(Q3-1997)
Question 3: Describe the physiological aspects of preschool children
and adulthood and draw a comparison between these two stages
PRESCHOOL CHILDREN (2 ½ TO 6 YEARS OLD)
Language and Cognitive Development
According to Piaget’s theory of cognitive development, it is categorized
in pre-operational stage
Use of language expands
Use sentences
Individual words have regular and consistent meaning at the
beginning of period
Ways of thinking: Symbolic, Egocentrism, Intuitive
Cannot place themselves in position of other child
Incapable of empathy
Do not understand cause and effect relations
Emotional and Social Behaviour
At the beginning of preschool, children can express complex emotion
verbally like Love, Unhappiness, Jealousy and Envy
Emotions are easily influenced by somatic (tiredness and hunger)
events, capacity for cooperation and sharing appears
Their anxiety is related to:
o Loss of person who was loved and depended upon
o Loss approval and acceptance
o Loss of respect and love
o Loss of emerging self-esteem
o Bodily injury
Emotions become relatively stable towards the end of preschool
period (Expansiveness, curiosity, pride and gleeful excitement related
to self and family are balanced with coyness, shyness, fearfulness,
jealousy and envy)
Shame and humiliation are evident
Capacity for empathy and love developed but loss easily when
competitive or jealousy striving intervene
Children between 3-6 years are aware of:
o Their bodies
o Genitalia
o Sex differences
o Parental values turn into self obedience and guidance
End of Pre-school Stage
o Conscience is established
o Sets tone for moral sense of right and wrong
ADULTHOOD (>20 YEARS OLD)
Longest phase of human life
According to Piaget’s theory of cognitive development, it is categorized
in formal operation stage
People are presumably mature and fully developed
Divided into:
o Young or early adulthood (20-40 years)
o Middle adulthood (40-65 years old)
o Late adulthood or old age (>65 years old)
Early Adulthood (20-40 years old)
The characteristics:
o Peaking of biological development
o Assumption of major social rules
o Evolution of an adult self and little structure
The successful passage into adulthood depends on the satisfactory
resolution of childhood and adolescent crisis
Adults think qualitatively different: based on personal experience
and perceptions
Gain skills to achieve career and domestic goals
Can differentiate between right and wrong
During the late adolescence to early adulthood:
o Graduating from high school
o Young people leave home
o Starting a job or entering college
o Living independently
o Sex relationship serious
o Quest of intimacy begins
Development task:
o Choice of occupation
o Marriage – a supreme importance
By the age of early 30, the young adult becomes progressively worried
about authority, independence, self sufficiency and goal autonomous.
They become less dependent on people and institutions
Transition process of some people are smooth but others experience
severe crisis like marital, job and psychiatric problems (anxiety,
depression)
In terms of vulnerability, some people grow up to be satisfied,
socially integrated and productive in spite of serious adverse
circumstances in childhood
A healthy adaptation to work provides an outlet for creativity,
satisfactory relationship with colleague, pride in accomplishment and
increased self esteem
Job satisfaction is not wholly dependent on money
Maladaptation can lead to dissatisfaction with oneself and the job,
insecurity, anger, resentment and decreased self esteem
Marriage provides the means for sustained intimacy, perpetuate the
culture and gratifies the interpersonal needs. It tends to be regarded
as a permanent tie
High value is placed on marital stability, love and happiness - there is
general correlation between happiness and stability
In most relationship, some forms of success precedes general
emotional fulfillment
Marital problems may occur. Unsuccessful unions may be terminated.
Irrational expectation between spouses increases the risk of marital
problems.
Middle Adulthood ( 40-65 years old)
Strong correlation between physical and emotional health
Sexuality is a major issue in midlife
Sexual functioning may decline
Fears and reality of impotence is the common problems
The cause of impotence is not due to aging, but excessive alcohol and
drug intake such as tranquilizers and anti depressants due to stress,
fatigue and anxiety.
Middle adulthood is the time for male and female to have
characteristic decrease in biological and physiological
functioning
In middle aged women, they may experience decline in sexual
functioning related to psychological more than to physical causes
Women do not reach their sexual prime until their mid 30 years, they
have a greater capacity for orgasm in middle than young adulthood
The menopause in women starts between 40-50 years old
Many experienced no adverse effects, but some experience anxiety
and depression and it may extend to several years
Characteristics: Estrogen secretion decreases with changes in flow,
timing and eventual cessation of menses, vasomotor instability (hot
flushes) may occur
In men, the male hormone is fairly constant through the 40-50 years
old
They must adapt decline in biological functioning over all physical vigor
Midlife crisis is related to severe emotional disorder when life events
are severe or unexpected like death of spouse, loss of job or due to a
serious illness
Empty nest syndrome is a depression that occurs in men and
women when their youngest child is about to leave home
Divorce is the major crisis of adult life. Most people report such feeling
as depression, ambivalence and mood swings at times of divorce
According to studies, the recovery process from divorce takes about
two years
Late Adulthood or Old Age (>65 years old)
The aging process/senescence is characterized by a gradual decline
in the functioning of the body’s systems like cardiovascular,
endocrine, respiratory, immune and genitourinary
It is not associated with decrease of profound intellectual and physical
infirmity. Most older people retain their cognitive abilities and
physical capacities to a remarkable degree
Each person is genetically endowed with one or more vulnerable
systems or systems may become vulnerable due to environmental
stressors or intentional misuses like excessive UV exposures, smoking
or drinking alcohol
Aging mean the aging of cells and the most commonly held theory is:
o Each cell has a genetically determined life span where it can
replicate itself for a limited number of times before it dies
o Structural changes in cells occur in age (CNS neurons, senile
brain with severe memory and intellectual, neuro fibrillary
degeneration and dementia Alzheimer’s)
o Changes in DNA and RNA structures due to genotypic
programming, X-Rays, chemicals or food products
o There is no single cause of aging, all areas of the body are
affected to some degrees
Postural stoop: characteristics slump, with head projected forward
and lower limbs flexed
Osteoporosis: bone tissues deteriorate, become thin and weaken
Vision, hearing, number of taste buds decrease
Longevity is related to the family history and hereditary, where it is
beyond a person’s control
Other conditions leading to a shortened life with effective intervention
can be prevented, ameliorated (reduced) or delayed
The predictors of longevity are regular medical checkup, no caffeine or
alcohol intake, work gratification, a perceived sense of the self as
being socially useful in an altruistic society as well as healthy eating
and adequate exercise (healthy lifestyle)
The leading causes of death among older people are heart disease,
cancer and stroke
Physiological Aspect of Aging
Social activity level is only slightly changed from that of earlier years.
For many elders, old age is a period of continued intellectual,
emotional and psychological growth.
Continued social interaction may be precluded by physical illness or
death of friend and relatives
Isolation feeling increases, person may become vulnerable to
depression
Health problems are more often chronic conditions, it is the evidence
of aging
Maintaining a good quality of life does not solely dependent on good
health, but good social contacts as well
Retirement may be the choice: Pursuit leisure or to seek freedom
from working environment
For others, it is the time of stress when financial problems or loss of
self esteem results
In cognitive capacities, to recall and learning new information may be
diminished, but not every individual experiences and appreciable loss
of mental ability
Cognitive decline may be affected by intelligence level, lack of
motivation, disuse or disease and not necessarily by diminished brain
function
The sexual activity among male is higher than female, but it is
limited by absence of available partner
The expected sexual physiological changes are:
o Men have longer time for erection to occur, decreased penile
turgidity and ejaculatory seepage (flow)
o Women have vaginal atrophy, lowered estrogen level and
decreased vaginal lubrication
o Medication may have adverse (harmful) effect on sexual
behaviour
o The more active a person’s sex life was in early adulthood, the
more likely it is to be active in old age
Psychiatric problems of older people are:
o Grief of multiple losses: death of spouse, friend and colleagues,
change of work status and prestige and decline of physical
abilities and health
o Emotional and physical energy expand enormously in grieving,
resolving grief and adapting changes that result from loss
o Depression in old age often accompanied by physical symptom
(Q2-2007)
2. First of all, coping itself mean process by which a person attempts to manage
the stressful demand on him. And on this case the demand is their physical
handicap. Such example is amputated limb, a person with colostomy who is
worrying about his leaking bag, etc. The coping strategies can result in 2 conditions,
improve impact of illness toward better form or worsen the situation.
The best way to cope with this situation is by managing label and stigma .Label
defined as individual characteristic given by others. This characteristic is usually
negative. This label actually does affect the person behavior because a person that
has been label such as a cruel person. Initially he’s not even a cruel person , but
when others identified him as a cruel person, he might become one of them.
In this case, people with physical handicap usually labeled by society as down grade
person and this will lead to behavioral change of this person. The way to cope with
it, the patient should not be affected by others thought on him. They should just
belive their still capable of doing ordinary thing that ordinary people used to do. It’s
just that their doing it in different way, yet get the same result as others.
Stigma is defined as sign branded onto criminal or traitors in order for publicly
identify them. The are 3 stages of stigma:
• Label and separate a person from society
Eg:-label a person as weird and didn’t accept them in society gathering
• Linking them to undesirable characteristic
Eg:-refer a person as lame, anti-social ,etc.
• Rejection and avoidance of stigmatized individual
Eg:-Doesn’t accept this type of person who applying for a job
For this type of person, they can develop several coping strategies based on type of
stigma they carries either very obvious(discrediting attribute) or
hidden(discreditable).For very obvious, they don’t have much choice of coping
method in other words the range is very limited. Some of the ways are:-
1.Passing
It means that some of their attribute can be regarded as ‘pass as normal’. This
usually refer to hidden stigma such as patient with colostomy who had to carry a
bag anywhere they goes.
2.Make own group
This physically handicap can form their own group and discuss upon what’s their
advantages and not focusing on their abnormalities .Can can develop skill that
sometimes even normal person doesn’t have it.
3.Covering
Cover their abnormalities. For attribute that are very discrete they can’t cover it
completely but they always can minimize or reduce the stigma.
4.Withdrawal
Avoid from being in a difficult social situation and avoid contact that may cause
embarrassment. Example, if there is an event and in that event everybody required
to do physical work such as running and aggressive task. Yet this person can’t
afford to do that due to his physical abilities and this person know when he goes to
this event and eventually can’t do all that stuff,he will feel embarrass when some of
the others laugh at him. In this condition, this person should not attend this event
Q(2-1998)
Define stress and discuss its medical and psychiatric aspect…
Stress is a process by which we change our behavior inresponce to demands
( stressor) placed on us….
Stress-related physical illnesses, such as irritable bowel syndrome, heart
attacks, arthritis, and chronic headaches, result from long-term
overstimulation of a part of the nervous system that regulates the heart rate,
blood pressure, and digestive system. Stress could also lead to hypertension
due to the excessive heart pumping action of the heart when we are in
stress. Muscle of the Heart can become hypertrophy and can lead to heart
failure. This is very dangerous as one could die due to this disease.
Studies have shown that people who are stressed out often suffer from
suppressed immune system and increased rate of illnesses over an extended
period of time. When we are in stress, we are more prone to get infected
with infections and will inevitably lead to more stress. While we are not in
stress , our immune system get stronger and can resist infections. This is
because the nervous system affects the endocrine system through the
pituitary gland, and the endocrine system indirectly affects the immune
system via the release of hormones secreted by endocrine system, so when
we are stressed, the amount, function, and distribution of hormones will be
altered. The autonomic nervous system also has a direct effect on the
immune system through the thymus gland, spleen and bone marrow.
Cytokines also affects our physiological ‘ illness response’ which mainly
affects our mood, fever, sleeping patterns and other behaviors. Besides, our
thoughts and emotions affect hormones, neurotransmitters, and natural
body chemicals that impact our immune systems and every part of our
bodies.
Stress-related emotional illness results from inadequate or inappropriate
responses to major changes in one's life situation, such as marriage,
completing one's education, becoming a parent, losing a job, or retirement.
Psychiatrists sometimes use the term adjustment disorder to describe this
type of illness. In the workplace, stress-related illness often takes the form of
burnout—a loss of interest in or ability to perform one's job due to long-term
high stress levels. For example, palliative care nurses are at high risk of
burnout due to their inability to prevent their patients from dying or even to
relieve their physical suffering in some circumstances. Stress can be divided
into two categories which are positive and negative stress. Some of the
examples of positive stress are marriage, promotion, getting baby, winning
money and graduation. Negative stress such as divorce, punishment, injury,
financial problems etc. There are varieties of emotional reactions to stress.
One might response by feeling anxiety, fear, guilt, grief, depression, sadness,
lost, isolated, anger, irritability etc.
(Q3-2009)
• Personality = an individual’s distinct and relatively enduring or long lasting
way of
o Perceiving
o Thinking
o Feeling
o The resultant behaviour
• Personality disorder = when a personality trait becomes too much or more
than expected in a society and causes suffering to others or to the patient
• Abnormality is manifested into or more of the following areas:
o Cognition = way of perceiving and interpreting self, other people and
events
o Affectivity = the range, intensity and appropriateness of emotions is
abnormal
• Can be divided into 3 clusters:
o Cluster A
Odd, eccentric and associable
Includes paranoid personality disorder, schizotypal, and schizoid
Paranoid = suspicion, distressful, sensitive, stubbornness, self
importance
Schizoid = emotional detachment, introspection, social isolation
Schizotypal = odd or sixth sense
o Cluster B
Too much but short lived sociability
Includes borderline, antisocial, narcissistic, and histrionic
Borderline = emotionally unstable, impulsivity, behaviour crisis,
variable mood
Histrionic = exaggerated, attention thinking, theoretical
expression of emotion
Narcissistic = self importance
Antisocial = law-breaking, selfish,
o Cluster C
Fearful of sociability
Includes avoidant, dependent and obsessive
Avoidant = anxious, persistent feeling of tension and
apprehension, avoidant of personal contact due to fear of
criticism or rejection
Dependent = excessive needs to be taken care of, poor
confidents, indecisive
Obsessive = too much orderliness
