BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page i Behavioral Science BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page ii BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page iii Behavioral Science Barbara Fadem, Ph.D. Professor Department of Psychiatry University of Medicine and Dentistry of New Jersey New Jersey Medical School Newark, New Jersey BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page iv Acquisitions Editor: Crystal Taylor Managing Editor: Stacey L. Sebring Marketing Manager: Emilie Moyer Production Editor: Paula C. Williams Designer: Holly Reid McLaughlin Compositor: International Typesetting and Composition Fifth Edition Copyright © 2009, 2005 by Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street 530 Walnut Street Baltimore, MD 21201 Philadelphia, PA 19106 Printed in United States of America All rights reserved. This book is protected by copyright. No part of this book may be reproduced or trans- mitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at [email protected], or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Fadem, Barbara. Behavioral science / Barbara Fadem. — 5th ed. p. ; cm. — (BRS) Includes bibliographical references and index. ISBN 978-0-7817-8257-9 1. Psychiatry—Outlines, syllabi, etc. 2. Psychology—Outlines, syllabi, etc. 3. Psychiatry— Examinations, questions, etc. 4. Psychology—Examinations, questions, etc. I. Title. II. Series: Board review series. [DNLM: 1. Behavioral Sciences—Examination Questions. 2. Behavioral Sciences—Outlines. 3. Behavior—Examination Questions. 4. Behavior—Outlines. WM 18.2 F144b 2009] RC457.2.F34 2009 616.890076—dc22 2008027135 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omis- sions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publi- cation. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of pub- lication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page v Once again, I lovingly dedicate this book to Sarah Jane Fadem and Joseph David Fadem. The future is theirs and we are in good hands. BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page vi BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page vii Preface The function and state of the mind are of significant importance to the physical health of an individual. The United States Medical Licensing Examination (USMLE) is closely attuned to the substantial power of the mind–body relationship and extensively tests this area on all three steps of the examination. This review was prepared as a learning tool to help students rapidly recall information that they learned in the first two years of medical school in behavioral science, psychiatry, epidemiology, and related courses. The fifth edition of BRS Behavioral Science contains 26 chapters. All chapters start with a “Typical Board Question,” which serves as an example for the manner in which the subject matter of that chapter is tested on the USMLE. Each chapter has been updated to include the most current information. A total of 634 USMLE-style questions (about 70 more than in the fourth edition) and answers with detailed explanations are presented after each chapter, as well as at the end of the Comprehensive Examination. Many of these questions were written expressly for this fifth edition and reflect USMLE style, using clinical vignettes in the stem and “quote” format in the answer. Many tables are included in the book to pro- vide quick access to essential information. vii BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page viii BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page ix Acknowledgments The author wishes to thank Betty Sun, Crystal Taylor, and Stacey Sebring of Wolters- Kluwer, Lippincott Williams & Wilkins, for their encouragement and practical assis- tance with the manuscript. As always, the author thanks with great affection and respect the caring, involved medical students with whom she has had the honor of working over the years. Special thanks to Timothy Kreider (New Jersey Medical School, 2011) for his valuable input into Chapters 25 and 26. ix BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page x BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page xi Contents Preface vii Acknowledgments ix 1. THE BEGINNING OF LIFE: PREGNANCY THROUGH PRESCHOOL 1 I. Childbirth and the Postpartum Period 1 II. Infancy: Birth to 15 Months 4 1 III. The Toddler Years: 15 Months–2 /2 Years 6 IV. The Preschool Child: 3–6 Years 7 Review Test 8 2. SCHOOL AGE, ADOLESCENCE, SPECIAL ISSUES OF DEVELOPMENT, AND ADULTHOOD 13 I. Latency or School Age: 7–11 Years 13 II. Adolescence: 11–20 Years 14 III. Special Issues in Child Development 15 IV. Early Adulthood: 20–40 Years 16 V. Middle Adulthood: 40–65 Years 16 Review Test 18 3. AGING, DEATH, AND BEREAVEMENT 23 I. Aging 23 II. Stages of Dying and Death 25 III. Bereavement (Normal Grief) Versus Depression (Abnormal Grief or Complicated Bereavement) 25 Review Test 27 4. GENETICS, ANATOMY, AND BIOCHEMISTRY OF BEHAVIOR 31 I. Behavioral Genetics 31 II. Behavioral Neuroanatomy 32 xi BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page xii xii Contents III. Neurotransmission 34 IV. Biogenic Amines 35 V. Amino Acid Neurotransmitters 37 VI. Neuropeptides 37 Review Test 39 5. BIOLOGICAL ASSESSMENT OF PATIENTS WITH PSYCHIATRIC SYMPTOMS 44 I. Overview 44 II. Measurement of Biogenic Amines and Psychotropic Drugs 44 III. Dexamethasone Suppression Test (DST) 45 IV. Tests of Endocrine Function 45 V. Neuroimaging and Electroencephalogram Studies 45 VI. Neuropsychological Tests 46 VII. Other Tests 47 Review Test 48 6. PSYCHOANALYTIC THEORY AND DEFENSE MECHANISMS 52 I. Overview 52 II. Freud’s Theories of the Mind 52 III. Defense Mechanisms 53 IV. Transference Reactions 53 Review Test 56 7. LEARNING THEORY 60 I. Overview 60 II. Habituation and Sensitization 60 III. Classical Conditioning 61 IV. Operant Conditioning 61 Review Test 64 8. CLINICAL ASSESSMENT OF PATIENTS WITH BEHAVIORAL SYMPTOMS 69 I. Overview of Psychological Testing 69 II. Intelligence Tests 69 III. Achievement Tests 70 IV. Personality Tests 71 V. Psychiatric Evaluation of the Patient with Emotional Symptoms 71 Review Test 74 BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page xiii Contents xiii 9. SUBSTANCE ABUSE 77 I. Substance Abuse, Definitions, Epidemiology, and Demographics 77 II. Stimulants 78 III. Sedatives 79 IV. Opioids 81 V. Hallucinogens and Related Agents 82 VI. Clinical Features of Substance Abuse 83 VII. Treatment 85 Review Test 86 10. NORMAL SLEEP AND SLEEP DISORDERS 91 I. Normal Awake and Sleep States 91 II. Classification of Sleep Disorders 93 III. Insomnia 93 IV. Breathing-Related Sleep Disorder (Sleep Apnea) 95 V. Narcolepsy 95 VI. Treatment of Sleep Disorders 95 Review Test 97 11. SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS 103 I. Schizophrenia 103 II. Other Psychotic Disorders 106 Review Test 108 12. MOOD DISORDERS 113 I. Overview 113 II. Classification of Mood Disorders 114 III. Etiology 117 IV. Treatment 118 Review Test 119 13. ANXIETY, SOMATOFORM AND FACTITIOUS DISORDERS, AND MALINGERING 124 I. Anxiety Disorders 124 II. Somatoform Disorders 126 III. Factitious Disorder (Formerly Munchausen Syndrome), Factitious Disorder by Proxy, and Malingering 127 Review Test 129 BRS-Fadem_FM_i-xvi.qxd 8/21/08 11:34 AM Page xiv xiv Contents 14. COGNITIVE, PERSONALITY, DISSOCIATIVE, AND EATING DISORDERS 136 I. Cognitive Disorders 136 II. Personality Disorders 139 III. Dissociative Disorders 139 IV. Obesity and Eating Disorders 141 Review Test 143 15. PSYCHIATRIC DISORDERS IN CHILDREN 150 I. Pervasive Developmental Disorders of Childhood 150 II. Attention Deficit Hyperactivity Disorder and Disruptive Behavior Disorders of Childhood 151 III.