Psychosocial test 2 Flashcards
Addiction
Repeated involvement with a substance or activity, despite current harm, because the substance or activity is pleasurable or valuable
“Addictive Personality”
not a diagnosis, an indicator. think addictions –>concern for substance abuse
Impulsivity
Sensation-seeking
Nonconformity to social standards
Social alienation and tolerance for deviance(may not fit into society and ok with others who are)
Heightened stress with poor coping skills (situations other would find tollerable)
substance abuse qualities
Impaired Control (doesnt feel in charge)
Social Impairment (causes)
Risky Use Patterns (even when know dangerous)
Pharmacological Indicators
substance abuse: social impairment
Substance use despite interference with work, social, or family obligations (missing work, isolation, loss of income)
Interpersonal impairment (fighting, withdrawal from social groups or hobbies)
substance abuse -Risky Use Pattern
Continued use in risky circumstances (driving, operating machinery, business transactions)
Continued use despite physical, medical, or financial impairments resulting from use. can include losing a job or cirrhosis.
Sleep Cycles
Proceed through stages of brain activity measured by EEG
REM - brain activity increased, physical paralysis
NREM - “deeper” stages of sleep characterized by increasing amounts of delta wave activity
“Average” adult sleep cycle is approximately 90 minutes
REM Sleep
“Rapid Eye Movement” Sleep
Lighter stage of sleep with dreams, partial or complete physical paralysis
Contributes less to feeling of restful sleep
Non-REM Sleep
Characterized by increasing delta wave frequency
Associated with increased feeling of restfulness
Divided into three, increasingly “deep” stages
How Other Creatures Sleep
Length of sleep cycle varies among species, roughly correlated with metabolic rate
Faster metabolism = shorter sleep cycles (high=short ex:rats)
Most animals have REM and NREM cycles
hemispheric sleep, can you see rem sleep in pets?
fish/some land animals, sleep one hemisphere at a time so that one half of brain is awake and aware (for possible risk). rem sleep: yes (when animals react to stuff not there when sleeping, dreams maybe)
what phase is the theta wave and what stage is the sleep spindkle and k complex and what state is the detla waves and how does rem sleep differ
theta waves = stage one, sleep spindle and k complex = stage 2 , stage 3 or 4 is delta waves, rem sleep is restful looks like awake
Insomnia
Dissatisfaction with quantity or quality of sleep
May be initial, middle, or late in sleep cycle
Non restorative sleep - complaint that the person does not feel rested upon awakening
May be associated with physical or other psychiatric disorders
pt says” cant sleep” : ask questions? challges: falling asleep, staying asleep, restlesness, pattern of where issue is this clues into what’s going on?
what disorders relate to falling asleep? aka sleep latency
normal is 30 minutes or less,
psychiatric disorders, such anxiety.
insomnia disorder qualifications
at least three nights a week for three months, causes distress or impairment, may not be explained by coexisting mental disorder
early wake sleep disorder associated with
major depressive disorder
sleep and wake up odd times?
dimensia or alzheimer disorder. loss of sarcadium rythuym.
Insomnia Disorder generally
Dissatisfaction with quantity or quality of sleep that may be:
Difficulty initiating sleep
Frequent awakenings or problems returning to sleep after awakening
Early awakening with problem returning to sleep
At least three nights a week for three months
Causes clinically significant distress or impairment
Not fully explained by a coexisting mental disorder
Differentials to Consider of insomnia disorder
Normal variations - age related changes, situational variables
Circadian disturbances - late shift work, day-night reversals
Medications, drugs, or beverages (a sign can be weight gain or loss)
shift jobs may cause sleep disterbences, meds/drugs/beverages/food can affect sleep.
Hypersomnolence Disorder
Excessive sleepiness despite adequate sleep time (7 hours)
Recurrent sleep periods during the day or slow awakening (fall asleep easily at wrong times)
Three times per week for three months
Not related to another sleep disorder or substance use
Sleep Disorders names
Insomnia/Hypersomnia
Narcolepsy
Breathing-related sleep disorders
Parasomnias
what psych disorder relates to poor sleep
most of them. major depress other psych, treat by hyponotic meds.
Narcolepsy
Sudden!! and recurrent episodes of an irrepressible need to sleep!!! can be driving a car or any activity–>during the day accompanied by two of the following:
Cataplexy - sudden loss of muscle tone with full consciousness, frequently precipitated by laughter (goes limp and fall, may have a cry before this)
–>Hypocretin deficiency in CSF
Brief sleep latency on EEG
controling when falling asleep, not the latency, still sleep at night. (not from being tired)
Associated Features of narcolepsy
May appear “hazy” or like an automaton
Vivid hypnogogic (falling asleep) or hypnopompic (awakening) hallucinations (during twilight zone)
Vivid dreams or nightmares
Appears sleepy most of the time
During episodes of cataplexy, reflexes abolished
Obstructive Sleep Apnea
On polysomnography (sleep study) at least 15 episodes of apneas (=x breath) or hypopnea (shallow breath) accompanied by snoring, gasping, or breathing pauses Excessive daytime sleepiness, fatigue, or unrefreshing sleep
hallucinations during twilight zone
narcolepsy Vivid hypnogogic (falling asleep) or hypnopompic (awakening) hallucinations (during twilight zone)
crazy vivid dreams associated with
narcolepsy
pickwicks syndrome
dude who fell asleep in chairs, character in dickins story
Circadian Rhythm Disorders
Sleep disruptions due to misalignment between endogenous circadian rhythm and the person’s sleep-wake cycle
Frequently results from physical environment or social/work schedules
Leads to excessive sleepiness or insomnia
Causes clinically significant impairment
-pineal gland sends sleepy time melatonin to brain to say time to sleep–>if dont do this then can get cardadian rythm distrubance
can a circadian rythm disorder show up in another disorder?
yes! any social reason or other issues.
Parasomnias
Abnormal behavioral, experiential, or physiological events associated with sleep
Associated with both REM and NREM sleep
-while alseep, in REM sleep and NON rem.
NREM Arousal Disorders (non rem)
Associated with incomplete awakening, usually during the first one-third of the sleep cycle
Sleepwalking - rising from bed and walking around, staring gaze, minimally responsive, difficult to awaken (really asleep!)
Sleep terrors - abrupt awakening in terror, usually crying out, signs of intense fear, minimally responsive
Minimal recollection for dreams or events during episode
“stuck inbetween states–>sleep walking”
Sleepwalking
rising from bed and walking around, staring gaze, minimally responsive, difficult to awaken (really asleep!), Minimal recollection for dreams or events during episode
in a non normal stage of sleep, on eeg abnormal.
Sleep terrors
abrupt awakening in terror, usually crying out, signs of intense fear, minimally responsive
Minimal recollection for dreams or events during episode
in a non normal stage of sleep, on eeg abnormal.
REM Sleep Disorder
(last 15-20 miniutes of REM ~90 min sleep cycle), wake up with full awareness. REM sleep but brain =x send parylitic sleep muscle.
Repeated episodes of arousal during sleep with vocalizations or complex motor behaviors
Usually occur in last part of sleep cycle, 90 minutes or so after sleep onset
Upon awakening, person becomes completely alert and not confused or disoriented
Polysomnography reveals REM sleep without atonia
May occur in Parkinson’s Disease or other motor system diseases
sleep issue, if not medication related but meets sleep disorder then what is it?
primary sleep disorder
Restless Legs Syndrome
Urge to move the legs accompanied by uncomfortable and unpleasant sensations that:
Begins or worsens during rest or inactivity
Primarily or completely relieved by movement
Worse in, or exclusive to, evening or night
At least three times a week for three months
almost exclusively when going to sleep to interefere with this.
“Sleeping It Off”
Alcohol induces somnolence quickly followed by wakefulness, vivid dreams, and restless sleep
Reduces NREM sleep (stages 3-4) and increases REM sleep
Light, fragmented sleep may persist long after sobriety is established in chronic users
-helps fall alseep, but as liver processes to aldehydes =stimulating=hurts sleep, chronically=x REM=non rested=chronically sleepy)
Sexual Disorders - related to sleep, generally
Functional disorders
Gender Dysphoria
Paraphilias
Functional Sexual Disorders and how effects sleep
Delayed or Premature Ejaculation (male) Female Orgasmic Disorder Erectile Disorder Genito-Pelvic Pain/Penetration Disorder Hypoactive Sexual Desire Disorder
DO NOT ASSUME THAT THIS IS PRIMARILY A PSYCH DISORDER (maybe related to sleep meds or many disorders, and antidepressants)
Gender Dysphoria
Marked distress associated with incongruence between assigned gender and experienced or expressed gender
Strong desire to be rid of assigned gender
Strong desire for primary or secondary sex characteristics of experienced gender
Strong desire to be of experienced gender and be treated as such
Strong conviction that one has typical feelings and reactions of experienced gender
Significant emotional distress and functional impairment
-upset about dysphoria of gender qualifies this
Paraphilic Disorders
halmark of all of these–>illegal or culturally unacceptable. and is patients primary form of sexual arousal.
Voyeuristic Disorder - arousal from observing an unsuspecting person naked or engaging in sex
Exhibitionistic Disorder - arousal from exposing one’s genitals to an unsuspecting person
Frotteuristic Disorder - arousal from touching or rubbing against a non consenting person
Sexual Masochism Disorder - arousal from being humiliated or made to suffer
Sexual Sadism Disorder - arousal from inflicting physical or psychological suffering on another person
Paraphilic Daisorders
Pedophilia - arousal from fantasies or actions involving prepubescent children
Fetishistic Disorder - arousal from use or focus on nonliving objects or non-genital body parts
Transvestic Disorder - arousal from cross-dressing
“Other”
Fantasies and Arousal
Paraphilias involve both fantasies and actions
Involvement in these activities causes distress, interpersonal difficulties, and legal problems
Sexual fantasies tend to increase in complexity over time, with arousal or climax more difficult to reach without elaboration of fantasies
Voyeuristic Disorder
arousal from observing an unsuspecting person naked or engaging in sex
non rem vs rem sleep disorder
if non rem, can walk around. if rem then unilkely to walk because paraylitic signal sent.
drugs: statins side effects can have what kind of effect
insomnia
Physiological Impairment (of addictive personality)
Tolerance - requiring higher doses of substance to achieve desired effect or to avoid withdrawal
Withdrawal - physiological symptoms associated with reduction or cessation of substance use
what can help with sleep quality
consistency bed times and no tv while bed
patients measure sleep how
by hours
docs measure sleep by
different cycle, mostly by REM
impaired control for addictive personality
Use in larger amounts or for longer than intended
Unsuccessful attempts to cut down or stop
Spending excessive time obtaining, using, or withdrawing from substance
Intense cravings that occupy attention
frustration to family and substance runs their life
what can cause change in sexual disfunction
LPE, DM, HTN, cardiac, metabolic disorders etc.
antidepressants most common side effects
delayed ejaculation and ed –>cause interpersonal issues
Genito-Pelvic Pain/Penetration Disorder and how to find out ?
pain with penetration, can ask if side effect of drugs.
