醫(yī)學(xué)心理學(xué)資料：1Intruduction

1、Medical Psychology 主講教師：張紅靜電話：88382039E-mail: 上課班級(jí)：臨床醫(yī)學(xué)7年制10級(jí) Introduction to psychology and Medical Psychology Medical model and Medical Psychology The Tactics of Psychological ResearchLearning goals 1.The modern definition of psychology and Medical Psychology 2. What Psychologists do and how to st

2、udy 3. Found out the status of medical psychology as a scienceWhat is psychology?What Psychologists Do？Type of psychologistsResearch psychologists Guiding focus Conduct research to discover the basic principles of behavior and mind Primary Workplace Academic settings , Private industry Examples of t

3、hey do Best study method for improving memory; impact of daycare on childs attachment; observe the effects of others on a persons helping behaviorApplied Psychologists Guiding focus Extending psychological principles to practical problems in the world Primary Workplace Private industry, Schools, Aca

4、demic settings Examples of they do Help performance of students ; improve employee morale and performance at work; design computers so that humans use them efficientlyClinical psychologists Guiding focus Diagnosis and treatment of psychological problems Primary Workplace Clinics,Private practice,Aca

5、demic settings Examples of they do Adjustment problems, psychological problems; evaluate diagnostic techniques and therapyObjectPermanence Medical psychology Research the relationship between mental factors and health or diseases Physical science and social science Theory science and practical scien

6、ce Medical psychology Medical psychology is a branch of applied psychology devoted to psychological problems arising in the practice of medicine, including psychological aspects of pain, terminal illness, bereavement, disability, and reactions to medical advice.The Branch and Relational Sciences of

7、Medical PsychologyClinic PsychologyPhysiological psychologyNurse PsychologyAbnormal PsychologyHealth Psychology Psychosomatic MedicinePsychohygieneBehavioral MedicineNeuropsychology (Neuroscience ,Brain and Behavior) Learning goals 1.why medical model changed from biological medical model to biopsyc

8、hosocial medical model or holistic medical model 2. Think about that why we should study medical psychology The concept of medical model The development of medical model What cause medical model change Medical model Medical model means the concepts, assumptions and rules that doctors and researchers

9、 in their pursuit of knowledge and the solution of problems, the brief definition is the opinion of health and disease. Balance Medical Model Biological Medical Model Bio-Psych-Social medical model Holistic Medical ModelBalance Medical Model心身觀：一元論 “天人合一”“形神合一”健康觀：陰陽(yáng)平衡疾病觀：陰陽(yáng)失衡 病因“內(nèi)傷七情、外感六淫”治療觀：整體辨證施

10、治、“心病心藥醫(yī)”Biological Medical Model心身觀：二元論健康觀：生理功能良好疾病觀：微生物入侵（細(xì)菌、病毒）、外傷造成有機(jī) 體的組織破壞，任何疾病都可以在組織、細(xì) 胞或生物大分子上找到生物病因治療觀：運(yùn)用藥物、手術(shù)等生物療法，消滅入侵的微 生物，機(jī)體組織修復(fù)即可恢復(fù)健康。特點(diǎn)： 單一病因單一方法 方法機(jī)械、絕對(duì)化,心身分離、人與環(huán)境分離Bio-Psych-Social medical modelBiological factors, psychological factors and social factors can all effect health and di

11、sease, and also effect the treatment.心身觀：心身統(tǒng)一、相互影響健康觀：生理、心理、社會(huì)功能完善疾病觀：社會(huì)、心理、生物因素都影響人的健康和疾病治療觀：從社會(huì)、心理、生物三軸系統(tǒng)全面對(duì)疾病進(jìn)行診斷、預(yù)防、治療和護(hù)理Holistic Medical Model Health consists of physical health, psychological health and having a good social function. Holistic medical model thinks that the behavior is more impo

12、rtant factor effecting health and disease.Holistic Medical ModelWHO 1990年 “生活方式病” 1.人的生物性、心理性、社會(huì)性是一體的、相互影響的、不可分割。2.健康即整體素質(zhì)健康，疾病是三者相互作用的結(jié)果（“生活方式病”主要與行為衛(wèi)生和生活方式有關(guān)）3.醫(yī)生要對(duì)病人進(jìn)行整體診斷、治療、護(hù)理，并提高病人整體素質(zhì)健康，預(yù)防現(xiàn)代病。What cause the change of medical model? 死亡順位和疾病譜的變化健康概念的變化預(yù)防疾病戰(zhàn)略的轉(zhuǎn)變臨床實(shí)際醫(yī)療工作的需要 死亡順位的變化 死亡原因排序過去傳染病、感染

13、性疾病、營(yíng)養(yǎng)不良現(xiàn)在腦血管疾病、心臟病、癌癥心腦血管病每年新發(fā)200萬(wàn)人次;死于：腦卒中150萬(wàn)左右 冠心病死亡率 53.4%（城市） 兩種病 經(jīng)濟(jì)損失1000億元人民幣。1995年-1999年最重要的死因排序全人口15歲-34歲人群疾病譜疾病從亞臨床表現(xiàn)或先兆表現(xiàn)到臨床表現(xiàn)和結(jié)局所呈現(xiàn)的所有表現(xiàn)形式稱為疾病譜 疾病譜的影響因素是多元的，大致可歸納為六大類：人類生物學(xué)、生活方式、環(huán)境、衛(wèi)生服務(wù)的可得性、社會(huì)經(jīng)濟(jì)環(huán)境和個(gè)人因素。世界衛(wèi)生組織認(rèn)為,慢性非傳染性病是外因,內(nèi)因交互作用而生成的.內(nèi)因占15%,外因占85%.社會(huì)條件:10%;醫(yī)療條件8%;氣候7%;遺傳15%;生活方式60%;計(jì)100%

14、. “慢性病 ”的特征原因 多 病程長(zhǎng) 難痊愈遺傳年齡性別 吸煙缺乏鍛煉應(yīng)激不良個(gè)性行為方式社會(huì)心理因素與現(xiàn)代病社會(huì)心理因素導(dǎo)致的行為危險(xiǎn)因子（behavior risk factors）增加與現(xiàn)代病發(fā)病有關(guān)。社會(huì)心理壓力增加，與現(xiàn)代?。ㄐ纳砑膊∨c心理疾?。┑陌l(fā)病率增高有關(guān) ?！斑^勞死” ( “慢性疲勞綜合征” )(2006年人才藍(lán)皮書表明,七成知識(shí)分子處于“過勞死”的邊緣);社會(huì)心理緊張刺激造成軀體疾病的中介機(jī)制的研究，心理因素對(duì)調(diào)節(jié)和維護(hù)健康的作用。中國(guó)上海（徐俊冕）軀體疾病、心身疾病、神經(jīng)癥各占30%多。如：抑郁癥：中國(guó)的抑郁癥發(fā)病率為4-5%，約7千萬(wàn)抑郁癥患者，成為中國(guó)醫(yī)療負(fù)擔(dān)最大的

15、第二號(hào)疾病。健康概念的變化健康不僅僅是沒有疾病和虛弱現(xiàn)象而是身體上、心理上和社會(huì)功能的完滿狀態(tài)。_WHO“亞健康” (亞健康狀態(tài)是指人們還未患病，但已有程度不同的各種患病的危險(xiǎn)因素，具有發(fā)生某種疾病的高危傾向。即身體上或精神心理上有不適感,但醫(yī)學(xué)上又不能發(fā)現(xiàn)疾病 ) 疾病的發(fā)生和發(fā)展有一個(gè)過程,不少疾病是由于健康狀態(tài)逐漸惡化 ,日積月累演變而成。如果從發(fā)展的眼光來(lái)看問題 ,疾病狀態(tài)之前有些表現(xiàn) ,盡管還沒有構(gòu)成疾病,但已經(jīng)處于不健康的狀態(tài) ,我們可以把這些表現(xiàn)看成為亞健康狀態(tài)亞健康狀態(tài)表現(xiàn)心血管癥狀 :一上樓或稍走動(dòng)多一些就感到心慌、氣短、胸悶、憋氣 ;消化系統(tǒng)癥狀 :見到飯菜沒有胃口 ,雖覺

16、得餓但不想吃 ;骨關(guān)節(jié)癥狀 :經(jīng)常感到腰酸背痛 ,雙膝發(fā)軟 ,活動(dòng)脖子時(shí)“格格”作響 ;神經(jīng)系統(tǒng)癥狀 :經(jīng)常頭痛 ,頭暈 ,記憶力差 ,全身無(wú)力 ,容易疲勞 ;泌尿生殖系統(tǒng)癥狀 :性功能低下 ,沒有性要求 ,常常遺精 ,尿頻 ,尿急 ;精神心理癥狀 :莫名其妙心煩意亂 ,遇小事易生氣 ,過后就后悔 ,易緊張 ,恐懼 ,遇事常往壞想 ,做事猶豫不決、不知所措 ;睡眠癥狀 :入睡困難 ,凌晨早醒 ,噩夢(mèng)頻頻 ,往往被嚇醒?！奥殬I(yè)枯竭”(“職業(yè)倦怠、“心理枯竭”) 職業(yè)枯竭(Job Burnout)，是人們對(duì)自己長(zhǎng)期從事的職業(yè)產(chǎn)生一種疲倦感，從而引起了心理和生理兩方面的問題，諸如身體疲勞、情緒低落、

17、創(chuàng)造力衰竭、價(jià)值感降低、人性化淡漠、攻擊性行為等。 它是在工作的重壓之下身心俱疲的一種狀態(tài)，是身心能量被工作耗盡，而使整個(gè)人處于一種被掏空感覺的狀態(tài)，是一種“當(dāng)代都市流行病”。職業(yè)枯竭的高發(fā)人群主要包括助人工作者、工作投入者、高壓力群體及自我評(píng)價(jià)低者。作為心理從業(yè)人員的心理咨詢師，因其工作的助人性質(zhì)，反而是最容易患枯竭的行業(yè)，占總比重的40%；其次是教師，占20%；此外是新聞工作者、警察，醫(yī)護(hù)人員等 。 北師大教授許燕 在“國(guó)際心理學(xué)大會(huì)”報(bào)告 最不和諧的三大職業(yè)排名：教師(76%)、醫(yī)生護(hù)士(73.8%)、編輯記者(70.3%) 中國(guó)人民大學(xué)公共管理學(xué)院組織與人力資源研究所 預(yù)防疾病戰(zhàn)略的轉(zhuǎn)

18、變疾病預(yù)防的階段第一階段環(huán)境衛(wèi)生：改善環(huán)境衛(wèi)生、隔斷、消滅傳染源，預(yù)防疾病。第二階段個(gè)人衛(wèi)生 ：母嬰保健、圍產(chǎn)期檢查、免疫注射等提高個(gè)人體質(zhì)，預(yù)防疾病。第三階段行為衛(wèi)生 ；改變有損健康的不良衛(wèi)生行為習(xí)慣，倡導(dǎo)健康的生活方式，預(yù)防“現(xiàn)代病”。健康行為習(xí)慣不吸煙、少飲酒、合理膳食、規(guī)律生活、鍛煉身體、應(yīng)激控制等 臨床實(shí)際醫(yī)療工作的需要 適應(yīng)臨床疾病譜變化,提高診療水平 降低醫(yī)療費(fèi)用 改善醫(yī)患關(guān)系 診療水平WHO調(diào)查我國(guó)五大城市的大醫(yī)院中僅有1/5的醫(yī)生能正確診斷出抑郁癥，僅有1/5的醫(yī)生會(huì)正確處理抑郁癥。心身疾病心理疾病全科醫(yī)生，社區(qū)醫(yī)生醫(yī)療費(fèi)用每年受生物醫(yī)學(xué)模式指導(dǎo)的醫(yī)生濫開不必要的藥物、檢查、

19、手術(shù)、誤診造成的醫(yī)療費(fèi)用浪費(fèi)難以計(jì)數(shù)。(每年8萬(wàn)人死于抗生素濫用,7歲以下兒童中因不合理使用抗生素造成耳聾的數(shù)量多達(dá)30萬(wàn)人)醫(yī)患關(guān)系醫(yī)患關(guān)系醫(yī)療糾紛醫(yī)療滿意度 中國(guó)的醫(yī)藥衛(wèi)生總體水平被WHO排在第144位，而衛(wèi)生公平性竟排在第188位，全世界倒數(shù)第4位。 發(fā)達(dá)國(guó)家 巴西 印度 贊比亞 中國(guó)年愛丁堡宣言醫(yī)學(xué)教育的目標(biāo)是培養(yǎng)促進(jìn)全體人民健康的醫(yī)生,而不只是造就僅將治療服務(wù)于能付得起錢或準(zhǔn)備接受治療的人們的那種醫(yī)生。病人理應(yīng)指望把醫(yī)生培養(yǎng)成為一個(gè)專心的傾聽者，仔細(xì)的觀察者，敏銳的交談?wù)吆陀行У呐R床醫(yī)生，而不再滿足于僅僅治療某些疾病。 “21世紀(jì)的醫(yī)學(xué)生必須在下述領(lǐng)域內(nèi)具備才能，本地、地區(qū)和全球流行

20、病學(xué)、生活方式對(duì)健康的影響、促進(jìn)健康、衛(wèi)生管理、健康教育。社區(qū)衛(wèi)生、預(yù)防醫(yī)學(xué)以及健康與經(jīng)濟(jì)的相互關(guān)系，學(xué)生必須獲得對(duì)個(gè)人而且對(duì)人群的促進(jìn)健康和處理疾病的能力”。 思考學(xué)習(xí)醫(yī)學(xué)心理學(xué)對(duì)你的“個(gè)人意義”The Tactics of Psychological Researchscience literacy科學(xué)研究是人們應(yīng)用科學(xué)方法發(fā)現(xiàn)世界奧妙的過程，科學(xué)知識(shí)是這一過程的某個(gè)階段的成果集合，科學(xué)是動(dòng)態(tài)的，而不是靜態(tài)的科學(xué)方法是科學(xué)素養(yǎng)中最重要的內(nèi)容，理解科學(xué)，最重要的就是要理解科學(xué)方法并應(yīng)用它們解決自己生活和工作中的各種問題。盲從行為，常與缺乏科學(xué)方法有關(guān)。 批判性思維(5What)（1）他們要說

21、服我相信或接受什么？（2）有什么有用的證據(jù)可以支持它？（3）這些證據(jù)還可以有什么不同的解釋？（4）有什么更多的證據(jù)可以幫助評(píng)價(jià)這些不同的解釋？（5）最合理的結(jié)論是什么？Example一種治療高血壓的藥物是否肯定有效。第一位科學(xué)家:將藥分給1000個(gè)高血壓病人服用，然后觀察有多少病人的血壓有所下降。第二位科學(xué)家:則將病人分成兩組，第一組500個(gè)高血壓病人服用，另一組500個(gè)高血壓病人則不服藥，觀察這兩組病人中血壓下降情況如何。問：哪一位科學(xué)家的方法測(cè)試藥的效果更有效？Why？ Learning goals 1.describe the goals and pitfalls of descript

22、ive research, correlational research and experimental research 2. Learn to analyze and design psychological experimental researchTypes of Research1橫斷研究和縱向研究Cross-sectional study & Longitudinal study2前瞻性研究和回顧性研究Perspective study & Retrospective studyObserving and describing behavior Descriptive resea

23、rchPredicting behavior Correlation ResearchDetermining why behavior occurs Experimental ResearchDescriptive ResearchNaturalistic observation: focusing on real lifeCase studies: focusing on the individualSurveys : focusing on the groupPsychological tests: assessing individual differencesStatistics: s

24、ummarizing and interpreting the dataNaturalistic observationA research methodology most often used in certain areas of social psychology, developmental psychology, and ethnology in which the investigator records behavior as far as possible without influencing it. An observational field study is cond

25、ucted in a naturally occurring situation, and an observational laboratory study is carried out in an artificial laboratory environment. NaturalisticobservationTheVisualCliffCase of H.MWhat H.M could no longer doCouldnt recall events that have just happened Couldnt recall any new factsCouldnt remembe

26、r new facesSurvey researchResearch methods for investigating the distribution of attitudes, opinions, mental disorders, and other characteristics of individuals in specific sections of a population, or in a whole population, often broken down into demographic groups defined by geographical location,

27、 ethnic identity, age, sex, social class, marital status, education, and similar criteria. Survey researchSurveys designed to compare different cultures or subcultures are called cross-cultural survey.Psychological tests Correlation studyAnon- experimental type of research design, without manipulati

28、on of an independent variables, in which patterns of correlations between two or more variables are analyzed.Predicting behavior Correlational ResearchRandom SampleExperimental Research In experimental research , the investigator actively manipulates or alters some aspect of the environment in order

29、 to observe the effect of that manipulation on behaviorExperimental design The general plan of an experiment, including the method of assigning research participants or subjects to treatment conditions, controlling extraneous variables, manipulating the independent variable, and measuring the depend

30、ent variableExperimentation Independent variable The aspect of the environment that is manipulated in an experiment. It must be consist of at least two conditions.Dependent variableThe behavior that is measured or observed in an experiment. It is the variable thought to be affected by manipulation o

31、f the independent variable.自變量（independent variable） 是指在實(shí)驗(yàn)中由實(shí)驗(yàn)者所操縱的，對(duì)被試的反應(yīng)產(chǎn)生影響的變量因變量（dependent variable）是指在實(shí)驗(yàn)中由于操作自變量而引起的被試的某種特定反應(yīng)。是研究者要觀察和測(cè)量的行為變量。X affects Y Formulate hypothesisAnxiety increases desire to be with others Formulate hypothesisTableAnxiety increases desire to be with others Formulate

32、hypothesis independent dependent variable variable How X affects Y1 Y2 Y3 （）extraneous variable無(wú)關(guān)變量 “第三者變量”、 “干擾變量”、“額外變量”實(shí)驗(yàn)者用在實(shí)驗(yàn)中不用于研究的那些相關(guān)變量稱為額外變量。額外變量也被稱為控制變量（controlled variable)。 額外變量是使實(shí)驗(yàn)結(jié)果發(fā)生混淆的主要根源，當(dāng)研究者選定的自變量與一些未控制好的因素共同造成了因變量的變化，這就叫做自變量的混淆。例：研究某種藥物對(duì)記憶的影響。英國(guó)研究牛奶對(duì)兒童發(fā)育的影響。實(shí)驗(yàn)者效應(yīng)(experimenter effe

33、ct) 霍桑效應(yīng)(Hawthorne effect) 安慰劑效應(yīng)(placebo effect)Experimenter effects:the experimenters expectations that may lead them to treat subjects differently in different groups or to record data in a biased manner 實(shí)驗(yàn)者效應(yīng)又稱實(shí)驗(yàn)者偏見(experimenter bias)，指實(shí)驗(yàn)者精心設(shè)計(jì)或無(wú)意處理而對(duì)受試者所產(chǎn)生的影響，當(dāng)實(shí)驗(yàn)者對(duì)于參與實(shí)驗(yàn)的受試者在接受實(shí)驗(yàn)處理以前已有相當(dāng)程度的理解，容易被誘

34、導(dǎo)。這種對(duì)于受試者地位的認(rèn)知可能引起實(shí)驗(yàn)者傳遞受試者一些足以影響實(shí)驗(yàn)結(jié)果的反應(yīng)，或可能影響實(shí)驗(yàn)者作客觀的判斷 Hawthorne effect An experimental effect in the direction expected but not for the reason expected; i.e. a significant positive effect that turns out to have no causal basis in the theoretical motivation for the intervention, but is apparently du

35、e to the effect on the participants of knowing themselves to be studied in connection with the outcomes measured. 霍桑效應(yīng)(Hawthorne effect)此為實(shí)驗(yàn)組所產(chǎn)生的效應(yīng)，當(dāng)受試者由于獲知參加實(shí)驗(yàn)或受到實(shí)驗(yàn)者的操作而影響其表現(xiàn)水平,往往是受人關(guān)注而帶來(lái)的提高(或進(jìn)步) (如工人、學(xué)生、病人等因受到研究人員的關(guān)注而增加產(chǎn)量、提高成績(jī)或報(bào)告病情改善等)Placebo effect:The improvement often shown in drug effectivenes

36、s studies when patients believe they have received a drug, although they have actually received an inert substance.安慰劑效應(yīng)所謂安慰劑，是指既無(wú)藥效，又無(wú)毒副作用的中性物質(zhì)構(gòu)成的、外形似藥的制劑。安慰劑多由葡萄糖、淀粉等無(wú)藥理作用的惰性物質(zhì)構(gòu)成。安慰劑對(duì)于那些渴求治療、對(duì)醫(yī)務(wù)人員充分信任或崇拜的病人，能在心理上產(chǎn)生良好的積極反應(yīng)，出現(xiàn)希望達(dá)到的藥效。這是由于病人的自我暗示的心理作用產(chǎn)生的一種效應(yīng)。安慰劑效應(yīng)在心理學(xué)實(shí)驗(yàn)中作為一種被試變量出現(xiàn)往往會(huì)影響實(shí)驗(yàn)的真實(shí)結(jié)果。額外變量的控制 （1）排除法：把額外變量從實(shí)驗(yàn)中排除出去。如控制霍桑效應(yīng)或?qū)嶒?yàn)者效應(yīng)的最佳辦法是采用雙盲實(shí)驗(yàn)(double blind experiment)（2）恒定法：使額外變量在實(shí)驗(yàn)的過程中保持固定不變。有效的控制方法是在同一實(shí)驗(yàn)室，由同一實(shí)驗(yàn)者，在同一時(shí)間對(duì)實(shí)驗(yàn)組和控制組使用同樣的實(shí)驗(yàn)程序進(jìn)行實(shí)驗(yàn)。如果實(shí)驗(yàn)時(shí)強(qiáng)度變化的噪音無(wú)法消除，則可以用噪音發(fā)生器發(fā)生恒定的噪音來(lái)加以掩蔽。 （3）匹配法：