BEHAVIORAL SCIENCE

Izben C. Williams, MD, MPHInstructor

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INTRO

OVERVIEW OF BEHAVIORAL SCIENCE

COURSE

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Definition & ScopeBEHAVIORAL SCIENCE:

A branch of science dealing broadly with human actions (behaviors). It usually includes elements from all social science related fields example: psychology, psychiatry, Sociology, cultural anthropologyBiologyEconomics, political science

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In Medical Curriculum – A basic science

BEHAVIORAL SCIENCE:In medical schools it is generally classified

as one of the basic (pre-clinical) sciences along with standards such as : Biochemistry Pharmacology Physiology

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In Medical Curriculum – A basic science

BEHAVIORAL SCIENCE:However because of the breath of disciplines

it straddles and under which it is taught, it is inherently different from the other basic clinical sciences.

As a sub discipline it is of core relevance to the education of the modern day physician and the clinical practice of medicine.

It has come to include everything that cannot be categorized in one of the traditional basic sciences

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Medical ExamsBEHAVIORAL SCIENCE:

The USMLE standards are fully cognizant of the significance and important of students appreciating the correlation between physical health and mental health.

Therefore on all three steps of the examination the substantial power of mind-body relationship is thoroughly tested

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The BioPsychoSocial Paradigm BEHAVIORAL SCIENCE: The BioPsychoSocial model holds that

biological, psychological, and social factors are involved in the maintenance of health and in the causations and manifestations of disease.

It is important to appreciate how the biopsychosocial model can help us understand the influence of the interaction between biology, psychology, and culture in influencing our health.

The biopsychosocial is conceptually boundless

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BioPsychoSocial Schema

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The BioPsychoSocial Paradigm

BEHAVIORAL SCIENCE: According to the biopsychosocial model, it is the

interaction between one's genetic makeup (i.e., biology), mental health and personality (i.e., psychology), and sociocultural environment (i.e., social) that contribute to health or illness.

The biological influences on mental health and mental illness are varied, and include genetics, infections, physical trauma, nutrition, hormones, and toxins.

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The BioPsychoSocial Paradigm

BEHAVIORAL SCIENCE:The psychological component looks for

potential psychological causes for a health problem such as lack of self-control, emotional turmoil, and negative thinking.

Social and cultural factors are conceptualized as a particular set of stressful events (e.g., losing one's job) that can differentially impact mental health depending on the individual and the social context in which they live.

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The BioPsychoSocial Paradigm BEHAVIORAL SCIENCE:

The biopsychosocial theory posits that each one of these factors is not sufficient to bring about health or mental illness, but the interaction between them determines the course of one's development.

Despite its usefulness, there are issues with the biopsychosocial model including the degree of influence that each factor has, the degree of interaction between factors, and variation across individuals and life spans.

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The BioPsychoSocial Paradigm

BEHAVIORAL SCIENCE:Then there is the value judgment regarding

the role of spirituality in wellbeing, and of its place in the biopsychococial scheme

 Global health as assessed by self-rated health (SRH) incorporates several health domains that dynamically and bi-directionally interact. For simplicity, five main domains are shown: biological/clinical, psychological, social, behavioral, and spiritual.

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Self-Rated Health

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Behavioral Science

COURSE TOPICS

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Course Topics

The Life Cycle The Beginning of Life - Pregnancy thru

PreschoolSchool age, Adolescence, Special issues of

Development and AdulthoodAging, Death and Bereavement

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Topics

Biology (Genetics & Anatomy)and Biochemistry of Behavior

Pharmacology of BehaviorBiological assessment of patients with

psychiatric symptoms

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Topics

PSYCHOPHYSIOLOGY: topics such as:Normal sleep, and sleep-wake

dysfunction Neuroanatomical correlates of

PsychophysiologyPsycho-endocrinologyPsychophysiological measurements

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Topics

THEORIES OF THE MIND:Psychoanalytic – Psychodynamic TheoryLearning Theory (Behaviorism)Cognitive Theory (CBT)Psychosocial Theory

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Topics

CLINICAL ASSESSMENTA. The Mental Status Examination: A structured

assessment of the patient's behavioral and cognitive functioning. The psychological equivalent of the physical examination

B. Psychometric Evaluation: A set of test techniques by which a sample of behavior is elicited, observed, recorder, analyzed and interpreted.

Example assessment of intelligence, personality, and achievement.

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MENTAL DISORDERS

CLINICAL SYNDROMES: A. Schizophrenia and other psychotic

disordersB. Mood DisordersC. Anxiety, Somatoform and Factitious

DisordersD. Other Psychiatric Disorders E. Psychiatric Disorders of Children

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MENTAL DISORDERS

OTHER PSYCHIATRIC DISORDERS: A. Cognitive DisordersB. Personality DisordersC. Dissociative DisordersD. Obesity and Eating Disorders

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TREATMENT

TREATMENT MODALITIES:A. Biological Therapies and ECTB. Psychological TherapiesC. Other Therapies

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Topics

PSYCHOSOCIAL BEHAVIOR:

The Family, Culture, and IllnessSexualitySubstance AbuseAggression and Abuse

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Topics

OTHER TOPICS:

Psychosomatic MedicineLegal & Ethical Issues in MedicineThe Physician patient Relationship

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Topics

OTHER TOPICS:

Healthcare in the United StatesEpidemiologyStatistical Analysis

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Developmental Journey

There are immensely complicated, mysterious, and beautiful transformation (biological, psychological and social) that take place between conception and old age

The period from CONCEPTION TO BIRTH sets the stage for all other development that we undergo as humans

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Some Prenatal Influences I

Genetic factors play a prominent role in determining the biological potential of a fetus.

The process of development is a sequential unfolding of normal events (and disorders) that are genetically determinedIn about 40% of children with ADD heriditary

factors are the basisDown syndrome (trisomy 21), Klinefelter

syndrome (XXY) and Fragile X syndrome are also genetically determined conditions

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Some Prenatal Influences II

Sex and survival factors:At conception 160 M : 100 FAt birth the ratio is aprox. 100 M : 100 F.

The surviving males have a higher risk of some brain dysfunction

ADD ten times more frequent in malesResponse to sensory stimulation

demonstrated in utero

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Neonatal CapacitiesAt birth the infant is pre-adapted to be

cared for by the mother by the presence of attachment behaviors (eg crying and clinging). These increase the likelihood of maternal care and assist the infant in attaching to the mother.

The neonate possesses a number of innate simple reflexes

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Intrauterine Influences on development I

The intrauterine environment can significantly affect fetal brain development, and hence all future actions (behaviors)Animal models used to mimic adverse intra

uterine conditions in humansIntrauterine insults to the brain may be

acute or chronic

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Intrauterine Influences II

Even brief periods of hypoxemic compromise can have significant effects on the fetal brain causing neuronal loss and cerebral white matter damage

Subtle brain injury can occur, for example to a particular class of neuron, and this can have a significant effect on the function of a specific system, (eg hearing, vision)

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Intrauterine Influences III

Chronic mild placental insufficiency can result in long term deficits in neuronal connectivity

Repeated acute exposure to an inflammatory agent results in diffuse subcortical white matter damage and in some cases periventricular necrosis.

The timing and severity of these prenatal insults determines outcomes, in terms of the severity of the damage and the regions of the brain affected.

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Smoking and Alcohol Placenta mediates fetal growth and

influences long-term healthPlacenta-to-birth weight ratio regarded as

an indicator of placental functionMaternal prenatal smoking and alcohol

consumption may influence fetal growth by either directly or indirectly altering the function of the placenta, and hence the development of the fetus. 

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Role of the placenta in feto-maternal exchanges

Reminder:Exchange process via membranous

exchange mechanismsThe fetal lungNutritive and excretory functionsProtective function and Immunological

barrierEndocrine function and protein transfer

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Some noxious trans placental influences

Some microbes can cross the placental barrier despite its efficiency: Sexually transmitted diseases (treponema

palidum, HIV, Neisseria GonorrheaFeto-toxic infections (rubella, toxoplasmosis,

cytomegalovirus, herpes simplex genitalis)Drugs (most antibiotics, corticosteroids,

teratogenic drugs such as Roacutane and Thalidomide

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Birth and Post-partumTwo separate patients: Mother and InfantInfant status

APGARPrimitive reflexes (Startle, sucking, grasp,

Babinski)Maternal status

Physical statusPsychological status

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Theories of Development

Several theories, derived primarily from clinical experience and experiment.

Perhaps the best known systems in use today, are:Freud’s psychoanalytic theory, Piaget’s Cognitive developmental stagesEricson’s Psychosexual stages

The theories mostly identify developmental landmarks

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Concepts of Child Development

There is a lawfulness to all natural development, which serves as a framework within which we can assess and understand children and adults

Epigenesis: The development of an embryo from the successive differentiation of an originally undifferentiated structure (Epigenetic= after genes)Physical EpigenesisBehavioral Epigenesis

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Developmental Tasks

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Multiple developmental scales Developmental tasks to be attained by

preschool childrenMotorVerbal cognitiveSocial

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Developmental Screening

There are many Developmental Screening-and-Assessment (S&A) Instruments for young children ages birth through five yearsLink to S&A instruments:

http://www.nectac.org/~pdfs/pubs/screening.pdf

These instruments emphasize Psychological, Social, Emotional and Physical Development

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Psycho-Social Development I

The principle psychological task of the first year of life is the formation of intimate differentiated attachment to mother of caregiver.

Failure of the infant to develop this specific early attachment may result in later defects in the capacity for empathy and for close warm reciprocal relationship.

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Psycho-Social Dev’nt IIThe social smile is an early marker of the

beginning development of a specific differentiated relationship, as are the preferential vocalization, visual pursuit and anticipatory gesturing of the 5-month-old infant in the presence of the motherEndogenous smiling develops from an innate

reflex response at birthExogenous smiling a response to the form of a

face – 8 weeksPreferred social smile a response to mother’s

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Psycho-Social Dev’nt III

Stranger anxiety begins at ~ 8 monthsObject relations (psychoanalytic theory)Response to Maternal

deprivation/separationPlay: its role and significanceAutonomy and self awareness

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Psycho-Social Dev’nt IV

Sociocultural factors:Innercity: increases risk of psyc. disordersADD: twice as high in low income familiesPsychosocial, or sociocultural,

retardation: deficient language, speech and cognitive skills associated with relative deficiency in adequate early stimulation (usually lower socio economic class)

Weaning from bottle shorter in middle class toilet training favors lower class

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