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110 Cards in this Set
- Front
- Back
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addiction pathway
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medial forebrain bundle (MFB)-->
nucleus accumbens (NAC)--> ventral tegmental area (VTA) |
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what plays a role in the addiction process owing to its regulation of impulse control
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serotonin (5-HT)
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most costly health problem to US
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alcoholism
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the best way to reduce long-term mortality with tobacco
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eliminate smoking
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the major cost issue for illegal drugs
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crime
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the most abused drug for all ages
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alcohol
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number one illicit drug for teenagers
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alcohol
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leading cause of mental retardation
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fetal alcohol syndrome (Down's is second)
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who is morelikely to develop alcoholism?
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Asians, Jewish Americans, and Italian Americans
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what is the key to alcohol?
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capacity to tolerate alcohol
(enzyme induction, lack of tyrosine kinase) |
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family history of alcoholism increases likelihood of what?
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unipolar (major) depression in offspring
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CAGE questions
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1. Cut down?
2. Annoyed about criticism 3. feel Guilty? 4. Eye opener? |
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chronic alcohol use can change genes related to what
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myelin in frontal cortex
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awake waves
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low voltage- random fast- beta waves
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drowsy
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8 to 12 cps alpha waves
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Stage 1 sleep
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3 to 7 cps thate waves
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Stage 2 sleep
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12-14 cps sleep spindles and K complexes
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Delta sleep
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1/2 to 2 cps delta waves greater than 75
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REM sleep
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low voltage random, fast with sawtooth waves
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what part of brain shows the greatest effects of sleep deprivation but has the capacity to cope with one night's sleep loss
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cerebral capacity
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how much of lost sleep is made-up
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1/3
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the longer the prior period of wakefulness leads to what
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the more Stage 4 sleep increases during the first part of the night and the more REM declines
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sleep pattern in short sleepers
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lose the latter part of REM sleep
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wat levels change in sleep-deprived individuals
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lymphocyte levels decline
cortisol levels rise |
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how is REM sleep in children and adults after learning
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slightly increase
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REM does what
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-clears out brain
-memory consolidation -dampens excitement- aids in prolonging sleep |
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REM deprivation does what
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does not impede simple tasks
-interfere with complex tasks -more difficult to learn complex tasks -decreases attention to details but not the capacity to deal with crisis situations |
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delta sleep increases after excercise why?
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raised cerebral temp.
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changes in first 3 hours of sleep
1. human growth hormone (HGH) 2. prolactin 3. dopamine 4. serotonin 5. TSH |
1. increase
2. increase 3. decrease 4. increase 5. decrease |
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melatonin
1. related to what? 2. produced where? 3. sensitive to what? 4. release inhibited by what? 5. at nighttime, how are levels 6. responsible for what 7. likely mechanism by which what |
1. feelings of sleepiniess (not related to sleeping)
2. pineal gland and directly in retina 3. light via a pathway from the eyes 4. daylight 5. dramatically rise 6. by which light and dark regulate circadian rhythym 7. jet lag |
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total sleep time/ 24 hours
1. neonate 2. 1 y 3. 10 y 4. 13-16 y |
1. 16-18 h
2. 12 h 3. 10 h 4. 8 h |
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number of sleep periods/ 24 hours
1. neonate 2. 1-2 y 3. 5-10 y |
1. 6-9
2. 2-3 3. 1 |
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EED demonstrates adultlike rhythyms of sleep and wakefulness by when
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1year
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neonatal sleep cycle starts when
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30 to 40 minutes, gradually lengthens to 90 minutes by teens
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adults
1. initial REM cycle when? 2. REM= % of sleep time 3. total sleep time/ 24 hour period |
1. 90 minutes
2. 20% 3. decreases gradually with age |
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elderly
1. total sleep time 2. REM % 3. how are stages |
1. continues to decline
2. remains at 20% up to 80 years 3. Stage 4 then Stage 3 NREM vanish (don't feel as rested) |
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narcoleptic tetrad
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1. sleep attacks and excessive daytime sleepiness
2. cataplexy 3. hypnagogic hallucinations 4. sleep paralysis |
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narcolepsy
1. hypnagogic 2. hypnopompic |
1. while falling asleep
2. while waking up |
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narcolepsy is disorder of what
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REM sleep
-within 10 minutes |
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narcolepsy is deficiency in what
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hypocretin protein (orexin) transport
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treatment of narcolepsy
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-no cure
-CNS stimulants control EDS (methylphenidate, dextroamphetamine) -tricyclin antidepressants control cataplexy (imipramine) |
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modafinil for narcolepsy
1. used for what? 2. MOA |
1. nonamphetamine alternative to CNS stimulants
2. inhibits DA reuptake activates glutamate inhibits GABA |
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sleep apnea
1. what is it? 2. code on what |
1. absence of respiration during sleep (breathing-related sleep disorder)
2. Axis III |
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obstructive (upper airway) sleep apnea
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rasping snoring
overweight middle-aged |
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central (diaphragmatic) sleep apnea
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elderly
overweight Cheyne-Stokes: 60 second hyperventilation, followed by apnea |
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clinical presentation of sleep apnea
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high risk of sudden death during sleep
-nocturnal cardiac arrhythmias -bradycardia, then tachycardia -males outnumber females by 8 to 1 -EDS and insomnia often reported -heavy snoring with frequent pauses -obesity often -short sleep duration, frequent waking, insomnia, decreased Stage 1, decreased delta and REM |
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treatment of sleep apnea
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weight loss
respiratory stimulants (medroxy-progesterone) -CPAP -possible tonsillectomy or tracheostomy |
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SIDS
1. who? 2. 50% reduction in incidence if what? 3. rates is 2 to 3x higher in what families 4. strong risk factor |
1. less than 1 year old
2. baby placed on back, rather than stomach 3. families where someone smokes 4. fetal exposure to maternal smoking |
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possible reasons for insomnia
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-secondary to hynotic medication abuse
-emotional problems -conditioned poor sleep -withdrawal from drugs or alcohol |
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treatment of insomnia
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behavior therapy best (muscle relaxation, stimulus control)
-action on GABA receptors -Ramelteon |
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Ramelteon
1. used for 2. MOA 3. dependency |
1. insomnia
2. melatonin receptor agonist (MT1 and MT2) 3. very low chance, no hangover, no insomnia rebound |
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Night terrors
1. sleep stage 2. physiologic arousal 3. recall upon waking 4. waking time anxiety 5. other issues |
1. Stage 4 (delta sleep)
2. extreme 3. no 4. yes, usually unidentified 5. runs in families -more common in boys -can be a precursor to temporal lobe epilepsy |
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Nightmares
1. sleep stage 2. physiologic arousal 3. recall upon waking 4. waking time anxiety 5. other issues |
1. REM
2. elevated 3. yes 4. yes, often unidentified 5. common from ages 3 to 7 -if chronic, likelihood of serious pathology -desensitization behavior therapy provides marked improvement |
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what does recent research suggest about a way to reduce nightmares and night terrors
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getting an extra 30 to 40 minutes of sleep a night
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Somnambulism
1. what is it? 2. characteristics |
1. sleepwalking
2. frist third of the night -Stage 4 sleep -if wakened, the person is confused and disoriented |
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Enuresis
1. what is it? 2. characteristics 3. drug |
1. bed-wetting
2. Stages 3 and 4 sleep -boys twice as likely as girls (at age 5, 7% boys and 3% girls) -boys cease wetting later -often history with same-sex parent -common after change a new sibling born-- defense mech. of regression 3. imipramine |
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Bruxism
1. what is it? 2. characteristics 3. prevention |
1. teeth grinding
2. Stage 2 sleep 3. oral devices, reduction of anxiety |
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dopamine in sleep
1. pharm. that increases dopamine 2. dopamine blockers |
1. increases wakefulness
2. increase sleep somewhat |
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benzodiazapines
1. effect on sleep 2. chronic use |
1. limited decrease in REM and Stage 4 sleep
-little rebound effect 2. increases sleep latency |
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1. moderate alcohol consumption on sleep
2. alcohol intoxication on sleep |
1. early sleep onset
-increased wakefulness during 2nd half of the night 2. decreases REM -REM rebound (with nightmares) during withdrawal |
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barbiturates effect on sleep
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-decreases REM
-REM rebound, including nightmares, follows stoppage of chronic use |
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effect of major depression on sleep
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-increases REM
-decreases REM latency (45 rather than 90 minutes) -decreases Stage 3 and 4 sleep -increased sleep in multiple periods over 24 hours -early morning waking -diurnal improvement -sleep deprivation gives 60% remission from symptoms -people who characteristically get a lot of REM are more susceptible to onset of depression |
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NTs associated with sleep
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SANDman
Serotonin- helps initiate sleep Acetylcholine- higher during REM sleep Norepinephrine- lower during REM sleep Dopamine- produces arousal and wakefulness; rises with waking |
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biochemical trigger for REM sleep
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ration fo Ach to NE
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NE pathway begins where
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in pons, which regulates REM sleep
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Axis 1 of DSM IV
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clinical disorders
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Axis 2 of DSM IV
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personality disorders and mental retardation
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Axis 3 of DSM IV
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physical conditions and disorders
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Axis 4 of DSM IV
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psychological and environmental problems
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Axis 5 of DSM IV
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global assessment of functioning (GAF)
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mental retardation
1. which axis 2. most common known cause 3. most common genetic causes |
1. 2
2. fetal alcohol syndrome (FAS) 3. Down's and Fragile X |
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mild mental retardation
1. IQ 2. functioning |
1. 70-50
2. self-supporting with some guidance -85% of retarded -2 times as many are male -usually diagnosed first year in school |
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moderate mental retardation
1. IQ 2. functioning |
1. 49-35
2. trainable -benefits from vocational training, but needs supervision -sheltered workshops |
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severe mental retardation
1. IQ 2. functioning |
1. 20-34
2. training not helpful -can learn to communicate -basic habits |
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profound mental retardation
1. IQ 2. functioning |
1. below 20
2. needs highly structured environment -constant nursing care supervision |
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Autism (persuasive developmental disorders
1. axis 2. diagnosed when 3. male:female 4. linked to what chromosomes 5. incidence 6. concordance 7. IQs 8. treatment |
1. Axis 1
2. in infancy (30 months) 3. 4:1 4. #15 and #11 5. 1 per 200 births 6. monozygotic greater than dizygotic 7. 80% below 70 8.. behavorial techniques |
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autism- clinical signs
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-problems with reciprocal social interaction, decreased repetoire of activities and interests
-abnormal or delayed language development -impairment in verbal and nonverbal comm. -no separation anxiety -oblivious to external world -fails to assume anticipatory posture, shrinks from touch -pronoun reversal -preference for innate objects -stereotyped behavior and interests |
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autism- potential causes
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-association with prenatal and perinatal injury (Ex. rubella)
-failure of apoptosis -brain 15% larger than normal at age 3 |
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ADHD
1. who 2. male: female 3. more common in who 4. overtreatment 5. treatment |
1. 10% lower class and 5% middle class
2. 10:1 3. firstborn males 4. common; need to differentiate over active child 5. methylphenidate, dextroamphetamine, pemoline |
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anhedonia
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can't experience or even imagine any pleasant emotion
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clang associations
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illogical connections by rhythm or puns
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echolalia
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repeating in answer many of same words as in question
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echopraxia
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imitations of movements or gestures
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flight of ideas
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topins strung together
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loose associations
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jump from one topic to the next
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mannerisms
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Ex. grimacing
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mutism
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no speech
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meologisms
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new expressions
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perservation
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repsonding to all questions the same way
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poverty of speech
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sparse and slow speech
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pressured speech
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abundant and accelerated speech
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verbigeration
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senseless repitition of same words or phrases
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delusions
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false beliefs not shared by culture
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illusions
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misperception of real stimulo
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hallucinations
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sensory impression, no stimuli
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criteria for schizophrenia
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-bizzare delusions
-auditory hallucinations (in 75%) -NOT VISUAL -blunted affect -loose associations -deficiency in reality testing, distorted perception, impaired functioning overall -disturbances in behavior and form and content of language and thought -changes in psychomoter behavior; loss of prosody |
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differential for schizophrenia
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-schizophreniform- if symptoms less than 6 months
-brief psychotic disorder |
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brief psychotic disorder
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-presence of delusions, hallucunations, or disorganized speech and behavior
-from 1 to 30 days -return to full former functioning -not a cultural response pattern -not due to substance abuse or organic cause |
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-potential causes of schizophrenia
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-trinucleotide repeat amplification
-birth trauma (hypoxia likely if early onset) |
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epidemiology of schizophrenia
1. onset 2. prevalence 3. extra infor |
1. male; age 15-24
female, age 25-34 2. 1% of pop. cross-culturally; less chronic and severe in developing countries than in developed countries 3. downward drift to low SES -50% attemplt suicide; 10% succeed -over 50% do not live with their families, nor are instiutionalized |
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genetic contribution of schizophrenia
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-rates for monozygotic twins reared apart= rates for MX twins raised together
-dizygotic concordance- 13% -if to schizo parents- 40% -if one parent or one sibling- 12% -risks in bilogic relatives 10x gen. pop. |
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heritability index
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=(MZ-DZ)/(100-DZ)
-proportion of conditon due to genetic factors |
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schizophrenogenic family
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-highly critical
-negative emotions -double messages -linked to schizoid personality disorders -not linked to development of schizophrenia |
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highly expressed-emotion families
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relapse rate 4 to 5x higher
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paranoid schizophrenia
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-delusions or persecution or grandeur
-often accompanied by hallucinations -older onet than other types with less regression of mental facultities and emotional response |
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residual schizophrenia
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-previous episode, but no prominent psychotic symptoms at evaluation
-some lingering negative symptoms |
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undifferentiated schizophrenia
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-psychotic symptoms
-does not fit paranoid, catatonic, or disorganized diagnoses |
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disorganized schizophrenia
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-incoherent, primitive, uninhibited
-unorganized behaviors and speech -active, but aimless -poor personal appearance -little contact with reality -pronounced thought disorder -explosive laughter -silliness -incongruous grinning |
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catatonic schizophrenia-- complete stupor
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-pronounced decrease in spontaneous moments
-may be mute -negativism, exhopraxiam automatic obedience -rigidity of posture -brief outbursts of violence without prvocation -waxy flexibility |
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catatonic schizophrenia- excited
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-evidence of extreme motor agitation
-incoherent and often violent or destructive -can hurt themselves, or collapse in exhaustion -repetitious, stereotypesd behaviors |
