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USMLE Step 1 Behavioral Science
The document covers a wide range of topics related to mental health, medical statistics, treatments, and research methodologies. It includes discussions on different types of psychological disorders, their symptoms, medication treatments, risks, and research designs such as cohort and case-control studies. Additionally, it elaborates on various neurotransmitters and their functions, along with health insurance plans and their characteristics.
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USMLE Step 1 Behavioral Science
- 2. Present Absent Totals Positive60 120 180 Negative 20 200 220 Totals 320 80 400 Present Absent Totals Positive TP FP TP+FP Negativ e FN TN TN+FN Totals TP+FN FP+TN N PPV NPV Sensit Specif Present Absent Totals Risk A B NO Risk C D Totals N AD/BC Odds Ratio 1200/2400 0.5 Present Absent Totals Risk A B NO Risk C D Totals N Relative Risk A/A+B C/C+D
- 3. A B CD E Healthy Diseased A B C D E Healthy Diseased B to D: Sensitivity D to E: NPV D to B: Specificity B to A: PPV C: Accuracy C: Fewest falses A B C D E Healthy Diseased - + FN FP
- 4. High Precision High Accuracy HighPrecision Low Accuracy Low Precision High Accuracy Low Precision Low Accuracy
- 5. Selection Bias Ex. Usingathletes to measure population’s fitness level. Berkson’s Bias Ex. Using medical records to talk about population Solution Get a random sample and weight the data to match the population
- 6. Hawthorne Effect: Subject’s behaviorchanges because they’re being observed. VS Solution: Get a control group
- 7. Observational Case ReportOne case Case Series Group of cases Cross-sectional study Look at Prevalence at a specific time Chi-square (x2) Case-control study Disease vs no Disease (retrospective) Odds-ratio Cohort study (Confirmation) Look at Incidence and Causality (prospective) Relative risk and Attributable risk (NNT, NNH) Interventional Clinical Trial Phase I (safety in healthy volunteers) Phase II (protocol and dose levels in patients) Phase III (efficacy and side effects in patients) Post-Marketing Survey (find negative effects in common use)
- 8. Negative Positive A BC A – Mode B – Median C – Mean Sensitivity 1-Specificity
- 9. 99.7% 95.5% 68% .15% 2.4% 13.5%34% 34% 13.5% 2.4% .15% Standard Deviation 50% 50% 84%
- 10. Name of TestInterval Nominal Pearson / Spearman correlation 2 / 0 0 / 2 Chi-square 0 2 Any number of groups T-test 1 1 2 groups One-way ANOVA 1 1 2 or more groups Two-way ANOVA 1 2 Nominal: Gender, treatment interventions Interval: Height, weight, blood pressure, drug dosage
- 11. Stimulus Behavior Add Remove Stops PunishmentExtinction Increases Positive Reinforcement Negative Reinforcement Types of Reinforcement Contingency Schedule Time Behaviors Constant Fixed Interval Fixed Ratio Changing Variable Interval Variable Ratio Reinforcement Schedules
- 12. IQ Score: MA CA x100 MA: MentalAge CA: Chronological Age X: Mean S: Standard Deviation S: ∑(X-X) n-1 2 √ Odds ratio: AD BC A: + Risk and + Disease D: - Risk and - Disease Relative R: EG UG EG: Exposed Group UG: Unexposed Group Attributable R:EG - UG EG: Exposed Group UG: Unexposed Group NNT: ARr1 ARr2 NNT: Number needed to treat ARr: Attributable risk result ARr1 ARr2 = Specificity: TN TN+FP TN: True Negative FP: False Positive HI: MZ-DZ 100-DZ MZ: Monozygotic Concordance DZ: Dizygotic Concordance HI: Heritability Index MA: IQ x CA 100 MA: Mental Age CA: Chronological Age
- 13. 3 years Circle 4 years Cross 41/2 years Rectangle 5 years Square 6 years Triangle 7 years Diamond Stacks 9 cubes 3 years* Stacks 3-4 cubes 18 months* Stacks 6 cubes 2 years* *Age multiplied by 3
- 14. Feet in mouth Changes hands with toy Stranger anxiety Standswith help Repetitive Responding Crawls Fear of falling Pincer Grasp Ma-ma Da-da Peek-a-boo Pat-a-cake Sits with support Laughs aloud Da-da, Ma-ma Follows objects to midline W E E K S • Puts everything in mouth • One handed approach / grasp of toy • Band and rattle stage • Issues of trust • Play is solitary and exploratory
- 15. 10 words Separation Anxiety Emergence of hand preference Climbsstairs alone Walks alone • Kicks ball, throws ball • Pats pictures in book • Bungee-kid • Onlooker play • Achieves object permanence First words, First steps, First birthday
- 16. 0 1 23 4 5 6 7 Wake Awake REM Stage 1 Stage 2 Stage 3 Stage 4 1-4 Hours: Delta sleep 4-8 Hours: REM and Stage 2 Less time: Stage 1 Most time: Stage 2 Wake up out of: REM, Stage 2
- 17.
- 18. Lymphocyte Cortisol Blood pressure Amygdala activation Negativemood Glucose tolerance Prefrontal cortical activity Sleep Deprivation
- 19. Intellectual Disability Level IQFunctioning Mild 70-50 Self-supporting with guidance Moderate 49-35 “Trainable” needs supervision Severe 34-20 Training not helpful, can learn basic habits Profound Below 20 Constant nursing care
- 20. Brief Psychotic Disorder SchizophreniformDisorder Schizophrenia From 1-30 days Return to full former functioning Less than 6 months Auditory Hallucinations Blunted affect Disturbance in behavior
- 21. Hallucinations Delusions Bizarre behavior Disorganized speech Catatonic behavior Unusualmotor behavior Depersonalization Flat affect Motor retardation Apathy Mutism Alogia Avolition Mood Disorder Mild Severe Stable Persistent Depressive disorder Major Depression Alternating Cyclothymia Bipolar At least for 2 years
- 22. Major Depression • Anhedonia •Lack of Motivation • Worthlessness • Decreased concentration • Weight loss/gain • Depressed mood • Recurrent thoughts • Insomnia/Hypersomnia • Agitation/Retardation • Somatic complains • Delusions or Hallucinations • Loss of sex drive Bipolar (Mania) • Increased self-esteem • Low frustration tolerance • Decreased need for sleep • Flight of ideas • Excessive involvement • Weight loss / Anorexia • Increased Libido
- 23. Disease SE DONE GL EP GA ACh ADHD Schizophrenia Major Depressive Bulimia Anorexia PTSD Anxiety Tourette’s Parkinson’s Alzheimer’s
- 24. Somatic Symptom Factitious Malingering Symptom Production Unconscious IntentionalIntentional Motivation Unconcious Unconscious Intentional Patient knows: Nothing Something Everything
- 25. Perseveration – FrontalLobe Constructional Apraxia – Nondominant Parietal Lobe Hemineglect – Right Parietal Lobe
- 26. Part of theBrain Function Lesion Frontal cortex Speech, personality, abstract thought, memory and concentration Dorsal: Docile, dirty, dim Orbitomedial: Explode into orbit Temporal cortex Language, memory and emotion. Learning proper names (left lobe) Left lobe: Happy psychotic Right lobe: Dysphoria and decreased visual/musical ability. Medial: Impaired new learning Parietal cortex Verbal processing (left) Visual-spatial processing (right) Left lobe: Gerstmann sx Right lobe: Neglect of the left side Occipital cortex Visual input and recall of objects, scenes, distances Cortical blindness Anton syndrome: Denial of blindness Hypothalamus Involuntary internal responses (heart, respiration, blood pressure, eating, sleep) Ventromedial: Hyperphagia, obesity Lateral: Anorexia and starvation Thalamus Pain perception Impaired memory and arousal Reticular activating system Motivation, arousal, wakefulness Hippocampus Memory and new learning Impaired new learning, long-term memory Amygdala Emotional memory and rudimentary learning Klüver-Bucy syndrome and Korsakoff Sx Basal Ganglia Initiation and control of movement Parkinson, Huntington, Wilson, Fahr
- 27. Neurotransmitter Function DiseasePathway Acetylcholine (Ach) Voluntary and involuntary muscle movements, erections in REM sleep Alzheimer’s disease Norepinephrine (NE) Acceleration of heart, dilation of bronchi, elevation of blood pressure Decrease: Depression Increase: Mania Locus Ceruleus Dopamine Motor control, motivation, arousal, reinforcement, reward, sexual gratification, nausea N: Tremors, muscle rigidity, bradykinesia M-L-C: Reduction of psychotic symptoms T: Increases of prolactin Decrease: Extrapyramidal symptoms Nigrostriatal Meso-limbic-cortico Tuberoinfundibular Serotonin Inhibitory influence, linked to impulse control. Regulation of sleep, sexual activity, aggression, anxiety Low: Low impulse control Raphe nuclei Glutamic Acid Fast excitation, learning and memory. Schizophrenia, PCP, Stroke, Autism Major neuronal Enkephalins Mimic effect of opiates Substance P Pain sensation from the skin into the spinal cord Pain relief by opiates Gamma Amino- Inhibitory Anxiety, cannabis and benzodiazepines
- 28. Medication Type Notes HaloperidolTypical Most used for acute symptoms Fluphenazine Typical Long-lasting injection 2-3 weeks. Schizo and bipolar Thioridazine Typical Retrograde ejaculation, retinal pigmentation Loxapine Typical When non-responsive to other drugs Clozapine Atypical High affinity for serotonin Agranulocytosis and seizures, NO TD Risperidone Atypical Dizziness, fatigue, dry mouth, tachycardia and hypotension, EP effects Olanzapine Atypical Low rate of side effects Little EP, may develop diabetes Quetiapine Atypical Serotonin, dopamine, NE, H1 Works for bipolar Same somatic side effects Aripipazole Atypical Agonist on D2 and 5-HT1. Antagonist on 5-HT2 Bipolar, schizo and major depression Ziprasidone Atypical High affinity for DA, 5-HT, NE & H1 Inhibits serotonin reuptake, psychosis and mania, prolonged QT
- 29. Depression • Any drug Enuresis •Imiprimine Panic disorder • Imipramine or Alprazolam (acute) Obsessive-Compulsive disorder, PTSD • Fluoxetine, clomipramine, paroxetine Chronic pain w/wo depression • Amitriptyline, escitalopram Alprazolam, Clonazepam • Panic, Anxiety Diazepam • Anxiety, Insomnia Flurazepam, Triazolam, Temazepam • Insomnia Chlordiazepoxide, Oxazepam • Alcohol detoxification Lorazepam • Anxiety, alcohol-related seizures
- 30. Medication Notes Trazodone Serotoninantagonist, alpha-1 blocker. Improves sleep, causes priapism Mirtazapine Works on serotonin and NE. Somnolence, increased appetite and weight gain (tx for anorexia nervosa) Bupropion Non-sedating, no sexual effects, appetite suppression. Venlafaxine Inhibits reuptake of NE and 5-HT, mild dopamine effect Sweating, nausea, constipation, anorexia and vomiting Duloxetine Inhibits reuptake of NE and 5-HT, for depression and pain Somatic side effects and decreased libido
- 31. Lithium • First linetreatment for Bipolar disorder. • Can interfere with the action of vasopressin or the renal conducting ducts = Reduces water reabsorption. • Can give rise to Nephrogenic diabetes insipidus.
- 32.
- 33. Antidepressant Type Effect Amitriptyline Heterocyclic ProlongedQT interval Imipramine Matoprotiline May cause seizures Nortriptyline Less likely to cause hypotension Citalopram Selective Serotonin Reuptake Inhibitor More cardiotoxic Escitalopram Rapid symptom relief Fluoxetine Sexual dysfunction, weight loss Paroxetine Most sedating, sexual dysfunction Sertraline GI disturbances, sexual dysfunction Duloxetine Selective Serotonin and Norepinephrine Reuptake Inhibitor Rapid symptom relief, few sexual side effects Venlafaxine Rapid symptom relief, few sexual side effects, increased BP Tranylcypromine Monoamine Oxidase Inhibitor Hyperadrenergic crisis precipitated by tyramine foods Phenelzine Amoxapine Other Antidopaminergic effects (parkinsonian sx, galactorrhea, gynecomastia, sexual dysfunction) Overdose Dangerous Bupropion Seizures, sweating, decreased appetite Mirtazapine Increased appetite (tx for anorexia) Trazodone Hypotension, priapism
- 34. Schizoid Paranoid SchizotypalNarcissistic Borderline Antisocial Histrionic Anton Sx (PCAs occlusion)
- 35. Types of HealthInsurance Plans PPO HMO POS Monthly premiums $$$ $ $$ Copayments & deductibles $$ $ Variable PCP referral for specialist visits No Yes Yes Size of “in- network” provider Large Limited Limited May go outside provider network Yes No Yes (additional out-of-pocket)