Introduction of Course Requirements

The Clinical Practice of Behavioral Medicine
HUBS/OCCT 3207
Jeff Baker, Ph.D. - Primary Instructor & Course Coordinator

Review Objectives, Textbook, Evaluation, Grading Scale, Links, Faculty Information, Classroom Interaction, & Syllabus; Faculty Background, contact information.  

Case Presentations.

Scope of Course: Practicing Physician Assistant clinical information regarding behavioral medicine.

Lecture Notes

Percentage of patients that present with psychological distress or depression at a family practitioner’s office: ?
Percentage of psychotropic medications prescribed by primary care physicians: ?

Models of Disease
Integrated systems approach to Human Behavior

Biopsychosocial model is derived from general systems theory
*Biological system deals with the anatomical, structural, and molecular substrates of disease and the effects on patients' biological functioning
*Psychological System treats the effects of psychodynamic factors, motivation, and personality on the experience of, and reaction to, illness.
*Social system examines cultural, environmental, and familial influences on the expression and experience of illness.

Meaning of Being Sick
Illness Behavior
Patients' reactions to the experience of being sick.
Sick Role
The role that society ascribes to sick people because they are ill.

The dependent-patient role stage
A decision is made to transfer control to the doctor and to follow prescribed treatment.

The recovery or rehabilitation stage
A decision is made to give up the patient role.

Doctor-Patient Models

Active-passive
    Patients’ complete passivity and the physician takes control.

Teacher-student
    Physician's dominance is assumed and emphasized.

Mutual participation model
    Implies equality between doctor and patient; both participants require and depend on each other's input.

Friendship model   
    Generally considered dysfunctional if not unethical.

Effective Interviewing

Define an effective interview from HD3225
What happens when you go to the physician for a medical problem?
Patient Relationship
Empathy, warmth, and genuine
What if there is a psychological component to the illness?

Psychiatric Interviewing
Insight Oriented
Symptom Oriented

Implement Treatment plan

Phases of the Clinical Interview (Table 1-2, Page 4)

Developing Relationship/Problem Identification

Demonstration of Understanding/Clarification of Problem

Decision Tree/History and data gathering

Diagnoses and feedback

Prognosis and Plan

Medical Interview

Table 1-3

How do each of the medical interview functions relate to understanding the problem?

Determining the nature of the problem

Therapeutic alliance

Feedback and treatment plan

Domains
Table 1-5
Reason for the evaluation
History of the present concern
Past psychiatry history
Gen medical history
History of substance abuse
Psychosocial developmental history
Social history
Occupational history
Family history
Review of systems
Physical exam
Mental status exam
Functional assessment
Diagnostic tests
Information derived from the interview process (observations)

Difficult Patients (High Maintenance Patients)

Depressed - Video Sleepless IS Chapter 10
Histrionic - Video Basic Instinct Chapter 12
Dependent - One FOTCN Chapter 2 Billy Bibbit
Impulsive -
Narcissistic
Obsessive - Video As Good AIG Chapter 3
Paranoid - Video - One FOTCN Chapter 4 17:00
Isolated
Demanding and passive-aggressive - Video FWAF Chapter 18 1:43:00
Malingering - Video One FOTCN Chapter 3 McMurphy

The Health Care Practitioner is Susceptible to Burnout when they are exposed to a large number of these patients.

Chapter 7

Common Interview Techniques
Table 7.1-1 (page 241)
Discuss how these techniques influence the interview.

Treating Violent Patients
Table 7.1-2
Review the Do's and Don'ts of working with violent patients

Outline of the Mental Status Examination
Table 7.1-5 (page 250)

Summary of memory Tests

Table 7.1-7 (page 253)

Remote

Recent past (past few months)

Recent (past few days)

Immediate retention and recall: digit-span, etc.

Laboratory Tests in psychiatry (page 256)

Thyroid Function Tests
Catecholamines
Renal Function
Liver Function
STDs
Pharmacologic effects (Pharm course and lecture on psychopharm later in course)
Textbook is an excellent resource for years to come, time limits a comprehensive discussion.

Chapter 8

Signs and Symptoms (slide)
Table 8-1
An excellent index for locating the definitions of mental phenomena and the signs and symptoms of psychiatric illness.

Chapter 9

DSM-IV
Table 9-1 Lists DSMIV Classifications (17 major classifications and more than 300 specific disorders).

ICD-10 Classification of Mental Disorders ICD-10
Table 9-2

DSMIV Axis
Axis I
Clinical Disorders - Axis I consists of clinical disorders and other conditions that may be a focus of clinical attention.
Table 9-4 (page 297)

Axis II
Consists of Personality Disorders & Mental Retardation The potential use of a particular defense mechanism can be indicated on Axis II.
Table 9-5

Axis III
General medical Conditions - any physical disorder or general medical condition that is present in addition to the mental disorder. Could be causative usch as kidney failure delirium. Table 9-6

Axis IV
Psychosocial and Enviornmental Problems that significantly contribute to the development or exacerbation of the current disorder.
Table 9-7

Axis V
Global Assessment of Functioning (GAF Scale) - overall levels of functioning during a particular time (patient's highest level of functioning over the last few months.
Table 9-8