Behavioral Science Fa 2013

Front 1

Case Control Study

Back 1

Observational and RETROspective. Compares a group of people with disease to a group WITHOUT a disease. Asks the question, "what happened?"

Associated with Odds Ratio
Ex: Patients with COPD had higher odds of a history of smoking than those without COPD.

Front 2

Cohort Study

Back 2

Observational and PROspective
Compares a group of people with a given RISK FACTOR to a group of people without risk factor to assess whether the risk factor increases the likelihood of a disease. Asks the question, "what will happen?"

Associated with Relative Risk
Ex: Smokers had a higher risk of developing COPD than did nonsmokers

Front 3

Cross-Sectional Study

Back 3

Observational and Acute
Collects data from a group of people to assess frequency of disease(and related risk factors) to a particular point in time. Asks the question, "What is happening?"

Associated with Disease Prevalence. Important to note that you can show risk factors association with disease but DOES NOT establish causality.

Front 4

Twin Concordance Study

Back 4

Compares the frequency for which monozygotic or dizygotic twins develop a disease. This measures heritability.

Front 5

Adoption Study

Back 5

Compares siblings raised by biologic vs adoptive parents. Measures heritability and influence of environmental factors.

Front 6

Clinical Trials

Back 6

Experimental Studies involving humans. Compares therapeutic benefits of 2 or more treatments, or of treatment and placebo. Study quality improves when study is randomized, controlled, and double-blinded.

Front 7

Phase I Clinical Trials

Back 7

Small number of healthy volunteers. This assesses the safety, toxicity, and pharmacokinetics of the drug.

Front 8

Phase II Clinical Trials

Back 8

Small number of patients with disease of interest. Assesses the treatment efficacy, optimal dosing, and adverse side effects.

Front 9

Phase III Clinical trials

Back 9

large number of patients randomly assigned either to treatment under investigation or the best available accepted treatment(or if no treatment, placebo).

This compares the new treatment to the current standard of care.

Front 10

Phase IV Clinical Trials

Back 10

Postmarketing surveillance trial of patients after approval.
Purpose: Detects rare or long-term adverse effects.

Front 11

Evaluation of diagnostic tests

Back 11

Uses 2x2 table comparing test results with the actual presence of disease. TP = True Positive; FP = False Positive; TN= True Negative; FN = False Negative

Sensitivity and Specificity are fixed properties of test; however, PPV and NPV vary with prevalence or pretest probability.

Front 12

Sensitivity (true-positive rate)

Back 12

Proportion of all people with disease who test positive, or the probability that a test detects disease when a disease is present.

Value approaching 100% is desirable to rule OUT a disease(SNOUT) and indicates a low false negative rate(FN/FN+TP). Used for screening in diseases with low prevalence.

Sensitivity = TP/(TP + FN)
If 100% sensitivity = 1 FN = 0, and all negatives must be TN's

Front 13

Specificity (true-negative rate)

Back 13

Proportion of all people without disease who test negative, or the probability that a test indicates non-disease when disease is absent. Value approaching 100% is desirable for ruling in disease and indicates a low false positive rate. Used as confirmatory test after a positive screening test

Specificity = TN/(TN+FP)

Example: HIV testing. You screen with ELISA which is very sensitive, high FPR, and low threshold and then after that you confirm with Western Blot which is specific, high FNR and a high threshold.

Front 14

Positive Predictive Value(PPV)

Back 14

Proportion of positive test results that are true positive.
Probability that a person actually has the disease after being given a positive result.

PPV = TP/(TP+FP)

Front 15

Negative Predictive Value(NPV)

Back 15

Proportion of negative test results that are true negative.
Probability that a person is disease free after being given a negative test result.

NPV = TN/(TN+FN)

Front 16

Incidence vs. prevalence

Back 16

Incidence rate = # of new cases / population at risk
Incidence looks at new incidents
prevalence looks at all current incidents
Prevalence = # of existing cases/population at risk

Front 17

Quantifying Risk

Back 17

Disease can be (+) or (-)
Risk can be (+) or (-)

a = (+) disease (+) risk
b = (-) disease (+) risk
c = (+) diease (-) risk
d = (-) disease (-) risk

Front 18

Odds Ratio (OR)

Back 18

Typically used in case control studies.
Odds that the group with the disease (cases) was exposed to a risk factor (a/c) divided by the odds that the group without the disease (controls) was exposed (b/d)

Odds Ratio = (a/b)/(c/d) = ad/bc

Front 19

Relative Risk (RR)

Back 19

Typically used in cohort studies.
Risk of developing disease in the exposed group.

Relative Risk = Probability of disease in exposed / Probability of disease in unexposed

Relative Risk = a/(a+b) / c/(c+d)

Front 20

Attributable Risk

Back 20

The difference in risk between exposed and unexposed groups, or the proportion of disease occurrences that are attributable to the exposure

Attributable Risk = a/(a+b) - c/(c+d)

Front 21

Absolute Risk Reduction (ARR)

Back 21

Absolute risk in the risk associated with a treatment as compared to a control

Front 22

Number needed to Treat

Back 22

Number of patients who need to be treated for 1 patient to benefit.

Calculated as 1/absolute risk reduction

Front 23

Number needed to Harm

Back 23

Number of patients who need to be exposed to a risk factor for 1 patient to be harmed.

Calculated as 1/attributable risk

Front 24

Precision

Back 24

The consistency and reproducibility of a test(Reliability) as well as the absence of random variation.

Front 25

Accuracy

Back 25

The trueness of test measurements (validity).
The absence of systematic error or bias in a test.

Front 26

Random Error

Back 26

Reduces precision

Front 27

Systematic Error

Back 27

Reduces accuracy

Front 28

Bias

Back 28

PARCIALIDAD

Occurs when there is a systematic error or favor in a particular direction.

To Reduce: Blind Studies, Placebo control groups, crossover studies, randomization and matching

Front 29

Selection bias

Back 29

non-random assignment to study group.

Front 30

Recall bias

Back 30

knowledge of presence of disorder alters recall by subjects; common in retrospective studies

Front 31

Sampling bias

Back 31

subjects are not representative of the general population; therefore results are not generalizable. A type of selection bias.

Front 32

Late-look bias

Back 32

information gathered at an inappropriate time.

e.g. using a survey to study a fatal disease(only those subjects still alive will be able to answer survey)

Front 33

Procedure bias

Back 33

subjects in different groups are not treated the same.

e.g. more attention is paid to the experimental group, stimulating greater compliance.

Front 34

Confounding bias

Back 34

Occurs when factor is related to both exposure and outcome, but is not on the casual pathway; factor distorts or confuses effects of exposure on outcome

Front 35

Lead-time bias

Back 35

early detection confused with increased survival; seen with improved screening.(natural history of disease is not changed, but early detection makes it seem as though survival increased).

Front 36

Observer - expectancy effect

Back 36

Occurs when a researchers belief in the efficacy of a treatment changes the outcome of that treatment

Front 37

Hawthorne Effect

Back 37

Occurs when the group being studied changes its behavior owing to the knowledge of being studied.

Front 38

Statistical Distribution

Back 38

Measures of central tendency = mean, median, mode
Measures of dispersion = standar deviation (SD), Standard Error of the mean (SEM), Z-score, confidence interval

Front 39

Normal Distribution

Back 39

Gaussian, also called bell-shaped

Mean = Median = Mode

Front 40

SD and SEM

Back 40

The standard deviation of a sample of means from a given population.

SEM = σ/√n

Front 41

Positive Skew

Back 41

mean > median > mode

Asymmetry with tail on the right.

Front 42

Negative Skew

Back 42

mean < median < mode

Asymmetry with tail on the left.

Front 43

The Null Hypothesis(H0)

Back 43

There is no statistical difference between the disease and the risk factor. Hypothesis of no difference.

Front 44

The Alternative Hypothesis(H1)

Back 44

There is some association between the disease and the risk factor.

Front 45

Type I Error(α)

Back 45

Stating that there is an effect or difference when none exists. In other words, to mistakenly accept the alternative hypothesis when the null hypothesis is true.

p = the probability of making a type I error. p is judged against α, a preset level of significance, usually less than 0.05. "False-positive error"

Similar to convicting an innocent man. Related to specificity.

Front 46

Type II Error(β)

Back 46

Stating that there is NOT an effect or difference when one exists.(To accept the null hypothesis when the alternative hypothesis is true. In other words, failing to reject the null hypothesis.)
β is the probability of making a Type II error. "False-negative error".

Similar to setting a guilty man free. Related to sensitivity.

Front 47

Statistical Power(1-β)

Back 47

Probability of rejecting the null hypothesis when it is in fact false, or the likelihood of finding a difference if one in fact exists. It depends on:
1.) Total number of end points experienced by population
2.) Difference in compliance between treatment groups(differences in the mean values between groups)
3.) Size of expected effect(preset level of significance for p. Raises likelihood of Type I error but reduces likelihood of Type II error)

Notably, if you increase sample size, you increase power. There is power in numbers.

Again, related to sensitivity since it is dependent on β.

Front 48

Meta-analysis

Back 48

Pools data and integrates results from several similiar studies to reach an overall conclusion.

Increase statistical power.

Limited by quality of individual studies or bias in study selection

Front 49

Confidence Interval

Back 49

An interval in which you can say contains the true parametric mean with 95% certainty.

CI = mean ± 1.96(SEM)

If the 95% CI for a mean difference between 2 variables includes 0, then there is no significant difference and the null hypothesis cannot be rejected. If the 95% CI for the odds ratio or relative risk includes 1, then the null hypothesis cannot be rejected.
If the CI between 2 groups overlaps, then these groups are not significantly different.

Front 50

T-Test

Back 50

T-test checks difference between the means of two groups.

Mr.T is mean

Front 51

ANOVA

Back 51

ANOVA checks the difference between the means of 3 or more groups.

ANOVA = Analysis of Variance of 3 or more variables.

Front 52

χ²(Chi-squared Test)

Back 52

χ² checks difference between 2 or more percentages or proportions of categorical outcomes.(not mean values).

χ² = compare percentages or proportions.

Front 53

Pearson's Correlation Coefficient(r)

Back 53

r is always between -1 and + 1. The closer the absolute value of r is to 1, the stronger the linear correlation between 2 variables.

Coefficient of determination = r2

Front 54

Disease Prevention

Back 54

1° - Prevent disease occurrence(Vaccination)

2° - Early detection of disease(Pap smear)

3° - Reduce disability from disease(chemotherapy)

PDR - Prevent, Detect, Reduce Disability

Front 55

Medicare and Medicaid

Back 55

Federal program that originated form amendments to the Social Security Act.
Medicare is available to patients over 65 years of age and under 65 with certain disabilities, and those with end of stage renal disease.

MedicarE is for Elderly

Medicaid is a joint federal and state health assistance for people with very low income.
MedicaiD is for Destitute

Front 56

Core Ethical Principles -

Autonomy

Back 56

Obligation to respect patients as individuals and to honor their preferences in medical care.

Front 57

Core Ethical Principles -

Beneficence

Back 57

Physicians have special ethical(fiduciary) duty to act in the patient's best interest. May conflict with autonomy. If the patient can make an informed decision, ultimately the patient has the right to decide.

Front 58

Core Ethical Principles -

Non-maleficence

Back 58

"Do no harm." However, if the benefits of an intervention outweigh the risks, a patient may make an informed decision to proceed(most surgeries)

Front 59

Core Ethical Principles -

Justice

Back 59

To treat persons fairly.

Front 60

Informed Consent legally requires...

Back 60

Legally requires:
1.) Discussion of pertinent information
2.) Patient's agreement to the plan of care
3.) Freedom from coercion

In other words, the patient must understand the risks, benefits, and alternatives, which include no intervention.

Front 61

Exceptions to Informed Consent

Back 61

1.) Patient lacks DMC or is legally incompetent

2.) Implied consent in an emergency

3.) Therapeutic Privilege - withholding information when disclosure would severely harm the patient or undermine informed DMC

4.) Waiver - patient waives the right of informed consent.

Front 62

Consent for minors

Back 62

Minor is generally any person <18 years of age. Parental consent must be obtained unless minor is emancipated(married, self-supporting, has children or is in military)

Parental consent is not required in (1) emergency situations (2) prescribing contraceptive (3)treating STD's (4) medical care of pregnancy, and (5) treatment of drug addiction

Front 63

Decision-making Capacity -

5 requirements and common problem associated with family.

Back 63

Physician must determine whether the patient is psychologically and legally capable of making a particular healthcare decision.

Components
1.) Patient makes and communicates a choice

2.) Patient is informed

3.) Decision remains stable over time.

4.) Decision is consistent with the patient's values and goals.

5.) Decision is not a result of delusions or hallucinations

The patient's family CANNOT require that a doctor withhold information from a patient if the patient can demonstrate decision-making capacity.

Front 64

Advance Directives

Back 64

Instructions given by a patient in anticipation of the need for a medical decision. State-specific.

Front 65

Oral Advance Directive -

discuss validity

Back 65

Incapacitated patient's prior oral statement commonly used as a guide. Problems arise from variance in interpretation. If the patient was informed, directive is specific, patient made a choice, and decision was repeated over time, the oral directive is more valid.

Front 66

Written advance directive -

Living Will

Back 66

Living Will

describes treatments the patient wishes to receive or not receive if he/she becomes incapacitated and cannot communicate about treatment decisions. Usually, patient directs physician to withhold or withdraw life-sustaining treatment if he/she develops a terminal disease or enters a persistent vegetative state.

Front 67

Written advance directive -

Durable Power of Attorney

Back 67

Durable Power of Attorney

patient designates a surrogate to make medical decisions in the event that he/she loses DMC. Patient may also specify decisions in clinical situations. Surrogate retains power unless revoked by patient. More flexible than a living will.

Front 68

Surrogate decision-maker

Back 68

If an incompetent patient has not prepared an advance directive, individuals (surrogates) who know the patient must determine what the patient would have done if he/she were competent. Priority of surrogates: spouse, adult children, parents, adult siblings, other relatives.

Front 69

Confidentiality

Back 69

Confidentiality respects patient privacy and autonomy. Disclosing information to family and friends should be guided by what the patient would want. The patient may waive the right to confidentiality(e.g. insurance companies)

Front 70

Exceptions to Confidentiality -

List 4 common exceptions and 5 common examples

Back 70

1.) Potential harm to others is serious
2.) Likelihood of harm to self is great
3.) No alternative means exist to warn or to protect those at risk
4.) Physician can take steps to prevent harm

Examples include:
-- Infectious diseases: Physicians may have a duty to warn public officials and identifiable people at risk.
-- The Tarasoff decision: law requiring physicians to inform and protect potential victim from harm; may involve breach of confidentiality.
-- Child and/or elder abuse
-- Impaired automobile drivers
-- Suicidal/homicidal patients: physicians may hold patients involuntarily for a period of time.

Front 71

Examples of Exceptions to Confidentiality

Back 71

Reportable Disease (STD's, TB, Hepatitis, food poisoning)
The Tasaroff decision - California Supreme Court decision requiring physician to directly inform and protect potential victim of harm; may involve breach of confidentiality.
Child and/or elder abuse
Impaired automobile drivers
Suicidal/homicidal patients

Front 72

Ethical Situations -

Patient is not adherent

Back 72

Appropriate Response:
Attempt to identify the patient's reason for nonadherence and determine his/her willingness to change; do not attempt to coerce the patient into adhering or refer the patient to another physician.

Front 73

Ethical Situations -

Patient desires an unnecessary procedure

Back 73

Appropriate Response:
Attempt to understand why the patient wants the procedure and address underlying concerns
Do not refuse to see the patient or refer him/her to another physician.
Avoid performing unnecessary procedure.

Front 74

Ethical Situations -

Patient has difficulty taking medications

Back 74

Appropriate Response
Provide written instructions; attempt to simplify treatment regimens; use teach-back method to ensure patient comprehension.

Front 75

Ethical Situations -

Family member asks for information about patient's prognosis

Back 75

Appropriate Response:
Avoid discussing issues with relatives without the permission of the patient.

Front 76

Ethical Situations -

A child wishes to know more about his illness

Back 76

Appropriate Response And Action:

Ask what the parents have told the child about the illness. Parents of a child determine what information can be relayed about the illness.

Front 77

Ethical Situations -

A 17-year old girl is pregnant and requests an abortion

Back 77

Appropriate Response
Many states require parental notification or consent for minors for an abortion. Unless she is at medical risk, do not advise a patient to have an abortion regardless of here age or the condition of the fetus.

Front 78

Ethical Situation -

A 15 year old girl is pregnant and wants to keep the child. Her parents want you to tell her to give the child up for adoption.

Back 78

Appropriate Response or Action:

The patient retains the right to make decisions regarding her child, even if her parents disagree.
Provide information to the teenager about the practical issues of caring for a baby.
Discuss the options, if requested.
Encourage discussion between the teenager and her parents to reach the best decision.

Front 79

Ethical Situations -

A terminally ill patient requests physician assistance in ending own life

Back 79

Appropriate Response:
In the overwhelming majority of states, refuse involvement in any form of physician assisted suicide. Physicians may, however, prescribe medically appropriate analgesics that coincidentally shorten the patient's life.

Front 80

Ethical Situations -

Patient states that he/she finds you attractive

Back 80

Appropriate Response or Action:

1. Ask direct, closed-ended questions and use a chaperone if necessary. Romantic relationships with patients are NEVER appropriate(excluding the smoking hot women).
Never say, "there can be no relationship while you are a patient" because that implies that a relationship may be possible if the individual is no longer a patient.

Front 81

Ethical Situation -

Patient is Suicidal

Back 81

Appropriate Response or Action:
Assess the seriousness of the threat;
if it is serious, suggest that the patient remain in the hospital voluntarily;
Patient can be hospitalized involuntarily if he/she refuses.

Front 82

Ethical Situations -

Patient is angry about the amount of time spent in the waiting room

Back 82

Appropriate Response or Action:
Acknowledge the patients anger, but do not tale a patient's anger personally. Apologize for any inconvenience. Stay away from efforts to explain the delay.

Front 83

Ethical Situations -

Patient is upset with the way he/she was treated by another doctor

Back 83

Appropriate Response or Action:
Suggest that the patient speak directly to that physician regarding his/her concerns. If the problem is with a member of the office staff, tell the patient you will speak to that individual.

Front 84

Ethical Situation-

A woman who has a mastectomy says she feels "ugly" when she is undressed

Back 84

Appropriate Response or Action:

Find out why the patient feels this way. Do not offer falsely reassuring statements (e.g. you still look good)

Front 85

Ethical Situations -

A drug company offers a "referral fee" for every patient a physician enrolls in a study.

Back 85

Appropriate Response or Action:
Eligible patients who may benefit from the study may be enrolled, but it is never acceptable for a physician to receive compensation from a drug company. Patients must be told about the existence of the referral fee.

Front 86

Ethical Situation -

A physician orders an invasive test for the wrong patient

Back 86

Appropriate Response or Action:

No matter how serious or trivial a medical error, a physician is ethically obligated to inform a patient that a mistake has been made.

Front 87

Ethical Situation -

A patient requires a treatment not covered by his/her insurance

Back 87

Appropriate Response or Action:

Never limit or deny care because of the expense in time or money. Discuss all treatment options with patients, even if some are not covered by the insurance companies.

Front 88

APGAR score

Back 88

Assessment of newborn vital signs following labor via a ten point scale evaluated at 1 minute and 5 minutes.

Appearance, Pulse, Grimace, Activity and Respiration

Front 89

Low Birth Weight

Back 89

Defined as <2500 grams.Caused by prematurity or intrauterine growth retardation. Associated with risk of SIDS and with rise in overall mortality. Complications include infections, Respiratory Distress Syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and persistent fetal circulation.

Front 90

Early Developmental Milestones -
Birth - 3 months

Back 90

Motor - Rooting reflex, holds head up, Moro reflex disappears

Social - Social Smile

Verbal/ Cognitive - Orient and Responds to voice

Front 91

Early Developmental Milestones -

7 - 9 months

Back 91

Motor - Sit alone, crawls, transfers toys from hand to hand.

Social - Stranger anxiety

Verbal/ Cognitive - Responds to name and simple instructions, uses gestures, plays peekaboo.

Front 92

Early Developmental Milestones -

12 - 15 months

Back 92

Motor - Walks, Babinski sign disappears

Social - Separation Anxiety

Verbal/ Cognitive - Few Words

Front 93

Early Developmental Milestones -

12 - 24 months

Back 93

Motor - Climbs stairs, stacks 3 blocks at 1 yrs, 6 blocks at 2 years (age x 3 = no. of blocks)

Social - Rapprochement (moves away from and then returns to mother)

Verbal/ Cognitive - 200 words and 2 word phrases at age 2

Front 94

Early Developmental Milestones -

24 - 36 months

Back 94

Motor - Feed self with fork and spoon, kicks ball

Social - Core gender identity, parallel play.

Verbal/ Cognitive - Toilet training (pee at age 3)

Front 95

Early Developmental Milestones -

3 years

Back 95

Motor - Rides tricycle(rides 3-cycle at age 3); copies line or circle drawing

Social - Comfortably spends part of day away from mother

Cognitive/Social Milestone - 900 words and complete sentences

Front 96

Early Developmental Milestones -

4 years

Back 96

Motor - Uses buttons and zippers, grooms self (brushes teeth), hops on 1 foot, makes simple drawings (stick figures).

Cognitive/Social Milestone - Cooperative play, imaginary friends

Cognitive - Can tell detailed stories and use prepositions.

Front 97

Changes in the elderly -

Back 97

1.) Sexual changes - Men have slower erection/ejaculation with a longer refractory period while Women have vaginal shortening, thinning and dryness.

2.) Sleep patterns - decreased REM, slow-wave sleep, increased latency and awakenings.

3.) Common medical conditions are arthritis, HTN, heart disease, osteoporosis

4.) decreased incidence of psychiatric disorders

5.) increased suicide rate(males 65-74 years of age have the highest suicide rate in the US)

6.) decreased vision, hearing, immune response, and bladder control.

7.) decreased renal, pulmonary and GI function

8.) decreased muscle mass, increased fat

NOTABLY sexual interest does NOT decrease and intelligence does NOT decrease.

Front 98

Grief

Normal vs pathological

Back 98

Normal bereavement characterized by shock, denial, guilt and somatic symptoms, typically lasts 6 months to a year. May experience illusions.

Pathologic grief includes extensively intense or prolonged grief or grief that is delayed, inhibited or denied. May experience depressive symptoms, delusions and hallucinations.

Front 99

Sexual Dysfunction Differential Diagnosis

Back 99

Includes secual desire disorders, orgasmic disorders and secual pain disorders

Differential Diagnosis includes:

1.) Drugs(antihypertensives, neuroleptics, SSRIs, ethanol)
2.) Diseases(depression, diabetes)
3.) Psychological(performance anxiety)

Front 100

Body Mass Index(BMI)

Back 100

BMI is a measure of weight adjusted for height.

BMI = weight in kg/(height in meters)²

Measure of weight adjusted for height
<18.5 underweight
18.5 - 24.9 normal
25.0 - 29.9 overweight\
>30.0 obese
>40.0 morbidly obese
>45.0 super obesity

Front 101

Sleep Stages -

Awake

Back 101

Awake(eyes open),alert, active mental concentration
EEG Waveform - Beta(highest frequency, lowest amplitude)

Awake(eyes closed)
EEG Waveform - Alpha

Front 102

Sleep Stages -

Stage N1

Back 102

(5%) light sleep

EEG waveform - Theta

Front 103

Sleep Stages -

Stage N2

Back 103

(45%) Deeper sleep; bruxism

EEG waveform - sleep spindles and K complexes

Front 104

Sleep Stages -

Stage N3

Back 104

(25%) Deepest, non-REM sleep; sleepwalking, night terrors, bedwetting(slow-wave sleep0

EEG waveform - Delta(lowest frequency, highest amplitude)

Front 105

Sleep Stages -

REM

Back 105

(25%) Dreaming, loss of motor tone, possibly a memory processing function, erections, increased brain O2 use.

EEG waveform - Beta

At night, BATS Drink Blood

Front 106

Key Points to remember about sleep

Back 106

1.) Serotonergic predominance of raphe nucleus key to initiating sleep.
2.) Sleep enuresis is treated with oral desmopressin acetates (DDAVP), which mimes vasopressin; preferred over imipramine because of the latter's effects
3.) Alcohol, benzodiazepines, and barbiturates are associated with reduced REM and delta sleep.
4.) Benzodiazepines shorten stage 4 sleep; thus useful for night terrors and sleepwalking

Front 107

REM Sleep

Back 107

increase and variable pulse, REM, increase and variable blood pressure, penile/clitoral tumescence. Occurs every 90 minutes; duration increases through the night. ACh is the principal neurotransmitter involved in REM sleep. REM sleep decreases with age.

REM sleep is like sex: increase pulse, penile/clitoral tumescence, decrease with age

because rem has the same EEG patterns as wakefulness, it has been termed "paradoxical sleep" and "desynchronized sleep"

Front 108

Sleep patterns of depressed patients

Back 108

Patients with depression typically have the following changes in their sleep stages:
Low slow wave sleep
Low REM latency
High REM early in sleep cycle
High total REM sleep
Repeated nighttime awakenings
Early-morning awakenings (important screening question)

Front 109

Narcolepsy

Back 109

Disordered regulation of sleep/wake cycles. May include hypnagogic(just before sleep) or hypnopompic(just before awakening) hallucinations. The patients nocturnal and narcoleptic sleep episodes start off with REM sleep. Cataplexy(loss of all muscle tone following a strong emotional stimulus) in some patients. Strong genetic component. Treat with stimulants(amphetamines and modafinil) and night time sodium oxybate (GHB)

Front 110

Circadian Rhythm

Back 110

Driven by suprachiasmatic nucleus(SCN) of hypothalamus; controls ACTH, prolactin, melatonin, nocturnal NE release, SCN --> NE release --> pineal gland --> melatonin. SCN is regulated by environment (i.e. light).

Front 111

Sleep terror disorder

Back 111

Periods of terror with screaming in the middle of the night; occurs during slow-wave sleep. Most common in children. Occurs during non-REM sleep (no memory of arousal) as opposed to nightmares that occur REM sleep (memory of a scary dream). Cause unknown, but triggers may include emotional stress during the previous day, fever, or lack of sleep. Usually self limited.