XIV.

Psychodynamics – Psychopathophysiology

Prenatal Period

Genetic Father Mother

Predisposition

Aunt of patient
with a history of
anxiety; Patient’s Enjoys drinking Fisherman
first cousin with Takes care of Fifth pregnancy
alcohol since household and with no prenatal
psychosis young adulthood children on her supplements and
own short
interpregnancy
Always out of the interval
Passage of
house
marker genes
(chromosomes Decreased sperm
1,2,3,5,6,8,10,11,1 health
3,20,22)
Leaves wife to take
care of children on
her own
 Constant fighting

Stressful pregnancy

Sympathomedullary pathway
stimulated

Preganglionic neurons release

acetylcholine

Adrenal medulla releases

epinephrine and norepinephrine

Epinephrine and norepinephrine

bind to alpha receptors
Vasoconstriction If this initial
mechanism fails

Inadequate fetal
Hypothalamus releases corticotropin
blood flow
releasing hormone

Anterior pituitary gland secretes

adrenocorticotropic hormone

Adrenal gland secretes cortisol

Cortisol promotes catabolism of

stores nutrients (glycogen, protein,
fats)

Depleted nutrient stores during

pregnancy
 Inadequate nutrients for the
fetus

Possible faulty organogenesis

Potential for neural tube defects

Predisposition to neuropsychiatric disorders

Delivery Period

Delivered at home
 Manghihilot came late

Long and difficult labor

Neonate introduced to a stressful

environment at birth

Gene-environment theory

Genetic predisposition may become more dominant due

to the environment an individual is in

Neonatal Period

Breastfed for only 1 month

 Decreased Decreased mother- Ungratified oral stage IgA antibodies not
nutrition child bonding passed early on

Lack of tissue Predisposition to Oral fixations later on IgA antibodies not

nourishment identify more with the in life passed early on
father

Possible More susceptible to

interruptions in infections (including
normal brain those that affect the
development nervous system)

Infancy

Birth of younger brother

 Parents attention diverted to
younger brother

Love, security, warmth, and

comfort unsatisfied

Mistrust develops (predisposition

to hostility and paranoia)

Toddlerhood

Sibling rivalry Very lenient

Very strict mother
father

Ambivalence
Constant fights with siblings, develops
especially brother

Would always scold Controlling attitude

during toilet training towards children Predisposition to a
fragmented thought process
First instance of aggression
development
Development of Mother chose what
anal-retentive crayon color to use,
personality and what time they
Carried on later in life could play

Predisposition to
obsessive compulsive Independence not
disorder later in life fostered

Delayed achievement
of autonomy

Shame and Doubt

develops

Low self-esteem and

self-confidence

Preschool Period
 Family now with 7 kids
Caught masturbating
by mother

Parents favored younger

Constantly siblings
reprimanded by
mother

Low self-esteem Attention-

seeking behavior
Delayed Emotional
gratification of attachment to
phallic stage father
Increased
frequency of
tantrums
Anxiety Identifies with
develops the father
Mother punished
patient A by letting him
kneel on seeds
Predisposition Father is silent and
to paranoia always wants to be alone
and irrational
fears Development of guilt
 Adopts father’s behavior

School Age Period

Beginning of financial Becomes silent and an

difficulties due to family size introvert

Enjoys spending time fishing,

does not enjoy school works
Steals the watch of Poor nutrition
his friend in school

Decreased glucose
Steals the watch of supply to the brain
his friend in school
Harshly punished Poor school
by mother performance

Further development of low

self-esteem

Inferiority develops

Carried later on in life

Adolescence

Continued familial
financial difficulties

Pressure to help support the

family
 Worked as a fisherman
even on some school days

Inability to cope with Role Confusion

school work

Strained family relationship

Failed 3rd year “Do I need to finish school,
high school or do I need to work?”

Dropped out of Feelings of anxiety,

high school confusion, and pressure

Increased internal
emotional stress

Broke up with Stunted cognitive

girlfriend development

Ungratified genital Formal operational

stage stage not achieved
 Predisposition to Neural circuits and
sexual preoccupation pathways not fully
if left unresolved formed

Potential for faulty

communication between
different regions of the brain

Early Adulthood

Pursued fishing
like the father

At the age of 25, drowned

and got lost in sea for 5 days

Was found starving and

alone in Santa Cruz
 Hypoperfusion to the Traumatic and stressful
brain life event

Neurons and glial cells

Intense fear of drowning
die
and starving

Neurons incapable of
repair or regeneration Preganglionic dopaminergic neurons
of ventral tegmental area release
excessive dopamine (mesolimbic
pathway)
Possible permanent
damage to unidentified
areas of the brain

Excess dopamine in Decrease in dopamine

Possible degeneration or synaptic cleft for mesocortical
damage of frontal lobe pathway

Dopamine binds with

Low amounts of
Impaired decision- dopamine receptors on
dopamine in synaptic
making skills postganglionic neuron of
cleft
nucleus of accumbens
 Overstimulation of Under stimulation of
nucleus of accumbens prefrontal cortex

Hyperactive thought
processes
Impairment in
Anhedonia Avolition
Wernicke’s
area
Increased blood flow to Affect
frontal lobe and Bronca’s Flattening
area
Alogia

Delusions Inability to Inability to

(persecutory recognize interpret
delusions and metacognition existing stimuli
ideas of
reference)
Hallucinations Illusions
 Onset of Schizophrenia

Patient started getting addicted to

smoking cigarettes

Nicotine triggers the more dopamine Poorer alveolar gas exchange

to get released from the mesolimbic
area

Hypoperfusion of brain tissue

Worsening of schizophrenia symptoms

Defense mechanism: denial

 Left disease untreated and decided to
get married and start a family at the
age of 27

Wife does not work Wife caught cheating Cousin-in-laws are

addicted to drugs

Forced to work again Unsatisfied intimacy Physically abused

as a fisherman stage patient A inside a drum

Failed marriage:
Reminded of traumatic Isolation Intense anxiety, fear,
events 2 years ago trauma

Intense feeling of
unworthiness, low self-esteem,
hypervigilance

Dopaminergic pathways triggered

 Paranoia Ideas of Reference Disorganized behavior

Intense fear that food Thinks that people in his

has worms or poison neighborhood are talking bad
about him
Aggression Yells random
words while
banging the
doors at home
Would grab a
knife and chase
people who would
pass by his house

Family decided to ask help from police officers and barangay officials

Admitted in Babista Rehabilitation Center

(2013): Diagnosed with Schizophrenia
Disorder
 Treated via: Antipsychotics

First Generation Antipsychotics Second Generation Antipsychotics

(Typical antipsychotics) (Atypical antipsychotics)

Blocks dopamine receptors, Blocks dopamine and 5HT2a receptors,

also blocks Histamine 1, Alpha also blocks Histamine 1, Alpha 1, and
1, and Muscarinic 1 receptors Muscarinic 1 receptors

Excessive decrease Increased appetite Dopamine decreased but

Improvement in
in dopamine levels additional 5HT2A antagonism
positive symptoms
inhibits excessive loss of
dopamine
Polyphagia

Acetylcholine Pars compacta Neuroleptic Rare instances of

increases can’t send signals Malignant Weight gain extrapyramidal symptoms,
to striatum Syndrome better prognosis
 Striatum sends More capable of
faulty signals to treating both positive
primary motor Rhabdomyolysis and negative
cortex symptoms
Tardive
Dystonia
Dyskinesia

Akathesia Primary motor Increased creatine

cortex sends kinase, potassium,
faulty signals to and white blood cells
muscles

Kidney failure
Primary motor
cortex sends
faulty signals to
muscles

Cogwheel Bradykinesia Postural

Tremors
rigidity instability

Parkinsonism

Extrapyramidal Symptoms
 Discharged (2016)

Worked as a cook in Babista from 2016-2017

Received regular medications

Absence of positive symptoms

Babista relieved staff

members in 2017

Patient A went home for the

first time in 5 years

Defense mechanism of denial

(May of 2018)
 Claimed he was 100% well and no
longer required monthly medications

Stopped antipyschotics from February

2018 to May 2018

Gradual surge in dopamine levels (in

mesolimbic area)

Disorganized behavior
Paranoia Ideas of Reference

Intense fear that food Thinks that people in his

has worms or poison neighborhood are talking bad
about him Aggression Yells random
words while
banging the
doors at home
Would grab a
knife and chase
people who would
pass by his house
 Family decided to ask help from police officers and barangay officials

Admitted in SPMC IPBM (May 2018):

Schizophrenia Disorder

Treated with antipsychotics

Discharged on August 2018

Came home and displaced emotions to a

more productive job: driving a trisikad

Children no longer Father died

visiting him (December 2018)
Has not achieved
generativity

Depression, Isolation, Feelings of loneliness, worthlessness, low self-esteem

Erratic aggressive behavior

again present (January 2019)

Threatened to kill sisters

Brought back to SPMC IPBM till this day

If left untreated

Psychotic symptoms
persist
 Neurotoxic effects of Delusions and
schizophrenia (theory) hallucinations remain

Multiple changes in brain Self-mutilation and

structure including tissue potential aggressive acts
death, atrophy, and towards others
enlargement of ventricles

Somatic dysfunctions
(hypothalamus affected)

Neural and Hormonal

centers fried

Death