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Terminology and Facts Shared in 

Behavioral Medicine

Behavioral Medicine for Mental Health Professionals

A Training Resource

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T

Patient not Client


n medical settings the person(s) you work with are referred to as patient(s) not clients and it is very important to use this language in such setting so that all the personal on the Medical Team are on the same page about whom you are speaking

SO who are the members on the Team?

Medical Teams in Primary Medicine Settings have the some if not all of the following Members:

1. Primary Care Physician: Internal Medicine, Family Medicine, Gerontologist, Gynecologist, Pediatrician

2. Nurses: APRN-Nurse Practitioner; PA- Physician Assistant; RN-Registered Nurse; LPN-Licensed Practical Nurse

3. Clerical: Front Desk Secretary, Medical Biller, Medical Records Clerk

4. Assistants: Medical Assistant, Phlebotomist

5. Rehabilitation Services: PT-Physical Therapist; OT-Occupational Therapist; SP-Speech Pathologist(Speech Therapist)

6. Dietary: Dietician, Nutritionist

7. Behavioral Health Consultant (YOU)

How Doctors Check Heart Rate

  • The doctor feels a patient’s pulse in order to check for heart's rate and rhythm.

  • Each pulse matches up with a heartbeat that pumps blood into the arteries.

  • The force of the pulse also helps evaluate the amount (strength) of blood flow to different areas of the patient’s body.

  • One can tell how fast one’s heart is beating (heart rate) by feeling one’s pulse.

  • A person’s heart rate is the amount of times the heart beats in one minute.

Measuring One’s Own Heart Rate

 To measure their own pulse, all patients need is a watch with a second hand. 

  • They place their index and middle finger of their hand on the inner wrist of the other arm, just below the base of the thumb.

  •  They should feel a tapping or pulsing against their fingers.
  • They then count the number of taps they feel in 10 seconds.

  • They then multiply that number by six to find out their heart rate for one minute (pulse in 10 seconds x six = ____ beats per minute).
  • When feeling their pulse, patients can also tell if their heart rhythm is regular or not.

Checking Heartbeat
  • Doctors listen to patients’ heartbeat with the aid of a stethoscope.

  • The opening and closing of the valves make a "lub dub" noise known as heart sounds.

  • Doctors can evaluate the patients’ heart and valve function and hear the patients’ heart's rate and rhythm by listening to the heart sounds.

8 Ways to Lower Patients’ Heart Disease Risk
1.  Quit smoking

2.  Improve cholesterol levels

3.  Control high blood pressure

4.  Get active with exercise

5.  Follow a heart-healthy diet

6.  Get to a healthy weight

7.  Control diabetes

8.  Manage stress and anger

*Recommendations from the American Heart Association

Measuring Blood Pressure
Optimal blood pressure is less than 120/80 mm Hg
 (systolic pressure is 120 AND diastolic pressure is less) 

Blood Pressure

mm Hg (upper #)


mm Hg (lower #)


less than 120


less than 80


120 – 139


80 – 89

High Blood Pressure
(Hypertension) Stage 1

140 – 159


90 – 99

High Blood Pressure
(Hypertension) Stage 2

160 or higher


100 or higher

Hypertensive Crisis
(Emergency care needed)

Higher than 180


Higher than 110

Hypertension Facts

Causes of  Hypertension

  • Age: High blood pressure is more common in older people. At age 45, more men have hypertension than women. By age 65, this is reversed, and more women are affected.

  • People with diabetes have a greater risk of hypertension than those without diabetes. About 60% of all people with diabetes also have hypertension

  • Genetics: having a close family member with high blood pressure increases risk of developing it

  • Race: African-Americans are at greater risk of developing hypertension than people of other races

  • Sodium: chemical found in salt, raises blood pressure by promoting the retention of fluid

  • Overweight: increases risk of getting hypertension & increases workload required of heart

  • Drinking: Drinking too much alcohol is a risk factor for high blood pressure

Behavioral Medicine Treatments of Hypertension

  • Low sodium diet

  • Exercise can lower blood pressure. It’s recommended: adults get about 150 minutes per week of moderate exercise such as: walking, bicycling, gardening, or other aerobic exercise. Muscle-strengthening activities are recommended at least twice a week.

  • Mindfulness Meditation and other relaxation techniques can help lower blood pressure.

  • Yoga, tai chi, and breathing exercises can also help reduce blood pressure.
 NOTE: It’s best when these are combined with changes in diet and exercise

Facts about Cholesterol
  • Cholesterol is a natural substance made by the body

  • Most of cholesterol in bloodstream (75%) is produced by liver & remaining 25% comes from foods eaten

  • Elevated blood cholesterol levels are not good for health, but right levels of cholesterol play a vital role in maintaining cell membranes & synthesizing hormones

  • Centers for Disease Control reports that one-third of adults have high cholesterol levels

  • Usually, high cholesterol does not produce any symptoms and one may not know one’s blood cholesterol is too high.

  • Too much cholesterol can build up in arteries, causing atherosclerosis, or hardening of the arteries. This restricts blood flow through the arteries and can lead to serious medical problems such as heart attack or stroke

  • Cholesterol screening is done with a blood test that measures levels of high-density lipoprotein (HDL) cholesterol ("good" cholesterol), low-density lipoprotein (LDL) cholesterol ("bad" cholesterol), and triglycerides

So what is Bad & Good Cholesterol?

“Bad” Cholesterol

  • Low-density lipoprotein (LDL) cholesterol, often referred to as "bad" cholesterol, is the type that tends to deposit on the walls of the arteries.

  • White blood cells combine with the LDL cholesterol, forming artery-narrowing plaque, which restricts blood flow.

  • The optimal level of LDL cholesterol for most people is 100 mg/dL or lower.

  • If a person has heart disease, there may be need to strive for LDL levels of 70 mg/dL or lower

“Good” Cholesterol - Not all cholesterol is bad

  • High-density lipoprotein (HDL) cholesterol is considered "good" cholesterol because it actually works to keep the LDL, or "bad" cholesterol from building up in your arteries

  • The higher the HDL, the better. HDL levels of 60 mg/dL and higher can help reduce the risk for heart disease

  • Conversely, HDL levels of 40 mg/dL and lower are considered a high-risk factor for developing heart disease

Results of Cholesterol Screening

A cholesterol test will measure the total cholesterol in the blood, and total cholesterol levels are made up of a combination of LDL, HDL, and VLDL (very low-density lipoprotein, another "bad" cholesterol) levels.

  • A total cholesterol score of 200 mg/dL or lower is considered optimal.

  • Levels above 200 mg/dL are considered high and can mean you are at greater risk for developing heart disease.
  • When health-care professionals order blood cholesterol levels to be checked, they will interpret and discuss the results such as cholesterol ratio and total cholesterol numbers (HDL, LDL, and VLDL), and what they each mean.

  • To calculate one’s cholesterol ratio, divide the total cholesterol number by the HDL cholesterol number.
  • For example, if one has a total cholesterol score of 200 and an HDL score of 40; divide 200 by 40 and this equals a ratio of 5 to 1.

  • The lower the ratio, the lower risk of heart disease.

  • Doctors recommend keeping the ratio 5 to 1 or lower. The optimal ratio is 3.5 to 1. While this ratio can be helpful in assessing risk for heart disease, doctors will take into account patients entire cholesterol profile and tell them what treatment is best for them

More Facts about High Cholesterol

Risk factors for high cholesterol. 

Risk factors that can be controlled include:

  • Diets high in trans fats, saturated fats, and cholesterol

  • Being overweight or obese

  • Sedentary lifestyle

  • Other risk factors which cannot be controlled include age (risk increases as people age), gender (women's risk for high cholesterol increases post menopause), and family history

Why High Cholesterol Matters

  • High cholesterol puts patients at risk for heart disease and stroke, leading causes of death in the U.S.

  • High levels of LDL ("bad") cholesterol can contribute to plaque buildup on the walls of the arteries, narrowing the arteries and restricting blood flow.

  • If some of this plaque breaks off and gets stuck in a narrowed artery, it can block the artery and cut off blood supply to the heart or brain, resulting in heart attack or stroke

When seeking to lower total cholesterol, what number should be aimed for?

  • A total cholesterol score of 200 mg/dL is desirable. Aim for an LDL ("bad") cholesterol level of 100 mg/dL or lower, and an HDL ("good") cholesterol level of 60 mg/dL or higher.

  • If patients have high risk factors for heart disease or stroke, including high blood pressure, smoking, family history of heart disease, are over the age of 45 for men and age 55 for women, have low HDL cholesterol (below 40 mg/dL), and/or are obese or inactive, they may need to aim for LDL levels of 70 mg/dL or lower.

Diet Can Change Cholesterol levels

FIBER: Diets high in fiber can reduce LDL ("bad") cholesterol. High fiber diets also may help with weight loss, and being overweight is a contributing risk factor for high cholesterol. Foods high in fiber include fruits, vegetables, whole grains, legumes, and beans

FATS: The American Heart Association recommends that just 25% to 35% of daily calories come from fats such as those found in fish, nuts, and vegetable oils.

  • For healthy people, saturated fat should comprise no more than 7% of total calories. On a 2,000 calorie-a-day diet, that’s about 140 calories (or 16 grams) worth of saturated fat.

  • If patients need to lower LDL cholesterol, they need to limit saturated fat to 5% to 6% of calories, or about 11 to 13 grams of saturated fat on a 2,000-calorie diet and reduce trans fats to less than 1% of total daily calories. This means avoiding fried foods and many junk foods.

PROTEINS: To reduce cholesterol, limit red meat and eat more fish and lean poultry. Trim all fat from meats and remove all skin from poultry before cooking.

  • Broil or bake, don't fry foods. Drain fat from any meats before serving. Avoid processed meats such as hot dogs or cold cuts, even those labeled "reduced fat," as many are still high in saturated fats and calories

  • Oily fish such as salmon or trout are high in omega-3 fatty acids, which can reduce triglyceride levels and improve HDL ("good") cholesterol levels

  • Soy proteins can also have a beneficial effect and help to reduce LDL ("bad") cholesterol and triglycerides, while raising HDL cholesterol levels

Life Style Changes Can Change Cholesterol levels

LOW CARB DIET: Low-carbohydrate diets may help improve HDL ("good") cholesterol levels. The National Institutes of Health conducted a study that found while both low-fat and low-carb dieters lost weight over the two-year study period, low-carb dieters also improved their HDL cholesterol levels. The problem with low-carb diets is that they may be difficult to adhere to.

LOSE WEIGHT: Losing weight can help lower patients’ cholesterol. Being overweight or obese tends to increase their levels of LDL ("bad") cholesterol. Weight loss can help reduce LDL cholesterol and triglyceride levels, and raise their HDL ("good") cholesterol levels.

QUIT SMOKING: Smoking is not only bad for thelungs; it also lowers HDL ("good") cholesterol and increase the risk for heart disease and stroke. When patients quit smoking, their HDL levels will rise

EXERCISE: can increase HDL ("good") cholesterol by up to 6% and reduce LDL ("bad") cholesterol by 10%. Just 40 minutes of exercise such as walking, swimming, or cycling three to four times per week can have an impact on blood cholesterol levels

MEDICATIONS: Sometimes, a healthy diet and regular exercise just aren't enough to attain healthy cholesterol levels. This is often the case when high cholesterol is caused by genetic factors, and in these situations, medications can help. Statins are usually the first choice because they also reduce risk for heart attack and stroke. Other types of medications that may be prescribed include selective cholesterol absorption inhibitors, resins (also known as bile acid sequestrant or bile acid-binding drugs), and lipid-lowering therapies such as fibrates, niacin, and omega-3s

Measure of Oxygen in Blood
Normal: 95-100

Low: 90-95 But not necessarily a health issue

Lower: Below 90 is considered low resulting in Hypoxemia

Lowest: Below 80 may compromise organ function, such as brain and heart

The measure of oxygen in the blood is an estimation of the oxygen saturation level

  • Oxygen saturation is a term referring to the concentration of oxygen in the blood It measures the percentage of hemoglobin binding sites in the bloodstream occupied by oxygen.

Some causes of Hypoxemia can be the result of causes of: 

  • Sleep apnea

  • Asthma crisis  
  • Pulmonary infection

  • Or other pulmonary disorders

  • Continued low oxygen levels below 80% may lead to respiratory or cardiac arrest
Facts about Asthma

Asthma is a chronic lung disorder that can make breathing difficult. It causes inflammation, swelling, and narrowing of the airways (bronchial tubes).

  • About 25 million people in the U.S have asthma

  • Asthma involves narrowing of the airways caused by three major factors: inflammation, bronchospasm, and hyper-reactivity.

  • Allergy plays a role in some, but not all, asthma patients.

  • Allergens and irritants can cause asthma attacks.

  • Asthma symptoms include shortness of breath,

  • Asthma is diagnosed based physical exam, patient history, and confirmed with breathing tests.

  • The best way to manage asthma is to try to avoid triggers such as allergens or irritants.

Asthma Classifications
Mild Intermittent - This includes attacks no more than twice a week and nighttime attacks no more than twice a month. Attacks last no more than a few hours to days. Severity of attacks varies but there are no symptoms between attacks

Mild Persistent - This includes attacks more than twice a week, but not every day, and nighttime symptoms more than twice a month. Attacks are sometimes severe enough to interrupt regular activities

Moderate Persistent - This includes daily attacks and nighttime symptoms more than once a week. More severe attacks occur at least twice a week and may last days. Attacks require daily use of quick-relief (rescue) medications and changes in daily activities.

Severe Persistent - This includes frequent severe attacks, continual daytime symptoms, and frequent nighttime symptoms. Symptoms require limits on daily activities.

Diabetes-Blood Sugar Levels

Daily Blood Sugar Level:

The American Diabetes Association recommends the following target ranges for most adults who do their own blood sugar level testing on a daily basis:

  • between 70 and 130 mg/dl before meals
  • below 180 mg/dl within two hours after eating

The A1c Level

Patients get a blood test called the A1c and the results of this testing reflect what stage of diabetes the patients are at:

Diagnosis                   A1c level

Normal                    Below 5.7 percent 
Diabetes                 6.5 percent or above
Prediabetes            5.7-6.4 percent

You can download the A1C to Blood Glucose Conversion Table at:

Facts on Diabetes

Risk factors related to both lifestyle choices and medical conditions can increase risk of developing type 2 diabetes. These include:

  • Cigarette smoking

  • Being overweight or obese, especially around the waist

  • Lack of exercise

  • Consuming a diet that is high in processed meat, fat, sweets, and red meats

  • Triglyceride levels over 250 mg/dL

  • Low levels of “good” HDL cholesterol (below 35 mg/dL)

Non-medical Treatment of Diabetes. People with type 2 diabetes

  • Diet: Need to monitor intake of carbohydrates and reduce calories as well as watching total fat and protein consumption

  • Exercise:  30 minutes of moderate exercise daily including walking, to lower blood glucose levels. Physical activity also reduces body fat, lowers blood pressure, and helps prevent cardiovascular disease

  • Stress Reduction: Stress not only increases blood pressure, but it can also increase blood glucose levels. Use relaxation techniques such as visualization, meditation, or breathing exercises.

Weight Management - BMI

The BMI is determined by comparing the height of the individual and the individual's weight

BMI Score            Diagnosis

19-24                     Normal
25-29                     Overweight
30-39                     Obese
40-54                     Extremely Obese

You can download The BMI Table which compare height and weight at:

Facts about Weight Gain

Taking in more calories than usual or reducing the amount of physical activity can result in weight gain for older adults. However, some older adults seem to gain weight even when they are eating and exercising the same as always.

Other Factors Causing Weight Gain:

1.Lack of Sleep: due to biochemical changes in the body resulting from sleep deprivation can make one hungrier and leave one feeling less full after eating

2.Stress: Cortisol, the so-called "stress hormone," increases in body when stressed out. This hormone, in turn, increases appetite. People tend to reach for comfort foods at times of stress thus resulting in weight gain

3.Antidepressants: A side effect of many antidepressant medications is weight gain

4.Steroids: Steroid medications such as prednisone are well-known causes of weight gain due to fluid retention and increased appetite

5.Prescription Medications: Especially Antipsychotics and meds which treat for seizures, migraines, diabetes, and hypertension

6.Hypothyroidism: Symptoms of an underactive thyroid gland include tiredness, feeling cold, and gaining weight. Having too low levels of thyroid hormone (hypothyroidism) slows metabolism and increases the chance of weight gain

7.Quitting Smoking

Facts about Smoking
Physical Impact of Smoking

  • Lung Cancer

  • Oral Cancer

  • Heart Disease and Erectile Dysfunction

  • Cataracts

  • Brittle Bones

  • Skin: Uneven skin tone; sagging skin and wrinkles; lines and wrinkles around the lips; age spots; Psoriasis -thick, scaly skin patches most commonly s on elbows, scalp, hands, back, or feet

  • Appearances: Damaged gums and teeth; Stained nails and fingers; Hair Loss

12 Health Risks from Heavy Drinking