Table Of ContentUSMLE®
Step 1
Lecture Notes
2020
Behavioral Science and Social Sciences
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Editors
Behavioral Science
Alice Akunyili, MD
Assistant Professor, Department of Cell Biology and Pharmacology
FIU Herbert Wertheim College of Medicine
Miami, FL
Alina Gonzalez-Mayo, MD
Psychiatrist
Department of Veterans Administration
Bay Pines, FL
Mark Tyler-Lloyd, MD, MPH
Executive Director of Academics
Kaplan Medical
New York, NY
Basic Science of Patient Safety
Ted A. James, MD, MS, FACS
Chief, Breast Surgical Oncology
Vice Chair, Academic Affairs
Department of Surgery
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston, MA
The editors would like to acknowledge
Kevin Schuller, MD, Irfan Sheikh, MD, and Kevin Yang, MD
for their contributions.
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Please email us at [email protected].
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Table of Contents
Part I: Epidemiology and Biostatistics
Chapter 1: Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 2: Biostatistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Part II: Behavioral Science
Chapter 3: Developmental Life Cycle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Chapter 4: Theories of Learning and Behavioral Modification. . . . . . . . . . 65
Chapter 5: Defense Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Chapter 6: Psychological Health and Testing. . . . . . . . . . . . . . . . . . . . . . . . .77
Chapter 7: Substance Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Chapter 8: Sleep and Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Chapter 9: Psychiatric (DSM-5) Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . 99
Chapter 10: Psychopharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Chapter 11: Brain Function and Neurocognitive Disorders . . . . . . . . . . . 125
Chapter 12: Ethics, Law, and Physician Behavior . . . . . . . . . . . . . . . . . . . 135
Chapter 13: Health Care Delivery Systems. . . . . . . . . . . . . . . . . . . . . . . . . 157
Part III: Social Sciences
Chapter 14: Basic Science of Patient Safety. . . . . . . . . . . . . . . . . . . . . . . . .161
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193
Additional resources available at
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PART I
Epidemiology and
Biostatistics
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1
Epidemiology
Learning Objectives
(cid:82) Answer questions about epidemiologic measures
(cid:82) Use knowledge of screening tests
(cid:82) Explain information related to study designs
EPIDEMIOLOGIC MEASURES
Epidemiology is the study of the distribution and determinants of health-related
states within a population. It refers to the patterns of disease and the factors that
influence those patterns.
• Endemic: the usual, expected rate of disease over time; the disease is
maintained without much variation within a region
• Epidemic: occurrence of disease in excess of the expected rate; usually
presents in a larger geographic span than endemics (epidemiology is the
study of epidemics)
• Pandemic: worldwide epidemic
• Epidemic curve: visual description (commonly histogram) of an epi-
demic curve is disease cases plotted against time; classic signature of
an epidemic is a “spike” in time
The tools of epidemiology are numbers; the numbers in epidemiology are ratios
converted into rates. The denominator is key: who is “at risk” for a particular
event or disease state.
To determine the rate, compare the number of actual cases with the number of
potential cases:
Actualcases Numerator
= = RATE
Potentialcases Denominator
Rates are generally, though not always, per 100,000 persons by the Centers
for Disease Control (CDC), but can be per any multiplier. (Vital statistics are
usually per 1,000 persons.)
A disease may occur in a country at a regular annual rate, which makes it
endemic. If there is a sudden rise in the number of cases in a specific month,
we say that there is an epidemic. As the disease continues to rise and spread to
other countries, it becomes a pandemic. Thus the terminology is related to both
the number of cases and its geographical distribution.
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