I.S. Vitenko, R.I. Isakov, V.O. Rud MEDICAL PSYCHOLOGY Edited by Professor A.M. Skrypnikov MINISTRY OF HEALTH OF UKRAINE UKRAINIAN MEDICAL STOMATOLOGY ACADEMY DEPARTMENT OF PSYCHIATRY, NARCOLOGY AND MEDICAL PSYCHOLOGY I.S. Vitenko, R.I. Isakov, V.O. Rud MEDICAL PSYCHOLOGY Recommend by Ministry of Public Health of Ukraine as Textbook for Students of Medical Universities IV accreditation’s level with English education’s form POLTAVA-2010 1 BBK UDK 616.89-159.9 Reviewers: professor N.O. Maruta, professor V.M. Kozidubova, assistant of professor K.V. Sedykh Edited by professor A.M. Skrypnikov I.S. Vitenko Medical Psychology: Textbook / I.S. Vitenko, R.I. Isakov, V.O. Rud. – Poltava: Dyvosvit, 2010. – 146p. ISBN The textbook consists of two parts which illustrates main positions of general and special medical psychology. Main criteria of normal, borderline and morbid psychic, peculiarities of physician’s psychology and interrelation between physician and patient were showed. Basis of psychosomatic mechanisms of diseases development and somatopsychic relations, problems of medical deontology, basis of psychohygiene, psychoprophylaxis and psychotherapy were showed. Special attention was devoted to the problems of human’s suicidality. For Students of Foreign Faculties with English education’s form of Medical Universities. 2 PREFACE Experience of teaching medical psychology in medical university reveals a great importance and actuality of basis of general psychology as part of common education of future medical specialists for all specialties. Without knowledge of basis of this science is impossible to teach future physician for understanding psychology of patients with different diseases. The role of patient’s psychic in the successful performing of diagnostic, treatment and rehabilitation is very important. The main objective of medical psychology teaching is learning a future physician of use patient’s psychologies peculiarities for the successful health’s rehabilitation and protection. There is critical important to educate medical students on the ethics, morality and humans principles. So a special attention in the textbook was devoted to medical deontology, problems of relations between physician, patient and relatives during different periods of medical care (diagnostic process, hospitalization, investigations, surgical manipulations, unsuccessful outcomes ect.). Authors of the textbook are hope for the use information from the textbook not only for education process in medical universities, but for professional practice of physicians too. 3 PART I General Medical Psychology CHAPTER I SUBJECT, TASKS, STRUCTURE AND METHODS OF MEDICAL PSYCHOLOGY Objectives: to learn the subject and tasks of medical psychology, it's history and place in the structure of psychological sciences, to get acquainted with main methods of medical psychology. Psychology is a science about the origin, development and regular manifestations of psychic activity of a human being. This term was formed from the Greek words "psyche"(soul) and "logos"(science). The main stages in development of psychology were: 1) Psychology as a science about human soul appeared in the field of philosophy more than 2 000 years ago. 2) In 17th century due to the accelerated development of natural sciences psychology appears as a science about consciousness which supposed to control the thoughts, wills and emotions. 3) In the 70ies of 19 century psychology develops as an independent science. Its task was the observation of human behavior, deeds and reactions without taking into account the motives and subjective factors. Also the experimental branch of psychology begins to develop. 4) Development of modern psychology. The principal tasks of psychology are: 1) Study of the regulations of the psychic development of a human in its development. 2) Investigations of the reflection of reality in the mind of a human being. 3) Study of mechanisms, regulating the actions and activity of a human being. 4) Study of the mechanisms creating the psychic traits of a person. 4 5) Determination of a certain dependence of psychic phenomena depending on the way of life and activity of the individual. Nowadays psychology is a complex system of interdependent psychological sciences. The principal branches of psychology are: - General psychology – the study of common regularities in the psychic activity of a grown-up. - Child psychology – the study of regularities of the psychic development of a child. - Teenage psychology – the study of regularities of the psychic activity of teenagers. - Late-age psychology – the study of regularities of psychic activity of elderly people. - Social psychology – the study of psychic phenomena in groups and collectives. - Pedagogical psychology – the study of the psychological basis of teaching and upbringing. - Work psychology – the study of the psychological basis of a man's working activity. - Pathopsychology – the study of various forms of disorders of psychic activity and their development. - Other (e.g. medical, military, artistic, space etc.). Separation of medical psychology and an attempt to determine its importance as a subject of teaching goes back to 1852 with the publication of "Medzinsche Psychologie", a work by R.H. Lotze, a German scientist. Medical psychology is a branch of psychology which studies the psychology of the patient, the role of psychic factors in the origin and development of the disease, the psychology of relationships between doctor, staff and patient, as well as the use of a psychological approach in medical practice. Medical psychology has two lines of development – general medical psychology and applied medical psychology. General medical psychology studies psychological peculiarities of the patient; the criteria of normal, temporarily altered and morbid psychics; the correlations between an individual and a disease; psychology of a doctor in his relations with the hospital staff; psychology of relationships between the doctor, his patient and relatives; teaching on a doctor's duty and ethics; teaching on iatrogeny caused by the carelessness of a doctor's words; peculiarities of ageing and its influence on the disease. Applied medical psychology studies psychology of patients suffering from nervous-psychic disorders; psychology of psychiatric patients and patients with dependencies; psychology of patients 5 with nervous diseases; psychology of patients prior to and after an operation; psychology of patients with cardio-vascular, gastric infectious, veneric, pulmonary, gynecological diseases; psychohygiene and psychoprophylactics in cases of pregnancy and child-birth; psychology of endocrinological and oncological patients; psychology of patients with physical abnormalities and sensory defects (e.g. blindness, deafness); psychology of the disabled. The basic points of contact of these sciences are the psycholo- gical peculiarities in doctor's conduct, correction of mentality while treating the patient and psycholotherapeutic influence. Medical psychology is connected with all medical specialities (therapy, surgery, obstetrics, gynaecology, paediatrics, hygiene and others). It has some specific methods and thus it plays an important role in doctor's training in any speciality. Mental phenomena are determined by the factors of environment (mentality is a form of reflection of the objective reality). However, any outer influence produces one or another psychological effect under inner conditions such as the mood of the individual, his aims, needs and life experience. Due to activity the mentality fulfils the function of orientation of the person in a variety of surrounding events and phenomena (it is manifested in selectivity of the subject regarding outer influence) and the function of regulating behavior (stimulation to the activity which meets needs and interests of the individual). In a definite situation the person's behavior depends on his interpretation and treatment of the situation. On the other hand, the character of treatment of the given situation, extent of knowledge about the situation will depend on interaction of the person with this situation. For the scientific cognition of different mental phenomena and their functional mechanisms medical psychology uses such methods: 1. Method of observation. 2. Method of clinical interview. 3. Experiment. 4. Psycho-diagnostic examination. One of the most typical ways of examination is observation of an object (a person, a group of people) pending the phenomena interested by an examiner will show themselves to be recorded and described. By means of this method the mental processes, states and properties of sick and healthy are studied. Mentality is studied under natural living conditions, and this study differs from an experiment because a doctor or a psychologist is a passive observer that has to wait for those phenomena he is interested in. The advantage of this method is that during the observation the natural 6 course of mental phenomena is not broken. The disadvantage of the observation is that it does not allow determining the cause of a certain mental phenomenon precisely, because it is not possible to take into account all interrelations of a mental phenomenon in the process of observation. Observation is carried out under usual living conditions: in families, at work, game, during studies, in a hospital ward. Independent activity, observation, reaction peculiarities of a patient, his relationship with other people are taken into consideration. Observation should be purposeful,