Concepts of Behavioral Science



1. Explain the importance of understanding human behavior for the physician.

Physical and mental illness are often associated with a one often causing the other. As a physician we must take this into account when considering how a patient presents symptoms and goes about the process of treating the disease i.e. choosing whether or not to fill a prescription.

2. Define the terms epidemiology, incidence and prevalence.

Epidemiology is the study of factors determining the occurrence and distribution of diseases in the human population. Incidence is the number of new individuals that develop an illness in a given period of time divided by the number at risk. Prevalence is the number of individuals in a population that have an illness divided by the total population.

3. List the major mental disorders in the U.S. population and their prevalence. Compare men's and women's prevalence of depression, substance abuse, and anxiety.

Women tend to report more morbidity, use mental services, and restrict their activities for health problems more often than men.

Disorder
Prevalence
More Prominent in
Any Disorder
46%

Anxiety Disorders
28%
Females
Mood Disorders
20%
Females
Substance Use Disorders
14%
Males
Psychotic Disorders (Schizophrenia)
1-1.5%


Most Common Specific Disorders
(1) Major Depressive Disorder
(2) Alcohol Abuse
(3) Specific Phobia
(4) Social Phobia

4. Define comorbidity; discuss the co-morbidity of medical and psychiatric illness.

Comorbidity is an association between two or more disorders.

Congestive heart failure patients have been shown to have greater incidence of depression leading to longer recovery time. People with anxiety disorders have greater incidence of acid reflux, migraine, and backache. Depressed patients have greater difficulty complying with treatment.

5. Define the biopsychosocial model of illness and implications for diagnosis and treatment.

The model considers psychological and social variables in addition to biological factors in
the predisposition, onset, course, treatment and outcome of illness: Personality, Family, Social class, Social support, Life events, Culture

6. Explain the relevance of the behavioral indicators of morbidity to overall assessment of patient status.

Behavioral indicators of morbidity are important indicators of a patients overall health, they can indicate conditions that may not be apparent on a medical examination that have a significant impact on the patients quality of life.

Examples:
Personality: internal or external locus of control affects relationship with physician; type A personality with hostility and time pressure has increased risk of cardiovascular disease.

Occupation: cook, computer operator, physician, etc. can affect the type of risk factors such as substance abuse or anxiety disorders.

Lifestyle: eating habits, exercise, use of leisure time can affect the onset of illness.

Attitudes: body size, likelihood of prevention, privacy issues and affect the likelihood of patients taking preventive health behaviors or seeking medical attention when symptoms present.

Life events: number of recent major life events, frequent daily can affect the onset of illness.

Social support: # of interactions and social roles are important because loneliness tends to be associated with more sleep disruption and cardiovascular disease.

7. Summarize the importance of psychological and behavioral factors in predisposition, etiology, and outcome of disease.

The personality type affects lifestyle choices predisposing some people to certain diseases i.e. heart disease or STI, as well as the likelihood and urgency with which one seeks treatment for conditions such as chest pain. A patient may present with different symptoms of the same underlying disease, for example insomnia as a manifestation of depression where another patient may present with anhedonia. The treatment outcome is largely dependent on the overall well being of the patient and their ability to participate in treatment.

8. Explain the effects of perception of illness and health beliefs on health seeking behavior. Discuss the influence of personality and social variables on decision time.

How one perceives symptoms determines whether immediate treatment is sought or delayed, this is largely affected by its impact on normal life and social activities, severity of symptoms, and any perceived embarrassment.

For example, if a person feels they are invincible, they may tend to delay action by disregarding their symptoms or, when forced to act, be amazed that they are vulnerable.

9. Explain the effects of psychiatric illness on course and outcome of physical illness. Define the principle of "offset costs" of treatment of mental illness in persons with medical illness.

Psychiatric illness often interferes in the treatment of physical illness. Patients with psychiatric illness often keep using medical services because they aren't getting properly diagnosed and treated for their mental illness. For example, they may keep coming back for treatment of insomnia when they really should be treated for depression instead.

If a patient receives needed psychological treatment their recovery is accelerated and their costs of treatment and number of work days missed are reduced. Offset costs are the costs that can be saved from medical services if mental illness treatment is implemented. Reduction of offset costs can include mental health care to decrease the usage of medical services, supportive counseling to facilitate earlier hospital discharge, and coping-skills training to empower the patient to change their unhealthy behaviors.

10. Differentiate between illness and illness behavior. Define the sick role and discuss its application to acute and chronic illness.

Disease refers to a disturbance in physiologic functioning of the organism while illness refers to a state of poor health recognized by the person and usually treated by an expert.

Illness behavior refers to the ways people respond to bodily sensations or symptoms and to the perceptions, values, attitudes and interpretations that lead people to behave in particular ways in reference to their bodies.

Illness behavior for acute disease typically involve (1) the experience of the symptom, (2) assumption of the sick role where one reduces usual responsibilities and takes it easy, (3) medical contact beginning a temporary linkage to the medical world, (4) assumption of the dependent patient role where some self-control is ceded to the physician, and (5) recovery with breakage of contact with the medical world. The 5 stage illness behavior model works well for acute illness but fails to accurately model chronic illness.

Recognizing the importance of the disease as well as the patient’s experience of the disease leads to better overall care.