Kaplan Medical USMLE Step 1 Lecture Notes: Behavioral Sciences

218 Pages·7.374 MB·English

Step 1
USMLE'
Behavioral Sciences Notes
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*USMLEisajointprogramofthe FederationofState MedicalBoardsofthe UnitedStates, Inc.andthe NationalBoardofMedicalExaminers.
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@2002Kaplan, Inc.
Allrights reserved.Nopart ofthisbook maybe reproduced in anyform, byphotostat,
microfilm,xerographyoranyothermeans, orincorporated into anyinformation
retrievalsystem,electronicormechanical,without tbe writtenpermissionofKaplanI,nc.
AuthorandExecutiveEditor
StevenR.Daugherty, Ph.D.
Director ofEducation and Testing
Kaplan Medical
Rush Medical College
Chicago, IL
Contributor
Alina Gonzalez-Mayo,Ph.D.
Psychiatrist
ExecutivDeirectorofCurriculum
RichardFriedland,M.D.
DirectorofPublishinagndMedia
MichelleCovello
ManagingEditor
Kathlyn McGreevy
ProductionEditor
Ruthie Nussbaum
ProductionArtist
MichaelWolff
CoverDesign
Joanna Myllo
CoverArt
RichLaRocco

Tableof Contents
Preface. ............................. .........................vii
Chapter1:Epidemiology 1
Chapter 2: Statistics. ............................................ 15
Chapter 3: Sociallife inthe UnitedStates. ..........................39
Chapter 4: Substance Abuse. ................................ .....49
Chapter 5: Human Sexuality. ................. .............. ......59
Chapter 6: Learningand BehaviorModification. ......................73
Chapter 7: Defense Mechanisms. .................... .............83
Chapter 8: PsychologicHealthand Testing. ..........................97
Chapter 9: ChildDevelopment...... ........ .... ..... .. ..... ... .. 103
Chapter 10: SleepandSleepDisorders........................... .. 121
Chapter 11:Physician-PatienRtelationships. ........................ 131
Chapter 12:Diagnosticand StatisticalManual IV(DSMIV) 141
Chapter 13:OrganicDisorders. .................................. 169
Chapter 14: Psychopharmacology.................... ....... ...... 181
Chapter 15:Ethicaland Legal Issues ...............................197
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Preface
Thesesevenvolumes of Lecture Notes represent a yearlong effort on the part of the Kaplan
Medicalfacultytoupdate our curriculum toreflectthe most-likely-to-be-tested materialonthe
current USMLEStep1exam. Pleasenote that theseareLectureNotes,not reviewbooks. The
Notes were designed to be accompanied by faculty lectures-live, on video, or on the web.
Readingthese Notes without accessingthe accompanying lectures is not an effectiveway to
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Tomaximizethe effectivenessoftheseNotes,annotate them asyoulistento lectures. Tofacil-
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Manystudents findthat previewingtheNotes prior tothe lecture isaveryeffectivewaytopre-
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Finally,wewant tohearwhatyouthink. What doyoulikeabout thenotes? Whatdoyouthink
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Thankyouforjoining KaplanMedical,and best ofluckonyour Step1exam!
KaplanMedical
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Epidemiology
Epidemiologyisthe study ofthe distribution and determinants ofhealth-related stateswithin Note
apopulation.
.
TheUSMlERequiresYouto
Epidemiologyseesdiseaseasdistributed within agroup, not asaproperty ofan indi-
Know:
vidual. .
. Thedefinitionsanduseof
Thetools ofepidemiologyarenumbers. Numbers in epidemiology areratios convert-
rates
edinto rates.
. .
Thedenominator iskey:whois"atrisk"foraparticular eventor diseasestate. Incidence and prevalence
. .
Ratesaregenerally,but not always,per 100,000bythe Centers for DiseaseControl and Standardizedrates
Prevention (CDC),but canbeper anymultiplier.
. .
Compare the number ofactualcaseswith the number ofpotential casesto determine Useand computations for
the rate. screening tests
Actual cases Numerator .
= Howto identify bias in
RATE
Potential cases Denominator research
.
Common study designs
A.Incidence and Prevalence
1. Incidencerate:the rateatwhichnew events occurin apopulation. The numerator is
the number of NEW eventsthat occur in a defined period; the denominator isthe
population atriskofexperiencing thisnew eventduring the sameperiod.
Number ofnew events in aspecifiedperiod
Incidence rate = "." . . . X IOn
Number ofpersons exposedto nsk durmg this penod
a. Attack rate: a type of incidence rate in which the denominator is further
reduced forsomeknown exposure
b. Focusonacuteconditions
2. Prevalencerate:allpersons who experiencean eventinapopulation. Thenumerator
isALLindividuals whohavean attribute or diseaseat a particular point intime (or
during aparticular period oftime);the denominator isthe population atriskofhav-
ingthe attribute or diseaseatthispoint in time or midwaythrough the period.
Allcasesofadiseaseatagivenpoint/period
Prevalence rate = Tootalpopul'atlOn"atn.sk" atagI.venpom. t or pen.od X IOn
a. Pointprevalence:prevalenceataspecifiedpoint in time -
b. Periodprevalence:prevalenceduring aspecifiedperiod or spanoftime -
c. Focusonchronic conditions
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USMLEStep 1:Behavioral Sciences
d. Prevalence can be changed by simply moving the cutoff that defines what
constitutes acaseofdisease.
20 Cutoff%Prevalence
90 = 25.3%
95 = 14.5%
%of 15-
100 = 8.5%
Screened
Population 105 = 4.8%
10-
110 = 3.0%
115 = 1.5%
5-
0
50 60 70 80 90 100 110 120 130
DiastolicBloodPressure (mmHg)
Figure 1-1.Prevalence ofHypertension
3. Understanding the relationship betweenincidenceand prevalence
= =
a. Prevalence Incidencex Duration (P Ix D)
b. "Prevalencepot"
i. Incident casesor newcasesaremonitored overtime.
ii. Newcasesjoin pre-existing casesto makeup totalprevalence.
iii. Prevalent casesleavethe prevalencepot in one of twoways:recovery
or death.
Incident Cases
General
Population
at Risk
1]1
y
Prevalent
Mortality
Cases
Recovery
Figure 1-2.Prevalence Pot
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