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Behavioral Science By Dr. Osama Samaneh For 3rd Year Students Dubai Medical College Course Outlines: This course on behavioral science has two purposes: to introduce you to psychosocial aspects of medical practice and to offer you an overview of clinical psychiatry. The course also increase the knowledge base, strengthen the skill, and improve capabilities of participants in the foundation of psychiatry, psychology, and biopsychology by using the DSM IV. Topics: Introduction to behavioral Science Behavioral Medicine. Techniques and application Mental disorders and DSM-IV. * Adjustment Disorders * Anxiety Disorders * Dissociative Disorders * Eating Disorders * Impulse-Control Disorders * Mental Disorders Due to a General Medical Condition •Neurocognitive Disorders •Mood Disorders •Neurodevelopmental Disorders •Personality disorders •Psychotic Disorders •Sexual and Gender Identity Disorders •Sleep Disorders •Substance Related Disorders Research studies in B.S. T Thinking Feeling F Acting/ Doing A Importance of Psychology Psychology reference and importance is in the usage and application of skill, knowledge and understanding various activities undertaken by humans and how they are used through daily activities, whether that is within events, talking to people, education and employment, relationships and even treating mental health issues. Psychologists study the mental processes and behavior of people. It can be applied to various areas of the life of a human. Everything a person does is connected to the subject. In its primary form, psychology studies a person – who and what they are – it looks into why they act and think the way they do and how someone can improve himself. Importance of Psychiatry psychiatry is an integral part of medicine; that it is a brainbased specialty that encompasses biological, psychological, social, interpersonal and spiritual parameters; and that it is most effective when practiced in an evidence-based manner, involving interdisciplinary academic collaboration and expertise. Introducing Psy. Psychology is the science of mental processes and behavior. What is science? (search for facts by using objective evidence to answer questions). What are mental processes? (the functioning of the brain) What is behavior? (acts of a person alone or in a group). THE 3 LEVELS of PSY. The Brain (Biological factors ..) The Person (beliefs, desires, & feelings ..) The Group (social, cultural & environmental…) Psychiatry The branch of medicine that deals with the diagnosis, treatment, and prevention of mental and emotional disorders. Psychiatry is about the workings of the brain and how the brain affects behavior. Psychiatry is the medical specialty devoted to the study, diagnosis, treatment, and prevention of mental disorders. These include various affective, behavioral, cognitive and perceptual abnormalities. The term was first coined by the German physician Johann Christian Reil in 1808, and literally means the 'medical treatment of the soul' (psych-: soul; from Ancient Greek psykhē: soul. Psychologist vs. Psychiatrist Psychologist 5 yrs. B.S. psychology 2 yrs. Masters in psychology 4 yrs. PhD psychology 6 yrs supervised training before individual works alone with patients 10 yrs training Can’t give medicine Psychiatrist 5 yrs. B.S. Pre Med 4 yrs. Med School 3 yrs. Residency – have patient load 11 yrs. Training Can prescribe medicine A medical doctor specializing in psychiatry is a psychiatrist. Psychiatric assessment typically starts with a mental status examination and the compilation of a case history. Psychological tests and physical examinations may be conducted, including on occasion the use of neuroimaging / other neurophysiological techniques. Mental disorders are diagnosed in accordance with criteria listed in diagnostic manuals such as the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, and the International Classification of Diseases (ICD), edited and used by the World Health Organization. The fifth edition of the DSM (DSM-5) is scheduled to be published in 2013, and its development is expected to be of significant interest to many medical fields.[1] The combined treatment of psychoactive medication and psychotherapy has become the most common mode of psychiatric treatment in current practice,[2] but current practice also includes widely ranging variety of other modalities. Anti-psychiatry was coined by psychiatrist David Cooper in 1967. Dangerous treatments like the Electroconvulsive therapy. Several books including Divided Self and The Myth of Mental Illness. History of Psychiatry Treatment of emotional and cognitive dysfunction have its origins at least as far back as the 5th century BC. The first hospices for the mentally ill appeared in the Middle Ages. The early 19th century saw the development of psychiatry as a recognized field. Mental health institutions came to utilize more elaborate and, over the course of time, more humane treatment methods. The 19th century saw a huge increase in the number of patients. The 20th century saw an upsurge of biological understanding of mental disorders, as well as the introduction of more systematic disease classification, and the advent of sophisticated psychiatric medication. An anti-psychiatry movement, hostile to most of the fundamental assumptions and practices of the discipline, emerged in the 1960s. A shift in emphasis in several Western societies led to the dismantling of state psychiatric hospitals in favor of more community-based treatment. DSM-IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Psychiatric Diagnoses are categorized by the DSM- Better known as the DSM-IV, the manual is published by the American Psychiatric Association and covers all mental health disorders for both children and adults. It also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches. Mental Health Professionals use this manual when working with patients in order to better understand their illness and potential treatment and to help 3rd party payers (e.g., insurance) understand the needs of the patient. The book is typically considered the ‘bible’ for any professional who makes psychiatric diagnoses in the United States and many other countries. Much of the diagnostic information on these pages is gathered from the DSM IV. The DSM IV is published by the American Psychiatric Association. The DSM-IV uses a five level diagnostic system to classify illnesses and disorders. When considered together, these 5 levels give the treatment provider a complete diagnosis that includes factors influencing your psychiatric condition. This is important for effective treatment planning. The five levels of the DSM are called “axes” and are defined as follows: Axis I is reserved for clinical disorders and developmental and learning disorders. Axis II is for personality disorders or mental retardation. Axis III is for medical and/or physical conditions or disorders. Axis IV indicates factors contributing to, or affecting, the current psychiatric disorder and treatment outcomes. Axis V is for the GAF or global assessment functioning. This is a 100point scale that the mental health professional uses to describe the patient’s overall level of performance in usual daily activities and social, occupational, academic and interpersonal functioning. Behavioral Medicine is the interdisciplinary field concerned with the development and integration of behavioral, psychosocial, and biomedical science knowledge and techniques relevant to the understanding of health and illness, and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation. Also it is the study, prevention, and treatment of medical and psychosomatic disorders and of undesirable behaviors, such as overeating and substance abuse, by the application of behavior therapy techniques, such as biofeedback, relaxation training, and hypnosis. Mental Health •1 in 4 people will experience some kind of mental health problem in the course of a year •Women are more likely to have been treated for a mental health problem than men •About 10% of children have a mental health problem at any one time •Depression affects 1 in 5 older people living in the community and 2 in 5 living in care homes •Only one in 10 prisoners has no mental disorder •Suicide remains the most common cause of death in men under the age of 35 •Mental illness affects people of all ages, educational and income levels, and cultures. •Approximately 8% of adults will experience major depression at some time in their lives. •Anxiety disorders affect 5% of the household population, causing mild to severe impairment. WHO definition of Health Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. The correct bibliographic citation for the definition is: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. The Definition has not been amended since 1948 Positive Psy. Positive psychology is a branch of psychology that focuses on improving the mental functioning of human beings above that of normal mental health. What to do ……? Mental disorders are patterns of behavioral or psychological symptoms that impact multiple areas of life. These disorders create distress for the person experiencing these symptoms. Adjustment Disorders This classification of mental disorders is related to an identifiable source of stress that causes significant emotional and behavioral symptoms. The diagnostic criteria listed by the DSM-IV diagnostic criteria included: • (1) Distress that is marked and excessive for what would be expected from the stressor and • (2) Creates significant impairment in school, work or social environments. In addition to these requirements, the symptoms must occur within three months of exposure to the stressor, the symptoms must not meet the criteria for an Axis I or Axis II disorder, the symptoms must not be related to bereavement and the symptoms must not last for longer than six months after exposure to the stressor. Anxiety Disorders Anxiety disorders are those that are characterized by excessive and abnormal fear, worry and anxiety. In one recent survey published in the Archives of General Psychology1, it was estimated that as many as 18% of American adults suffer from at least one anxiety disorder. Types of anxiety disorders include: • Generalized anxiety disorder • Agoraphobia • Social anxiety disorder • Phobias • Panic disorder • Post-traumatic stress disorder • Separation anxiety Anxiety Anxiety, worry, and stress are all a part of most people's life today. But simply experiencing anxiety or stress in and of itself does not mean you need to get professional help or you have an anxiety disorder. In fact, anxiety is a necessary warning signal of a dangerous or difficult situation. Without anxiety, we would have no way of anticipating difficulties ahead and preparing for them. Anxiety becomes a disorder when the symptoms become chronic and interfere with our daily lives and our ability to function. People suffering from chronic anxiety often report the following symptoms: •Muscle tension •Poor memory •Fear or confusion •Constant worry •Palpitations •Upset stomach •Physical weakness •Sweaty hands •Inability to relax •Shortness of breath •Poor concentration Treatments Diazepam/Tricyclic (antidepressants) /Buspirone/ Counseling /Self-Help/ and psychotherapy. Dissociative Disorders Dissociative disorders are psychological disorders that involve a dissociation or interruption in aspects of consciousness, including identity and memory. Dissociative disorders include: • Dissociative disorder (formerly known as multiple personality disorder • Dissociative fugue • Dissociative identity disorder • Depersonalization/derealization disorder Eating Disorders Eating disorders are characterized by obsessive concerns with weight and disruptive eating patterns that negatively impact physical and mental health. Types of eating disorders include: • Anorexia nervosa • Bulimia nervosa • Rumination disorder Factitious Disorders These psychological disorders are those in which an individual acts as if he or she has an illness, often be deliberately faking or exaggerating symptoms or even self-inflicting damage to the body. Types of factitious disorders include: • Munchausen syndrome • Munchausen syndrome by proxy • Ganser syndrome Impulse-Control Disorders Those that involve an inability to control impulses, resulting in harm to oneself or others. Types of impulse-control disorders include: • Kleptomania (stealing) • Pyromania (fire-starting) • Trichotillomania (hair-pulling) • Pathological gambling • Intermittent explosive disorder • Dermatillomania (skin-picking) Mental Disorders Due to a General Medical Condition This type of psychological disorder is caused by an underlying medical condition. Medical conditions can cause psychological symptoms such as catatonia and personality changes. Examples of mental disorders due to a general medical condition include: • Psychotic disorder due to epilepsy • Depression caused by diabetes • AIDS related psychosis • Personality changes due to brain damage Neurocognitive Disorders These psychological disorders are those that involve cognitive abilities such as memory, problem solving and perception. Some anxiety disorder, mood disorders and psychotic disorders are classified as cognitive disorders. Types of cognitive disorders include: • Alzheimer's disease • Delirium • Dementia • Amnesia Mood Disorders Mood disorder is a term given to a group of mental disorders that are all characterized by changes in mood. Examples of mood disorders include: • Bipolar disorder • Major depressive disorder • Cyclothymic disorder Neurodevelopmental Disorders Developmental disorders, also referred to as childhood disorders, are those that are typically diagnosed during infancy, childhood, or adolescence. These psychological disorders include: • Intellectual Disability (or Intellectual Developmental Disorder), formerly referred to as mental retardation • Learning disabilities • Communication disorders • Autism • Attention-deficit hyperactivity disorder • Conduct disorder • Oppositional defiant disorder Autism Spectrum Disorders The autism spectrum disorders are more common in children . A recent study estimated that 3.4 of every 1,000 children 3-10 years old had autism. Others suggested autism now affects 1 in every 110 children. And that number appears to be only increasing. Autism is on the rise. The earlier the disorder is diagnosed, the sooner a child can be helped through treatment interventions. Pediatricians, family physicians, daycare providers, teachers, and parents may initially dismiss signs of autism spectrum disorders. Autism demonstrate deficits in three primary areas: 1.Social interaction 2.Verbal and nonverbal communication, and 3.Repetitive behaviors or interests . Indicators of Autism spectrum Disorders •Does not babble, point, or make meaningful gestures by 1 year of age •Does not speak one word by 16 months •Does not combine two words by 2 years •Does not respond to name •Loses language or social skills •Poor eye contact •Doesn’t seem to know how to play with toys •Excessively lines up toys or other objects •Is attached to one particular toy or object •Doesn’t smile •At times seems to be hearing impaired Personality disorders create a maladaptive pattern of thoughts, feelings, and behaviors that can cause serious detriments to relationships and other life areas. Types of personality disorders include: • Antisocial personality disorder • Avoidant personality disorder • Borderline personality disorder • Dependent personality disorder • Histrionic personality disorder • Narcissistic personality disorder • Obsessive-compulsive personality disorder • Paranoid personality disorder • Schizoid personality disorder • Schizotypal personality disorder Psychotic Disorders Psychotic disorders are those that involve a loss of contact with reality. People experiencing psychotic disorders may experience hallucinations and often display disorganized thinking. Delusional beliefs are another common characteristic of this class of psychological disorders. Types of psychotic disorders include: • Schizophrenia • Delusional disorder Symptoms Recent social withdrawal and loss of interest in others. An unusual drop in functioning, especially at school or work, such as quitting sports, failing in school/difficulty performing familiar tasks. Problems with concentration, memory, or logical thought and speech that are hard to explain. Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations. Loss of initiative or desire to participate in any activity; apathy. A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality. Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or “magical” thinking typical of childhood in an adult. Fear or suspiciousness of others or a strong nervous feeling. Uncharacteristic, peculiar behavior. Dramatic sleep and appetite changes or deterioration in personal hygiene. Rapid or dramatic shifts in feelings or “mood swings.” Treatment INVEGA® SUSTENNA® is a long-acting medication given by injection that you only have to take once a month. It’s given by injection by a healthcare professional in the arm or buttocks once monthly after starting doses. Treatment for schizophrenia may include counseling and rehabilitation therapy. These programs, along with taking medication as the doctor prescribed and developing life skills, may help reduce the risk of relapse. And others such as Behavioral modifications & Electrical shocks. Sexual and Gender Identity Disorders Sexual disorders are those that impact sexual functioning, while gender identity disorders are those that involve a discontentment with the biological sex a person was born with. Examples of sexual disorders: • Erectile dysfunction • Sexual pain disorders • Paraphilias Sleep Disorders Sleep disorders involve an interruption in sleep patterns. These disorders can have a negative impact on both physical and mental health. Examples of sleep disorders include: • Narcolepsy • Sleep terror disorder • Sleepwalking disorder • Primary insomnia Somatoform Disorders Somatoform disorder is a class of psychological disorder that involves physical symptoms that do not have a physical cause. These symptoms usually mimic real diseases or injuries. It is important to note somatoform disorders differ from factitious disorders; people suffering from somatoform disorders are not faking their symptoms. • Conversion disorder • Somatization disorder • Hypochondriasis • Body dysmorphic disorder • Pain disorder Substance Related Disorders Substance-related disorders are those that involve the use and abuse of different substance, such as cocaine, methamphetamine, opiates and alcohol. These disorders can include dependence, abuse, psychosis, anxiety, intoxication, delirium and withdrawal that results from the use of various substances. Examples of substancerelated psychological disorders include: • Alcohol abuse • Caffeine-induced anxiety disorder • Cocaine withdrawal • Inhalant abuse # Item 1 I never seem to have enough time to accomplish my goals. I don't understand people who become so impatient in traffic that they start honking. I frankly don't care whether I do or do not make it into the top 10%. I find it difficult and useless to confide in someone. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 A driver's license should be more difficult to get in order to avoid having all those idiots on the road. It doesn't bother me if I cannot finish what I planned for the day. I often choose to spend time with my friends or family, even though I have something important to do. I am hardly ever satisfied with my achievements. I get no particular pleasure out of acquiring things. It is easy for me to express my feelings. People who don't know what they want get on my nerves. I think that hobbies such as fishing or bowling are just a waste of time. When I finish my task, I feel good about myself. I function best under stress or pressure. Talking about emotions is a sign of weakness and can be used by others to get at you. It doesn't matter whether my family is financially secure. The important thing is to be together. If everybody did their job properly, my life would be Disagree 1 Cannot say 2 Agree 3 How Outgoing Are You? # The Expression Quotient 1. 2. Loud parties make me feel tired I enjoy being at social events involving unfamiliar people 3. 4. 5. I like to sit alone and read I don't enjoy solitary sports like swimming. I'd feel uncomfortable making business calls to strangers. 6. 7. 8. 9. 10. 11. It's easy for people to read my moods. My friends are somewhat shy. I try to be the center of group attention. I dislike dining out in a big group. I like solitary hobbies like gardening. I get energized when in a large crowd at an outdoor event. 12. Chatting with strangers on a train or plane is fun for me. 13. 14. 15. 16. I don't mind dining alone. I like socializing in dance clubs. I'm a party person. Those who know me would describe ma as very out going. 17. After getting home, I soon get on the phone to chat with people. 18. 19. I take vacations alone. I prefer staying home by myself to being at a noisy party. 20. 21. 22. I usually share my moods with others. I like returning to a quiet home. At parties, I'd rather let others introduce themselves to me than Disagree 5 4 3 Agree 2 1 Am I At Risk for Developing Depression? # The statement 1 Have you been in a depressed mood most of the day, nearly every day for at least two weeks? 2 Have you lost interest or pleasure in most daily activities, nearly every day for at least two weeks? 3 Have you experienced a significant weight change (at least five pounds) either loss or gain recently? 4 Has your appetite changed (increased or decreased) for an extended period? 5 Have you suffered from insomnia or hypersomnia, nearly every day for at least two weeks? 6 Have you felt tired or experienced a loss of energy during the day, nearly every day for at least two weeks? 7 Have you had guilty feelings or feelings of worthlessness nearly every day for at least two weeks? 8 Have you had difficulty thinking, concentrating, or making decisions nearly every day ? 9 Have you had any thoughts of death or any thoughts of suicide without any specific plan? 10 Did the depressed mood begin after someone close to you died or within four weeks of giving birth? Yes/no