Published on March 12, 2014
Behavioral Sciences Instructor: Dr Ejaz Sb. Prepared by : Abdul Wasay email@example.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 – 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
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
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