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135 Cards in this Set
- Front
- Back
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Circadian Cycle
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Awake and sleep states closer to 25 hours than 24
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Awake State
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Characterized by alpha and beta waves
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Beta Waves
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Over the frontal lobes and are commonly seen with active mental concentration
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Alpha Waves
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Over occipital and parietal lobes and are seen when a person relaxes with eyes closed
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Sleep Latency
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Period of time from going to be to falling asleep is normally less than 10 minutes
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How is sleep divided?
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Divided into REM and non-REM sleep
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Non-REM sleep
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Consists of stages 1-4
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Sleep Architecture
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Mapping the transitions from one stage of sleep to another during the night.
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Characteristics of Sleep Architecture
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- Changes with age
- Elderly often have poor sleep because aging is associated with reduced REM sleep and delta sleep and increased nighttime awakenings leading to poor sleep efficiency |
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What is associated with reduced REM sleep and delta sleep
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Sedative agents, such as alcohol, barbiturates, and benzodiazepines.
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When does most delta sleep occur?
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During the first half of the sleep cycle
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When are the longest REM periods
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During the second half of the sleep cycle
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Sleep Stage 1
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Theta waves. Lightest stage of sleep characterized by peacefulness, slowed pulse and respiration, decreased blood pressure, and episodic body movements.
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Sleep Stage 2
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Sleep Spindle and K-Complex.
Largest percentage of sleep time, bruxism (teeth grinding) |
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Sleep Stage 3
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Delta Waves
Deepest most relaxed stage of sleep; sleep disorders such as night terrors, sleep walking, and bed-wetting may occur |
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REM Sleep
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"sawtooth"- beta, alpha, and theta waves
Dreaming, penile and clitoral erection Increased pulse respiration and bp Absence of skeletal muscle movement |
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During which sleep cycle do the highest levels of brain activity occur?
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REM
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Longest REM periods
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During second half of sleep cycle
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Average time to achieve REM after falling asleep
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90 minutes
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What happens to a person who is deprived of REM sleep one night?
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They have increased REM sleep the next night - REM rebound.
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How does increased Ach affect sleep?
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Increase sleep efficiency and REM sleep.
(Ach levels, sleep efficiency, and REM sleep decrease in normal aging and in Alzheimers) |
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Increased levels of dopamine and sleep
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Decreases sleep efficiency. Treatment with antipsychotics which block dopamine receptors may improve sleep in psychotic patients.
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Increased levels of NE and sleep
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Decrease sleep efficiency and REM sleep
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Increased levels of serotonin and sleep
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Increase sleep efficiency and delta sleep.
Damage to the dorsal raphe nuclei, which makes serotonin, decreases both of these. |
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Dyssomnias
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Problems in the timing, quality, or amount of sleep. Includes insomnia, breathing-related sleep disorder (sleep apnea) and narcolepsy as well circadian rhythm sleep disorder, nocturnal myoclonus, restless leg syndrome, and the primary hypersomnias.
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Parasomnias
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Characterized by abn in physiology or behavior associated with sleep. Include bruxism (tooth grinding) and sleep walking, as well as sleep terror, REM sleep behavior, and nightmare disorders.
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Insomnia
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Difficulty falling asleep or staying asleep - occurs 3x/week for at least a month and leads to sleepiness during the day.
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Sleep Terror Disorder
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Repetitive experiences of fright
Person cannot be awakened No memory of having the dream During delta sleep Onset in adolescence may indicate temporal lobe epilepsy |
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Nightmare Disorder
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Repetitive, frightening dream that can cause nighttime awakenings
Person usually can recall nightmare During REM sleep |
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Sleepwalking
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Walking during sleep
No memory Begins in childhood Delta sleep |
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Circadian rhythm sleep disorder
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Inability to sleep at appropriate times
Delayed sleep phase - falling asleep and waking later than wanted |
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Nocturnal Myoclonus
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Repetitive abrupt muscular contractions in the legs from toes to hips
Causes nighttime awakenings |
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Restless Leg Syndrome
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More common in elderly
Uncomfortable sensation in leg needing frequent motion Repetitive limb jerk during sleep Causes difficulty falling asleep and nighttime awakenings Most common with aging, Parkinsons, pregnancy, and kidney disease. Treat with antiparkinson agent (levodopa, ropinirole) |
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Primary Hypersomnias
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Recurrent periods of excessive sleepiness occurring almost daily for at least a month
Sleepiness not relieved by a nap Often accompanied by hyperphagia (overeating) Kleine-Levin syndrome is more common in adolescent males |
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Sleep Drunkeness
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Difficulty waking after adequate sleep
Rare, must be differentiated from substance abuse Genetic |
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Bruxism
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Tooth grinding during sleep (stage 1)
Can lead to tooth damage and jaw pain Treated with dental appliance worn at night |
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REM Sleep behavior Disorder
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REM sleep without the normal skeletal muscle paralysis
Patients can injure themselves or their sleeping partners Associated with Parkinson's Disease. Treat with antiparkinson agent |
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Major Depressive Disorder and Sleeping
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Short sleep latency
Repeated nighttime awakenings leading to poor sleep efficiency Waking too early in the morning |
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Characteristics of sleep stages in depression
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Short REM latency
Increased REM early in the sleep cycle and decreased REM later in the sleep cycle Long first REM period and increased total REM Reduced delta sleep |
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Bipolar Disorder and Sleeping
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Manic or hypomanic patients have trouble falling asleep and sleep fewer hours
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Physical causes of insomnia
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1. Use of CNS stimulants (caffeine)
2. Withdrawal of agents with a sedating action (alcohol, benzos) 3. Medical Conditions causing pain |
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Sleep Apnea
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Stop breathing for brief intervals. Low oxygen or high carbon dioxide level in blood repeatedly awakens the patient resulting in daytime sleepiness and respiratory acidosis
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Central Sleep Apnea
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Common in elderly, Littler or no respiratory effort occurs, less air reaching the lungs
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Obstructive Sleep Apnse
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Respiratory effort occurs, but an airway obstruction prevents air from reaching the lungs. Most common in men, obese. Patients tend to snore.
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Pickwickian Syndrome
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Airway obstruction results in daytime sleepiness
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Sleep apnea
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1- 10% of the population
Related to depression, morning headaches, and pulmonary htn. May also result in sudden death during sleeping in infants and elderly. |
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Narcolepsy
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Sleep attacks despite having the normal amount of sleep during the day. Nighttime sleep is characterized by decreased sleep latency, very short REM latency, less total REM and interrupted REM
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Decreased REM sleep leads to?
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Intrusion of characteristics of REM sleep while the patient is awake (nightmares, paralysis) leading to
1. Hypnagogic or hypnopompic hallucinations - strange perceptual experiences that occur just as the patient falls asleep or wakes up 2. Cataplexy - sudden physical collapse caused by loss of all muscle tone after strong emotional stimulus 3. Sleep Paralysis - Inability to move the body for a few seconds after waking |
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Narcolepsy
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Uncommon
Occurs most frequently in adolescents and young adults May be genetic Daytime naps leave the patient refreshed |
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Treating Insomnia
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Avoid caffeine
Develop series of behaviors associated with bedtime (sleep routine) Maintain a fixed sleeping and waking schedule Relaxation Techniques Daily Exercise Psychoactive Agents |
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Treating Breathing-related sleep disorder
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Weight loss (if overweight)
Continuous pos airway pressure Medroxyprogesterone acetate or protriptylene Surgery to enlarge airway Tracheostomy (last resort) |
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Treating Narcolepsy
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Stimulant agents
Scheduled daytime naps |
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Symptoms of Schizophrenia: Disorder of Perception
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Symptom = Illusion --> misperception of real external stimuli (thinking that a coat hanging in the closet is a man)
Symptom = Hallucination --> false sensory perception (hearing voices) |
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Symptoms of Schizophrenia: Disorder of Thought Content
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Symptom = Delusion --> False belief not shared by others (feeling of being followed by the FBI)
Symptom = Idea of Reference --> False belief of being referenced by others ( feeling of people on tv talking about them) |
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Symptoms of Schizophrenia: Disorder of Thought Processes
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Symptom = Impaired Abstraction Ability --> Problems discerning the essential qualities of objects or relationships (when asked what brought her to the ER she says, "ambulance")
Symptom = Magical Thinking --> Belief that thoughts affect the course of events (knocking on wood prevents something bad from happening) |
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Symptoms of Schizophrenia: Disorder of Form of Thought
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Symptom = Loose Associations --> Shift of ideas from one subject to another in an unrelated way (Patient begins to answer a question about her health and shifts to a statement about baseball)
Symptom = Neologisms --> Inventing new words (Patient refers to her doctors as a "medocrat") Symptom = Tangentiality --> Getting further away from the point as speaking continues. (patient begins to answer a question about her health by talking about sister's abortion) |
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Topographic theory of the mind
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The mind contains three levels: the unconscious, preconscious, and conscious
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Unconscious Mind
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Repressed thoughts and feelings that are not available to the conscious mind and uses primary process thinking
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Primary Process
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Associated with primitive drives, wish fulfillment, and pleasure seeking, and has no logic or concept of time. Primary process thinking is seen in young children and psychotic adults.
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Dreams
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Gratification of unconscious instinctive impulses and wish fulfillment
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Precocious Mind
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Contains memories that, while not immediately available, can be accessed easily.
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Conscious Mind
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Contains thoughts that a person is currently aware of. It operates in close conjunction with preconscious mind, but does not have access to unconscious min. Conscious mind uses secondary process thinking (logical, mature, time-oriented) and can delay gratification.
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Id
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Unconscious - present at birth - contains instinctive sexual and aggressive drives.
Controlled by primary process thinking Not influenced by external reality |
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Ego
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Unconscious, Pre-conscious, Conscious
Begins to develop immediately after birth Controls the expression of the Id to adapt to the requirements of the external world primarily by the use of defense mechanisms. Enables one to maintain satisfying interpersonal relationships |
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Superego
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Unconscious, Pre-conscious, Conscious
Begins to develop around age 6 Associated with moral values and conscience Controls the expression of the id |
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Defense Mechanisms
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Unconscious mental techniques used by the ego to keep conflicts out of the unconscious mind, thus decreasing anxiety and maintaining a person's sense of safety, equilibrium, and self-esteem
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Immature Defense Mechanisms
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Manifestations of child-like or disturbed behavior
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Mature Defense Mechanisms
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Altruism, Humor, Sublimation, and Suppression - when used in moderation, directly help the patient or others.
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Repression
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Pushing unacceptable emotions into the unconscious, is the basic defense mechanism on which all others are based
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Acting Out
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Avoiding personally unacceptable emotions by behaving in an attention-getting, often socially inappropriate manner
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Altruism
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Assisting others to avoid negative personal feelings
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Denial
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Not accepting aspects of reality that a person finds unbearable
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Displacement
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Moving emotions from a personally intolerable situation to one that is personally tolerable.
Ex: a surgeon with unacknowledged anger toward his mother is abrasive to female residents on service |
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Dissociation
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Mentally separating part of one's consciousness from real life events or mentally distancing oneself from others
Ex: although he was not injured, a teenager has no memory of a car accident in which he was injured and his girlfriend was killed |
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Humor
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Expressing personally uncomfortable feelings without causing emotional discomfort
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Identification
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Unconsciously patterning one's behavior after that of someone more powerful
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Intellectualization
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Using the mind's higher functions to avoid experiencing emotion
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Isolation of affect
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Failing to experience the feelings associated with a stressful life event, although logically understanding the significance of the event
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Projection
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Attributing one's own personally unacceptable feels to to others.
Associated with paranoid symptoms and prejudice |
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Rationalization
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Distorting one's perception of an event so that its negative outcome seems reasonable
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Reaction Formation
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Adopting opposite attitudes to avoid personally unacceptable emotions.
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Regression
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Reverting to behavior patterns like those seen in someone of a younger age
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Splitting
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Categorizing people or situations into categories of either "fabulous" or "dreadful" because of intolerance of ambiguity.
Seen in patients with borderline personality disorder |
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Sublimation
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Expressing a personally unacceptable feeling in a socially useful way
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Suppression
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Deliberately pushing personally unacceptable emotions out of conscious awareness
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Undoing
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Believing that one can magically reverse past events cause by "incorrect" behavior by adopting now "correct" behavior.
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Individuals with personality disorders show
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chronic, lifelong, rigid, unsuitable patterns of relating to others that cause social and occupational problems.
persons with PDs generally are not aware that they are the cause of their own problems (do not have insight), do not have frank psychotic symptoms, and do not seek psychiatric help. |
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Personality Disorder : A
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Paranoid, schizoid, schizotypal
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Personality Disorder : B
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Histrionic, Narcissistic, Borderline, and Anti-social
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Personality Disorder : C
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Avoidant, OCD, Dependent
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Treatment of Personality Disorders
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Individual and group psychotherapy may be useful
Pharmacotherapy also can be used to treat symptoms like depression and anxiety |
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Dissociative Disorders
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Characterized by abrupt but temporary loss of memory or identity, or by feelings of detachment owing to psychological factors
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Dissociative Disorders are commonly related to
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Disturbing emotional experiences in the patient's recent or remote past
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Hallmark of Cluster A Personalities
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Avoids social relationships "peculiar" but not psychotic
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Paranoid
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Distrustful, suspicious, litigious
Attributes responsibility for own problems to others Interprets motives of others as malevolent Collects guns |
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Schizoid
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Long-standing pattern of voluntary social withdrawl
Detached, restricted emotions, lacks empathy, but has no thought disorder |
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Schizotypal
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Peculiar appearance
magical thinking Odd thought patterns and behavior without frank psychosis |
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Hallmark of Cluster B
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Dramatic, emotional, inconsistent
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Histrionic
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Theatrical, extroverted, emotional, sexually provocative, life of the party
shallow, vain cannot maintain intimate relationships |
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Narcissistic
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Pompous, with a sense of special entitlement
Lacks empathy for others |
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Antisocial
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Refuses to conform to social norms and shows no concern for others
Associated with conduct disorder in childhood and criminal behavior in adulthood |
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Borderline
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Erratic, impulsive, unstable behavior and mood
feeling bored, alone, and "Empty" suicide attempt for relatively trivial reasons self-mutiliation |
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Cluster C
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Fearful, anxious
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Avoidant
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Sensitive to rejection, socially withdrawn
Feelings of inferiority |
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OCD
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Perfectionistic, orderly, inflexible
Stubborn and indecisive Ultimately inefficient |
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Dependent
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Allows other people to make decisions and assumes responsibility for them
poor self-confidence, fear of being deserted and alone may tolerate abuse from a partner |
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Fear
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Normal reaction to a known, external source of danger
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Anxiety
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Indiv is frightened but the source of danger in not known, not recognized, or inadequate to account for symptoms
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Panic Disorder
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Episodic (2x/week) periods of intense anxiety
Cardiac and respiratory symptoms and conviction that one is about to die or lose one's mind Sudden onset of symptoms, intensity over 10 min and lasting 30 min Strongly genetic young women in 20's |
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Panic disorder with agroaphobia
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Characteristics and symptoms of the panic disorder are associated with fear of open places or situations in which the patient cannot escape or get help
Associated with separation anxiety in childhood |
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Specific Phobia
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Irrational fear of certain things (snakes, spiders, etc)
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Social phobia
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Exaggerated fear of embarrassment
Because of fear pt avoids the situation Avoidance leads to social and occupational problems |
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OCD
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Recurring, intrusive feelings, thoughts, and images that cause anxiety
Anxiety is relieved in part by performing repetitive actions Patients usually have insight Can begin in childhood, early adulthood Genetic |
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Generalized Anxiety Disorder
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Hyperarousal and worrying lasting 6 months or more
GI symptoms common Symptoms not related to a specific person or situation Usually starts in 20s |
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PTSD and Acute Stress Disorder (ASD)
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Symptoms occurring after a catastrophic event that affects the patient or patient's close friend or relative
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Symptoms of PTSD and ASD
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1. Reexperiencing
2. Hyperarousal (anxiety) 3. Emotional Numbing 4. Avoidance |
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How long does PTSD last?
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More than 1 month - sometimes years and delayed onset.
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How long does ASD last?
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2 days - 4 weeks.
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Adjustment Disorder
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Emotional symptoms causing social, school, or work impairment occurring within 3 months and lasting less than 6 months after a serious, but not life-threatening event (divorce, bankruptcy, moving)
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Neurotransmitters involved in the development of anxiety
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GABA (decreased activity)
Serotonin (Decreased activity) NE (increased activity) |
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Brain areas involved in anxiety disorders
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Locus ceruleus, raphe nucleus, caudate nucleus, tempora cortex, and frontal cortex
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Organic causes of anxiety symptoms
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excess caffeine, substance abuse, pheochromocytoma
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Benzodiazepines
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Fast-acting anti-anxiety agents
Carry a high-risk of dependence and addiction they are usually used for only a limited amount of time to treat acute anxiety symptoms They work quickly so drugs like alprazolam are used for emergency treatment of panic attacks |
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Buspirone
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Non-benzo anti-anxiety agent
Low abuse potential useful for long-term maintenance of GAD Takes up to 2 weeks to work |
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Beta- Blockers
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Like propranolol are used to control autonomic symptoms in anxiety disorders and can be used for anxiety about performing in public
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Most effective long-term treatment of panic disorder and OCD
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Anti-depressants
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Treatment of social phobia
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Paroxetine, sertraline, venlafaxine
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Somatoform disorders
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Characterized by physical symptoms without sufficient organic cause
Patient thinks that the symptoms have an organic cause, but symptoms are believed to be unconscious expressions of unacceptable feelings |
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Somatization Disorder
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History over years of at least two GI symptoms, 4 pain symptoms, 1 sexual symptom, and 1 pseudoneuro sym (paralysis)
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Hypochondrias
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Exaggerated concern with health and illness for at least 6 months
Concern persists despite medical eval and reassurance Most common in middle and old age |
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Conversion disorder
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Sudden, dramatic loss of sensory or motor function associated with a stressful event
More common in unsophisticated adolescents and young adults Patients appear relatively unworried |
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Body Dysmorphic Disorder
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Excessive focus on a minor or imagined physical defect
Symptoms are not accounted for by anorexia nervose Late teens |
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Pain Disorder
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Intense acute or chronic pain not explained completely by physical disease and closely associated with psychological stress
30s-40s |
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Malingering
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Conscious stimulation or exaggeration of physical or psychiatric illness for financial or other gain
Avoids treatment by medical personnel |
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Factitious disorder by proxy
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Conscious stimulation of illness in another person - typically a child- to obtain attn from med personnel
Form of child abuse - child undergoes unnecessary procedures. |
