1. Lab Activity

2. * General learning objective Upon completing this session, the student should be able to create a genogram of patient and family * Specific learning objective * Explain the function of genogram * Describe the steps in creating a genogram * Interpret a given genogram * Given a case, create a genogram

3. Task: Please interpret this genogram! xxx Seni, 45Nunik, 40 Raffi, 13 Yuni, 10 Jecko 72 Gogon’s Family As of November 1, 2011 Gogon, 43 D= 2000 Jenny 65 Memet 65 1995

4. Red line: living together on week days Green line: living together on weekends

5. * Genogram The genogram is a biopsychosocial family tree. It records the family in its life cycle, family illnesses and relationships.

6. Function of genogram The uses of genogram are threefold: * as a quick overview of the interrelationships between family members * as a way of looking at the family medical and psychosocial problems * as a tool for understanding the multigenerational family systems

7. * Standardized Symbols used in Family Genograms A b m d D male female Sex not specified Deceased/death Adopted female date of birth date of marriage date of divorce Date of death abortion or miscarriage Pregnancy-child in utero Dizygotic twins Monozygotic Twins Induced abortion

8. * Standardized Symbols used in Family Genograms married and year Divorce and year Unmarried relationship Separation and year 1989 1990 1992 Conflictual relationship Distance relationship Close relationship 1989 1992 Family living together

9. * Standardized Symbols used in Family Genograms Symbols of diseases or situation Allergy Alcoholism Obesity Asthma Hypertension xxx ♥  ♥  Heart disease Stroke Depression War Casualty

10. * Commonly used Abbreviations ALC Alcoholic ALL Allergy ART H Arthritis CAD Coronary Artery Disease CVA Cerebrovascular Accident CA Cancer DEP Depression DM Diabetes mellitus GI GI tract disease HT Hypertension MI Myocard Infarction MV P Mitral Valve Prolapse PU D Peptic Ulcer Disease SL E Systemic Lupus Erythematosis TB Tuberculosis

11. * GENOGRAM COMPONENTS 1. Symbols 2. Three or more generations 3. The name of family 4. A listing of the first born of each family to the left, with siblings listed sequentially to the right 5. The names of all family member 6. Age or year of birth of all family members 7. Any deaths, incl. age of death and cause 8. Dates of marriages and divorces I II III Bakri, as of 8 April 2010 Ardi,68 Nia,64 1970 1969

12. * GENOGRAM COMPONENTS 9. Significant diseases or problems of family members 10. Indication of members living together in the same household 11. A key depicting all symbols used 12. Symbols selected for simplicity and maximum visibility I II III Bakri, as of 8 April 2010 Ardi,68 Nia,64 1970 1969

13. Interpretation: From the life cycle perspective…. From type of family… From the psychodynamic…. The risk factors……..

15.  xxx Lusi, 33, Fibroadenoma mammae Bobby’s Family As of October 9, 2011 M= 1972 D= 2004, Female cancer Ani, 54 Ina, 12 Ima, 5 Ratna, 36 Widodo, 25 Andre, 35 Bobby, 37 Susilo, 67

16. Case 3.1 * Alice is a 36-year-old single woman was diagnosed with eczema. Her brother, 25 years old had asthma. She has one big brother and 2 youngest sisters. No other family members have had asthma. Her father died at age 61 years old and her mother is post acute myocardial infarction patient. In a maternal aunt, breast cancer developed.

17. Case 3.2 * Mrs. Marni, is a 34-year-old woman was diagnosed with headache and injury in her shoulder. Her husband and 3 children (boy (12), and twin girls (5)) also are seen at the clinic. Two of children (boy and one of the twin) have been diagnosed as attention-deficit/ hyperactivity disorder (ADHD). Her husband has been treated for depression and high blood pressure. Further questioning * Her father had hypertension and her mother had migraine. Both are still alive. * She lives with her husband and her children. She has conflict with her husband and experienced domestic violence. * She is worry about her son because he is always rebelling to his father and influencing her sisters to do so.

18. * Case 3.3 Jojon is a 44-year-old man was diagnosed with chronic obstructive lung disease. His parents are living and both have type 2 diabetes. He has two siblings, both older brothers. One of his brothers died because of traffic accident. His wife died because of alcohol intoxication. He had overt close relationship with his wife. They have no children. He is living alone in his house.