Kaplan USMLE Step 1 Lecture Notes 2009-2010: Behavioral by Steven R. Daugherty, Ph.D.

By Steven R. Daugherty, Ph.D.

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MEDICAl 55 USMLE Step 1: Behavioral Sciences ---- - - - -- �---- iii. These "dual diagnosis" patients are very difficult to treat and tend to continue use when on inpatient wards. c. Substance abuse adds to the suicide risk of any underlying psychiatric diagno'" d. 50% of emergency department visits are substance related. e. Physicians tend to underdiagnose substance abuse problems of all types, espe­ cially those in women, high-SES patients (and other physicians) SUBSTANCE-ABUSING PHYSICIANS L Psychiatrists and anesthesiologists have highest rates 2.

Lowers the activity of the receptors for glutamate (chronic alcohol abuse increases the numher of these receptors) iii. Effects persist after treatment ended IV. Not widely used c. Topiramate (anticonvulsant) 1. n. Helps support abstinence Abstinence 6x more likely than if not on drug for over 1 month iii. Stimulates GABA blocks action of glutamate release of dopamine on NAC pathway slows d. , lorazepam) 1. l Helps prevent seizures ii. Seizures can occur during periods of heavy drinking or during detoxi­ fication e.

Melanoma: 42,000 cases per year, more than 7,000 deaths 1v. Incidence rate 16 times higher for whites than blacks Mortality rates per 100,000 Table 3-4. Leading Sites of Cancer Incidence and Death Incidence Types of Cancer Males I Deaths Prostate I 2 Lung 2 I Colorectal 3 3 Breast I 2 Lung 2 I 3 3 I Females Colorectal . � MEDICAL 45 USMLE Step 1: Behavioral Sden,ce=''---- - ------- Table 3-5. S. 7 (approx. 2 Table 3-6. Top Three Leading Causes of Death by Age Group R•nk Less than 1 l to 4 4 to9 10to14 IS to 24 " Congenital Unintended Unintended Unintended anomalies injuries injuries injuries Short Congenital Neoplasia Neoplasia gestation anomalies SIDS Neoplasia " " Congenital Suicide 25 to 34 3Sto44 45 to 54 Unintended Unintended Neoplasia Neoplasia injuries injuries Homicide Suicide Suicide Homicide anomalies over 65 lssro6s Neoplasia Heart disease Unintended Heart Heart inju�b disease disease Heart Unintended Bronchitis, Cerel>ro- disease injurie> asthm�, vascular Neoplasia emphysema l Table 3-7.

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