Exam 2 Flashcards
According to the DSM V, when a person has experienced trauma, they have been exposed to a traumatic event where they experience, witness, or are confronted with ___, ___, or ___. The person responds with ___, helplessness, or horror. Children may respond by feeling disorganized or agitated.
Death/threated death; serious injury; threat to physical integrity; fear.
What are some common traumatic events?
MVA, natural disasters, sexual assault, childhood sexual abuse, domestic violence, combat, elder abuse, homicide, suicide of a loved one
What are the three parts of the practical definition of trauma?
- Non-consensual
- Victim is in discomfort, fear, feels intimidated
- Bodily integrity is threatened
What is a statutory offense where the offender knowingly causes another person to engage in unwanted sexual acts by force or threat of force?
Rape/sexual assault
What is the prevalence of sexual assault in the US (women/men)?
Women: 22%
Men: 3.8%
What is any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation OR an act or failure to act which presents an imminent risk of serious harm?
Child abuse
More than ___ children die every day as a result of child abuse. The vast majority are under age ___.
5; 4
What is the prevalence of child sexual abuse (women/men)?
Women: 16.8%
Men: 7.9%
What is a violent confrontation between family or household members involving physical harm, sexual assault, or fear of physical harm?
Intimate partner violence
Nearly ___ of women in the US reports experiencing violence by a current/former spouse or boyfriend in her lifetime.
1/4
On average, greater than ___ women are murdered by their husbands or boyfriends in the US.
3
Men who have witnessed their parents’ domestic violence are ___ times more likely to abuse their own partners.
2
More than ___% of batterers also abuse their children or their victim’s children.
50
What is the physical, sexual, or emotional abuse of an elderly person, usually one who is disabled and frail?
Elder abuse
___% of older people reported significant abuse in the last month.
6
___% of vulnerable elders reported significant levels of psychological abuse.
25
___% of family caregivers reported physical abuse towards care recipients with dementia in a year, and 1/3 reported significant abuse.
5
___% of care home staff admitted significant psychological abuse.
16
___% of men and ___% of women have been exposed (either as soldiers or civilians).
10-20; 2-10
The rate of ___ and MVA are now equal as the leading cause of non-medical deaths in the US.
Firearms
Describe the cycle of trauma.
Childhood traumatic stress -> Adult traumatic stress -> Toxic stress in the community (repeat)
Describe the stress response in the body.
- Amygdala senses threat
- Hypothalamus releases corticotropin-releasing hormone
- Pituitary releases adrenocorticotropic releasing hormone
- Adrenal cortex releases glucocorticoids (including cortisol)
- Sympathetic nervous system stimulates fight or flight response
In PTSD, individuals begin to generalize their fear responses to situations that once felt safe. What happens as a result?
The amygdala can no longer discern threatening from safe stimuli and the SNS and HPA axis become chronically activated.
Describe the utilization of preventative care by trauma survivors.
Trauma survivors are less likely to use preventative care.
What is secondary victimization?
Victimization which occurs through the response of institutions and individuals to the victim
What is trauma-informed care?
Every part of an agency or institution understands the effects of traumatic events, sensitively interact with trauma survivors, avoid re-traumatization, and engage in trauma screening and prevention as appropriate
Describe the trauma-informed care pyramid.
- Patient-centered communication skills
- Understanding the health effects of trauma
- Collaboration and understanding your professional role
- Understanding your own history
- Screening
When should screening occur?
- High risk environments
2. Acute injuries
What are the general categories of adverse childhood events?
- Abuse (physical, emotional, sexual)
- Neglect (physical, emotional)
- Household dysfunction (mental illness, incarceration, mother abused, substance abuse, divorce)
What are the two major findings of the ACE study?
- ACEs are more common than anticipated or recognized.
2. ACEs have powerful correlations to health outcomes later in life.
___ of study participants reported at least one ACE. More than 1 in 5 reported 3+ ACEs.
~2/3
ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into what three things?
- Organic disease
- Social malfunction
- Mental illness
Describe the mechanism by which ACEs influence health and well-being throughout the lifespan.
- ACE
- Disrupted neurodevelopment
- Social, emotional, and cognitive impairment
- Adoption of health-risk behaviors
- Disease, disability, and social problems
- Early death
Describe the two syndromes involved in Selye’s Stress Response Theory.
- Localized Adaptation Syndrome (LAS) - regional response, localized inflammation
- Generalized Adaptation Syndrome (GAS) - backup for LAS, system-level response to stressor that has overwhelmed current adaptive resources.
What is GAS and when does it occur?
Manner in which the body copes with stress; occurs when homeostasis is overwhelmed
What are the three stages of GAS?
- Alarm
- Resistance
- Exhaustion
What are the two parts of the Alarm stage of GAS?
- HPA axis
2. SNA suppression
What are the two parts of the Resistance stage of GAS?
- Decreased alarm reaction
2. Attempts to coexist with stressor
What are the three parts of the Exhaustion stage of GAS?
- Increased endocrine activity
- Continued high cortisol circulation
- Wear and tear or death
What is an allostatic load?
An allostatic load is the “wear and tear” on the body which grows over time when the individual is exposed to chronic stress.
Describe the allostatic load theory.
In the short term, allostasis is essential for survival/maintenance of homeostasis. In the long term, it exacts a cost and can accelerate disease processes.
How is the allostatic load measured?
Measured as a chemical imbalances in the ANS, CNS, neuroendocrine, and immune system activity, daily anxiety, an, in some cases, plasticity changes to the brain structures
What are the four types of allostatic loads?
- Repeated hits
- Lack of adaptation
- Prolonged response
- Inadequate response
What is a criticism of the GAS theory?
Did not take into account cognition, perception, and interpretation of the stimulus
Describe Walter Cannon’s theory of stress.
Behavior and emotions + autonomic and endocrine regulation = homeostasis
Describe the Schacter and Singer theory of stress.
Cognitions and perceptions shape emotions (emotional biasing)
Describe Richard Lazarus’s theory of stress.
Role of perception in the stress response - primary/secondary appraisals
How does the transactional model define stress?
Process of interchange between an organism and its environment that involves self-generated or environmentally-induced changes that, once they are perceived by the organism as exceeding available resources, disrupt homeostatic processes in the organism-environmental system.
What are some medical conditions related to stress?
- Wound healing and surgical recovery
- GI disorders
- Pain
- Asthma
- Addiction
- Trauma and Stress-related disorders like PTSD
Why might women report feelings of stress more often?
- React to a wider range of stressors
- Often have 2 jobs
- Tend to internalize stress
How do men tend to handle stress?
Men tend to externalize stress
Perceived ___ is a key factor in chronic stress-related health disparities.
Discrimination
What is one of the most powerful health predictors?
SES (direct linear correlation)
What are the 4 R’s involved in trauma-informed care?
- Realize the widespread impact of trauma
- Recognize the signs and symptoms of trauma
- Respond by fully integrating knowledge about trauma into policies, procedures, and practices
- Resist Re-traumatization
What are some ways to assess health disparities/inequality?
Race/ethnicity, gender, SES, disability status, LGBT status, geography
Describe the trend of life expectancy at birth by sex and race.
Highest life expectancy: white female -> black female -> white male -> black male: lowest life expectancy
What is a disparity?
A difference; two quantities are not equal
Inequalities in health are based on observed ___ in health.
Disparities
Inequities in health are based on ___.
Ethical judgments
We can measure ___ in health status between groups. However, social and political discourse is required to asses ___.
Disparities; inequities.
Health care is a matter of ___, not ___.
Equity; equality
What is any degree of uncertainty a physician may have relative to the condition of the patient?
Clinical uncertainty
If the physician has difficulty accurately understanding the symptoms, what happens?
The physician is likely to place greater weight on the prior beliefs about the likelihood of patients’ conditions that will be different according to age, gender, SES, race, or ethnicity.
What is stereotyping?
The beliefs (stereotypes) and general orientations (attitudes) that people bring to their interactions help to organize and simplify complex or uncertain situations and give perceives greater confidence in their ability to understand a situation and respond effectively.
Health disparities are driven by ___.
Social and economic determinants
What are some social and economic determinants of health disparities?
Economic determinants, education, geography and neighborhood, environment, stress, lower-quality care, inadequate access to care, inability to navigate system, provider ignorance or bias
What are some of the major steps health care organizations need to take to reduce disparities?
- Recognize disparities and commit to reducing them (explore performance data, disparities training)
- Implement a basic quality improvement structure and process upon which to build interventions (culture of quality, set goals, obtain support from top admins)
- Make equity an integral component of quality improvement efforts
- Design the intervention(s)
- Implement, evaluate, and adjust the interventions
- Sustain the interventions
What are the six levels of influence?
Patient, provider, microsystem, organization, community, policy
What is one example of an implementation model?
Consolidated Framework for Implementation Research (CFIR)
What are the 5 domains of the CFIR?
- Intervention characteristics
- Outer setting
- Inner setting
- Characteristics of the individuals involved
- The process of implementation
Caring, committed relationships (family or friends) are health-____.
Producing
What is the WHO definition of health?
State of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
According to a BYU study, lack of social connections risk…
…equivalent to smoking 15 cigarettes a day, equivalent to being an alcoholic, more harmful than not exercising, twice as harmful as obesity.
What were the strongest social predictors of likelihood of post-open heart surgery survival?
- Those who were active in their community
2. Those who found strength and comfort in their religious faith
What is social support and what are the 4 types?
The presence of others or the resources they provide
Emotional, Spiritual, Physical, Financial
What qualities of social support are likely to impact health?
- Number of support persons
- Availability and access to support
- Quality of support system (satisfaction gained)
___ and loneliness create responses in the human body similar to those of stress.
Isolation
Male medical students/physicians are ___% more likely to commit suicide.
40
Female medical students/physicians are ___% more likely to commit suicide.
130
___ doctor per day commits suicide.
1
___% of medical students will experience clinical depression.
30-40
___ medical students harbor active suicidal thoughts.
1 in 10
What are possible direct and indirect mechanisms for the positive effect of social interaction?
Direct: immune function, increased catecholamine and inflammatory cytokine release
Indirect: resources of the social network buffer the impact of the disease process
Those with a higher loneliness rating are more likely to develop ___ problems.
Cognitive
The loneliest 10% of a study were more than twice as likely to develop ___.
Alzheimer’s
True or false - social networks have the same protective impact as real relationships.
False
___ is most predictive of depression.
Marital status
Why is marital status predictive of depression?
People who are single may:
- Eat less healthily
- Consume more alcohol
- Smoke more cigarettes
- Less preventative medicine visits
- Work longer hours
What is one of the single most powerful predictors of physical and emotional illness?
Divorce
Patients who interact with patients in a ___ manner make more accurate diagnoses and produce greater patient copmliance.
Compassion
How does faith help people cope with health-related stress?
Hope, control, strength, meaning, purpose
What are the three components of Freud’s structural model of the psyche?
- Id (biological urges, instincts, seeks to maximize pleasure)
- Ego (realistic thinking, postpone pleasure until appropriate, mediates id and superego)
- Superego (values, conscience, how the ego should behave)
What operates according to the pleasure principle? The reality principle?
Id; ego
What are unconscious mechanisms by which ego wards off anxiety and controls unacceptable instinctual urges and unpleasant affects or emotions by manipulating, distorting, or denying relatiy?
Defense mechanisms
When does a defense mechanism become pathological?
When its persistent use leads to maladaptive behavior such that the physical or mental health of the individual is adversely affected
What is denial?
Primitive defense to avoid pain or anxiety; reality is refused in favor of internally generated, wish-fulfilling fantasies
What is projection?
Falsely attributing your own unacceptable feelings, impulses, or thoughts to someone else
Projection is most typical of…
…physical and sexual impulses
What is regression?
Method of escaping anxiety by returning to an earlier level of adjustment during which gratification was ensured
What is identification?
Some traits or attributes of another person are taken as your own
What is repression?
Memories, feelings, and drives associated with painful and unacceptable impulses are excluded from consciousness
What is reaction formation?
Managing unacceptable thoughts, feelings, or behaviors that are opposite
What is isolation of affect?
Separating ideas from feelings originally associated with them; emotional component of idea is repressed while the cognitive component remains conscious
What is intellectualization?
Shifts emphasis from immediate interpersonal conflict to abstract ideas and esoteric topics; avoid painful feelings by focusing on ideas
What is displacement?
Redirecting an emotion from its original target to a more acceptable substitute; most commonly involves anger
What is sublimation?
Divert unacceptable drives into socially acceptable channels
What is altruism?
Kindness, concern for the welfare of others; adaptive against feelings of inferiority, lack of fulfillment; helps alleviate feelings of isolation, lack of significance
What is suppression?
Conscious decision to postpone paying attention to an unpleasant subject, impulse, or conflict
What is the only conscious defense mechanism?
Suppression
What is humor?
Unconscious or forbidden feelings are expressed via socially acceptable outlets; joking in effort to lighten and diffuse a tense or sad situation
What are the four levels of Valliant’s classification of defense mechanisms based on effectiveness?
- Level I - pathological defenses (psychotic denial, delusional projection)
- Level II - immature defenses (fantasy, projection, passive aggression, acting out)
- Level III - neurotic defenses (intellectualization, reaction formation, dissociation, displacement, repression)
- Level IV - mature defense (humor, sublimation, suppression, altruism)
What is transference?
Patient unconsciously transfers feelings and attitudes from a person or situation in the past onto a person or situation in the present.
True or false - transference is conscious.
False - it is unconscious
True or false - transference is at least partly inappropriate to the present situation.
True
True or false - transference is the transferring of a relationship dynamic.
True
True or false - transference involves transfer of the entire relationship.
False - it involves one aspect of it
What are four factors that increase transference?
- Vulnerable personality (impulsive, little capacity for reflection)
- Rigid expectations
- Anxiety about physical or psychological safety
- Frequent contact with physciian
What is countertransference?
Physician unconsciously transfers feelings and attitudes from a person or situation in the past onto a patient.
What is shame?
Painful feelings caused by the lowering of one’s pride, self-respect, or self-concept; note that shame is that state of the self, humiliation is a temporary status of self
What are physical, behavioral, and cognitive manifestations of shame?
Physical: blushing, sweating, freezing, fainting, sense of weakness
Behavioral: urge to hide or disappear, break eye contact, anxious laughter, withdrawal, avoidance
Cognitive: feeling defeated, exposed, deficient, a failure, inadequate, worthless, wounded
What are examples of shame-inducing events in the medical setting?
- Examining physical and psychological deficits
- Treatments with side effects
- Dying with(out) dignity
- Fear of stigmatization (perception of low status, poor living conditions, bad choices, character defects, failures)
- Fear of alientating others
- Medical terms
What are some patient vulnerabilities in the medical setting?
- Need to be strong and powerful
- Need to succeed/win
- Need to be clean and tidy
- Need to be whole and complete in physical and mental makeup
- Need to be in control of bodily functions and feelings
What are some variables that influence shaming experiences?
- Who is perceived as doing the shaming?
- What is the nature of the communication?
- What is the nature of the social event?
What are some adaptive reactions to shame in the medical setting?
- Response appears and disappears within seconds
- Strengthening of vulnerable aspects of self
- Humor, laughter
What are some maladaptive reactions to shame in the medical setting?
- Becoming subdued, withdrawn
- Lying, withholding information
- Counter humiliating
- Long lasting grudges
- Avoidance of future appointments, changing doctors
- Seeking care away from community
- Complaining, speaking to patient care representative
- Suing
True or false - more women than men experience shame.
True
What are the three most frequent shaming topics?
Sexual behavior, teeth, and weight
When patients condemned themselves, the reactions were ___. Reactions were ___ when patients condemned the behavior.
Negative; positive
What are three purposes of emotions?
- Prepare us for actin
- Communicate to others
- Communicate to ourselves
What are four evolutionary functions of emotion?
- Fear
- Anger
- Shame
- Guilt
What is validation?
Communicating to a person that his/her experience makes sense; informs a person that you understand the reason for his/her emotion; is not agreement
What is stating an opinion instead of listening?
Counter-argument
What are why/how/what questions?
Interrogation
What demands behavior change?
Command
What focuses on one’s own point of view instead of the patient’s?
Evading/missing/avoiding
Misuse of and addiction to alcohol, nicotine, and illicit/prescription drugs cost Americans more than ___/year in increased health care costs, crime, and lost productivity.
$700 billion
Every year, illicit and prescription drugs and alcohol contribute to the death of more than ___ Americans, while tobacco is linked to an estimated ___ deaths/year.
90,000; 480,000
Describe the DSM-IV’s definitions of substance-related issues.
- Substance use: maladaptive pattern of use leading to clinically significant impairment or distress (12 month period, occurs 1x)
- Substance dependence: same definition, occurs 3x with tolerance and withdrawal
Describe the DSM-V’s definitions of substance-related issues.
No longer uses substance use/dependence. Instead, it refers to substance use and addictive disorders, which are defined as mild, moderate, or severe.
What are the four major categories looked at when diagnosing a substance use disorder (SUD)?
- Impaired control
- Social impairment
- Risky use
- Pharmacological criteria
To be diagnosed with a SUD, one needs to have 2 of the following criteria within a 12-month period:
- Substance taken in larger amounts or over a longer period than intended
- Persistent desire or unsuccessful effort to cut down or control use
- Great deal of time spent in activities necessary to obtain/use/recover from the substance
- Craving
- Recurrent use of substance results in failure to fulfill major obligations
- Continued use of substance despite persistent problems
- Important activities are given up/reduced because of use
- Recurrent use of substance in situations which are hazardous
- Use continues despite knowledge of a problem
- Tolerance
- Substance is taken to relieve/avoid withdrawal
What is a need for markedly increased amounts of a substance to achieve intoxication or desired effect/a markedly diminished effect with continued use of the same amount of substance?
Tolerance
What is withdrawal?
The characteristic withdrawal syndrome for that substance as specified in the DSM-5
___ adults had a substance use disorder when asked about the past year’s use.
20.2 million (8.4%)
Of these, 7.9 people also had…
…co-occurring mental and substance use disorder.
True or false - Men aged 12 or older are more likely than women to report illegal drug use.
True
___% of people with SUDs start using the substance before age 18.
90
What are the three risk factor categories for SUDs?
- Biological (genetics, neuroanatomy)
- Environmental (social)
- Psychological (trauma, learned behavior)
What are 4 psychological risk factors?
- Mental illness (self-medication)
- ADHD
- Low self-esteem/self-worth
- Trauma
If you have a parent with an alcohol-use disorder, you are ___ times more likely to have one.
4
What are the functions of the dopamine pathway?
Reward, pleasure, motor function, compulsion, perseveration
What are the functions of the serotonin pathways?
Mood, memory processing, sleep, cognition
What are some environmental risk factors?
- Familiar, social, cultural normalization
- Peer pressure
- Interpersonal violence
- Directed advertisement
What are some of alcohol’s impacts on health?
- Heart health (alcoholic cardiomyopathy, arrhythmias, strokes, hypertension)
- Pancreas (pancreatitis)
- Cancer
- Immune system
- Liver failure
- Head injuries from falls
- Korsakoff Syndrome
- Toxic effect on brain cells
- Biological stress of repeated intoxication/withdrawal
- Cerebrovascular disease
What happens when mixing Tylenol with alcohol?
Liver failure
What happens when mixing alcohol and sedatives?
Multiplication of sedative effect
What is a peripheral neuropathy related to lack of Vitamin B?
Korsakoff syndrome
What are some of the health effects of heroin/opiates?
Physical complications due to neglect, infection
What are some of the health effects of cocaine?
Cardiovascular disease, destruction of nasal tissue
What are some of the health effects of methamphetamine?
Literally everything
What are some of the health effects of inhalants?
Varied effects - increase/decrease HR, headache, dizziness, loss of sense of smell, pain at nose/mouth, lung collapse, confusion
What are some of the health effects of nicotine?
90% of long cancer deaths, 80-90% emphysema, cancers
What are some of the health effects of ecstasy?
Liver damage, anxiety disorders, irregular heartbeats, brain damage, depression, confusion, paranoia
___% of older women misuse prescribed medications.
10
What are some examples of the impact of drugs on others?
- Prenatal drug exposure
- Secondhand smoke
- Spread of infectious disease
What are some treatment options?
- Early intervention
- Outpatient treatment
- Intensive outpatient/partial hospitalization
- Residential/inpatient treatment
- Medically managed intensive inpatient
What are some types of behavioral and cognitive treatments and what are the goals?
Types: motivational interviewing, cognitive therapy, contingency management, relapse prevention
Goals: modify attitudes/behaviors, strategies to plan for triggers and/or relapse, increase life skills, coping techniques
What is the function of the medication ondansetron (zofran)?
Decreases craving
What is the function of the medication Zyban (buproprion)?
Reduces cravings and other withdrawal effects
What is the function of the medication chantix?
Produce more dopamine; best when combined with the patch
What is the function of the medication Naltrexone?
Blocks receptors for getting high
What is the function of the medication Disulfiram (antabuse)?
Addresses alcohol-use disorder
What are some examples of harm reduction practices?
- Needle exchanges
- Methadone maintenance (synthetic form of heroin)
- Buprenorphine (reduces likelihood of overdose)
- Suboxone (buprenorphine + naloxone)
What are some examples of holistic treatments?
Herbal remedies, St. John’s Wort, hypnosis, acupuncture, massage therapy, physical exercise to reduce tension
What is the CAGE screening for?
Alcohol-use:
Have you ever felt the need to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Eye-opener?
What is the TWEAK screening for?
Alcohol-use during pregnancy:
Tolerance Worried Eye-opener Amnesia Kut Down
What is the AUDIT screening for?
Alcohol Use Disorders Identification Test
What is the MAST screening for?
Michigan Alcoholism Screening Test
What is the DriInC assessment for?
Drinker Inventory of Consequences
What is the SASSI assessment for?
Substance Abuse Screening Inventory
Everyone has a sexual orientation, a gender ___, and a gender ___.
Identity; expression
What are the three components of sexual orientation?
- Identity
- Attraction
- Behavior
Define identity as it relates to sexual orientation.
How a person defines or labels their sexuality
Define behavior as it relates to sexual orientation.
The gender of a person’s sexual and romantic partners; sexual identity may not always align with sexual behaviors
Define attraction as it relates to sexual orientation.
Refers to the genders a person is attracted to; does not always align with behavior or identity
What is a person’s internal sense of being a man/male, woman/female, both, neither, or another gender?
Gender identity
What is the manner in which a person represents or expresses their gender identity?
Gender expression
When a person’s gender identity correspond with their assigned sex at birth, this is termed ___.
Cisgender
When aa person’s gender identity, expression, or behavior is different from those typically associated with their assigned sex at birth, this is termed ___.
Transgender
People assigned male sex at birth but who identity as female may call themselves…
Transgender women, trans women, male-to-female persons, women, or another term
People assigned female sex at birth but who identity as male may call themselves…
Transgender men, trans men, female-to-male persons, men, or another term
What describes the period during which a transgender person begins to express their gender identity?
Transitioning
What percentage of people self-identify as LGB in the US?
2.2-4%
What percentage of people self-identify as transgender in the US/
0.6%
LGBQ persons experience higher rates of ___ and ___ than do heterosexual peers.
Victimization; violence
Who experiences the highest rates of violence and victimization?
Transwomen
What are primary drivers of LGBTQ health disparities?
Stigma, discrimination, and inequality
What are the three aspects of the cross-cultural interview?
- Respect
- Curiosity
- Empathy
What happens to the ANS, body temperature, and respiration during sleep?
ANS - parasympathetic dominates
Body temperature: lower set-point
Respiration: decreased ventilation
All mammals have ___ sleep.
NREM/REM
What is one of the most important determinants of sleep?
Age
What is the ratio of REM:NREM in infants and adults?
Infants: 50:50
Adults - 20-25:75-80
SWS declines most significantly at what age?
Second decade
__ sleep increases to adult level 45-55%.
Stage 2
Describe normal sleep in children.
Sleep Onset REM Periods (SOREMs) until 3 months old; NREM stages 3-6 months
Describe normal sleep in adults.
Sleep entered through NREM sleep; REM cycles every 90-120 minutes
When does NREM predominate? REM?
NREM sleep predominates in first half of sleep and is linked to prior level of wakefulness. REM predominates in last half of sleep and is circadian linked.
Describe the homeostatic sleep drive model.
Sleep responses are proportional to the duration of prior wakefulness; increased sleepiness, increased sleep, increased depth/maintenance of sleep
What is a circadian rhythm?
When isolated from time cues such as sunlight, most creatures show intrinsic rhythms of nearly, but rarely exactly, 24 hours.
What generates circadian rhythm?
Circadian pacemaker located in the suprachiasmatic nuclei (SCN) of the hypothalamus
What is the biological clock?
SCN
Circadian rhythms are involved in what functions?
Wake/sleep, hormonal, temperature, immune, drug metabolism, renal function, airway function, cardiovascular activity, hematology, neoplastic cells
How are circadian rhythms synchronized to the external environment?
Entrainment
How is entrainment done?
Through presentation of stimuli that signals the time of day (Zeitgebers)
What is a Zeitgeber?
Any stimulus capable of shifting the phase of the circadian clock in a systemic manner
What is it called when individuals run on their own intrinsic clock?
Free run
Describe the Two Process Model of Sleep Regulation.
- Process S is homeostatic, increasing sleep pressure with increased time awake.
- Process C is circadian
S is built up over the day; C is high before you fall asleep and low during sleep
What are the primary determinants of sleepiness?
- Circadian
- Homeostatic
- Age
- Other - drugs, sleep disorders
What is the Epworth Sleepiness Scale (ESS)?
0 = no chance of dozing 1 = slight chance 2 = moderate chance 3 = high chance
What are the stages of sleep?
- W (Wakefulness)
- NREM (N1, N2, N3)
- R (REM)
What is the Multiple Sleep Latency Test (MSLT)?
Tests the underlying physiologic tendency to fall asleep during usual waking hours
What is the Maintenance of Wakefulness Test?
Tests the patient’s ability to stay awake
How long must insomnia be present to be diagnosed?
At least one month
What are the symptoms of obstructive sleep apnea?
Loud snoring, observed apneas, daytime sleepiness, morning sore throat/headache, elevated BMI, crowded oropharynx, hypertension
How is obstructive sleep apnea diagnosed?
Polysomnography
What is the etiology of sleep apnea?
Narrowing or occlusion of the upper airway during sleep
How is sleep apnea treated?
CPAP (continuous positive air pressure)
Describe URGES (Restless Leg Syndrome).
U: Unpleasant limb sensation with urge to move R: symptoms precipitated by rest G: better with movement (Getting up) E: symptoms worse in Evening/night Sleep disturbance and consequences
What are some symptoms of narcolepsy and their prevalence?
Excessive daytime sleepiness (100%)
Cataplexy (70%)
Hypnagogic hallucinations (66%)
Sleep paralysis (60%)
What are disorders that intrude into the sleep process and are not primarily disorders of sleep and wake state; undesirable physical events or experiences that arise from sleep or sleep-wake transition.
Parasomnias
