Chapters 17 and 18 Sleep/Wake disorders and Thought, Emotion, and Memory Disorders Flashcards
What role does the thalamus play in the sleep-wake cycle? What can it be compared to?
The thalamus can be compared to a switch board. It receives information from the lower neurologic system and relays it to the correct part of the brain. In regard to the sleep/wake cycle, it passes the information to the correct part of the cerebral cortex.
What is the cerebral cortex?
The cerebral cortex is the outer most layer of the cerebrum (the brain). It is divided into the frontal, parietal, occipital, and temporal lobes.
Why is sleep so important to the body’s health?
- Allows the body and mind to recharge.
- Allows the immune system of the brain to “clean and repair”
- Lack of sleep impairs concentration, thinking, and memory processing
What is the needed amount of sleep for adults? What about children and teens?
Adults need 7-9 hours of sleep
Children and teens need more
REM Sleep
1. What changes with body functions occur during REM sleep?
2.. What ANS changes can be seen during REM sleep?
Rapid Eye Movement Sleep
1. REM, loss of muscle movements, vivid dreaming, ANS changes.
2. BP, HR, and RR increase during REM. Cerebral blood flow and metabolic rate decrease during REM sleep.
Non-REM sleep
Quiet type. Inactive but fully regulated brain. Body moveable.
Stage 1 Non-REM sleep
low-voltage, mixed-frequency EEG activity
Occurs at onset of sleep, lasts about 1-7 minutes. Transition between awake and sleep. Easily aroused.
Transitional stage for repeated sleep cycles throughout the night.
Stage 2 Non-REM sleep
Deeper sleep, lasts 10-25 minutes.
EEG shows sleep spindles.
Stage 3-4 Non-REM sleep
Deep sleep, high-voltage, low frequency EEG. difficult to arouse person.
Stage 3 (few minutes) Stage 4 (20-40 minutes)
Muscles of the body relax
Decreased BP, slowed GI activity
Describe the differences in breathing found throughout the stages of sleep
Stage 1 and 2 - waxing and waning of tidal volume. Periods of apnea.
Stage 3 and 4 - regular
REM - irregular breathing, not periodic though. Some apnea spells that are brief.
What controls the circadian cycle?
Hypothalamus - specifically the suprachiasmatic nucleus.
What helps control the circadian cycle?
- Exposure to light/darkness
- Locomotion
- Food
- Glucocorticoids
- Temperature
What is melatonin? What makes it?
The pineal gland synthesizes melatonin. Melatonin is a hormone that produces changes to the circadian rhythm, making the person sleepier.
What stimulates the anterior pituitary gland? What does the anterior pituitary gland control?
The hypothalamus stimulates the AP to release hormones. The hormones released by the AP:
1. Thyroid
2. Growth
3. Cortisol
4. Sex hormones
F - FSH
L - L
A - ACTH
T - TSH
P - Prolactin
I -
G - growth hormone
What is the SCN? What formations does it interact with in the brain?
A small group of hypothalamic cells that regulate the sleep/wake cycle.
Interact with the forebrain, the thalamus, and the hypothalamus.
What does the hypothalamus regulate in regard to sleep/wake?
Temperature and metabolic processes. It also stimulates the AP, brain stem, reticular formation, and the pineal gland.
What does the brain stem and the reticular formation do in regard to sleep/wake?
Regulation of the ANS and along with the hypothalamus, have a direct role in sleep/wake cycles
Slow wave sleep
Non-REM sleep
Dyssomnia
Disorders of initiating and maintaining sleep or excessive sleepiness
Parasomnias
Undesirable phenomena that occur primarily during sleep. Does not interrupt the sleep/wake cycle.
Sleep hygiene
How the persons prepares for going to sleep. Brush teeth, play on phone, watch TV, wind down time are examples.
EOG/ EMG/ ECG/ EEG
These are monitored during a sleep study. EOG - electrooculogram
EMG - electromyogram
ECG - electrocardiogram
EEG - electroencephlagram?
Actigraphy
Measures muscle motion. Useful tool for measuring sleep efficiency outside the sleep labs.
Non-24-hour sleep-wake syndrome
1. What causes this?
2. Who is commonly affected?
When there is lack of synchronization between internal sleep-wake rhythm and the external 24-hour day.
- This is caused by constant exposure to light or darkness that throws off the body’s normal circadian rhythm.
- Blind or nearly blind people commonly struggle with this disorder (2/3 of blind people affected). People with lesions on the SCN.
Narcolepsy
1. Associated symptoms
2. Onset
3. Etiology
Disorder of excessive daytime sleepiness unchanged by getting a full night’s sleep.
1. Cataplexy, hallucinations (hypnagogic hallucinations), sleep paralysis.
2. Typically develops around 15-30 years of age.
3. Abnormality in REM sleep. Genetic components. HLA DQB1.
Cataplexy
sudden muscle weakness
Restless leg syndrome
1. Primary VS secondary causes
RLS - uncomfortable urge to move the limbs. Can manifest as pacing, tossing and turning, rubbing the legs. Urge worsens at night and improve with activity.
1. Primary - thought to have a genetic component
2. Secondary - Iron deficiency, neurologic disease, pregnancy, uremia, and medications.
HLA
Human leukocyte antigen
Central VS obstructive sleep apnea
Central sleep apnea is rare. It is characterized by cessation or decline in ventilation during sleep often resulting in desaturation.
OSA - upper airway obstruction (tongue or other structure) results in decreased airway clearance. There is no decline in respiratory function. Results in excessive daytime sleepiness, snoring, frequent wakings during the night, morning headaches.
What problems can sleep apnea lead to?
- Sexual impotence - related to decreased sleep.
- Systemic hypertension - increased sympathetic activity
- Pulmonary hypertension - increased sympathetic activity
- Polycythemia - the body recognizes the decrease in oxygenation and produces more RBC to compensate and carry oxygen to prevent this issue.
Parasomnias
Nightmares
Sleepwalking
Teeth grinding
Enuresis
Sleep terrors
Sleepwalking
1. Who is most commonly affected?
2. What part of sleep does it occur?
1 Most commonly occurs between the ages 5-12 in children.
2. Occurs in NREM sleep, stages 3-4.
Nightmares VS sleep terrors
Nightmares - vivid and terrifying nocturnal episodes. Occur most commonly in REM sleep.
Sleep terrors - repeated episodes of awakening for slow-wave sleep.
Enuresis
Bed wetting - child is unaware of it happening.
Acetylcholine
1. Proposed action
2. Psychiatric disorders associated
- A neurotransmitter that plays its role in excitation or inhibition and learning and memory.
- Neurocognitive disorders (NCD)
Dopamine
1. Proposed action
2. Psychiatric disorders associated
- Involuntary motor movement, mood, reward system, judgement
- Schizo, mood disorders, anxiety, SUD, NCD
Norepinephrine and Epinephrine
1. Proposed action (psych related)
2. Psychiatric disorders associated
- Learning and memory and reward systems
- Mood disorders and anxiety disorders
Serotonin
1. Proposed action
2. Psychiatric disorders associated
- Appetite, sleep, mood, hallucinations, pain preception
- Schizo, mood disorders, anxiety, NCDS
Enkephalins
Endogenous opioids - play a role in pain reception
Schizophrenia
1. What is it?
2. Onset and who most commonly affected?
3. What structures are affected by schizo?
- Chronic disorder of disconnection between thought and language. Affects how people think, feel, perceive, and behave in the environment.
- Typically affects men and women equally. Onset between 17 and 25 years of age. A first degree relative with schizo increases familiar risk by 10 fold.
- Schizophrenic patient’s brains have abnormalities that can be seen on diagnostic imaging. Overall there is a loss of gray matter, shrinking of the frontal and temporal lobes, many other changes are seen too.
Positive VS Negative symptoms of schizophrenia
Positive/ Negative - reflects the presence or the absence of abnormal behavior.
Positive:
- Hallucinations
- Delusions
- Incomprehensible speech
- Catatonic behavior
- Enhancement or blunting of senses
- Sensory overload due to loss of ability to screen stimuli
Negative:
- Lack of normal social and interpersonal behaviors
- Alogia
- Avolition
- Apathy
- Affective flattening
- Anhedonia
Neologisms
Using invented words
Derailment
Loose associations
Tangentiality
Inability to stick to the original point
Incoherence
Loss of logical connections
Word salad
Groups of disassociated words
Alogia
Tendency to speak very little
Avolition
Lack of motivation for goal-oriented activity
Affective flattening
Lack of emotional expression
Anhedonia
Inability to experience pleasure in things that are normally pleasurable
How is schizo diagnosed?
Two or more of the following must be present of about a month.
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
Catatonic excitement
Hyperactive, purposeless activity with abnormal movements
Echopraxia
Imitation of another person’s movement
Stereotypy
repetitive, idiosyncratic movements
Pharmaceutical treatment of Schizophrenia
- Typical antipsychotics - more effective on the positive symptoms of the illness. Haloperidol. thioxanthenes.
- Atypical antipsychotics - more effective in treating the negative symptoms of schizo, can produce extrapyramidal effects.
Depression
1. Depression is the first manifestations of this other psychiatric disorder.
2. What neurotransmitter is associated with depression?
A mood disorder characterized by pessimistic sense of inadequacy and despondent lack of activity.
- Adolescents who are diagnosed with depression have a 20-40% chance to develop bipolar disorder within 5 years.
- Lack of serotonin
Mania
Extremely elevated mood, energy, and thought patterns
Affective disorders
1. Who is most commonly affected?
Mood disorders:
A. Depression
B. Mania
1. Women are twice as likely to be affected.
What are the two classifications of major depression? What are their differences?
- Unipolar - persistent unpleasant mood
- Bipolar - alternating episodes of depression and mania
How is unipolar and bipolar illness treated?
Antidepressants
Electroconvulsive therapy
Lithium
Anticonvulsants
Psychotherapy
Panic disorder
Recurrent unexpected surges of fear and intense discomfort accompanied by physical or behavioral symptoms
OCD
Need to repeat distressful, uncontrollable thoughts (obsessions) and behaviors (compulsions)
Social anxiety disorder
Symptoms of anxiety and fear with any social interactions
Mesolimbic dopamine system
Associated with the addiction. The MDS helps regulate biological drives and motivation.
How is addiction treated?
Biologically, behaviorally, and psychosocially
Drugs commonly used to treat opiate addiction
- Methadone - opiate
- Buprenorphine
- Naltrexone
Dementia
Progressive failure of cerebral functions that is not caused by an impaired LOC. Impairs short- and long-term memory.
Types of dementia
- Alzheimer - thinking that problem is something to do with the BBB
- Vascular - symptoms caused by reduced blood flow to the brain
- Frontotemporal dementia
- Creutzfeldt-Jakob - prion infection
- Wernick-Korsakoff
- Huntington - autosomal dominant disorder affect chromosome
Neurofibrillary tangles and Senile plaques Amyloid
Found postmortem in Alzheimer patients.
Initial changes with Alzheimer disease
- More forgetful
- Mild personality changes
- Short-term memory loss
Moderate Alzheimer disease
- Impairment of cognitive functioning
- Extreme confusion, poor ADLs, disorientation
Late Alzheimer’s disease
Cannot interact with the environment
Wernicke-Korsakoff Disease
1. Seen with what patient population
2. Cause?
3. Symptoms?
- Chronic alcoholics
- Caused by nutritional deficiencies - thiamine
- Symptoms -
- Weakness
- Paralysis
- Nystagmus
- Ataxia
- Confusion
