CLINICAL BEHAVIORAL SCIENCE CLINICAL BEHAVIORAL SCIENCE Edited by Frederick Sierles University of Health Sciences The Chica90 Medical School North Chica90. Illinois SP IIII11 SP MEDICAL & SCIENTIFIC BOOKS New York Copyright @ 1982 Spectrum Publications Softcover reprint of the hardcover I st edition 1982 All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means without prior written permission of the copyright holder or his licensee. SPECTRUM PUBLICATIONS, INC. 175-20 Wexford Terrace, Jamaica, N.Y. 11432 Library of Congress Cataloging in Publication Data Main entry unter title: Clinical behavioral science. Includes index. 1. Medicine and psychology. 2. Human behavior. 3. Social medicine. I. Sierles, Frederick. [DNLM: 1. Behavioral sciences. 2. Psychopathology. WM100 C6386] R726.5.C55 616.89 80-36786 ISBN 978-94-011-7975-1 ISBN 978-94-011-7973-7 (eBook) DOI 10.1007/978-94-011-7973-7 To Laurene and my parents Acknowledgments I wish to thank the following individuals for their constructive criticism of portions of the book: Michael Taylor, Ingrid Hendrickx, Richard Abrams, Julian Berman, Hazim Zakko, Joseph Ryan, Georgeda Buchbinder, Hilliard Foster, Morton Miller, Hagop Akiskal, John Halversen, and Harvey Strassman. I am most grateful to Charlotte Hughes and Georgia Gunn for countless hours of typing the manuscript, to Erna Braun for her illustrations, to Jack DeBruin and Joseph Nadakapadam for their photographs, and to Laurene Sierles for indexing. Hannah and Joshua Sierles deserve special mention for tolerating my unavailability during the writing ofthis book. Finally, I wish to thank my parents for their gift of intel­ lectual curiosity. Some of the funds for the writing of the book came from National In­ stitute of Mental Health Grant MHOS-984-2S. Contributors RICHARD ABRAMS, M.D. P.S.B. SARMA, M.D. Professor and Vice Chairman Associate Professor and Chief Department of Psychiatry Division of Child Psychiatry University of Health Sciences University of Health Sciences The Chicago Medical School The Chicago Medical School North Chicago, Illinois North Chicago, Illinois BERNHARD E. BLOM, Ph.D. WILLIARD SHANKEN, M.D. Assistant Professor Private Practice of Psychiatry Department of Psychology Lansdale, Pennsylvania University of Health Sciences The Chicago Medical School FREDERICK SIERLES, M.D. North Chicago, Illinoi$ Associate Professor and Director Medical Student Education in Psychiatry GEORGEDA BUCHBINDER, Ph.D. University of Health Sciences Research Associate The Chicago Medical School Department of Anthropology North Chicago, Illinois Queens College The City University of New York MICHAEL ALAN TAYLOR, M.D. New York, New York Professor and Chairman Department of Psychiatry MICHAEL EGGER, M.D. University of Health Sciences Private Practice of Psychiatry The Chicago Medical School Council Bluffs, Iowa North Chicago, Illinois CHARLES HILLENBRAND, M.D. EDWARD TYLER, M.D. Assistant Professor Clinical Professor Department of Psychiatry Department of Psychiatry Stritch School of Medicine University of Louisville School of Medicine Loyola University Louisville, Kentucky Maywood, Illinois Preface This short text is designed to present those aspects of the behavioral sciences that are clinically relevant to physicians in all branches of medicine. It should also be helpful to medical students studying for the behavioral sciences section of Part 1 of the national boards, to physicians taking the behavioral sciences portion of the FLEX exam, and to psychiatrists prepar­ ing for their American Board of Psychiatry certifying exam. Behavior is a product of brain function and is manifested by actions in response to sitmuli. It is fundamental to the maintenance of health, and plays a role in causing and intensifying many illnesses. Abnormal behaviors can re­ veal to us, and even allow us to localize, brain dysfunction and disease. And they can cause, for patients, their families, and friends, considerable suffer­ ing. On an intellectual level, trying to comprehend the behavior of our patients (and our own behavior as well), contributes to making medicine a truly intriguing profession. Behavioral science is not, as you might suspect, synonymous with psychiatry. When I began teaching behavioral sciences 7 years ago, I was struck by how little I knew about behavior and behavioral sciences. The scope of the behavioral sciences is so vast that the field, as well as the discip­ lines of which it is composed, is unmasterable. Entire books, and entire careers in research, could be devoted to subjects that are merely touched upon in this book. Thus, for any individual subject this brief book cannot properly convey the depth or sophistication of a high-quality monograph or years of clinical experience. Nevertheless, there is merit in brevity, for clini­ cians and medical students are busy people who appreciate a book that gets to the point: Clinical Behavioral Science is certainly an attempt to pare down subjects to their essentials. It begins with the biological sciences as they pertain to behavior, moves to areas that are on the interface between the biological and the social sciences, and concludes with social sciences and social issues. The reader must realize, of course, that the dichotomy between the biological and social sciences is an arbitrary one-biological and social influences are usually interwined. As a teacher of medical students and physicians, and as a practicing psychiatrist, I rely heavily upon the information contained in this text. I hope the reader finds it an equally helpful companion. Frederick Sierles Contents Part I The Biological Sciences and Behavior 1 The Genetics of Behavior 3 Michael Alan Taylor 2 The Behavioral Neurological Examination 11 Michael Alan Taylor 3 The Aphasia Screening Test and the Minimental State Examination 21 Frederick Sierles 4 Psychological Testing 35 Frederick Sierles 5 Brain Biochemistry and Its Relevance to Behavior 47 Frederick Sierles 6 Sleep 65 Frederick Sierles and Charles Hillenbrand 7 Sex 77 Frederick Sierles and Edward Tyler 8 Psychopathology 93 Frederick Sierles 9 Psychopharmacology 111 Richard Abrams 10 Alcoholism 127 Frederick Sierles 11 Drug Abuse 139 Frederick Sierles 12 Behavioral Medicine 159 Frederick Sierles Part II General Theories of Behavior 13 Psychoanalytic Theory 181 Frederick Sierles 14 Conditioning 193 Frederick Sierles and Bernhard E.Blom Part III Verbal and Nonverbal Communication 15 Interviewing Techniques 207 Frederick Sierles 16 Issues in Talking with Patients 217 Frederick Sierles 17 The Phenomenological Mental Status Examination 223 Michael Alan Taylor Part IV Development 18 Ethology 237 Georgeda Buchbinder 19 Child Development 245 P.S.B. Sarma 20 Mental Retardation 277 Michael Egger 21 Early and Middle Adulthood 297 Frederick Sierles 22 Aging 305 Frederick Sierles 23 Dying and Death 311 Frederick Sierles Part V Social Sciences, Social Problems, and Social Systems 24 Medical Sociology 325 Frederick Sierles 25 The Potentially Suicidal Patient 357 Williard Shanken 26 Psychiatric Aspects of Criminal Behavior 363 Frederick Sierles 27 Rape 371 Frederick Sierles 28 Forensic Medicine 377 Frederick Sierles 29 Health Care Delivery I: Quality of Our Health Care System 387 Frederick Sierles 30 Health Care Delivery II: Relationship of the Health Care System to Society in General 391 Frederick Sierles 31 Health Care Delivery III: Third Party Payers 397 Frederick Sierles 32 Health Care Delivery IV: Influential Organizations 401 Frederick Sierles 33 Health Care Delivery V: Providers of Health Care 407 Frederick Sierles 34 Biostatistics 411 Frederick Sierles Index 427 CLINICAL BEHAVIORAL SCIENCE .