Human Behavior Midterm

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model

Back 1

construct useful for organizing and understanding facts and observations, and predicting outcome

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humoral model

Back 2

hippocrates and Galen

disease caused by imbalance of four humors

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four humours

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black bile
yellow bile
phlegm
blood
-physicians would bleed or cup pts to restore humeral balance

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biomedical model

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traditional, reductionist

explains disease as deviation from normal function due to
-pathogen
-genetic/developmental abnormality
-injury

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equation of biomedical model

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Hx+PE-->DX-->Tx

history + physical exam -->diagnosis (work-up)-->treatment (monitor)

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criticisms of biomedical model (3)

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non-preventative (treat dx, not preventing)

-not comprehensive (only addresses what is wrong)

-can be authoritative/paternalistic-may not empower the patient, may not address their real needs

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biopsychosocial model (1970s)

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-encourages comprehensive understanding of disease and treatment

-economic status, education, culture, technology, religion, interpersonal relationships all influence health

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3 components of biopsychosocial model

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Biological system (anatomic, structural, molecular)

psychological (psychodynamics, motivation, personality)

social system (cultural, environmental, familial)

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criticisms of biopsychsocial model

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overly broad/vague

does not well integrate psyche and soma, instead coexistance of perspectives

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recovery model

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aims to support and empower individuals in their personal journey thru illness

-outgrowth from the psychiatric consumer/survivor/ex-patient movement
*endorsed by AZ dept of health

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10 fundamental componenets of recovery

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self-direction, individualization
empowerment, holistic
nonlinear, strengths based
peer-support, respect
responsibility, hope

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criticisms of recovery model

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-some proponents are anti-professional and anti-psychiatry

-may give unrealistic expectation of disease course (not everyone can recover)

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holistic model

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how well the physical, mental, emotional, and spiritual elements of the body are connected to maintain wellness

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criticism of holistic model

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dubious nutritional, herbal, other treatments that have little empirical support

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osteopathy and psychology

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-emphasizes interrelationship btw structure and function of body

-recognizes body's ability to heal itself

-role of osteopathic practitioner to facilitate that process

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evidence based medicine

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aims to appy the best available evidence gained from scientific method to clinical decision making
*decisions based on scientific evidence

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evidence based medicine forms

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guidelines, policy, or regulations at institutional level (this is what the evidence shows...)

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evidence based medicine at individual practitioner level

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effort to utilize best available evidence to inform practice to ensure the best outcome

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sensitivity

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if a test has high sensitivity then a negative results suggests the absence of the disease
TP/TP+FN

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specificity

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ability to find the negatives; positive results suggests high probability of presence of disease

-TN/TN+FP

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number needed to treat

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way of expressing the effectiveness and safety of a treatment

*e.g. NNT of 3 means if 3 patients are treated only 1 will respond

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criticism of evidence based medicine

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-"evidence BIASED medicine"
-biased towards biologic interventions
-publication bias towards + studies
-$ from pharmaceuticals
-some randomized tests are not ethical to test

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phenotypes of baby with fetal alcohol syndrome

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small eye openings

smooth philtrum

thin upper lip

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Mahler 0-4 weeks

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normal autistic

develop equilibrium

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Erikson 0-4 weeks

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trust vs Mistrust

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Piaget 0-4 weeks

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reflexes sensory-motor,

assimilation/accomodation

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Freud 0-4 weeks

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Oral (rooting reflex, suckling)

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Mahler 4 weeks-4 months

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symbiosis, social smile

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Erikson 4-weeks-4 months

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Trust vs. mistrust

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Piaget 4 weeks-4 months

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primary circular-smile

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Freud
4 weeks-4 months

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oral

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Mahler
4-10 months

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separation-individualization
*differentiation
*stranger anxiety 9 months

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Erikson
4-10 months

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Trust vs. Mistrust

Front 34

Piaget
4-10 months

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secondary grasp reflex

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Freud 4-10 months

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Oral

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Mahler
10-16 months

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practicing: walking, talking

separation anxiety (know that mom is gone and she has the ability to come back)

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Eriksson
10-16 months

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Trust vs. Mistrust

Front 38

Piaget
10-16 months

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Schemas
*inhibit grasp reflex (like to let go because they know it will come back)
*object permanence 1-2 yrs

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Freud
10-16 months

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Oral

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Mahler
16-24 months

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rapprochement (want to turn back to safety, looking for mom)

temper tantrums (want independence but developmentally they can't--frustrated! need your help but don't want it)

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Erikson
16-24 months

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Trust vs. Mistrust

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Piaget
16-24 months

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language

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Freud
16-24 months

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Anal
(sphinchter control)

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Mahler
2-3 yrs

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consolidation object constancy

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Erikson
2-3 yrs

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autonomy vs. shame doubt

pride in independence

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milestones at age 3

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gender set

separation anxiety resolves

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Piaget
2-3 yrs

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pre-operational

egocentric (fear for themselves-band-aid effect)

pretend play begins

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Freud
2-3 years

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Anal

(bladder/bowel control)
**capable of potty training

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Erikson
3-5 years

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initiative vs. guilt

curiosity vs. difficult to interact with others

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Piaget
3-5 years

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preoperational, egocentric, pretend play (parallel vs. cooperative)

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Freud
3-5 yrs

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phallic Oedipal complex

sexual, aggression, nighmares/someone out to get them

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climb stairs holding on

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18 months

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climb stairs alone

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age 2

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ride a tricycle

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age 3

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climb stairs alternating feet

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age 4

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catch with 2 hands

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age 5

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bike without training wheels

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age 6

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draw a circle

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age 3

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draw a cross

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age 3-4

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draw a square

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age 5

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draw a triangle

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age 6

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draw a diamond

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age 7

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accomodation definition

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adapt to new ways

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regression examples

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potty issues

spearation

*adults with illness

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well cultivated critical thinking

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-raises vital Qs and problems, clearly and precisely formulated
-gathers/assesses relevant information; use abstract ideas to interpret effectively
-comes to well-reasoned conclusions and solutions, testing then against criteria and standards

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critical thinking definition

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process we use to make a judgement about what to believe and what to do about the symptoms our patient is presenting for diagnosis and treatment

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encoprosis/enuresis

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soiling/bed-wetting

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separation anxiety disorder

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separation anxiety that has not resolved itself by age 3

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reactive attachment disorder

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child unable to form normal reciprocal attachment ot a caregiver, resulting in abnormal behavior
-inhibited: withdrawn, unresponsive
-disinhibited: overly cuddly with everyone

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concept of death/finality

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age 6

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object constancy

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out of sight out of mind

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sublimation

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Freud theory--funnel thoughts of sexual impulses to high performance in school

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Erikson
5-12 yrs

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industry vs. inferiority

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Latency

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theory of Freud; sexual feelings at rest

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school age play

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right/wrong a priority.

spend more time deciding rules than actually playing

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Piaget
5-12 yrs

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concrete operations, syllogistic reasoning, conservation, classify

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Freud
5-12 yrs

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latency, superego, moral

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Erikson
12-18 yrs

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identity vs. role confusion (if unable to find an identity of your own)

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Piaget
12-18 yrs

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formal abstract

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Freud
12-18 yrs

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genital--was quiet (latent), now it's back

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early adolescence

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11-13

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middle adolescence

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14-17

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late adolescence

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18-20

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formal operations

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abstract reasoning--can think about thinking; logic, reason, deduction

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challenges of ages 12-18

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puperty
peer pressure
argues
diary
want independence so challenge the system
*being different = very distressing

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things happening age 14-16

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dating (moving beyond a crush)

individualizing-still practicing--identity starts solidifying a bit more

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events of 16-18

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dating

driving

how do i do this?? practice!

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why so emotional?

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prefrontal cortex not developing as quickly as limbic system is

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interviewing adolescents

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-be upfront/honest about what you can keep confidential

-may have to initiate some topics

-be aware of developmental stage of the patient

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HEADSS

Back 90

home
education
activities
drugs
sex
suicide

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Home of Headss

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social setting
who lives with you?
does your mom/dad date?
how do you get along with parents?
what happens when people fight in your home?
are there guns in your home?

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At risk youth (3)

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homeless/runaways

chronic disease (teenagers decrease compliance--don't want to be different)

gay/lesbian youth

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splitting defense mechanism

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can be marker of borderline personality

love/hate; things are all good or all bad; everything dealt with in black and white

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adolescent parent relationship

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taking down off pedestal

embarrassment

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early adult parent relationship

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learn to establish relationship with parents as equal

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Piaget

early adults

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myelination of brain continues into 3rd decade of life esp. in frontal cortex

deductive reasoning skills in place

follow formal rules of logic = better judgement

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Erikson

early adults

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Intimacy vs. Isolation
coming out of adolescence there is a sense of identity

-develop loving, emotional, sexual relations with another person

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marriage advantages

Back 98

more $/more savings

more sexual frequency

better health

more medically compliant

less risky behavior

lower mortality than single adults

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risk factors for divorce

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short courtship

family hx of divorce

differences in religion, socioeconomic background

life stressors

absence of family supports

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singe parent homes

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25%

mostly headed by women

at risk for physical and mental illness (lower income, lesss social support possibly related)

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early adulthood tasks (5)

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-work out unresolved issues with family origin

-find a permanent life partner

-education/career

-coping with the "novice" role in life

-facing simultaneous new demands in multiple life areas

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impact of impulsive decisions

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not easily reversed!!

-career choice
-geographic choices
-marriage
-parenthood/family
-student loans/bank loans

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30's
4 steps

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role in society defined

physical development has peaked

individual is independent

reappraisal of one's life (age 30 crisis)

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body changes in the 30's

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muscle tone/strength decreases

sagging chins

protruding abd/body fat inc.

eyes loose elasticity--farsightedness/bifocals?

hearing begins to decline