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Psychiatry and
Behavioral Science
An Introduction and Study Guide
for Medical Students

EDITORS:

David Baron, MSEd, DO, and

Ellen H. Sholevar, MD

TEMPLE UNIVERSITY PRESS

Philadelphia
Temple University Press
1601 North Broad Street
Philadelphia PA 19122
www.temple.edu/tempress

Copyright © 2009 by Temple University

All rights reserved
Published 2009
Printed in the United States of America

Photograph on page 282 courtesy of Joseph V. Labolito / Temple University

The paper used in this publication meets the requirements of the American National
Standard for Information Sciences—Permanence of Paper for Printed Library Materials,
ANSI Z39.48-1992

Library of Congress Cataloging-in-Publication Data

Psychiatry and behavioral science : an introduction and study guide for medical students /
[edited by] David Baron and Ellen H. Sholevar.
p. ; cm.
Includes bibliographical references.
ISBN-13: 978-1-59213-531-8 (pbk. : alk. paper)
1. Psychiatry—Examinations, questions, etc. 2. Psychology—Examinations, questions, etc.
I. Baron, David A. II. Sholevar, Ellen H., 1940–
[DNLM: 1. Mental Disorders—Examination Questions. 2. Mental Disorders—
Outlines. 3. Behavioral Symptoms—Examination Questions. 4. Behavioral
Symptoms—Outlines. 5. Disease—psychology—Examination Questions. 6. Disease—
psychology—Outlines. 7. Human Development—Examination Questions. 8. Human
Development—Outlines. 9. Patients—psychology—Examination Questions.
10. Patients—psychology—Outlines. WM 18.2 P97312 2008]
RC457.P775 2008
616.890076—dc22 2007049307

2 4 6 8 9 7 5 3 1
 To Ned, Abe, Lou, Ada, Andy, Shawn, and especially Patti.
Thanks for all your support.
—DB

To Pirooz, Dari, Priya, Avi, and Meera, Catherine, and Kathy

for their unconditional support and love.
—EHS
 CONTENTS

PREFACE ix

SECTION I THE JOURNEY OF LIFE . . . . . . . . . . . . . . . . . . . . . . . 1

1. The Early Years of Childhood—ELLEN H. SHOLEVAR, MD 3
2. The Elementary School and Teenage Years
—ELLEN H. SHOLEVAR, MD 31
3. Young Adulthood—ELLEN H. SHOLEVAR, MD 53
4. Middle Adulthood and Aging—DAVID BARON, MSED, DO, AND BURTON
MARK, DO 68
5. Human Sexuality—DAVID BARON, MSED, DO, ELLEN H. SHOLEVAR, MD, AND
THOMAS HARDIE, RN, EDD 84

SECTION II LIFE’S VICISSITUDES . . . . . . . . . . . . . . . . . . . . . . 107

6. Stress and Coping—DAVID BARON, MSED, DO, THOMAS HARDIE, RN, EDD,
AND RICHARD ROEMER, PHD 109
7. In Sickness and in Health—JAVED A. JOY, MD, MPH, AND DAVID BARON,
MSED, DO 121
8. Substance-Related Disorders—JOSEPH GARBELY, DO, AND JENNIFER
LUFT, MD 141
9. Interpersonal Violence—ELLEN H. SHOLEVAR, MD, AND DAVID BARON,
MSED, DO 160
10. Suicide and Attempted Suicide—DAVID BARON, MSED, DO, ELLEN H.
SHOLEVAR, MD, AND THOMAS HARDIE, RN, EDD 178

SECTION III HEALING AND THE PHYSICIAN . . . . . . . . . . . . 191

11. The Medical Students and the Physician—ELLEN H. SHOLEVAR, MD,
AND DAVID BARON, MSED, DO 193
12. The Clinical Encounter—AURELIA N. BIZAMCER, MD, MPH, PHD 214
13. Major Psychiatric Disorders and Medicine—JOSEPH
GARBELY, DO 233
viii CONTENTS

SECTION IV OUR WORLD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263

14. Social and Cultural Issues in Health Care—ELLEN H. SHOLEVAR, MD,
AND DAVID BARON, MSED, DO 265
15. Health Policy and Economics—AUTUMN NING, MD 282

ABOUT THE CONTRIBUTORS 301

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 PREFACE

W
e know that the path to becoming a physician is long and
rigorous. It is easy to become discouraged or over-
whelmed in your training years. However, the skills
you will acquire through the years of dedication and hard work are
invaluable.
The particular challenge in the first two years of medical education is
the sheer volume of material to be absorbed. You have a heavy load of
daily lectures and labs, and even more time is required for nightly study-
ing. Being acutely aware of the time stress this creates, we have attempted
to write a user-friendly, goal-directed book using an innovative format in-
tended to engage you. We want you to succeed, and we have created this
book with that goal in mind. The structure of each chapter is as follows:

The Menu is a list of the goals and objectives of each chapter.

Pre–Step Prep and Step Prep are board preparation questions that
appear at the beginning and end, respectively, of each chapter. The
medical student reader is advised to review the Pre–Step Prep prior
to reading each chapter and then review the Step Prep at the end
of the chapter. The questions in Pre-Step Prep and the answers in
Step Prep prepare the reader for the U.S. Medical Licensing Ex-
amination (USMLE) Step 1 and COMLEX Part 1 questions, as this
book functions as a basic text and board review primer.

Suggested Readings and Web Sites for the Highly Motivated at the
end of each chapter refer the reader to basic sources that will am-
plify the information given within the chapter.

Consistent with the format of the boards, case vignettes are used
extensively for the board-review questions. Information is often pre-
sented in brief bulleted lists to allow quick scanning.
This book is intended to present information to and guide the be-
havior of student physicians in their patient care and in their own
developing professional identity. It will help year-one and year-two
x PREFACE

medical students prepare for the USMLE Step 1 and the COMLEX
Part 1. We are concerned not just with your responsibilities to your pa-
tients, but also with your responsibilities to your colleagues and, most
important, to yourself.
We hope this book will help you appreciate the important role psy-
chiatry and the behavioral sciences play in the practice of medicine.
We wish you the best of luck in your career.
SECTION

I
THE JOURNEY
OF LIFE
1 THE EARLY YEARS
OF CHILDHOOD
Ellen H. Sholevar, MD

“Children are the anchors that hold a mother to life.”

—SOPHOCLES
(And what about the dads?)

While autonomous in their play, children show their emotional connection to

mother with a smile.
4 PSYCHIATRY AND BEHAVIOR AL SCIENCE

MENU • Describe the main theoretical concepts used in

understanding early childhood development.
• List dimensions of temperament.
• Discuss factors that influence development.
• Summarize normal motor, emotional, cognitive, and
interpersonal development.
• Describe the genetic, cultural, and family influences on
growth and development.
• Assess the ideas of the leading developmental theorists.

Introduction

Why should the medical student study growth and development?

There are 69.9 million people under the age of eighteen in the United
States at present, and the U.S. government estimates that there will be
77.6 million by the year 2020. Health care for the majority of these
youth is provided by primary care physicians who will need to under-
stand the concepts of growth and development. Additionally, USMLE
and COMLEX consistently include questions on normal growth and
development. This reflects the national consensus that all physicians
should be aware of these issues. Finally, human growth and develop-
ment has have a profound impact on disease and illness. Medical stu-
dents and physicians need to understand this complex interplay.

Pre–Step Prep

1. You are consulted by worried parents who report that their child
is showing the following behaviors: increased masturbation, concern
about bodily injury and excessive anxiety about insignificant scratches
and bumps, increased interest in his infant sister’s genital area and his
parents’ bodies, fears of monsters at night, and an expressed desire to
marry his mother when he grows up. This child is most likely showing
behaviors typical of which of the following stages of Sigmund Freud:
a. Genital
b. Oral
c. Latency
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