United States Medical Licensing Examination (USMLE) Behavioral Science, Psychiatry, and Population Health Syllabus

Behavioral Science, Psychiatry, and Population Health syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Behavioral Science, Psychiatry, and Population Health in United States Medical Licensing Examination (USMLE), not a summary of it.

1. 1

   Psychiatry and Behavioral Health

   5 topics

   • Mood and anxiety disorders
     • Major depression and bipolar disorder
     • Generalized anxiety and panic
   • Psychotic disorders
     • Schizophrenia spectrum
   • Substance use disorders
     • Intoxication and withdrawal
   • Personality, somatic, and eating disorders
   • Psychopharmacology
2. 2

   Behavioral Science and Human Development

   4 topics

   • Life-cycle development and aging
   • Sleep physiology and disorders
   • Stress, coping, and health behavior
   • Sexuality and gender
3. 3

   Biostatistics and Epidemiology

   5 topics

   • Study design
     • Cohort, case-control, RCT
     • Bias and confounding
   • Diagnostic test characteristics
     • Sensitivity, specificity, predictive values
   • Measures of association and risk
     • Relative risk and odds ratio
   • Hypothesis testing and statistical inference
   • Evidence-based medicine and screening
4. 4

   Public Health and Preventive Medicine

   4 topics

   • Disease prevention levels
   • Health screening guidelines
     • Cancer screening recommendations
   • Health systems and quality improvement
     • Patient safety and error reduction
   • Population and global health

Behavioral Science, Psychiatry, and Population Health flashcards for United States Medical Licensing Examination (USMLE)

25 of 51 cards from the Behavioral Science, Psychiatry, and Population Health deck — real questions with worked answers.

1. What are the DSM-5 diagnostic time thresholds that distinguish major depressive disorder (MDD) from persistent depressive disorder (dysthymia)?

   MDD requires >=5 depressive symptoms (including depressed mood or anhedonia) for >=2 weeks. Persistent depressive disorder requires depressed mood most of the day, more days than not, for >=2 years (>=1 year in children/adolescents).

2. What is the key diagnostic difference between bipolar I and bipolar II disorder?

   Bipolar I requires at least one full manic episode (>=1 week, or any duration if hospitalized), with or without depression. Bipolar II requires at least one hypomanic episode (>=4 days) plus at least one major depressive episode, and NO history of full mania.

3. How are generalized anxiety disorder, panic disorder, and specific phobia distinguished by their core anxiety pattern?

   GAD = excessive, persistent worry about multiple events for >=6 months. Panic disorder = recurrent unexpected panic attacks plus >=1 month of anticipatory anxiety/avoidance. Specific phobia = marked fear cued by a specific object/situation, lasting >=6 months.

4. What is the minimum symptom duration to diagnose schizophrenia, and how does it relate to schizophreniform and brief psychotic disorder?

   Schizophrenia requires continuous signs for >=6 months (with >=1 month of active-phase symptoms). Schizophreniform disorder = 1 to 6 months. Brief psychotic disorder = >=1 day but <1 month with full return to baseline.

5. How do schizoaffective disorder and a mood disorder with psychotic features differ?

   Schizoaffective disorder requires >=2 weeks of psychotic symptoms in the ABSENCE of a major mood episode (with mood symptoms present a majority of the illness). In mood disorder with psychotic features, psychosis occurs ONLY during mood episodes.

6. List the positive versus negative symptoms of schizophrenia and which class responds poorly to typical antipsychotics.

   Positive: delusions, hallucinations, disorganized speech/behavior. Negative: flat affect, alogia, avolition, anhedonia, asociality. Typical (first-generation) antipsychotics treat positive symptoms well but are relatively ineffective for negative symptoms.

7. What is the time course distinguishing alcohol withdrawal tremulousness, withdrawal seizures, alcoholic hallucinosis, and delirium tremens?

   Tremulousness/anxiety: 6-24 h. Withdrawal seizures: 12-48 h. Alcoholic hallucinosis (usually visual, sensorium intact): 12-48 h. Delirium tremens (autonomic instability, confusion, hallucinations): 48-96 h, highest mortality.

8. Contrast the clinical findings of opioid intoxication versus opioid withdrawal.

   Intoxication: CNS/respiratory depression, MIOSIS (pinpoint pupils), constipation, euphoria. Withdrawal: mydriasis, lacrimation, rhinorrhea, yawning, diarrhea, piloerection, myalgias, dysphoria - uncomfortable but rarely life-threatening.

9. What medications treat opioid use disorder, and what is the mechanism of each?

   Methadone (full mu-opioid agonist), buprenorphine (partial mu-agonist, often combined with naloxone), and naltrexone (mu-opioid antagonist). Naloxone is the short-acting antagonist used to reverse acute overdose.

10. Define the Cluster A, B, and C personality disorder groupings and their general theme.

    Cluster A (odd/eccentric): paranoid, schizoid, schizotypal. Cluster B (dramatic/emotional/erratic): antisocial, borderline, histrionic, narcissistic. Cluster C (anxious/fearful): avoidant, dependent, obsessive-compulsive.

11. How do somatic symptom disorder, illness anxiety disorder, conversion disorder, and factitious disorder differ?

    Somatic symptom disorder: >=1 distressing somatic symptom with excessive thoughts/anxiety. Illness anxiety disorder: preoccupation with HAVING illness with minimal symptoms. Conversion: neurologic deficit incompatible with disease. Factitious: intentional falsification to assume the sick role (no external gain).

12. Contrast anorexia nervosa and bulimia nervosa on body weight and core behaviors.

    Anorexia nervosa: significantly LOW body weight, intense fear of weight gain, restriction +/- binge-purge. Bulimia nervosa: NORMAL or above-normal weight, recurrent binge eating with compensatory behaviors >=1x/week for 3 months.

13. Which SSRI is generally avoided in the first trimester of pregnancy and why, and which is often preferred?

    Paroxetine is avoided in the first trimester due to association with cardiac (e.g., septal) defects. Sertraline is often preferred in pregnancy given relatively favorable safety data.

14. What are the cardinal features and treatment of serotonin syndrome, and how does it differ from neuroleptic malignant syndrome (NMS)?

    Serotonin syndrome: clonus, hyperreflexia, tremor, autonomic instability, agitation; onset within hours; treat with cyproheptadine. NMS (dopamine antagonists): lead-pipe rigidity, hyporeflexia, hyperthermia; onset over days; treat with dantrolene/bromocriptine.

15. What ongoing monitoring is required for clozapine, and what serious adverse effect drives it?

    Clozapine requires regular absolute neutrophil count (ANC) monitoring because of the risk of agranulocytosis. It can also cause myocarditis, seizures, and metabolic effects, and is reserved for treatment-resistant schizophrenia.

16. What dietary restriction and drug interaction are critical for patients taking MAO inhibitors?

    Avoid tyramine-rich foods (aged cheese, cured meats, wine) to prevent hypertensive crisis, and avoid serotonergic drugs (SSRIs, meperidine) to prevent serotonin syndrome. A washout period is needed when switching agents.

17. What motor, social, and language milestones are expected at approximately 12 months of age?

    ~12 months: first steps/walks with assistance, pincer grasp, says 1-2 words, waves bye-bye, separation anxiety present, follows a one-step command with gesture.

18. According to Erikson, what is the psychosocial conflict of adolescence and of the toddler stage?

    Adolescence (~12-18 yr): identity vs. role confusion. Toddler (~1-3 yr): autonomy vs. shame and doubt. (Infancy: trust vs. mistrust.)

19. What are the Kubler-Ross stages of grief, and how is normal grief distinguished from a major depressive episode?

    Stages: denial, anger, bargaining, depression, acceptance (not necessarily sequential). Normal grief: waves of sadness, possible illusions of the deceased, preserved self-worth, improving by ~6-12 months. Pervasive worthlessness and active suicidality suggest a depressive episode.

20. Describe the sequence of normal sleep stages and identify which contains slow-wave (delta) sleep.

    N1 (light, theta) -> N2 (sleep spindles, K complexes) -> N3 (slow-wave/delta, deepest) -> REM (dreaming, muscle atonia, EEG resembling wakefulness). N3 dominates early in the night; REM lengthens toward morning.

21. What is the classic tetrad of narcolepsy and its first-line treatments?

    Tetrad: excessive daytime sleepiness, cataplexy, hypnagogic/hypnopompic hallucinations, sleep paralysis; due to low CSF orexin (hypocretin). First-line: modafinil for sleepiness; sodium oxybate or SNRIs/SSRIs for cataplexy.

22. In which sleep stage do night terrors and sleepwalking occur versus nightmares?

    Night terrors and sleepwalking occur in N3 (slow-wave, non-REM) sleep, typically without recall, in the first third of the night. Nightmares occur during REM sleep with vivid recall.

23. Distinguish acute stress disorder from PTSD by symptom duration and list first-line treatment.

    Acute stress disorder: symptoms last 3 days to 1 month after trauma. PTSD: symptoms persist >1 month (intrusion, avoidance, negative cognition/mood, hyperarousal). First-line treatment: SSRIs/SNRIs and trauma-focused CBT.

24. List the stages of the transtheoretical (Prochaska) model of behavior change.

    Precontemplation -> contemplation -> preparation -> action -> maintenance (with possible relapse). Counseling (e.g., motivational interviewing) is tailored to the patient's stage.

25. What are the stages of Selye's General Adaptation Syndrome and their dominant mediators?

    Alarm (acute sympathetic/catecholamine surge), resistance (sustained cortisol via the HPA axis), and exhaustion (resource depletion). Chronic stress elevates cortisol, impairing immune function and wound healing.

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