Table Of ContentCLINICAL
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
