Behavioral sciences Flashcards
APGAR score
Assessment of newborn vital signs following labor via a 10-point scale evaluate at 1 minute and 5 minute.
Appearance, Pulse, Grimace, Activity, and Respiration
7=good, 4-6 assist and stimulate, <4 at later time points, there is increased risk that the child will develop long-term neurologic damage.
Low birth weight
Defined as <2,500, caused by prematurity or IU growth retardation. Associated with SIDS (sudden infant death syndrome) and other mortality.
Other problems thermoregulation, immune function, hypoglycemia, polycythemia, and impaired neurocognitive/emotional development.
Complications include infection, ARDS, necrotizing entercolitis, intraventricular hemorrhage, and persistent fetal circulation.
Developmental milestones:
Infants Birth-3month
Motor: rooting reflex, holds heads up, moro reflex disappears
Social: smile
Verbal: orients and responds to voice
Developmental milestones:
Infants 7-9 months
Motor: sits alone, crawls, transfer toys from hand to hand
Social: stranger anxiety
Verbal: responds to name and simple instruction, uses gesture, plays peek a boo
Developmental milestones:
Infants 12-15 months
Motor: Walks, babinski disappears.
Social: separation anxiety
Verbal: few words
Developmental milestones:
Toddler 12-24 months
Motor: climbs stairs, stacks (age x 3) # of blocks
Social: rapprochement (moves away and return to mom)
Verbal: 200 words and TWO-word phrases at age of TWO
Developmental milestones:
Toddler 24-36 months
Motor: Feeds self with for and spoon, kills ball
Social: core gender identity, parallel play
Verbal: toilet training, PEE at age THREE
Developmental milestones:
Preschool 3 yr
Motor: rides TRIcycle at THREE, copies lines and circle drawings
Social: comfortably spends part of day away from mother
Verbal: 900 words and complete sentences
Developmental milestones:
Preschool 4yr
Motor: Uses buttons and zippers, grooms self (brushes teeth), hops on 1 foot, makes simple drawings (stick figure)
Social: cooperative play, imaginary friends
Verbal: can tell detailed stories and use prepositions.
Changes in elderly
Sexual:
Men; slower erection, ejaculation, longer refractory
Women: vaginal shortening, thinning, dryness
Sleep: DECREASED REM and slow-wace sleep; INCREASED latency and awakening
Increased: SI
Decreased: vision, hearing, immunity, bladder control
Compromised: renal, pulm, GI, muscle mass, more fat
However, sexual interest or intelligence do NOT drop.
Grief
May last up to 1 year, may experience illusions.
Pathologic grief: excessively intense, prolonged grief lasting 2-6 months, or grief that is delayed, inhibited, or denied. May experience depressive symptoms, delusions, and hallucinations.
Sexual dysfunction
desire disorders (hypoactive, aversion), arousal disorder (ED), orgasmic disorder (anorgasmia, premature ejaculation), sexual pain disorder (dyspareunia, vaginismus)
DDx: drug (antiHTN, neuroleptics, SSRIs, ethanol), dz (depression, DM), psychologic (performance anxiety)
BMI
weight in KG/height in meter^2
30= obesity
>35=severe obesity
>40=morbid obesity
>45=super obesity
Sleep stage
Awake eyes open Awake eyes closed Stage N1 5% Stage N3 45% Stage N3 25% REM 25%
Remember, at night, BATS Drink Blood
Sleep stage: awake eyes open
Alert, active mental concentration
EEG: Beta (highest freq, lowest amp)
Sleep stage: awake eyes closed
EEG: alpha
Sleep stage: N1
light sleep
EEG: theta
Sleep stage: N2
Deeper sleep; bruxism (teeth grinding)
EEG: sleep spindles and K complexes
Sleep stage: N3
Deepest, non-REM sleep (slow wave sleep); sleep walking, night terrors, bedwetting
EEG: delta (lowest freq, highest amp)
Sleep stage: REM
Dreaming, loss of motor tone, memory processing function, erections, increased brain O2 use
EEG: Beta
Sleep
Raphe nucleus: serotonergic predominance is the key to initiating sleep
Sleep enuresis: treated with oral desmopression DDAVP (ADH); preferred over imipramine
Alcohol/benzo/barbituates associated with reduced REM and delta sleep
Benzo useful for night terrors and sleep walking
REM sleep
Occurs every 90 min, duration increasing thru night.
ACH is the principal NT in REM sleep, NE reduces REM sleep.
Increased and variable pulse and BP
EOM during REM due to activity of PPRF (paramedian pontine reticular formation/conjugate gaze center).
Penile, clitoral tumescence.
REM sleep is like sex: increase pulse, penile/clitoral enlargement, decreased freq with age
Because REM has the same EEG patterns as wakefulness, been termed paradoxical sleep and desynchronized sleep.
Sleep patterns of depressed pts
- decreased slow wave sleep
- decreased REM latency
- increased REM early in sleep cycle
- increased total REM sleep
- repeated nighttime awakenings
- early morning awakening (IMPORTANT SCREENING Qs)
Narcolepsy
Hypnagogic (just before sleep), or hypnopompic 9just before awakening) hallucination.
The pt’s nocturnal and narcoleptic sleep episodes start off with REM sleep.
Cataplexy (loss of all muscle tone following a strong emo stimulus) in some pts.
Strong genetic components. Treated with daytime stimulants (amphetamines, modafinil) and nighttime sodium oxybate (GHB)
Circadina rhythm
Suprachiasmatic nucleus (SCN) of hypothalamus Controls ACTH, prolactin, melatonin, nocturnal NE release
SCN -> NE release -> pineal gland -> melatonin
SCN regulated by environment (light)
Sleep terror disorder
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 occurs during REM sleep (memory of a scary dream)
Unknown causes, but might be due to emo stress during the previous day, fever, lack of sleep. Usually self limited.
