This document provides an overview of somatoform and dissociative disorders. It describes the major classifications in the DSM-IV including somatization disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, pain disorder, and undifferentiated somatoform disorder. Key characteristics, differential diagnoses, treatments, and prognoses are outlined for each disorder. Paraphilias are also discussed including types such as pedophilia, voyeurism, and fetishism. Gender identity disorder and homosexuality are differentiated from paraphilias.
This is the Final for Dr. Bachman's Psychopathology Course for Webster University. This has been uploaded to assist with studying for the Counselor's Examination.
Personality disorder are a group of mental health conditions that are characterized by inflexible and atypical patterns of thinking, feeling, and behaving.
"Psychosis in Youth"
Portland, Maine; March 30, 2004
Psychiatry Grand Rounds at Maine Medical Center
*Learn clinical assessment of psychosis in youth
*Learn neurobiology of psychosis
*Learn course and prognosis of psychosis
*Learn treatment of psychosis in youth
This is the Final for Dr. Bachman's Psychopathology Course for Webster University. This has been uploaded to assist with studying for the Counselor's Examination.
Personality disorder are a group of mental health conditions that are characterized by inflexible and atypical patterns of thinking, feeling, and behaving.
"Psychosis in Youth"
Portland, Maine; March 30, 2004
Psychiatry Grand Rounds at Maine Medical Center
*Learn clinical assessment of psychosis in youth
*Learn neurobiology of psychosis
*Learn course and prognosis of psychosis
*Learn treatment of psychosis in youth
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
Schizophrenia is one of the most debilitating mental illness which demands immediate attention by the family. There are certain types of schizophrenia based on its symptom presentation and its management mostly depends sxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
Schizophrenia is one of the most debilitating mental illness which demands immediate attention by the family. There are certain types of schizophrenia based on its symptom presentation and its management mostly depends sxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
This lecture is presented by our volunteer Talha Saleem, he is from Karachi Pakistan, and he is covering Schizophrenia topic.
For video: https://www.youtube.com/watch?v=CyL9KlCHRPs&feature=youtu.be
Brain fag syndrome,hypochondriasis and conversion disorderDr.Emmanuel Godwin
Brain fag syndrome,hypochondriasis and conversion disorder are forms of somatoform disorder....This are disorders that present with Physical symptoms with an unexplained cause.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. 2 Somatoform Disorders These a group of mental disorders characterized by physical symptoms They do not have corresponding organic pathology Patients truly believes that they have a physical problem
3. 3 Six major DSM-IV classifications Somatization disorder Conversion disorder Hypochondriasis Body dysmorphic disorder Pain disorder Undifferentiated somatoform disorder (combo of other somatoform disorders)
4. 4 DDX: Major differential diagnosis involves the possibility that the patient truly has a an unidentified underlying physical ailment CNS illness Multiple sclerosis Dementia Epilepsy Brain tumor Connective tissue disorder Lupus Endocrine disorder Thyroid dysfunction hypoglycemia
5. 5 Somatoform disorders are more common in female except for Hypochondrasis, which is found equally in both 50% of patients also have another mental disorder [depression and anxiety] Patient unconsciously expresses an unacceptable emotion as a physical symptom so he does not have to deal with the emotion [primary gain] Symptoms allows the patient to get attention from others or avoid responsibility [secondary gain]
6. 6 Treatment can control symptoms but they often return Useful factors in treatment Formation of a good doctor - patient relationship Individual and group psychotherapy, hypnosis and behavioral relaxation therapy Identification and reduction of patient’s life that may exacerbate the symptoms Reducing the secondary gain associated with the symptoms Medications are useful for treatment of comorbid psychiatric illness
7. 7 Somatization Disorder Multiple vague physical symptom Nausea Dyspnea Tiredness Menstrual irregularities Occurrence Onset before 30 years of age More common in lower socioeconomic groups 10% of patients of primary care practitioners Course of disorder is chronic and lifelong Symptoms are increased by stressful life events
8. 8 25 year-old woman has a history of unclear somatic complaints. She tells you that she has consulted many doctors but that they are unable to help her
9. 9 Conversion Disorder Abrupt, dramatic loss of motor or sensory function or organ of special sense Motor Presentation Paralysis [which shifts to different areas of the body] Seizures, which are often bizarre Globus hystericus (lump in the throat)
10. 10 Sensory Presentation Paresthesias (abnormal sensations) anesthesias Visual problems Occurrence More common in adolescents and young adults Patients from rural areas Psychiatrically unsophisticated patients
11. 11 Course and Prognosis Most patients show Sx remission in less than 1 month Sometimes immediately after hypnosis Sx go away 25% of patients have recurrent episodes [ when stressful life events occur
12. 12 Hypochondriasis Exaggerated concern with health and illness More common in middle and old age Equal in both sexes Episodic periods of Sx Each lasting up to a few years Interspersed with periods when few Sx are present 50% of patients improve over course of their lives
13. 13 Body Dysmorphic Disorder Patient is preoccupied with a defect in appearance [but has a normal appearance] If defect present it is usually very minor Most often complaint involves slight flaws of the face and head Onset usually in the late teens Chronic course with variable levels of concern over time about the physical feature causing distress Plastic surgery or other medical treatment rarely alleviates Sx
14. 14 Pain Disorder Patient experiences intense, prolonged pain with no physical cause or not explained completely by physical cause or not explained completely by physical disease Can be acute (lasting less than 6 months) Chronic is lasting more than a6 months Often coexists with a general medical condition
15. 15 Usually onset is in the 30s and 40s Disorder can be disabling – addiction to pain medication Anti-depressants (SSRIs) may be useful
16. 16 Factitious Disorder Also called Munchausen Syndrome Mental or physical illness or induced physical illness to gain attention from medical personnel Patient often have worked in the medical field and have specific knowledge of how to imitate medical illness effectively
17. 17 Common Sx: Abdominal pain Blood in urine Induction of tachycardia Fever Skin lesions Seizures
18. 18 Factitious Disorder by proxy Induction of illness in another person Usually a child by parent Some patients report a history of childhood abuse or neglect
19. 19 Malingering Simulation of physical or mental illness for financial or other gain Patient avoids medical treatment and “recovers” as soon as the gain is realized
20. 20 Dissociative Disorders Four types of patient Presentation A 20-year-old woman cannot remember any of the events of a car accident in which she was driving had her sister was killed. A 44-year-old man has been living and working in a town 500 miles from his home for over 2 years. He has no memory of his life before this time.
21. 21 A 32-year-old woman discovers clothes in her closet that she has no memory of buying and that are quite different from the clothes that she usually wears. A 45-year-old woman tells you that she often feels like an observer rather than a participant in her life.
22. 22 The four major types of dissociative disorders are: Dissociative amnesia Dissociative fugue Dissociative identity disorder Depersonalization disorder
23. 23 DDX: Head injury Substance abuse Seizure disorder Sequelae of electro-convulsive therapy Sequelae of anesthesia Delirium Dementia
24. 24 Post-traumatic stress disorder and malingering are the psychological differentials to think about Some cultures or religions have perception that altered states of identity, consciousness are seen in concert with certain experiences
25. 25 Dissociative Amnesia Patient is not able to remember important information about oneself It is uncommon and occurs more often in young adults and in women It is used as defense mechanisms for denial and repression after an emotionally traumatic event
26. 26 Hypnosis and sodium amorbarbital interviews are to recover the lost traumatic memories Long-term psychotherapy to deal with the recovered material Amnesia after acute stress may resolve in minutes or may last for years
27. 27 Dissociative Fugue Sudden inability to remember important information about oneself with leaving home and assuming a different identity Patient is usually not aware that he has done this Has a rare occurrence and is associated with a history of excessive alcohol use While etiology ? Most have a traumatic event in recent past
28. 28 Hypnosis and sodium amobarbital interviews is used Usually resolves within days --- occasionally last years
29. 29 Dissociative Identity Disorder Also called Multiple Personality Disorder Patients have at least two separate personalities One ‘alter’ usually dominates the others Most commonly seen in women Not uncommon in mild form Rare in severe form
30. 30 Mild forms may resemble borderline personality disorder or schizophrenia Malingering must be ruled out[when the patient presents in a forensic (legal) context] Early traumatic experience Usually abuse in childhood or adolescence Most commonly associated with incest
31. 31 In some cases, integration of the personalities using insight-oriented psychotherapy with or without hypnosis Antidepressants, antianxiety and anticonvulsant agents may be helpful Often chronic and associated with other psychiatric symptoms [depression and anxiety]
32. 32 Depersonalization Disorder Recurrent and persistent feeling of detachment from one’s own body or social situation [ if involves environment its called derealization disorder] Sx often present in psychiatric disorders such as schizophrenia, depression, anxiety and histrionic personality disorder
33. 33 In transient form, occurs in many people There is no sex difference Traumatic event in childhood or adolescence may be the etiology Anti-anxiety and SSRIs may be useful Psychotherapy is rarely useful
34. 34 Starts most often between 15 and 30 years of age Occurs episodically and commonly continues for many years
35. 35 What are the characteristics of Paraphilias? Preferential use of unusual objects of sexual desire or engagement in unusual sexual activity Behavior should occur over a period of at least 6 months Behavior causes impairment in occupational or social functioning Primary disturbance in mood causing subjective distress and occupational or social problems These individuals act on their fantasies – if they don’t it is not Paraphilia
37. 37 Types of Paraphilias Pedophilia Voyeurism Exhibitionism Fetishism Frotteurism Necrophilia Sexual Sadism and Masochism Telephone Scatologia Zoophilia
38. 38 Pedophilia Preferred method of sexual gratification is to engage in sexual activity with children of the opposite or same sex Up to 20% of children have been sexually abused It is the most common Paraphilia Typical patient: A 45 y/o scoutmaster is arrested after an 11 y/o boy scout complains that the scoutmaster fondled him during a photography session.
39. 39 Voyeurism Obtaining sexual satisfaction from secretly watching people undressing or engaging in sexual activity Typical patient A 28 y/o man is repeatedly arrested for using binoculars to spy on women in a neighboring apartment building
40. 40 Exhibitionism Exposing the genitals to unsuspecting people in a manner that shocks them A typical patient: 34 Y/O MAN IS REPEATEDLY ARRESTED FOR UNZIPPING HIS TROUSERS AND BARING HIS PENIS TO WOMEN ON THE SUBWAY
41. 41 Fetishism Sexual preference for inanimate objects, such as women’s gloves, shoes, feet, etc. Typical patient: A 30 y/o man commonly masturbates while stroking a woman’s high-heeled shoes Transvestic fetishism Sexual gratification obtained from wearing women’s clothing ….. Most common is lingerie A 23 y/o man reports that to become aroused he must wear a woman’s nightgown, when ever he has sex with his wife
42. 42 Frotteurism Sexual gratification is obtained from rubbing the penis against a non-consenting, unaware woman Typical patient 29 y/o man is arrested for masturbating by rubbing up against a woman in a crowded subway car.
43. 43 Necrophilia Sexual satisfaction is obtained from sexual activity with corpses Typical patient 32 y/o man is arrested for murder after he confesses to killing a young women to have sex with her
44. 44 Masochism and Sadism Obtaining sexual pleasure from receiving (masochism) or causing (sadism) physical suffering or humiliation Typical patient 46 y/o stockbroker regularly pays a woman to beat and humiliate him
45. 45 Telephone Scatologia Deriving sexual pleasure from calling unsuspected women and engaging them in sexually explicit conversations Typical patient 32 y/o man makes anonymous telephone calls to teenager girls after school hours so that he can talk to them about sex
46. 46 Zoophilia Preferred sexual activity is with animals Can be dangerous because sexually aroused animals are often unpredictable Typical patient A 18 y/o man prefers to have sexual intercourse with his female dog
47. 47 Treatment Psychoanalytically oriented psychotherapy Aversive conditioning (electric shock) Anti-androgens and female sex hormones used for paraphilias characterized by hypersexuality Factors for best prognosis: Ability to have sexual intercourse in the absence of the paraphilia Presence of guilt about the paraphilia Factors for worse prognosis Referral by police rather than self Younger age of activity onset
48. 48 Gender Identity Disorder Patient sense of being male or female Commonly called Trans-sexuality Expression of one’s gender identity in society Age gender identity develops is between 2 and 3 years of age Must R/O schizophrenia, serious distress homosexuality More common in man Can be diagnosis in childhood Many patient obtain sex hormones to help with secondary characteristics
49. 49 Sex surgery is rarely performed now because in past the depression and psychological symptoms were not relieved following surgery Prognosis Often chronic, lifelong distress Depression with risk of suicide
50. 50 Typical patient 28y/o male patient tells you that ever since childhood he has felt like he was “a woman born into the body of a man”. He hates his penis and feels like it does not belong to him. He is sexually attracted to heterosexual men, prefers to dress in women’s clothes, and would like to have a sex operation.
51. 51 Homosexuality Likes people of the same sex as a sexual and love object Most have experienced heterosexual sex 50 – 75% have children DSM IV see it as a normal variant of sexual expression Is considered a dysfunction when the discomfort about sexual preference is pronounced (Sexual disorder NOS) These patients may become chronically depressed
52. 52 Indicators of a Genetic Etiology High concordance rate in monozygotic twins than dizygotic twins Markers on the X chromosome