Introduction

Tawfiq Daratkeh
Shakeeb & Zaid
05 . 07 . 2009
07 . 07 . 2009
1


This is the first lecture in this module: Clinical Psychology or Behavioral Science.

The doctor emphasized on the importance of attendance saying that: who attends the lecture
will guarantee a good mark in this module besides for those who wants to apply for the USMLE
exam, this module is included in many questions in the USMLE and there is a high chance of
succeeding in the USMLE and even getting high marks after studying this module

The doctor asked us to study the notes that he gives us in the lecture, and said that the
questions in the exams are all from the lectures and what he says


The course is a 36 lectures course, seminars also can be done, and for those who like to
participate in a seminar he/she may go write her/his name and book a lecture to do it as a
seminar groups or individually. And for those who are interested about research they can do so
and this is optional, the doctor will be more than happy to help.

At the end of the fourth week we will have the first exam, 50 questions not 60, multiple
choice, and all the questions are from the lectures this is what the doctor said nothing comes
from a different source so all you have to do is to study the lectures and the doctor slides and
youll get a high mark Inshalla

The second exam is at the middle of the 8
th
week, and theres a bonus up to ten marks for those
who attend regularly, and for those who absent more than 10% of the total number of lectures
will be prohibited to attend the second exams and these are the University rules which we cant
ignore!!!!

For those who like to check some references there are three books: 1.behavioral science for
medical students, 2.behavioral science in medicine 3.brain and behavior this book talks about
the neurological aspect in addition to the psychological and social aspects. And for those who
wants to get some chapters only they can go to the doctors office and ask about the website to
get the chapters from. And then the doctor asked us to ask questions frequently and said that
behavioral science is an important subject that we will use in our practice.

NOW lets begin our lecture:

This lecture is an introduction to the course:
When we talk about behavioral science in medicine there are some interrelated fields these are
studied in other universities for example in our university they named the course Clinical
Psychology and I (the doctor) think this is not applicable to you as medical students, because
clinical psychology is an element of Behavioral Science, which is the main science. So some
colleges use the name Health Psychology or Behavioral Medicine theyre all elements of
behavioral science but there is an overlap between these.

Now we come to the Health Psychology

Health psychology is a subfield within psychology (not a subfield of medicine) devoted to
understanding psychological influence on 1.why people stay healthy 2.why people become ill
3.how people response when they become ill for example the responses will be different if
someone healthy gets a disease someone else have. The second patient will respond differently.
Here there are inter-individual variances although the causes are the same.

Behavioral medicine is an interdisciplinary field ( ), it was founded in
1977, that includes psychologists, physicians, nurses, pathologist, geneticist etc. its is mainly
concerned with the psychological an social implications of physical conditions, for example a
patient with cancer, behavioral medicine is mainly interested in the consequences of this
physical condition in the term of social and psychological perspective.

fNow we come to the question: What is health?
We have the WHO definition, its not the perfect definition but its the best one we have.
HEALTH is a complete state of well being: physical, mental and social well being.
For example if someone has physical well being and mental well being but not social
well being means that he/she is not healthy according to this definition!!!
So this definition emphasizes on the mental physical and social dimension of health.

So as you can see health is not defined by the absence of infirmity ( yb denifed ton si ,(
the exclusion of physical illnesses, and the state of optimum health is called wellness and
there are special tools for measuring wellness, instruments for measuring how well you are,
its very simple to use you answer some questions and by a computer program it measures
how well you are and the degree of your wellness, the doctor has these tools and is ready to
provide it to whom is interested, and he mentioned a program called SF36 which is the best
tool to measure the degree of wellness weather its physical social or mental according to the
doctor.



The four areas that health psychology focuses on are:

1. Health promotion and maintenance
2. Prevention and treatment of illness
3. Etiology and correlations of health, illness and dysfunction
4. Improving the health care system, which is very important thats why we have a lecture
about delivering the health care system in our country. Youll find out whether our health
system is appropriate, inappropriate, helpful, unhelpful, or how much its helpful/
appropriate and what is needed to modify this system.



Now the question is: is there a connection between the mind and the body???? Or are the
mind and the body two separate systems? Are they totally independent system? Or are they
related?

In the Earliest times (stone age): the conception was the body and the mind are one organ
therefore the shamans ( ) performed the treatment, as the diseases were thought to
be cause by daemons and evil spirits, therefore for the shaman job was to expel these evil
spirits by different methods and youll find that some of those treatments are still applicable.
One of those methods is trephination, which was used to expel evil spirit as what they
believed by making holes in the skull in order to let the evil spirit out.

Greeks note the role of the body in health and illness

-Hippocrates (the father of medicine) said the diseases are from natural cause and not caused
by evil spirits

-Galen came out with what is called the Humeral Theory (4 circulating fluids)

This theory says that mental diseases are caused by the imbalance of the 4 circulating fluids
in our body (blood, black bile, yellow bile, and phlegm (lymph)):

Galens four humors are: Melancholic type, sanguine type, choleric type and phlegmatic type.

Melancholic type: caused by an excess of the black bile so the person becomes melancholic
which means the patient becomes depressed, moody and glum. One type of major depression
is the melancholic type

Sanguine type: means good blood and air makes people happy and healthy.

Choleric type: excess yellow bile makes patients irritable and hot temper (3asabeyeen =p)

Phlegmatic type: excess phlegm makes people slow and droopy. The opposite of sanguine
type.


The end of part one, done by: Zaid Zreigat.










Middle Age:
People in the middle age return to believe that the supernatural
power is the cause of illness.
They also assume that illness could be because of demons or Gods
punishment.
So, Priests (physicians) were responsible for treating physical
diseases, and Philosophers are responsible for treating mind
disorders (behavioral problems).
So, we can conclude that Mind and Body in this age was totally
separated.

Models of Health Care
1
st
: Biomedical Model:
- Focus on illness: For example, someone with hypertension, the
doctor is only concerning with the management of hypertension,
without looking to other disease or complications.

Note: Almost 30-50% of common medical diseases are
accompanied with psychological problems, so if you just take
the physical aspect of the disease, you are ignoring other
aspects (psychological), so bothering the patient and delaying
the recovery period.

Note: Studies show that complications of the disease are more
painful than the disease itself.
- Is dominant for the past 300 years.
- All illnesses can be explained on the basis of aberrant somatic
processes.
- Psychological processes are independent.
- According to this model all patients are victims, on the other hand,
patients nowadays are of full role in picking up the suitable therapy
and so on.

Characteristics of the Biomedical Model:
1- Dualistic: Mind and body is totally separated.
2- Mechanistic: Does not pay attention to psychological aspect of the
disease.
3- Reductionalistic: Simplification of the disease (one factor causes the
disease).
4- Disease oriented.

Factors that promote this model:
1- Rise of Germ theory of diseases:
Doctor said: People in early 70s are used to believe that their
diseases could be relieved only by taking Anti- biotics and
injection- form drugs!!!! And this idea participates to a large
extent in bacterial resistance in these days.
2- Microscope invention in the 19
th
century.

Advantages of Biomedical Model:
1- Major biomedical advances.
2- Diagnostic testing.
3- Prevention (immunization).
4- Treatment.

Limitations of the Biomedical Model:
1- Evidence that lifestyle and behavioral/ psychological factors influence
health.
2- Evidence that health influences psychological functioning.
3- Psychotherapy medical cost offset data.
2
nd
: Biopsychosocial Model:
Its used nowadays instead of the Biomedical Model.
Factors that promote this model:
1- Psychoanalytic contributions: Psychoanalytic theory was introduced
by Freud in the 19
th
century. He was a neuroanatomist then he
became clinical neurologist, he was interested in patients with
neurological defects caused by unconscious psychological conflicts
(e.g. vision loss without any somatic cause).
Y3ni Psychological conflicts cause somatic defects.
2- Psychosomatic Medicine: Pschosomatic theory states that there are
some physical problems caused by psychological problems in
personality. (E.g. Bronchial Asthma, Atopic dermatitisetc).
3- Changing patterns of illnesses: such as infant mortality rate, new
diseases (Swine flu), and increment in the health compromising
behaviors (obesity, hypertension). and 50% of total mortality in this
world is caused by this cause, the Behavioral medicines role is to
reduce this percentage to the minimum limits.
We can divide illnesses into new patterns and past patterns:
- Acute disorders (past patterns):
Short- term medical illnesses.
Examples: TB, Pneumonia.
- Chronic disorders (new patterns):
Slow developing medical diseases.
Cant be cured (only managed).
Psychological factors are often the cause.
4- Escalating health care costs.
5- Research.





Clinical implications of the Biopsychosocial Model:
1- The process of diagnosis must consider the interaction of the
biological, psychological, and social factors.
2- Recommendations for treatment should also consider these three
factors (Biological, psychological, and social).

Alameda County:
7 health habits (life styles) arise in the late 80s, applied on people, then
followed up for 10 years to study the effects on them:
1- Never smoking cigarettes.
2- Exercising regularly.
3- Maintaining normal weight.
4- Not eating between meals.
5- Sleeping 7-8 hors nightly.
6- Using Alcohol moderately.
7- Eating breakfast daily.
Second part done by: Shakeeb Raslan.


THE END
Sorry for being late