Behavioral Sciences

Instructor: Dr Ejaz Sb.

Prepared by : Abdul Wasay

abdulwasay789@gmail.com

Amna Inayat Medical College (AIMC)

16-Sep-13

Four Pillars of Medical Ethics

Autonomy – patient has absolute right to opt procedure and treatment for himself

Beneficence – all medical professionals do good to patient under all cicumstances

Non Malefiences – no harm to patient or minimize it to best possible level

Justice – recourses to be delivered on equal need and measures of equity

How to Break a Bad News Bio Psycho Social Model

This model prefers delivery of information to the

patient on evidenced based medical facts and

tailoring it acc to need of patient

Seating and sitting

Exclusivity

Involvement of significant other

Seating arrangements

Attentive and calm

Listening mode

Availibility

Patient’s perception – what is the idea of patien

about specific disease

Invitation – ask patient what amount he want to

know about his disease

Knowledge – give hints and tell him with pause

and delay, like incident

Empathy – understand the feelings of pateint

Summarize

Plan of Action

Maslow’s Pyramid of Hierarchical Needs Slef

actulization

Esteem and recognition

Love and belonging

Safty – avoid harm attaining security ,order and Phys safty

Basic physiological needs – biological needs for food, shelter, water, oxygen sex

SEL the SaBon

Defense mechanism

(3D 3R 2I PSF)** Denial** – blocking out painful inducing events – knowing smoking hazard, not quitting

Displacement – discharging emotions less dangerous, low grade and shout on paramed

Disassociation – handling emotional conflicts by temp alteration in behavior, Kabootar Bill relation

Fantasy – symbolic satisfaction of wishes through nor rational, Hawai Qilly, Ahmqon ki jannat

Identification - assuming similarity bw oneself and other, Kaali Billi, Nazar

Intellectualization - separation of emotion from ideas, emotions painful. Samjhdari sy

Projection – attributing ones own unacceptable thoughts on others

Rationalization – altering the experience through logical and socially approved explanation

Reaction formation – unacceptable feeling disguised by repression of the real feelings and by

reinforcement of opposite feelings

Repression - unconsciously keeping unacceptable feelings away , jealous for friends success

Suppression – consciously keeping away unacceptable thoughts, exams focussing

Eriksson’s 8 Development Model

age Stage of Dev Task/ Area of Concepts / Basic Attitude

Birth – 18months infancy Trust vs. Mistrust

18 M – 3 Y Early Childhood Autonomy vs. shame and

doubt

3 – 5 Y Late childhood Initiative vs. guilt

6 – 12 Y School age Industry vs. Inferiority

12 – 20 Y adolescence Identity vs. role diffusion

18 – 25Y Young adulthood Intimacy vs. isolation

25 – 65Y Adulthood Generativity vs. stagnation

65Y – Death Old age Integrity vs. Despair

Forgetting

Forgetting is the apparent loss of information already encoded and stored in LTM

Due to lack of attention,

May be information not converted to LTM from STM

FACTORS

Interference – e new info

Retrieval problems – retrieval cues for later recall not found

Motivated forgetting – repression , forgetting the unpleasant incidences and

remebering pleasant one

Repression is tendency of people to have difficulty in retrieving anxiety provoking

and threatening information.

Metacognition is thinking about how we think. It refers to knowledge of people have

about their own thought processes

Memory

The mental faculty of retaining and recalling past experience

Memory can be explained as our interactions, our actions, perceptions which change

us continuously and determine what we are able to perceive, remember, understand

later on.

Stages of Memory: Encoding, storage and Retrieval

Types

I. Sensory Memory – what we perceive by our five senses. Brief image of all the

stimuli

II. Short term memory – store as Images and sounds

III. Long term memory – sotred on the basis of meaning and importance

Methods to improve Memory

Knowledge of results – feedback or check to see if you are learning

Attention – have setting that enhance your foccus

Recitation and Rehersal – reading a textbook stop studying and remind what you have

just read

Organize – into chunks, put similar things in order, remember long list of words by

making up sotries

Selection – its like fisherman’s net, keep good big fish. Practice careful selective

marking in textbooks. Do not underline everything

Serial position – tendency to forget in middle, long list of name, forgets middle one

names. Try to put more effort and attention

Mnemonics – aid or assoisiation to remember things.

Mnemonics .

Use mental pictures

Make things meaningful

Make info familiar

Form Bizarre. Unusual , or exaggerated mental assosiation

Attach emotions

Overlearning – mean when learnt something then study the material. Best insurance

against going blank on a test because of anxiety

Spaced Practice – sup to mass practice, e.g three 20min study session can produce

more learning than an hour continuous

Whole Vs Part Learning – better to practice learning whole packages of info rather

than small note. Study the largest meaningful amount of information at a time. Text

vs Notes. Only notes helpful that you make yourself on the base of SELECTION

Sleep – after study, sleep reduce the inference. Breaks and free time in a shedule are

as impotant as study. Whole night study before exam is not smart

Review – reviewing shortly before exam is helpful. Avoid tendency to memorize new

things. The review should be of An Hour rather than a whole night study

Common Psychiatric Disorders Substance use and abuse, e.g Alcohol

Anxiety disorder

Anorexia nervosa

Adult attentionn deficit disorder

Bipolar disorder

Bullemia nervosa

Depression

General anxiety disorder

Panic disorder

Obsessive compulsive disorder

Schizophrenia

Post traumatic stress disorder

Social phobia

Disassosiative disorder pychosis

Headache

Learning

Learning is a process by which new behavior patterns are acquired

Classical conditioning – by which instinctual or inheren patterns are acquired without

reinforcement. E.g salavation , autonomic arousal, piloerection

Uses

Acquisition of fear and anxiety about hospitals – paired response, white coat with

injection, an assosiation

Chemotherapy for treating cancer – chemotherapy, food disturbacne after last

therapy, reluctant, given sweets, more nutritionally good

Treatment of Phobias – intense feelings, relax, think about, relax and calm, think

and overcome

Operant Conditioning – instrumental conditioning in which a behavior that is not a

part of persons natural response is learned by consequences for the individual in the

form of Reward and Punishment

Shaping and Modelling – rewarding closer and closer apporximities of the wanted

behavior until the correct behavior is achieved e.g.

Modelling is type of observational learning. E.g. learn to be a surgeon after doing it

with good surgeon

Conditioning principles

I. Positive reinforcement – work for sake of praise – stop scold younger bro for praise

II. Negative reinforcement – incr behavior by avoiding and escape – stop bad

III. Punishment - behavoir is decr by supression – stop due to mothers scold

IV. Extinction – by ignoring, behavior is eliminated by non reinforcement – stop due to

mother is ignoring

Emotions Emotion is a feeling with its distinctive thoughts, psychobiological states, and range of propensities to

act

Person behaves arousal during emotions

Types of Emotions

Innate or Primary Emotions – fear, sadness, surprise, digust, anger, anticipation, joy and acceptance

Secondary or Mixed Emotions – primary emotions can be mixed to give rise secondary emotions e.g.

jealousy, Remorse

MOTIVATION The driving and pulling forces which results in persistent behavior directed towards particular goal is

called Motivation

Crisis interventionns/ Disaster Management Types of crisis

Developmental crisis – like pregnancy, adultohood, school

Situational crisis – un natural trauma, disaster, flood

Robert’s 7 stages of Crisis intervention (ARIF APF)

Plan and conduct crisis assessment

Establish report and rapidly establish Relationship

Identify major problems inclue Law straw, or Crisis Precipitatnts

Deal with feelings and emotions – Listening and Validation

Generate and explores Alternatives

Develop and formulate action plan CRISIS RESOLUTION

Establish follow up plan and Agreement

Bio Psycho Social Model

Bio Psycho Social perspective of disease

Based on systemic theory

Presents a triad of life ensures, structural, biochemical and molecular study of a

disease

BIO – ensures structural , Biochemical, molecular study of disease

PSYCHO – insight to role of personality, attitudes, attribbutes and other dynamic factor and

motivation in the genesis of illness

SOCIAL – emphasizes the impact of family, society, social forces, culture and milieu on the

etiology, presentation and management of given illness

Non Pharmacological Interventions in C.P

These interventions augmenting the impacts of physical methods of treatment

Communication skills

Attending and listening – listening and making notes

Active listening – along with, noting voulme, pitch of sound, body language

Verbal techniques - using communication skills

Funneling – questions guiding the conversion from a broader area to a specific area

Paraphrasing - repeating last few word of patient and summarizing

Empathy building – make the patient understand that his/her feelings have been understood ( it is diff

from sympathy)

Checking for understanding – summarize the patients statement or ask him to comment

Counseling - an environment that makes sure achieving a greater depth of understanding

Disaster Management 3 phases

Emergency phase

Rehabilitation phase

Recovery phase

Factors to remember during diasaster management

Trauma affect all psycosocial changes rather surgical and medical alone

Most psychosocial consequences are normal

Vulnerable group is childern, women, aged

Provision of early psycosocial supporty prevent long term psychiatric morbidity

Psychosocial and mental health should be integral part of medical treatment

Best recovery is to support each other rather relying on outside and active participation and

returning home

Rescue workers should also take care of themselves using BUDDY SYS

Post traumatic conditions becomes longer related to the event

Avoid wave of second Disaster by providing hygeinic water food, debris