Answers
———

a) This gynecologist adapted the active-passive relationship, in which the patient's role
is completely passive. In this model the doctor wants to lead all the treatment process
without taking into consideration the patient's rights to choose her treatment plan and
to decide what's best for her.

b) I think this model isn't appropriate in this situation as the patient is able to make her
own decision and she has the right to participate in choosing the treatment plan that's
best fits her life style. I also think that doctors shouldn't ignore the patient's opinion
and willingness.
The best doctor-patient relation ship is the rapport model, in which patient and doctor
are cooperative to approach the best for the patient. This model is based on
acceptance, care, empathy, understanding the patient's feelings and problems within a
professional context.

c) Bad news is a relative concept that depends on the patient's interpretation of the
information given and their reaction to it, therefore what's considered bad news for
someone might not be bad news for others. It depends on the patient's personality,
situation and emotions. That's why doctors should consider the individual patient's
needs and circumstances. Doctor needs to be open, honest and provide reassurance
and emotional support to his patients.

———————————

3- A 56- years old man has been hospitalized to prepare him for a kidney
transplantation surgery.

a- What are the psychological responses of this patient to the hospitalization, and why is it
considered a stressful medical condition? (5 marks)
b- What is your role to reduce such responses? (5 marks)

Answers
———

a) Hospitalized patients go through both social and psychological changes as follows:
1. Social changes:
- Patient is removed from his normal routine life
- patient can't do his daily activities.
- Patient losses much of his privacy
2. Psychological changes:
- Invasion of patient's privacy.
- He losses independency and individualism
- He losses interest in social contact.
In response to these changes patient becomes under stress and manifest the following
reactions:
- Fear and irritability
- Unhappiness & loss of interest in the outside world
- Increased need for social reassurance from family relatives and professional
personnel.


b) My role is to protect the patient from going through these manifestations by good
communication with him, understanding his feelings and worries and trying to
reassure him. I should provide him with information about his procedure so he won't
be worried, make him comfortable by noticing what irritates him and remove it and
encourage his family members and health care staff to provide him with social and
emotional support.

———————————

Name the 3 types of memory with their definitions and functions?

Answer
———

1-
Sensory memory:
- Holds large amounts of information (large capacity),
- very briefly,
- long enough to connect one impression to the next to be processed further. -Maintained by sensory registers temporary storage bins.

2-
Short Term: (STM): Def
1. Short-term memory: The maintenance component of working memory, which
holds rehearsed information for a limited time.
2. Working memory; allows us to mentally work with, or manipulate information
being held in short-term memory
Functions
Storage of information for only few seconds.
b. Computations, important in thinking & problem solving.
c. Integrates short-term perceptions & memories while other cognitive processes
are taking place; combine & contrast new memories with stored past-experience d. It serves as a way station to long term memory.

3-

C) Long Term Memory (LTM):
Permanently retained information, even for life- unlimited capacity

———————————

How to decrease these stress?

Answer
———
(A) Acute Stress Conditions

1. Symptomatic drug treatment:
anxiolytic, antidepressant, antipsychotic
2. Psychotherapy, crisis intervention, cognitive behavioral therapy "CBT" enables the individual to:
a. be aware of their own problem & its cause
b. evaluate the exact significance of stresso
teach him how to develop & maintain the use of stress-management skills,
correct maladaptive pattern of thinking le. do proper management of time & problem-
solving skills.

(B) Chronic Stress


Try to change the individual's behavior & personality style by:
1. Relaxation training, eg, progressive muscle relaxation.
2. Religious meditation, praying ....
3. Biofeedback, trial to put the involuntary physiological (ANS)
responses under voluntary control (device which gives an alarm when
+++ABP so that the person relaxes).
4. Physical exercise, yoga, music, art, dance & social activities.

———————————

What are theories and causes of human aggression?

Answer
———
Theories of Aggression:
(A) Psychosocial theories:
Freud theory: sex & aggression are the 2 basic instincts (death instinct).
Lorenz theory: aggression stems from fighting instinct (as other organisms)
Learned response theory: aggression is a form of learned behavior, through observation, imitation, identification & needs reinforcement to be repeated.
B) Biological Basis:
1-Genetic Studies:
-Aggression runs in families & in monozygotic › dizygotic twins
Polymorphism of Tryptopha hydroxylase gene with lower CSF & blood SHIAA
& serotonin level in aggressive persons.
Chromosomal abnormality (XYY, Phenylketonuria, Sanfilippo's) → ++ aggression
2- Hormones:
Testosterone, androgens, progesterone related to aggressive behavior,
Males with androgen insensitivity syndrome → tend to be feminine & calm
Females with adrenogenital syndrome → masculinized & +++ aggression.
Criminals who commit violent crimes have higher levels of testosterone
Murderers with ++testosterone have known their victim & planned their crime
3-Neurotransmitters
Cholinergic & catecholaminergic systems → +++ aggression
Serotonin & GABA → ---- aggression
4-Neuro anatomy:
Damage to Limbic system, amygdala, hypothalamus → defensive aggression
Cerebral cortex (prefrontal area may also be involved in aggression
—

Causes of Aggression:
(A) Psychosocial:
1) Intense frustration when prevented from reaching some goals especially when it is massive & unexpected. Frustration-aggression hypothesis: frustration always results in aggression & aggression will not occur unless frustrated.
However, frustration may produce depression & withdrawal & not all aggression is preceded by frustration

2-Direct provocation from others (insults), threatening self-esteem in public

3-Oppression from unjust authority (events in political conflicts)

4-Exposure to media charged with violence (aggressive models)

5-Situational eg, +++ psychological or sexual arousal or pain.

6-History of child physical, sexual abuse or neglect.

7- Family conflicts and problems.

8-The presence of physical anomalies and handicap.

(B) Environmental:
1-Air pollution, noise, over-crowding.
2-low socioeconomic status, minority groups
3-availability of weapons as in upper Egypt.
(C) Substance abuse:
Opioids, amphetamines, cocaine, hallucinogens, cannabis; high doses of anxiolytics & barbiturates; Alcohol drinking → aggressive thoughts & actions

———————————

a- Patient related factors & doctor related factors in medical
interview.
b- How to improve information giving skills.

Answers
———

A-

1. Patient related factors:
- Patient's belief of health and illness
- Problem wished to discuss
- Previous experience with medical care
- Current experience with medical care
- Expectations of the doctor will do
- How the patient perceives the role of the doctor
2. Doctor related factors:
- Personality
- Physical factors
- Psychological factors
- Problem wanted to be discussed with patient
- Communication skills
- Self-confidence in the ability to communicate

B-

1. Discuss& clarify every given information.
2. Begin the interview by summarizing the patient's condition.
3. Assess the patient's understanding of the condition.
4. Outline plan of the rest of the interview.
5. Discuss& explain every part of information in appropriate language
6. Mention the most important first
7. If relevant, use drawings to supplement the information
8. Negotiate management with him
9. Explore his view and encourage him to ask ques.
10. Check the patient's understanding.

———————————

⭕ PSY

Files

Med Map's
Part 1
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Dr Effat's
Department's book
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Sources

1️⃣ Dr Nagi
PlayList in the order of Dr Effat's file
Playlist in the order of Department book
Task: Last 5 videoes
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2️⃣ MedMap
Medical Psychology 2
Medical Psychology 3
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⭕ Pathology

Files

Written Q For every chapter
Written Q Dr. Eman

Sources

Today's task: Blood  
DR.Elnemr

What are psychological changes in old age?

Answer
———

a. ---- mental capacity
b. rigid memory
c. less adaptable to new ideas & tasks; d. has a large useful experience