1. Behavioral Sciences
Instructor: Dr Ejaz Sb.
Prepared by : Abdul Wasay
abdulwasay789@gmail.com
Amna Inayat Medical College (AIMC)
16-Sep-13
2. 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
3. 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
4. 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
5. 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
6. Eriksson’s 8 Development Model
age Stage of Dev Task/ Area of Concepts / Basic Attitude
Birth – 18months infancy Trust vs. Mistrust
18 M – 3Y Early Childhood Autonomy vs. shame and
doubt
3 – 5Y Late childhood Initiative vs. guilt
6 – 12Y School age Industry vs. Inferiority
12 – 20Y 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
7. 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.
8. Metacognition is thinking about how we think. It refers to knowledge of people have
about their own thought processes
9. 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
10. 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.
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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