KICK THE BOARDS USMLE STEP 1BEHAVIORAL SCIENCE Prepared by Dr. Irfan Mir KICK THE BOARDS. USMLE STEP 1 BEHAVIORAL SCIENCE Prepared byDr. IRFAN MIR1 BEHAVIORAL SCIENCE * Adoptation Study : use twins to distinguish the effect of genetic factor from environmental factor in dis. If bothtwins have traitthan they are concordant for Trait. * Incidence : is the No of new individual that develop illness in given time ( commonly 1 yr ) divided by total No ofindividual at riskof the illness at that time. * Prevalence : is the No of individual in the population who have illness. Prevelence is higher than Incidence whendis is long term. ---------------------------------------------------------------------- Prospective Study : ( 3 types ) 1. Prospective or Cohort Study : is Cohort (population) receiving one Tx is compared with a cohort receiving adifferent Tx or Placebo. eg different survival b/w men with lung cancer who receive the new cancer drug thanthose who receive standard drug. 2. Retrospective Study or Case Control Study : Cases (diseased) and Control (not diseased) are identified and information on their prior exposure to risk factor Is obtained and compared with odd ratio. Odd Ratio is an estimate of reletive risk when incidence data are not available. 3. Cross setional Study : provide information on possible risk factor and health status of a group at one specificpoint, in time. -------------------------------------------------------- Relative Risk (RR): compares the incidence rate of the disorder among those who exposed to a risk factor with unexposed individual. Attributable Risk (AR): is Incidence rate of the lung cancer in smoker than in non smoker. RR =Dis risk in exposed group / Dis risk in unexposed group. AR =Dis risk in exposed group Dis risk in unexposed group. ----------------------------------------------------------------------- BIAS : Bais test is constructed to make one out come to occur more likely than other. Blind, Cross over, Randomized study, Placebos are used to reduced the Bias. Blind Study : In Single Blind study subject does not know what drug he or she is taking. Where as in Double Blind study neither subject nor experimenter know what drug subject is receiving. Cross Over Study : In which the subjects from group 1 receive the drug and the subjects from group 2 receive the placebo than vice versa. ----------------------------------------------------------------------- Statical Analysis : 1. t Test : examine difference b/w mean of two sample. eg. Body wt from group 1 and 2 at 1 and 2 occasion. 2. Analysis of varience : examine difference b/w mean of more than two samples. eg. wt from Group 1,2 & 3 attime 2. 3. Chi - square Test : examine difference b/w frequencies in sample. eg. Difference b/w the % of women who losewt versus those who fail to lose wt on the diet. 4. Correlation : examine the relation ship b/w two variables. eg. Relation ship b/w BP and body wt at time 2 in agroup. 5. Multiple Regression : is used to examin a relation ship b/w many measures. eg. BP, body wt, at time 2 and cholesterol, uric acid, BUN at time 1.----------------------------------------------------------------------- Hypothesis is the statement inference, literature, preliminary study and postulates that the difference exist b/w two groups. Null Hypothesis postulates that there is no difference b/w two groups can either be rejected or not rejected following statical analysis. Meta Analysis -- is pooling data from several studies to achieve greater statistical power. (cannot overcome Bias & limitation)

KICK THE BOARDS. USMLE STEP 1 BEHAVIORAL SCIENCE Prepared byDr. IRFAN MIR2 LIFE GROWTH & DEVELOPMENT* 90% pragnancies are planned and Mood swing are common during pregnancy. * Meternal competence is strongly influenced by her own mother as a role model. * Pseudo pregnancy may occur in women who have strong wish or strong fear of pregnancy. * Some pregnant women have increases sex drive where as other decreases. * Husbands extra marital affairs most likely to occur during last three month of pregnancy. * Cessation of intercourse is suggested about 4 week prior to the expected date of delivery. * American teenagers give birth to about 600,000 babies and 400,000 abortions annually. * 50% unmarried mothers are teenagers. * First sexual intercourse are average at 16 years of age. By age 19 yrs 80% of males and 70%of female have had sexual intercourse. * Teen agers are at risk of obstetrics complications. * Factors predispose adolescents to pregnancy include, Depression, low academic achievement, poor futureplanning and divorced parents. * USA rank 20thin world in infant mortality rate. Which is 9.2/1000 live birth. * Low socioeconomic status correlate with high infant mortality rate. * Prematurity define as gastation less than 34 weeks or birth wt less than 2500 gms. * 1/3 to 1/2of women develop short lived depressed mood known as Baby Blue or post partum Blue following the birth of child usually results from change in hormonal level, stress of child birth, disoppointment over the childappearance and fatigue. * Major depression affect 5 - 10% of women aftr birth. * Postpartum Psychosis affect 1 - 2% of severly depressed women. ( hallucination, delusion, anxiety are signs ). * Long-lasting postpartum reaction is due to lack of child care experience or social support by hasband or family. -------------------------------------------------------------------------- INFANCY (Birth to 15 months) :- Period of Intimate attachment* Infant is at risk of Anaclitic Depression with the continuous absence of mother, in which infant become withdrawn and unresponsive. * Males are more affected than females by such isolation. * Moro Reflex ( startle reflex ) --- 3 to 6 months it disappears. * Palmar grasp Reflex --- 2 months it disappears. * Babinski Reflex --- 12 months it disappears. * Rooting Reflex present at birth and disappear around 4 month of age. (newborn turn their head toward anything that touces their cheek or mouth. help full in breast feeding) * Other reflexes 1. Reflexive smile --- present at birth. 2. Social smile --- Develop b/w 5 to 8 week. 3. Turning over --- occur at 5thmonth.4. Sitting alone --- occur at 6th month. 5. Strangers anxiety --- 7 to 9 months.6. Walking unassisted --- occur at 12th month. 7. Separation anxiety --- peak at 18 month. 8. Core gender identity --- 18 to 30 months. 10. Galant Reflex --- (infant will swing toward the side that storke) present at birth fade in 4 to 6 months. if persist indicate pathology. STAGES OF HUMAN DEVELOPMENT------------------------------------------------------------------------------------------------------------------------------------ AGE FREUDERIKSONPIAGETCHARACERSTICS------------------------------------------------------------------------------------------------------------------------------------0 - 1 yrOral Basic trust vs. MistrustSensory motor(0 - 2 yrs) Strangers anxiety 1 - 3 yrsAnal Autonomy vs. Shame & doubtPreoperational(2 - 7 yrs) Separation Anxiety 3 - 5 yrsPhallic ( penis) - Oedipal (confusion) Initiative vs. GuiltPreoperational (2 - 7 yrs) Imaginary companions 6 - 11 yrsLatency Industry vs. Inferiority Concrete operational (7 - 11 yrs)Logical Thought 11 - 20 yrsGenitalIdentity vs. diffusion Formal Operation (11 - 20 yrs)Abstract Thought------------------------------------------------------------------------------------------------------------------------------------ * According to Piaget child develop internal representation with out seeing object (Object Permanence) at age 12 to 24 months. KICK THE BOARDS. USMLE STEP 1 BEHAVIORAL SCIENCE Prepared byDr. IRFAN MIR3 MARGARITA MAHLER : * Normal Autistic Phase --- 0 to 1 month ( infant has little interaction with enviornment ) * Symbiotic Phase --- 1 to 5 month ( share a sense of oneness with mother ) * Separation individuation Phase --- 5 to 16 month ( mother is first precieved as separate individual later child moveaway frommother but return from time to time ). TODLERS YEARS : ( 15 MONTHS TO 2 YEARS ) * Mehler called this period as Rapprochement ( period of moving away and returning for comfort & reassurance ). * Child behave like a separate person by about 18 month of age, however process of Seperation - Individuation isnot complete until about age 3 yrs. * At age 2 child is increasingly autonomous, favorite word is NO. and toilet training begins. ( term autonomous isused when child has command on his impulse ) * Core gender identity established b/w 18 to 30 months of age. PRESCHOOL CHILD : ( 2 YEARS TO 6 YEARS ) * Child reach half of adult height b/w 2 to 3 yrs. Vocabulary increases, sibling rivalry begins. * Nightmare are common, transient phobia occur (such as monster), Fear of bodily harm, superego begin to form. * Develop Band-Aid phase ( in which child is concern about illness may point every injury ). * Usually very interested in sexual differences. ( act out the fantasy in doctor game ) * Has love for parent of opposite sex. * Formation of consciences (differentiate from bad to good) begin to form. Learn aggressive impulse can be usein acceptable way. * By age 4 child begin to play cooperatively with others. * Donot understand fully the meaning of death. * From 3 to 10 yrs of age almost half of childrens have imaginary friends. ----------------------------------------------------------------------- LATENCY OR SCHOOL AGE : ( 7 TO 11 YEARS ) * Child learn to perform complex motor tasks and consciences is completed. * Peers become more important. * Opposite sex parent is no longer wanted. * Prefer to play with same sex child. ----------------------------------------------------------------------- ADOLESCENCE : ( 11 TO 20 YEARS ) * Adolescence is distinguished biologically by puberty, a process marked by Menarche in girls and 1st ejaculationin boys. * Formation of personality, accepting responsibilities. Growth acceleration occur. * Endocrine changes occur at 12 yrs in girls and get mature 2 yrs before boys. * Sex dreive release by masturbation or physical activity in early adolescence ( 11 to 14 yrs ) * Middle adolescence ( 14 to 17 yrs ) in which body image and popularity often preoccupy. * Boy equals or exceed girls in height in middle adolescence. * Heterosexual crushes occur. Homosexual experiences may occur. * Late adolescence ( 17 to 20 yrs ) self control, normal and ethical sense develop. * Identity crisis develop, suffer from identity diffusion or role confusion ( behavioral abnormality such as criminalityor cult may occur. * School age children and adolescence (17 to 29 yrs) is best time for elective surgery. * Adolescence may challenge the authority of doctor or nurse and not comply with medical advise. * Highest incidence of sexual abuse occur at 9 to 12 yrs ( abuser are usually known person eg. Relatives, stepfather etc ). * Highest incidence of physical abuse occur under age 5 yrs ( abuser are usually females ). ----------------------------------------------------------------------- KICK THE BOARDS. USMLE STEP 1 BEHAVIORAL SCIENCE Prepared byDr. IRFAN MIR4 ADULTHOOD AGEING AND DEATH : * At about age 30 there is period of Reappraisal ( reastimate ) in ones life. * Middle adulthood ( 40 to 65 yrs ) is the period of generativity vs. stagnation. * Climenterium is diminution of physiologic function occur in middle life ( in women it is menopause ). * In ageing intelligence remains approximately the same but learning may be decreased as a result of disease. * According to Erikson at late adulthood many adult achieved ego integrity, pride in ones past accomplishmentor a sense of despair or worthlessness. ( ego integrity vs. despair ) * Depression is the most common disorder in elderly. Risk factors are, loss of spouse, family member, loss of prestige,loss of health. * Sucide is twice as commonly in elderly as in general population. * Other disorder of aging are Alziemers, hypertension, heart dis, kidney dysfunction, change in sleep pattern. * Longitivity correlates with family history, work involving physical activity, sleep 6 to 9 hrs nightly, suburban living,advanced education, calm personality, occupational activity. * Thenatology is the study of death, dying, breavement, grief, and mourning. * SIDS--unexplained death in children younger than 1 yr of age. (fetal exposure of maternal smoking is strong riskfactor) ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- THEORY OF MIND * Primary Process of thinking is primitive type, it involve wish fulfillment, pleasure, logic is discarded, concept of timeis absent . * Secondary process thinking is logical and associated with reality . * Unconscious mind contain repressed thoughts & feelings that are not available to consciousness. It use Priprocess thinking.* Preconscious mind evolve during childhood available for both conscious and unconscious mind. It use Secprocess thinking.* Conscious mind operate in close junction with preconscious mind. It use Process of attention. ( Process of attention in which individual is aware of stimuli from external world )

STRUCTURAL THEORY OF MIND * Id, Ego, Superego operate primarily on an unconscious level. * Id represents instinctual sexual and aggressive drive control by primary process thinking, and is not influenced byexternal reality. * Ego control the expression of instinctual drives in order to adopt the requirement of external reality. * Major function of ego is to maintain a relationship to the outside world and to be flexible to life fraustation; it alsomaintain sense of reality and object relationship. * Superego : Id impulse are also controlled by superego which represent moral value and consciences. DEFENCE MECHANISM * Are of 2 types mature and less mature. 1. Less mature : * Acting out -- Unacceptable feeling are expressed in action. * Deniel -- Disbelief of intolerable fact about external reality eg. Serious illness or death. * Displacement -- Emotions are transferred from unacceptable to acceptable idea, person or object. * Dissociation -- Seperation of function of some mental process as seen in multiple personality disorder. * Identification -- A persons behavior is patterned after that of another. * Intellectualization -- A mind is used to explain away frightening feeling or conflict. * Isolation of Effect -- Feeling are separated from stressful event and ideas. (describing murder without emotion) * Projection -- Unacceptable impulse are attributed to other. * Rationalization -- An irrational feeling or behaviour is made to appear reasonable. * Reaction formation -- Unconscious feeling are denied and opposite attitude or behaviour are adopted. * Regression -- Child like behaviour reappear under stress such as physical illness and hospitalization. * Repression -- Unacceptable feeling are prevented from reaching awareness. * Splitting -- People or events are seen as totally bad or totally good. * Blocking -- transient inability to remember (momantary relapse is an imp association) KICK THE BOARDS. USMLE STEP 1 BEHAVIORAL SCIENCE Prepared byDr. IRFAN MIR5 * Introjection -- outside become inside ( superigo, being like parent in their abscence or after recent death) * Undoing -- action to symbolically reverse the unacceptable (fixing or repairing, obssesive compulsivebehaviors) 2. Mature : * Altruism -- An individual unselfishly assist others. * Humor -- Reduces anxiety * Sublimation -- An unacceptable instinctual drive is rerouted to a socially acceptable action. * Suppression -- Unwanted feeling are consciously put aside but not repressed. ------------------------------------------------------------------------- * Transference -- Pts unconscious feeling from past about the parents are experienced in the present relationship with the therapist. * Counter Transference -- Analyst unconsciously experience feeling about his own parent with the patient. ------------------------------------------------------------------------- Classical Conditioning (by Ivan Pavlov) : * Acquisition is learning (gain) of behavioral pattern which ilicit in response to unconditional or conditional stimuli . * Unconditional respose is natural eg like slivation in response to odor of food (unconditional stimuli) where asconditional response is that one learned eg. Sound of bell (conditional stimuli) in conjunction of the presentationof food. * Extinction -- Is decrease or fading of response when conditional stimulus (bell) is never followed by unconditional stimulus (food).* Spontaneous Recovery -- occur after extinction when conditional response reappear (salivation) in response to presentation of food after bell (conditional stimuli). Operant condition (by B.F. Skinner) * Operant condition relates the concept of Reinforcement, Behavior can be learned through reward & punishmentThe organism history is not important. * Reinforcement could be positive or negative ( positive like reward and negative like electric shock ). * + ve Reinforcement is increase in future frequency of behaviour due to addition of stimulus immidiately followinga responce. * - ve Reinforcement is increase in frequency of behaviour due to removal of aversive (unpleasant) stimulus. * Variable Reinforcement is very resistant to extinction. Where as Contineous reinforcement is least resistant to extinction.* Ignoring a child who misbehave rather than hiting him ( punishment ) is more likely to result in long lastingdisappearance of unacceptable behavior. * Dissociation -- Temporary drastic change in personality, memory, consciousness, motor behavior to avoidemotional stress. ------------------------------------------------------------------------- MOOD DISORDER : * MOOD is an internal emotional condition of a person where as AFFECTis how that emotional condition is expressed. * MANIA is elevation of mood, sleep, grandiosity, Rapid excited speech, flight of ideas, thoughtlessness. * DEPRESSION is of mood, energy, appetite, suicidal thought. Orientation with respect to person, place, timeis normal. * No racial difference, more common in singles, divorced and separated peoples. 75% pts are successfullytreated. * Non psychological reasons are infections, drugs, endocrine abnormality eg. Altered NorEN, and Serotonin. * Hall mark of Depression is depressed mood where as Hall mark of Mania is elevated, expensive or irritable mood.( Remember Depressed mood is different from sadness ). * TX of Depression --Heterocyclic antidepressant in conjugation with MAO inhibitor. Lithium is the drug of choice in Mania and Bipolar disorder and Carbamezapine is substitute.* Each untreated Manic episode last 3 months. KICK THE BOARDS. USMLE STEP 1 BEHAVIORAL SCIENCE Prepared byDr. IRFAN MIR6 * Mood Disorder types : 1. Major Depressive Disorder ( UNIPOLAR DISORDER ) shows only Depression and Anhedonia (no correlation with status).2. Manic Depressive Disorder ( BIPOLAR DISORDER ) shows both Mania and Depression ( in upper socioeconomic group) 3. Dysthymia chronic depressed mood and lost of interest or plessure (anhedonia) for at least 2 yrs. . 4. Cyclothymia (NONPSYCHOTIC BIPOLAR DISORDER) chronic alternating state of hypomania and dysthymia. (milder form of bipolar dis) 5. Seasonal effective disorder -- depressive symptom in winter caused by abnormal melatonin metabolism. Tx withbright light. ----------------------------------------------------------------------- ANXIETY DISORDER : * Locus ceruleus and Raphe nuclei are involved.Major neurotransmitter involve in anxiety is GABA, NorEN, Serotininalso Histamine and Ach.Tingling is one of the menifestation of anxiety.* Agoraphobia is fear of open space. Algophobia is fera of pain. Acrophobia is fear of height. Claustrophobia isfear of closed space. Aerophobia is fear of airplanes. Anxiety disorder have 5 types : 1. Panic Disorder -- * Episode of intense anxiety (last 30 min) occur twice weekly. (50% pts shows mitral valve prolapse) * Often associated with Agoraphobia and have strong genetic component. * Tx is combination od cognitive behavioral therapy & medication like antidepressant or bezodiazepine. 2. Phobias --* Phobia is irrational fear of object, enviornment, or social with resultant palpitation. Eg.Claustrobhobia etc.Tx is Systemic desensitization, MAO inhibitor, Propranolol, Antidepressant. 3. Obsessive Compulsive Disorder -- * Characterize by obsession ( recurrent thoughts, feeling, images ) and Compulsion (repetitive action ). It shows EEG and Neuroendocrineabnormality. Tx is Clomepramine, Trazodone, Flouxetine. 4. Post Traumatic Disorder -- * and develop Disorder after trauma.(stress, experience trauma, numbness, hyperalertness, exaggerated startle, guilt, memory impairment, trouble concentrating) * Tx MAO inhibitor, Antidepresant, Short psychotherapy. 5. Generalized Anxiety Disorder -- * Persistent anxiety last 6 month with tension. More common in women in 3rd

decade. Tx Relaxation therapy, Buspirone, Benzodiazepine. * Repetitive action or compulsion such as checking locks indicate that pt is suffering from Obsessive Compulsivedisorder. ------------------------------------------------------------------------ COGNITIVE DISORDERS : * Hall mark of Cognitive disorder are Deficit in memory, orientation, judgement, or mental function. * Mood change, anxiety, irritability, paranoia, psychosis, if present is secondary to cognitive loss. Cognitive disorder have 4 Types : 1. Dilirium ---- * Clouding of consciousness, illusion, hallucination (often visual), Hypo or hyperactive, Anxiety, fear, sun downer (worst at night) .Causes are : cerebral, somatic, external (pharmacologic) .* Common in elderly, children and hospital.Delirium treated successfully, if left untreated advancesto dementia. 2. Dementia -- * Memory loss, intellectual abilities, mood change, confusion, psychosis, coma, death. * Subcortical dementia occur in Hungtingtung, Parkinson & movement disorder, Alzheimer, picks dis, Korsakoff $. * Common in elderly (15% in USA) . * 15% of dementia is reversible. 3. Pseudo dementia -- Occur with depression ( loss of memory, cognitive problem ). Succesfully Treated. 4. AIDS related dementia -- memory loss, confusion, dilusion, aggitation, Depression, Psychosis, coma. ----------------------------------------------------------------------- KICK THE BOARDS. USMLE STEP 1 BEHAVIORAL SCIENCE Prepared byDr. IRFAN MIR7 SCHIZOPHERENIA * Occur commonly in young age in any culture or country. ( common in industrial country ). Most individual born incold weather and more common in population of low socioeconomic status. * It may be caused by endocrine abnormality like GABA, or Dopamine activity or Anatomical abnormality or infection. * Schizopherenia shows hallucination, bizarre behavior, delusion, illusion. * Hallucination is False sensory preception eg. Hearing voice in quiet room. * Delusion is False belief not share by others eg. Feeling of being followed by FBI. * Illusion is mis preception of real external stimuli like coat in dark room as a man. * Positive symptoms are productive which include delusion, auditory hallucination, thought disorder, they typicallyregarded as menifestation of psychosis.* Negative symptoms are deficit or loss of normal trait or abilities such as flat affect (lack of emmotional responce),alogia (lack of speech), anhedonia (inability to experience plessure), avolition (lack of motivtion). * Pt is usually oriented to person, place, and time. Memory intact, IQ tend to declined over the course of dis.(Remember cognitive defecit is symptom of schizopherenia ). Suicide is common in 50% .Relapse is common after treatment. Subtypes of Schizopherenia : 1. Paranoid type -- Delusion of persecution or grandeur and auditory hallucination. 2. Catatonic type -- Complete stupor. alternating excitement and motor agitation. 3. Disorganized -- Incoherent, primitive, uninhibited. Active but aimless, pronounced thought disorder. unorganized behavior and speech, flat affect. 4. Undifferentiated -- Psychotic symptoms but not fits in paranoid, catatonic and disorganized type. 5. Residual -- Previous episode but no prominant psychotic symptoms at evaluation. some lingering neg symptoms.

--------------------------------------------------------------------- * Paranoid -- Suspiciousness, mistrust, Responsibility of problem attributed to other. * Schizoid -- Life long pattern of social withdrawal with out psychosis. * Schizotypal -- Peculiar appearance, odd thought pattern and behavior with out psychosis. * Histrionic -- Dramatic, extroverted behavior and cannot maintain intimate relation. * Narcissitic -- Grandiosity, sense of entitlement, lack of empathy, envy (jelousy). * Borderline -- Unstable affect, mood and behavior: suicide attempt, impulsiveness (thoughtless, rushy). * Antisocial -- Inability to conform the social norm: bedwetting, Criminality ( fire setting, animal torturing ). * Avoidant -- sensitive to rejection, socially withdrawal, shy, inferiority complex. * Depandant -- Lack of confidence, let other resume responsibility. * Obsessive Compulsive -- Orderliness, stubborn, indecisiveness, perfectionist. ------------------------------------------------------------------------- PSYCHIATRIC DISORDER SOMATOFORM DISORDER : * Consist of physical symptoms with out any organic pathology. * It can be treated by Antianxiety, Hypnosis, Behavioral relaxation therapy. * 7 types of Somatoform disorder. 1. Somatization Disorder -- Multiple physical complains, pt seeks medical help, shows genetic influence ( in( Briquets $ )women ), in low socioeconomic groups.

2. Undifferentiated Somatoform Disorder -- Multiple physical symptoms lasting more than 6 months. 3. Conversion Disorder -- Loss of sensory or motor function, common in adolescent and young women. Pt appearrelativelyunconcerned ( la belle indifference ). 4. Hypochondriasis -- Exaggerated concern with ones health and illness, no genderor age difference. 5. Body Dismorphic Disorder -- Normally appearing pt belief that he or she is physically abnormal. 6. Pain Disorder -- Prolong intense pain without physical illness. 7. Fictitious Disorder -- pt with Somatoform Disorder truly belief that they are ill where as pt with Fictitious Disorder fake illness for physiological or tangible gain. Also called Milingering. Tx: SSRI may help condition. KICK THE BOARDS. USMLE STEP 1 BEHAVIORAL SCIENCE Prepared byDr. IRFAN MIR8 Manchousen $ is chronic form of factitious $ in which pt persistently stimulate sign & symptoms of his illness. ------------------------------------------------------------------------- PERSONALITY DISORDER : * Schizoid, Paranoid, Obsessive compulsive are common in male. * Histrionic, Avoidant, Dependant personality disorder are common in female.* TX is individual and group psychotherapy. * Are of 4 types. 1. Cluster A --Are Eccentric, strange, and fear of social relationship. 1. Paranoid2. Schizoid3. Schizotypal. 2. Cluster B --Are Emotional, Dramatic, Erratic. 1. Histrionic 2. Narcissistic 3. Antisocial 4. Borederline. 3. Cluster C --Are Fearful, Anxious. 1. Avoidant2. Obsessive Compulsive3. Dependant. 4. Passive Aggressive -- Procrastination (to postpone unduly), Stubborn, Inefficient. ----------------------------------------------------------------------- DISSOCIATIVE DISORER : Is caharacterized by Temporary loss of memory and identity. It is rare. * Tx is Hypnosis, and amobarbital sodium intravenous and long term psychotherapy. * Are of 5 types 1. Dissociative Amnesia - Failure to remember information about one self. 2. Dissociative Fugue - Amnesia combined with sudden wandering from home. 3. Dissociative Identity Disorder - At least two distinct personality in one individual. 4. Depersonalization Disorder - Feeling of detachment of ones own body or social situation. (going through the life but not experiencing it) 5. Derealization - Feels that enviornment or object with in it are unreal. (lack of vividness and emotional cloouring.felling of deja vu & jamais vu) * Depersonalization is a subjective experience of unreality in one's sense of self, while derealization is unreality ofthe outside world ------------------------------------------------------------------------ EATING DISORDER : 1. Anorexia Nervosa -- No desire of eating. Common in women in high society group. TX is Reinstating the nutritional condition, family therapy, Amytryptyline, Cyproheptadine. 2. Bulimia -- Eating followed by purging common in adolescents. TX is Psychotherapy, Behavioral therapy, Antidepressant etc. 3. Obesity -- Body wt >20% over ideal wt. Common in low socioeconomic group, genetic factor is imp. ---------------------------------------------------------------------- INFANTILE AUTISM : Deficit in the ability to interact and communicate. Shows rigidity. Pt usually have subnormal intelligence. Common in boys, Prenatal complication frequently found in history. Shows serum serotinin. Possible role enviornmental mercury exposure, prenatal injury, failure of appoptosis in cortex. ATTENTION DEFICITHYPERACTIVITY DISORDER : Shows Hyperactivity, limited attention span, impulsiveness, emotional liability, and intelligence is normal. Subject shows high sensitivity to stimuli ( donot sleep well). * Common in boys, genetic factor may involve, and may have minor brain damage. * TX is amphetamines, antidepressant. Remission occur during adolescense in some pts. TOURETTES $ : Disease begin usually b/w 7 and 8 ( before 21 ). Common in boys. It is characterize by motor and vocal tics, involuntary use of profanity often occur. TX is haloperidol. * IQ --70 - 50 ( Mild retardation ) -- self supporting with some guidance. 49 - 25 ( Moderate retardation) -- Trainable 34 -20 ( Severe retardation ) -- training not helpfum but can learn communicate and basic habbits 65 yrs) and chronically ill of any age. Medicare is organized into 2 divisionsPart A and B. Part A. for hospital coverage and Part B for supplements or continued care out side the hospital. * Both Medicaid and Medicare programs are supported by social security. --------------------------------------------------------------------------

KICK THE BOARDS. USMLE STEP 1 BEHAVIORAL SCIENCE Prepared byDr. IRFAN MIR13