemann two centuries ago
"The cure of the part should not be attempted
without treatment of the whole. No attempt
should be made to cure the body without the soul
and, if the head and body are to be healthy, you
must begin by curing the mind... for this is
the great error of our day in the treatment of
the human body, that physicians separate the soul
from the body" -
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Case of Klockenbring
Was "Hanoverian Minister of Police and Secretary
to the Chancelleryand In his fast life, He
developed great eccentricity," had "the most
dangerous venereal disease and moral vices
ranging from drunkenness to fraud," "became
violently insane," Bradford, 53.
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• 1793, that "Pinel made his first experiment of
  unchaining maniacs in the Bicêtre," ibid.,
  which was some fifteen months after Hahnemann had
  commenced treating Klockenbring.
• Hahnemann's entry into the psychiatric field "was
  four years before William Tuke, the English
  Quaker had finally established the Retreat in
  Yorkand a year before Pinel reformed the Bicêtre
  Asylum in Paris," Hobhouse, 85.

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This single incident undoubtedly provided
Hahnemann with some pioneering ideas about the
nature of mental disease and how sufferers ought
to be treated. Whether it gave him any
conception of mental illness, as a separate
category of sickness seems unlikely, because such
an idea clearly flies in the face of the holistic
views inherent to homeopathy itself.
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Hahnemanns concept
CONSTITUTIONAL
MIND

• Mind Body Inseparable
• Level of Expressions
• Causation
• A chronic disease
• 5. Miasmatic origin Psoric origin

BODY
L T E R A T I O N S
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MENTAL DISORDERS CONCEPTS ORGANON
APH 210
Chronic disease One-sided diseases Psoric
origin
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CLASSIFICATION OF MENTAL ILLNESS
ACCORDING TO ORGANON
Mental illness
Aph 215 Corporeal diseases
(Fatal)
Acute expression of mental illness
Aph 221 Acute emotions
Mental illness
Aph 224 Social background
(Corrupt Morals, Bad practices,
Superstitions)
Mental illness
Aph 225 Corporeal diseases
(Maintaining factors) Corporeal disease
worsen
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ORGANON ( 87- 90)

• Sensation
• Functions
• Disposition of Mind State
• Observations (Mood,Comprehension,
• Speech,Expressions)

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ORGANON (94 5)

• Moral Intellectual Character
• Ordinary occupations
• Unusual mode of living diet
• Social Domestic Relations/Situations
• What is there in it which produce,
• maintains disease so that its removal
• recovery may be Promoted

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ORGANON (96-98)

• DISPOSITIONS

Hypochondriac Indolent Mild Falsely Modest
Demands- Circumspection,Knowledge of Human
Nature, Caution in Conducting Enquiry,Patience
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CATEGORIES OF MENTAL ANALYSIS
1. MENTAL SYMPTOM/S 2. MENTAL STATE 3. MENTAL
DISPOSITION
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MENTAL STATE

• A combination of Circumstances or Attributes
  belonging for the Time being to a certain person
  or thing
• A Particular manner or way of existing as defined
  by the presence of certain Circumstances or
  Attributes

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MENTAL STATE
INTELLECTUAL
REACTIONS
EMOTIONAL
I M B A L A N C E
ACTIVITY
A C T I O N
BEHAVIOUR
EVIDENCE
INACTIVITY
FUNCTIONING
FAMILY
DISSATISFACTION
SOCIETY
WORK
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MENTAL DISPOSITION

• Arrangement for the accomplishment of a Purpose
  Plan
• The State or Quality of Being disposed (to, OR to
  do something)
• The condition of Being

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Classification of Psychiatric Symptoms
Cognition (thinking)
Affect (feeling)
Conation (action)
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BASIS FOR DSM-IV PSYCHIATRIC DIAGNOSIS

• EXPLICIT DIAGNOSTIC
  
  CRITERIA
• MULTI-AXIAL SYSTEM
• DESCRIPTIVE APPROACH

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MULTIAXIAL CLASSIFICATION
AXIS I CLINICAL DISORDERS OTHER CONDITIONS THAT
MAY BE A FOCUS OF CLINICAL ATTENTION AXIS II
PERSONALITY DISORDERS MENTAL RETARDATION AXIS
III GENERAL MEDICAL CONDITIONS AXIS IV
PSYCHOSOCIAL AND ENVIRONMENTAL




PROBLEMS AXIS V GLOBAL ASSESSMENT OF
FUNCTIONING
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(No Transcript)
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HOMOEOPATHY CAUSATION
Individual Susceptibility PREDISPOSITION,
DISPOSITION , DIATHESIS, ENVIRONMENTAL
FUNDAMENTAL-EXCITING-MAINTAINING
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CAUSATION - 1
1. GENETIC LINKAGE
FUNDAMENTAL MIASMATIC BACKGROUND
2. DEVELOPMENTAL PRE-DISPOSITION
DISPOSITION
3. TEMPERAMENT
APH. 224 3
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CAUSATION - 2
DOMESTIC LIVING FAMILY RELATIONS SOCIAL /
CULTURE

• LIFE EVENTS
• LOSES
• LACK OF SUPPORT
• SOCIAL REPUTE

APH. 225, 94 5
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CAUSATION - 3
BIOLOGICAL STRESSORS ?CHRONIC/ TERMINAL
ILLNESS ?PHARMACOLOGICAL AGENTS
CORPOREAL DISEASES SUBSTANCE ABUSE/ SUPPRESSIONS
SEX ? FEMALES
GENETIC
DISPOSITION FUNDAMENTAL MIASMS
HORMONAL
TEMPERAMENT
APH. 213
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PSYCHODYNAMICS EXPRESSIONS ARE A RESULT OF
VARIETY OF CONFLICTS
Old age
EVOLUTIONARY
SITUATIONS
ENVIRONMENT
Middle age
PERSON
Adulthood
Adolescence
College
School
Pre school
Child
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MATERIA MEDICA
Symptomatic expressions of functional human
pathology
Mind Body
Expressions
Disposition
State
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MIASMATIC DERIVATION OF MIND
Fundamental Fly h/o Past h/o
(Personality attributes)
Structure
evolution
time
form
function
(Present symptomatology)
(Defence mechanism)
Dominant Present state
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KNOWLEDGE OF DISEASE PERSON SYMPTOMS CLASSIFICATI
ON ANALYSIS EVALUATION SYNTHESIS TOTALITY
C O N C E P T S
APPROACHES
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MIASMATIC CONCEPT
Ref Notes on miasms Dr. Ortega.
Past History
Non Venereal disease (Psoric)
OVER GRATIFICATIONS

• Hypersensitivity
• Desires

CONFLICTS
DEPRIVATIONS
POLLUTIONS
VENEREAL DISEASE (SYCOSIS/SYPHILIS)
SYCOTIC MENTAL SYMPTOMS
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Ref Dr. J.H. Allen
Thought
Faults
Will
Action
Venereal Disease ? Sycosis (most Potent, lust
disease)
Gonorrhoeal discharges
Suppression

• Fibrous
• Chronic rheumatism

Suppression of such Sycotic Expressions
Mania, Insanity other Mental Aberrations
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PREDISPOSITION
Psora
Sycosis
Tubercle
Syphilis

HEREDITY
Tubercular Base
Family History Past Personal History Tubercular
type (constitution)
Syphilitic Base
Family History Past Personal History Syphilitic
type (constitution)
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MIASMATIC CONCEPT
Dr. Paschero
BIRTH
PSORIC ORIGIN
ANGUISH
EXPERESSIONS
SYPHILITIC DESTRUCTION
SYCOSIS RETENTION
MENTAL SYMPTOMS