Behavioral Sciences

Behavioral Sciences Defined:

Behavioral Sciences in medical education is an
aggregate body of knowledge which has been argued
and refined.
Behavioral Sciences is Defined as the science of
behavior,
As a science it formed from many sciences as follows:
Biochemistry, genetics, pharmacology, physiology,
anthropology, sociology, and psychology. Also it
shares with other sciences the scientific method.
As behavior it consists of many behaviors like
psychomotor, sensor motor,
Mental functioning, thought process, emotional state,
and personality structure.
Integration of Behavioral Sciences and Psychiatry:
There are two practical ties between Behavioral
Sciences and Psychiatry:
The first is academic history for Behavioral Sciences
was introduced through the department of
Psychiatry.
The second both Behavioral Sciences and Psychiatry
deal with abnormal behavior as follows:
Behavioral Sciences: assessment, intervention (
psychotherapy), And Follow up.
Psychiatry: diagnosis, intervention( drugs), and
Follow up.
 Basic concepts
1- Motivation:
Motivation is a concept that represents the energy which
moves a person to satisfy basic or primary (survival)
needs, and secondary (psychological and social) needs.
Primary needs: air, water, food, shelter, and sex.
Secondary needs: security, identity, love and self esteem.
2- Gradient:
Gradient refers to the slope of a line on a graph which
shows a relationship between elements.

∟
X represents surgical time and Y represents anxiety level
closer surgical time more anxious the patient.
3- Stress:
Is a disruption of homeostatic balance of the individual.
There are three causes as follow:
- Loss of significant objects.
- Injury or threat of injury.
- Frustration.
In this case the reaction of the individual is:
Flight or fight which demonstrable by: increase blood
sugar, increase blood pressure, increase muscle tone and
dilated pupils.
4- Conflict:
Conflict is present when two or more desires arise
together.
There are three kinds of conflicts:
- Approach- approach conflict.
- Approach- avoidance conflict.
- Avoidance - avoidance conflict.
The resolution is to choose one of the desires.
5- Organic -Functional:
Organic disease means the etiology is known and usually
in pathologic states.
 Functional disease means the etiology is not known at the
present time or the etiology is not known yet.
6- Acute-Chronic:
Acute disease in B.S and psychiatry means that the
condition is reversible.
Chronic in B.S and psychiatry means that the condition is
not reversible.

Dimension of Behavior
1-Emotion:
Emotion is an affect, it accompany the alteration of the
homeostatic state of the human organism.
The kinds of Emotion:
Positive Emotion: happiness
Negative Emotion: sadness- depression, anxiety- fear,
anger-hostility.
Anxiety- fear : fear is related to a real thing that a frightened
person recognizes and a person can make a protective
behavioral response. Anxiety is fear of something that the
person cannot identify .the symptoms of anxiety experienced
subjectively by the anxious person
Because he has no awareness of the threatening object. The
subjective evidence of anxiety what the person reports ( I am
nervous, my knees are shaky,) the objective evidence (excessive
perspiration ,fine motor tremor, speaking at the height of
inspiration , head pulled back, eyes open wide, headache,
hypertension , abdominal pain, hyperventilation.)
Kinds of anxiety:
Strange anxiety
Separation anxiety
Anger emotional response usually has frustration stimulus.
Frustration is occurs when motivated behavior or a goal is
blocked or there is a threat to obtain.
Anger is also related to hostility
Anger is short term (20)
Hostility is long term (week and over) and destructive.
Sadness as an emotional response usually has loss of a
significant object
Subjective evidences ( I feel down, I am sad) .objective
evidences (flacid face, down cast gaze, head titled down)
Sadness is short term (below 1-3ms)
Depression is long term (more than 3ms).
2-Thought: or thinking is mental process for creativity and
problem solving.
Thinking is divided in two kinds :
Process : describe how a person thinks (production rate).
Content: concern the meaning of the thoughts themselves, the
reality.(delusions)
3- Orientation:
Orientation is knowing ,who, where, when, and why one is at
the present time.
4-consciousness:
Consciousness is mental process that has three definitions:
a- Physiological a rousal.
b- Physiological alert
c- Whether a piece of data is in a person awareness at the
present time.
Consciousness
in psychoanalytic theory stages of Consciousness as following:
a- un Consciousness.
b- pre Consciousness.
c- Consciousness.
Lecture4:
5- Sensation:
Response for stimulation of five senses. Sight, sound, touch,
smell. taste. Sensory deprivation 0ccur in following conditions:
1-Toxic conditions (various drugs).
2- neuropathologic condition,(irritating lesions of the visual
cortex)
6-Perception: understanding of sensory stimulus, or activation
results or attention to the stimulus which called orienting
response. The person understand or perceives the stimulus
according to his past experience or frames of reference some
times for either organic or functional reasons misperception of
stimulus occur. A shadow or a leaf on a wall at night perceived
as spider (illusion,) hallucination (auditory types).
7-Memory & forgetting:
Memory is ability to bring into awareness past event and
experience.
Types of memory:
1. Immediate memory: ability to reproduce data which one
has just been exposed.
2. Recent or short term memory :ability to remember
information after at least ten minutes after exposure,
3. Remote or long term memory: ability to remember
information at any time.
Both neuroanatomical sites and neurochemical substance
are important in memory process. RNA and protein
synthesis is important in memory storage particularly long
term data.
Lesion in the hippocampus deficits short term
memory.long term memory deficit by psychosis disease.
Forgetting(amnesia) is nonrecollection of material which
one has been previously exposed.
types of amnesia :
1-patchy amnesia (selective).
2-anterograte amnesia forget all information about certain
event.
 3-retrograte amnesia forget recent event and remember past
events.
8- Intelligence : ability to act purposely, to think rationally
and to deal effectively with environment .
Types of Intelligence:
1- verbal Intelligence, under the control of the left hemisphere.
2- performance Intelligence, under the control of the right
hemisphere.
In most people Intelligence determined by heredity 70% and by
environment 30%.
Intelligence quotient is expression of relation between mental
ability and age.
IQ: 20 : Profound mental retardation
IQ:21-35 : Severe mental retardation
IQ:36-51: moderate mental retardation
IQ:52-67 : mild mental retardation
IQ:68-85 : borderline mental retardation
IQ:86-109 : normal intelligence
IQ:110-119 : bright normal
IQ:120-129 : superior
IQ:130- and above : very superior

Lecture 5
Genetic influences on human behavior:
Genetic factors are responsible for unique human conditions
as following:
Chromosome disorders in man: those behavioral
disorders that have been established to be genetic in
etiology can be divided into four major subgroups:
1- sex Chromosome disorders:
A-turners syndrome:
Occurs in one per 3000 to 5000 girls.
Characterized by underdeveloped external
female genitalia, small uterus, short stature,
webbed neck and usually. a lack of ovaries,
intellectual impairment but not usually severe
mental retardation with 45 chromosomes .
B-Klinefelter syndrome: in one per 340 to 500
male characterized by external male genitalia,
sterile, intellectual impairment with 47
chromosomes (xxy).
C- xyy : Occurs in male Characterized as super
men tall, greater than average, hyper sexuality,
with criminal history.
D-xxx : Occurs in female, Characterized as super
woman, , hyper sexuality, low ability, sterile.
2- Inborn error of metabolism:
A- Phenylketonuria :(pku) results from
insufficient amounts or absence of the enzyme
phenylalanine hydroxylase, which oxidizes
phenylalanine to tyrosine.
B- Tay-sachs :is a disorder caused by a specific
enzymatic deficiency. is characterized by
progressive mental deterioration ,loss of visual
function, death by 3 years.
3- genetically transmitted blood disorder:
A- sickle cell anemia : is a disease confined
mostly to blacks . The red blood cells have a
sickle shape .carriers are much resistant to
malaria, 25% per cent of blacks have disease
9% are carries.
B- Hemophilia is a recessive sex-linked genetic
disorder. The responsible recessive gene is on
the x Chromosome. The disorder occurs
almost exclusively in males but is transmitted
 by female who carries the responsible gene.
The father cannot pass the disease to his son.
4- Translocation errors:
Down syndrome is characterized by short
stature, stubby hands feet, mental retardation.
There are two causes Translocation of
Chromosome 21 . higher prevalence of older
mothers. And having been exposed to x ray
within the recent past.

Lecture 6
Biochemical Determinant of Behavior:
-Neurotransmitters are biochemical substance that facilitate
transmission of nerve impulses from one neuron across the
synapse to the next neuron, or from neuron to muscle fibers at
the myoneural junction.
Each Neurotransmitter has a specific function as follows:
-Acetylcholine is the principle chemical mediator at the
myoneural junction of skeletal muscles . its central
Neurotransmitter also.
-The best Neurotransmitters of CNS are epinephrine, nor
epinephrine, dopamine , serotonin, and endorphins.
-Other likely central Neurotransmitters include histamine, and
gamma.
-The are evidences that nor epinephrine, and serotonin are
important in pathology of depressive syndrome.
-The are evidences that dopamine are important in pathology
of schizophrenics syndrome.
-The are evidences that endorphins are important in pathology
of stress syndrome.
-The are evidences that endorphins are important in pathology
of major thought disorders.
-The are evidences that endorphins has important role in
addiction
Their for withdrawal defined as endorphins deficiency.
-hereditary play a major role in schizophrenia and manic
depressive.
- hereditary play no role in criminality, alcoholism and
homosexuality.

Lecture 7
Physiologic determinants of behavior:
Limbic system:
Is apart of older cortex.
Activities:
1- Modulation and coordination of the central processes of
emotional elaboration motivation.
2- Establishment of conditioned reflexes .
3- Memory storage.
Dysfunction:
1- Deficits of short term memory.
2- Klver-Bucy syndrome:
submissive behavior, hyper sexuality, visual Agnosia.
3- Electrical stimulus produce intensive pleasurable
responses
Reticular Activating System: is the oldest part of the brain.
Activities:
1-all sensory and motor impulses pass through it when enter
or exit the brain.
 2- filter in coming information.
4- Facilitate the process of sleep.
Dysfunction:
1- Schizophrenia
2- Sensory deprivation.
3- Sleep disorders.
Sleep:
Is an active physiologic process.
full awareness (30- 17 hertz). Theta.
full relaxation(17- 8 hertz) peta.
Sleep(8- down hertz).
Stages of sleep:
1- Stage 1 & stage 2.(8- 3.5 hertz) Alfa (each stage 90 m)
consciousness.
2- Stage3 & stage 4 (3.5- down hertz) delta (each stage 90
m) un consciousness, REM sleep.
Dreams. Penile tumescence in male.
Neuroanatomical sites:
Neuroanatomical sites are in executive control of much of
human behavior.
1- The left cerebral hemisphere is responsible for verbal
abilities.
Dysfunction:
Dysfunction results aphasia, a person is able to understand
communication but has difficulty expressing himself.
2- The right cerebral hemisphere is responsible for visual-
spatial aspects of behavior.
Dysfunction:
Dysfunction results difficulties in visual- spatial aspects of
behavior.
Lecture 8
Acquisition of Behavior:
Learning is defined as the permanent change in a behavioral
tendency.
Many theories discuss acquisition of behavior as follows:
1. Psychoanalytic theory:
Popularized by Freud, The main motivations for
acquisition of behavior are sexuality and aggression.
2. Behavioral theory:
(a) Classical conditioning learning:
Popularized by Pavlov, stimulus substitution leads
to generalization which is the main issue in
acquisition of behavior. The needle stick is
unconditioned stimulus (UCS) produces the cry or
unconditioned response (UCR). The physician is the
conditioned stimulus (CS) and the cry on seeing the
physician is the conditioned response (CR)
(b) Operant conditioning learning:
Popularized by Skinner, the main issue in
acquisition of behavior is reinforcement positive or
negative. The reinforcement is present100 percent
of the time only during the response acquisition
phase. Acquisition , a schedule of partial
reinforcement produces behaviors that are resistant
to extinction.
3. Cognitive theory:
Popularized by Piaget, Cognitive theory emphasizes the
role of understanding. It assumes the individual is fully
aware and attention and mature.
4. Social theory:
Popularized by Pandora, focus on modeling. The learner
observes another person perform, and act and models
behavior after the observed person (child- mother).
Lecture 9
Growth & Development:
In addition to biochemical, physiologic, genetic, and learned
influences on human behavior there is impact from the natural
unfolding growth and development process. This process will be
presented in two parts: theories and phenomenal observation.
Theories:
1. Psychoanalytic theory:
Stages of development:
Freud postulated five stages as follows:
a. The oral stage. (birth- 18) moths:
The child major source of Interest and
gratification is the mouth (sucking& biting ) the
personality issues of learning is trusting others.
b. The anal stage (18m-3) years:
The child major source of interest and gratification
is the anus the personality issues of learning is
control of excretory function.
c. The phallic stage (3-7) years: The child major
source of
Interest and gratification is the sexual organs
the personality issues of learning is awareness of
sex
Differences (Oedipal/ Electra complex)
d. The latency stage (7- 12) years:
The child major source of Interest and
gratification is the same sex relation. the
personality issues of learning is socialization and
companionship.
e. The genital stage (12- to adult) years:
The child major source of Interest and gratification
is the opposite sex relation and romantic love. The
personality issues of learning are independence
from parents selecting a spouse & vocational goals.
Freud divided personality into three conceptual
subdivided:
 The ego, super ego, id. The ego interfaces internal
needs with external reality using defense
mechanism (repression, suppression, displacement,
projection, regression, fixation, denial). The id
seeks gratification of needs which is unrealistic.
Super ego is a value system.
2. Social theory:
The stages:
Eric Erikson postulated eight stages as follows:
The stages:
a. Trust versus mistrust (birth- 18) moths:
The child main issue in this stage is the basic needs that
must be met therefore he will trust others, either
mistrust others.
b. Autonomy versus shame & doubt (18m-3) years:
The child main issue in this stage is self control
therefore he must attain confidence, either he must be
ashamed.
c. Initiative versus guilt (4-6) years:
The child main issue in this stage is to attain
independent activities , either he must be guilt.
d. Industry versus inferiority. (6-13) years:
The child main issue in this stage is to interact without
the support of the parents either he must develops sense
of inferiority.
e. Identity versus role of confusion (13-18) year:
The child main issue in this stage is to maintain a sense
of personal identity otherwise he must develops role of
confusion.
f. Intimacy versus isolation (18-25) years:
The child main issue in this stage is to establish
intimate relationship otherwise he must develops state
of isolation.
g. Generativity versus stagnation (25-40) years:
The child main issue in this stage is developing
children as a personal extension and occupational
 advancement otherwise he find no meaning in life and
become stagnant.
h. Integrity versus despair(40- up) years:
The child main issue in this stage is to develop
emotional integration otherwise despair is the
consequence.
3. Cognitive theory:
postulated four stages as follows:
a. .sensorimotor stage (birth- 18) moths:
During this stage the infant employs senses and motor
activity.
b. Preoperational stage (18m-7) years:
During this stage the child can only center cognitive
processes on one dimension at a time.
c. Concrete operation stage(7-13) years:
During this stage the child begins to abstract
commonalities from tangible objects.
d. Formal operation stage(13-up) years:
During this stage the child has the ability to indulge in abstract,
conceptual thinking
Lecture 10
Interpersonal and small Group Determinant of
Behavior:
Group Dynamics:
No single individual can meet all his needs alone, so all
individuals need to form group. Groups form according to sex,
age, race, occupation, socioeconomic status, etc. the link
depends on the size of the group, dyad group have an
opportunity to develop intimacy more than triad group. Some
group formed for specific goal and ended when the goal met.
The most rigid and closed group is the family, every member
has a certain role, this role has stability and resistance to change.
There are two kinds of families:
1- Nuclear family: is a unit of procreation (mother, father,
and children)
Advantages: children adapt a strong super ego.
Disadvantages: no chance for orphaned, single, aged, new
marriages.
2- Extended families: are those in which there is inclusion of
more than one unit of procreation eg., grandparents, parents,
grandchildren, aunts, and uncles.
Advantages: support orphaned, single, aged, new marriages.
Disadvantages: children adapt a strong super ego.
Leadership: Leadership is tied to the nature, focus and
needs of the group. Leader is divided into kinds:
1- Democratic Leader:
Democratic Leader gives all the members’ chances to
contribute in decision making, so the production rate is high
when the leader is present or absent.
2-Authoritarian Leader:
Authoritarian Leader doesn’t give the members chances to
contribute in decision making, so the production rate is high
when the leader is present. But when he is absent the
production rate is low.
Destructive Issues:
 Destructive Issues or destructive variables to internal group
structure are competition and aggression.

Lecture 11:
Assessment of behavior:
Observation of specific aspects of human behavior has been
standardized into formal and consistent samples called
psychological tests. The major types of psychological tests are
described as below:
1- Developmental scales:
a- Denver developmental scale :
Denver developmental scale is applicable from birth to six
years. it include developmental progress in social, fine
motor, language.
b- The vineland social maturity scale:
The vineland social maturity scale is applicable from birth
to maturity. it include developmental progress in
socialization.
2-Intelligence tests:
Intelligence tests reflect Intelligence. an Intelligence quotient
(IQ) is derived by one of the two following methods:
a- Mental age divided by chronological age multiplied by100.
The Stanford-binet Intelligence test is an example of this
process.
b- The IQ is derived from age subgroup norm tables ,the
Wechsler scales test is an example of this process.
3-Achievement tests:
Achievement tests these are norm-based assessments which
usually have been established on stratified representative
national samples.
4-Aptitude scales:
Aptitude scales or ability scales are those attempts to assess
creativity, musical, psychomotor coordination, speed and
artistic aptitude.
5- Interest tests:
Interest tests are derived to persons who are successful in
different occupations. The strong vocational interest inventory
is an example of this tests.
6-Personality scales:
Personality scales are presume to assess dimensions of stable
intra and interpersonal interaction patterns. The Personality
scales are subdivided into:
a- objective tests:
-Minnesota multiphase personality inventory (MMPI) it
contain ten clinical scales 166 questions.
-the Meyers-Briggs
Has three dimensions
B-Subjective test
The Subjective test are derived from theories .the clinician
analysis the responses to stimulus to internal needs. The
major subjective tests are the Rorschach(ink blot) .
The thematic apperception test(TAT).
7- Neuropsychological tests: neuropsychological tests are
psychological instruments sensitive to cerebral dysfunction. The
bender-gestalt test is an example of this test.
Lecture12:
Psychosocial Issues in health care delivery:
Issues associated with the patient:
People from different professional, socio-economic, sexual and
ethnic backgrounds display illness differently for example
health professionals frequently won’t recognize illness in
themselves because of the (omnipotent) role forced on them by
culture.
Women tend to seek more health care than men. Middle &
upper socioeconomic persons tend to seek more health care than
lower socioeconomic persons.
Rates for all functional psychosis tend to be higher in rural
settings, and rates for neuroses and personality disorders appear
higher for urban areas.
Attitudes, Beliefs, prejudice, and values are at the core of the
psychosocial issues that associated with the patient.
Attitudes: are the evaluative (good-bad) and affective aspects of
response toward a given object or situation.
Beliefs: are the cognitive information an individual has about an
object.
Prejudice: is harmful attitude directed towards a subgroup of
people involves overgeneralization.
Values: are the personal guide an individual develops that give
direction to life which help the person to take decisions.
Attitudes & Prejudice begins to appear at about a preschool age.
Beliefs & Values developed later in life and all these aspects
conveyed by the parenting persons ,cultural norms and
significant group.
Death and dying:
If the patient is informed of a serious or fatal illness these stages
can be observed:
1- Denial.
2- Anger.
3- Bargaining.
4- Sadness or depression.
5- Acceptance.
Grief and Bereavement:
The stages of the grief process:
The persons remaining after the loss of a loved one undergo
predictable reaction as follows:
1- Acute disbelief or phase of protest.
2- Phase of disorganization.
3- Phase of reorganization.
Age related grieving:
Infants: refuse to eat and die if the mother is not replaced.
Children: react with hyperactivity.
Adolescents: may develop dissocial behavior including hyper
sexuality, delinquent activity , substance abuse, and violence.
Adults : develop psychosomatic illness and substance abuse.
Elderly: like infants refuse to eat and frequently withdraw from
social contact and often die within one year unless support
system steps are taken to involve them in a life process.

Lecture 13
Issues associated with the doctor:
The doctor –patient relationship:
There are three major interviewing style each can be used for
specific purpose:
1- Laundry list interview:
the physician asks a series of preprogrammed ,structured
questions. This is useful to patient with thought disorders,
mania, and obsessive compulsive disorder.
2- associative interview:
any communication from the physician is associated to
what the patient is presenting. This is more efficient
method for most patients.
3- open-ended interview:
This interview is useful for psychotherapeutic encounters.
The physician must put in his mind while interviewing the
patient the following concepts:
Support.
Reassurance.
Empathy.
Reflection.
Interpretation.
Silence.
summation.
The patient rights:
1- The patient has a right to live.
2- The patient has a right to receive appropriate help
3- The patient has a right to know his disease.
4- The patient has a right to know the kind of appropriate
treatment.
5- The patient has a right to know the side effects of his
treatment.
6- The patient has a right to be treated without
discrimination according to, socio-economic, sexual and
ethnic backgrounds .