Notes provided in a sense to make the final preparation easy and revised before exams. good for MBBS students.

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