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Department of nervous diseases, psychiatry and medical psychology




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Ministry of Health of Ukraine

Bukovynian State Medical University

Department of nervous diseases, psychiatry and medical psychology



Approved on the methodology meeting

of the Department of nervous diseases, psychiatry

and medical psychology

on the “21” of April 2010 (Report No 1).

Chief of the Department

_______________________

Professor V.M.Pashkovskyy


MethodOLOGical Guidance

for the lesson

Theme 2: Accentuated personalities. The way of communication with patients with accentuated personality. The internal view of disease. Classification, peculiarities of the behavior of the patients. Research of the basic types of the internal view of disease.


For 4-th year students of medical faculty No 2


Module 1. Medical psychology

Topical module 1. General questions of medical psychology.


Сhernivtsi, 2010

^

1. Actuality Aim

Personality is a description of consistent emotional, thought, and behavior patterns in a person. The several theoretical perspectives on personality involve different ideas about the relationship between personality and other psychological constructs as well as different ideas about the way personality develops. Character accentuation is an extreme variant of norm, which separate character traits are superfluously underline, in this connection selective vulnerability appears in relation to certain psychical influences at sufficient, and even enhanceable firmness to others.

2. Hours: 2


3. Teaching goal

The students must know:

  • the definition of personality;

  • the historical view on personality;

  • tactic of behavior of doctor with patients which have accentuations of personality;

  • research methods of personality;

  • research of basic types of attitude toward a disease.


and be able to:

  • objectively and scientifically determine the place and role of personality of medical personal;

  • interpret conditions to create healthy psychological climate in the medical environment;

  • analyze psychological peculiarities of patients with various pathologies;

  • to determine the way of communication with patients with accentuated personality;

  • know methods of research of personality;

  • evaluate the results of experimental-psychological research of patient’s personality and attitude toward a disease.

Assimilate practical skills

  • analyze psychological peculiarities of patients with various accentuation;

  • communication with patients;

  • methods of research of attitude toward a disease;

  • experimental-psychological research of patient’s personality.


^ 4. List of disciplines necessary

for learning theme 1


Title of the discipline

Content of the discipline necessary for learning medical psychology

Anatomy

Brain construction

General psychology

Psychic functions of a normal person. Consciousness and self-consciousness. Psychology of personality.

Neuropsychology

Functions of different brain structures.

Normal physiology

Brain functions. Physiology of high nervous activity.


^ 5. Content of the theme

Personality is a description of consistent emotional, thought, and behavior patterns in a person. The several theoretical perspectives on personality involve different ideas about the relationship between personality and other psychological constructs as well as different ideas about the way personality develops.

An early model of personality was posited by Greek philosopher/physician Hippocrates. Hippocrates recorded the first known personality model, postulating that one's persona is based upon four separate temperaments. Another Greek physician, Galen, extended Hippocrates' theory by applying a body fluid to each temperament: blood, mucus, black bile and yellow bile, respectively. The fluid which was dominant was said to be the person's "humor".

There are several theoretical perspectives on personality in psychology, which involve different ideas about the relationship between personality and other psychological constructs, as well as different theories about the way personality develops.

Critics of personality theory claim that personality is "plastic" across time, places, moods, and situations. Changes in personality may indeed result from diet (or lack thereof), medical effects, significant events, or learning. However, most personality theories emphasize stability over fluctuation.

The four humors theory was to become a prevalent medical theory for over a millennium after Galen's death. By the 18th century, medicine was advancing rapidly. The discoveries of the functions of the circulatory, respiratory and digestive systems served to discount the four humors theory as a realistic practice of medicine. However, it remained important in terms of designating personality. Swiss physiognomist Johann Kaspar Lavater used the four humors to advance four specific persona types as dictated by their respective facial structures, expressions and colorations. Lavater also assigned certain characteristics, such as jollity, generosity and kindness to some types, while brooding, introspection and contemplation were assigned to others. He referred to the four temperaments as the sanguine, choleric, melancholic and phlegmatic, preserving the etymology of these terms having their origins in antiquity.

What makes personality theories so interesting, I think, is that we can actually participate in the process. You don't need labs and federal funding, just a bit of intelligence, some motivation, and an open mind.


Theory

It might be nice to start off with a definition of theories of personality. First, theory: A theory is a model of reality that helps us to understand, explain, predict, and control that reality. In the study of personality, these models are usually verbal. Every now and then, someone comes up with a graphic model, with symbolic illustrations, or a mathematical model, or even a computer model. But words are the basic form.

Different approaches focus on different aspects of theory. Humanists and Existentialists tend to focus on the understanding part. They believe that much of what we are is way too complex and embedded in history and culture to "predict and control." Besides, they suggest, predicting and controlling people is, to a considerable extent, unethical. Behaviorists and Freudians, on the other hand, prefer to discuss prediction and control. If an idea is useful, if it works, go with it! Understanding, to them, is secondary.

Another definition says that a theory is a guide to action: We figure that the future will be something like the past. We figure that certain sequences and patterns of events that have occurred frequently before are likely to occur again. So we look to the first events of a sequence, or the most vivid parts of a pattern, to serve as our landmarks and warning signals. A theory is a little like a map: It isn't the same as the countryside it describes; it certainly doesn't give you every detail; it may not even be terribly accurate. But it does provide a guide to action -- and gives us something to correct when it fails.

Personality. Usually when we talk about someone's personality, we are talking about what makes that person different from other people, perhaps even unique. This aspect of personality is called individual differences. For some theories, it is the central issue. These theories often spend considerable attention on things like types and traits and tests with which we can categorize or compare people: Some people are neurotic, others are not; some people are more introverted, others more extroverted; and so on.

However, personality theorists are just as interested in the commonalities among people. What, for example, does the neurotic person and the healthy person have in common? Or what is the common structure in people that expresses itself as introversion in some and extroversion in others?

If you place people on some dimension -- such as healthy-neurotic or introversion-extroversion -- you are saying that the dimension is something everyone can be placed on. Whether they are neurotic or not, all people have a capacity for health and ill-health; and whether introverted or extroverted, all are "verted" one way or the other.

Another way of saying this is that personality theorists are interested in the structure of the individual, the psychological structure in particular. How are people "put together"; how do they "work;" how do they "fall apart."

Some theorists go a step further and say they are looking for the essence of being a person. Or they say they are looking for what it means to be an individual human being. The field of personality psychology stretches from a fairly simple empirical search for differences between people to a rather philosophical search for the meaning of life!

Perhaps it is just pride, but personality psychologists like to think of their field as a sort of umbrella for all the rest of psychology. We are, after all, concerned about genetics and physiology, about learning and development, about social interaction and culture, about pathology and therapy. All these things come together in the individual.

With all the different pitfalls, assumptions, and methods, you might think that there is very little we can do in terms of organizing "theories of personality." Fortunately, people with like minds tend to be drawn to each other. Three broad orientations tend to stand out:

1. Psychoanalytic or "first force." Although psychoanalytic strictly speaking refers to Freudians, we will use it here to refer to others who have been strongly influenced by Freud and who -- though they may disagree with nearly everything else -- do share attitude: They tend to believe that the answers to the important questions lie somewhere behind the surface, hidden, in the unconscious.

There are three versions of this approach. The first is the Freudian view proper, which includes Sigmund and Anna Freud, of course, and the ego psychologist, of whom Erik Erikson is the best known.

The second might be called the transpersonal perspective, which has a much more spiritual streak, and which will be represented here by Carl Jung.

The third has been called the social psychological view, and includes Alfred Adler, Karen Horney, and Erich Fromm.

2. Behavioristic or "second force." In this perspective, the answers are felt to lie in careful observation of behavior and environment and their relations. Behaviorists, as well as their modern descendants the cognitivist, prefer quantitative and experimental methods.

The behavioristic approach is represented by Hans Eysenck, B. F. Skinner, and Albert Bandura.

3. Humanistic or "third force." The humanistic approach, which is usually thought of as including existential psychology, is the most recent of the three. Often based on a reaction to psychoanalytic and behavioristic theories, the common belief is that the answers are to be found in consciousness or experience. Phenomenological methods are preferred by most humanists.

The most popular are two "streams" of the humanistic approach. The first is humanism proper, represented by Abraham Maslow, Carl Rogers, and George Kelly.

The second is existentialist psychology by Ludwig Binswanger and Viktor Frankl, a philosophy-based humanism quite popular in Europe and Latin America.

Temperament is defined as that part of the personality which is genetically based. Along with character, and those aspects acquired through learning, the two together are said to constitute personality.

^ Ivan Petrovich Pavlov (Russian: Иван Петрович Павлов) (September 14, 1849 – February 27, 1936) was a Russian physiologist, psychologist, and physician. Pavlov contributed to many areas of physiology, neurology and psychology. Most of his work involved research in temperament, conditioning and involuntary reflex actions. Further work on reflex actions involved involuntary reactions to stress and pain. Pavlov extended the definitions of the four temperament types under study at the time: phlegmatic, choleric, sanguine, and melancholic. Pavlov and his researchers observed and began the study of transmarginal inhibition (TMI), the body's natural response of shutting down when exposed to overwhelming stress or pain. This research showed how all temperament types responded to the stimuli the same way, but different temperaments move through the responses at different times. He commented "that the most basic inherited difference... was how soon they reached this shutdown point and that the quick-to-shut-down has a fundamentally different type of nervous system."

Carl Jung continued Pavlov's work on TMI and correlated the observed shutdown types in animals with his own introverted and extroverted temperament types in humans. Introverted persons, he believed, were more sensitive to stimuli and reached a TMI state earlier than their extroverted counterparts. This continuing research branch is gaining the name highly sensitive persons.


A personality test aims to describe aspects of a person's character that remain stable throughout a person's lifetime, the individual's character pattern of behavior, thoughts, and feelings.

There are two major types of personality tests. Projective tests assume that personality is primarily unconscious and assess an individual by how he or she responds to an ambiguous stimulus, like an ink blot. The idea is that unconscious needs will come out in the person's response, e.g. a very hostile person may see images of destruction. Objective tests assume that personality is consciously accessible and measure it by self-report questionnaires. Research on psychological assessment has generally found that objective tests are more valid and reliable than projective tests.

Examples of personality tests include:

The Rorschach inkblot test was introduced in 1921 as a way to determine personality by the interpretation of abstract inkblots. The Rorschach inkblot test is a method of psychological evaluation. Psychologists use this test to try to examine the personality characteristics and emotional functioning of their patients. The Rorschach is currently the second most commonly used test in forensic assessment, after the MMPI, and is the second most widely used test by members of the Society for Personality Assessment. It has been employed in diagnosing underlying thought disorder and differentiating psychotic from nonpsychotic thinking in cases where the patient is reluctant to openly admit to psychotic thinking.


The Thematic Apperception Test or TAT is popularly known as the picture interpretation technique because it uses a standard series of 31 provocative yet ambiguous pictures about which the subject must tell a story. In the case of adults and adolescents of average intelligence, a subject is asked to tell as dramatic a story as they can for each picture, including:

  • what has led up to the event shown

  • what is happening at the moment

  • what the characters are feeling and thinking, and

  • what the outcome of the story was.

For children or individuals of limited cognitive abilities, instructions ask that the subject tell a story including what happened before and what is happening now, what the people are feeling and thinking and how it will come out.

The 31 cards are meant to be divided into two "series" of ten pictures each, with the pictures of the second series being purposely more unusual, dramatic, and bizarre than those of the first. Suggested administration involves one full hour being devoted to a series, with the two sessions being separated by a day or more.

The Minnesota Multiphasic Personality Inventory (MMPI) is one of the most frequently used personality tests in the mental health fields. This assessment, or test, was designed to help identify personal, social, and behavioral problems in psychiatric patients. The test helps provide relevant information to aid in problem identification, diagnosis, and treatment planning for the patient.


Character accentuation is an extreme variant of norm, which separate character traits are superfluously underline, in this connection selective vulnerability appears in relation to certain psychical influences at sufficient, and even enhanceable firmness to others.


The Shmishek's psycho-diagnostic methodology of detecting character accentuation.

The LOBI is based on V. N. Myasishchev’s theory of ‘psychology of attitudes’

and has been developed in the Bechterev’s institute (Saint Petersburg).

It consists of 12 items, which concern different aspects of the system

of estimation and relations:

1. estimation of the patient’s own health;

2. estimation of mood;

3. estimation of sleep and awakening from the sleep;

4. estimation of appetite;

5. attitude towards the disease;

6. attitude towards the treatment;

7. attitude towards the doctor and the medical personnel;

8. attitude towards family and friends;

9. attitude towards the work (studies);

10. attitude towards surrounding people;

11. attitude towards solitude;

12. estimation of the patient’s own future.

For each item the patients are asked to choose not more than 3 statements

that most appropriately describe their condition. With the LOBI the following

most frequently encountered psychological reactions to illness are

detected: anxious, obsessive-phobic, anosognosic, sensitive, apathetic,

neurotic, paranoid, euphoric, or hypochondriacal reactions.


^ 5.2. Theoretical questions:

  1. Definition of personality?

  2. Definition of accentuated personality?

  3. Describe historical periods of the development of view on personality.

  4. Psychodynamic view on personality.

  5. What methods of research of personality do you know?

  6. What personality tests do you know?

  7. Describe personality tests.

  8. Research of the attitude toward a disease. Types?

  9. Behavior of the patient with accentuation of character.


^ 5.3. Practical training during the tutorial

1. Clinical observation of the behavior of the patient.

2. Clinical interview and plan of psychological research.


5.4. Materials for self-control

A. Questions for self-control:

  1. Definition of personality?

  2. Definition of accentuated personality?

  3. Describe historical periods of the development of view on personality.

  4. Psychodynamic view on personality.

  5. What methods of research of personality do you know?

  6. What personality tests do you know?

  7. Describe personality tests.

  8. Research of the attitude toward a disease. Types?

  9. Behavior of the patient with accentuation of character.

B. Tasks for self-control

1. Typical, ordinary – II level.

2. Untypical, no ordinary – III level.

C. Tests for self-control.


Literature

  1. R.J.Gatchel An introduction to health psychology. – New York: Random house. – 386 p.

  2. Lectures.

  3. Internet resource.

  4. Вітенко І.С., Вітенко Т.І. Основи психології: Підручник для студентів вищих медичних навчальних закладів ІІІ – ІV рівнів акредитації. – Вінниця, 2001.

  5. Вітенко І.С., Чабан О.С., Бусло О.О. Сімейна медицина: психологічні аспекти діагностики, профілактики і лікування хворих. – Тернопіль, ”Укрмедкнига”, 2002.

  6. Гавенко В.Л., Вітенко І.С., Самардакова Г.О. Практикум з медичної психології. – Харків: Регіон-інформ, 2002.

  7. Загальна та медична психологія (практикум) /Під заг. ред. професора І.Д.Спіріної, професора І.С.Вітенка. – Дніпропетровськ, АРТ ПРЕС, 2002.

  8. Квасенко А.В., Зубарев Ю.Т. Психология больного. М., 1980.

  9. Лакосина Н.Д., Ушаков Г.К. Медицинская психология. М., 1984.

  10. Менделевич В.Д. Клиническая и медицинская психология. – М.: Мед.прес., 1998.

  11. Мягков И.Ф., Боков С.Н. Медицинская психология: основы патопсихологии и психопатологии: Учебник для вузов.- М.: Издательская корпорация „Логос”, 1999.


Prepared by assistant N.V.Grinko



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