Sullen v.5



Review a few things.. don't bother reading.

Monday, May 02, 2005

Corcadian rhythms "in a day"
Ultradian rhythms - 90 min. **low and high brain arousal
Role of thalamus - onset of sleep **relays info from most sensory
?hypothalamocortical loop - onsets sleeps and lowers attention to external stimuli*

superchiasmic nucles of the *hypo*thalamus - holds biological clock (regulates sleep/wake cycle)
RAS - onset/off REM sleep
Type of EEGs - Theta waves from hippocampus (what else??)
Delta waves.. Stage 3-4 .. Deep sleep
Non-Rem Stages 1-4 ... Rem = 5
Pattern??? Shallow to deep.. to shallow.. to deep.. to REM? (every 90 min = REM)
* Animal studies show that REM may advance learning (i.e. go to bed and wake up and they show more neuronal firing in area of previous task learning... like what may be lacking tomorrow for me..)
Other studies...Iraq?? show that when aiming.. ppl. who had not been interrupted in REM had better aim/target overal.. improved! ... whereas others either remained the same or decreased performance
Sleeping pills.. Benzodiazepines (sp??) .. facilitate* neurotransmitter GABA.. do show some evidence of amnesia
Paralysis during REM so don't act out dreams
Lucid dreaming = conscious awareness of dreaming, cannot influence outcomes cannot influence amount of time spent in REM.. etc... DO have vivid sensations.. usually joy/euphoria

Sleep Disorders
Sleep apnea... trouble breathing.. waking up 5x or more in hour (diagnosis)
irritability, inc. blood pressure, hypertension, personality changes, daytime sleepiness, headaches (symptoms)
males, older, obese (etiology.. although not entirely known)
Memory and concentration problems!

Circadian Rhythm Disorder:
-rare , never can sleep, leads to death, widespread organ failure
3 categories of apnea
Obstructive*, Central, Mixed
Obstructive: In REM, upper airway path collapses.. sometimes due to body chest pressure* , airway closes .. hypoxia! (Inc. Blood pressure, Inc. Heart Rate... makes body wakeup).. Inc. blood pressure can lead to heart failure*
Central: brainstem abnormality.. signal to breathe not sent to brain
Mixed: Starts as obstructive moves to central...

- neurotransmitter function??
- cellular metabolism??
-sodium-potassium pump??

What famous person had Apnea?? President Taft!

Treatment: CPAP... continuous positive* airway pressure
loud mask over face.. forces air through upper
... lose wt.

Sudden sleepiness in day...
Associated with hypnAgoGic* hallucinations (wake-REM vivid imagery).. sleep paralysis (REM-wake.. can't move.. twitch fingers to get out of)
(Etiology unknown: 1-1000, puberty-age 25, can run in families!)****
*Treat: **Stimulants (daytime sleepiness) & Tri-cyclics (cataplexy)??
2 Types...
Daytime sleepiness + Sleep Attacks.. Nonrem
last 15 min. .. some frequent others not.. warnings and no warnings??
urge to fall alseep when bored + normal times

Cataplexy... REM
mild: head droop
severe: atonia** abrupt limpness, fall to floor
*sudden change in emotion (excitement, anger) causes

*penetrating head injuries = 20% EPILEPSY (recurring seizures)
ictal*** (DURING seizure)
postictal (after... dizzy, disoriented, *fatigue, *depression)
interictal (between .... ????)

Generalized (entire brain) vs. Partial (localized to one area)
Gen: Tonic (stiffen, blue face), Clonic (rhythmic jerking), Atonia (sudden limpness)
**absence seizure.. daydreaming... attriobute to prob. w/ *thalamacotrical circuit
4-14 yrs? .. grow out of.. may be due to underdeveloped... ?
Part: *Simple (?? ).... *2ndrily Gen (Jacksonian Seizure, "march".. starts one area and spreads) ,
*Complex: Dejas Vu (already seen) ... ?*Jamais* Vu (never seen), panic, terror, ecstacy (esp. fear??)

Prevent with Countering Aura: Sensation (smell, tactile/tingling,), dizzy, *nausea, numb*
ALSO USE ANTICONVULSANT MEDS ... all have side-effects, impair cognition, ***RIGHT DOSAGE important
... how they work..
... increase GABA (inhibitory) ??phenobarbital??... decrease Glutamate (excitatory) ??tegretol??, ??dilantin??... note that seizures primarily due to inbalance in excitatory/inhibitory firing... "EXCESSIVE EXCITATORY FIRING")... ***BLOCK SODIUM CHANNEL ***GABA-B for ABSENCE seizures only???

20% meds won't work.. need to do surgery.. WADA testing (knock out 1-hem).. Sodium Amytal injection.. test for *hemispheric dominance of langugage and memory*
*takes 7 min
*insert into **Anterior carotid artery*
note RH 96% L.Hem dominance
LH 70% L.Hem dominance.. 15% R.hem.. 15% mixed

Halstead-Reitan Neuropsyhological battery???
GOAT: Galveston Orientation & AMNESIA TEST
Who (name), What (date), Where... and other questions relating to amnesia.. who was the president? who is currently? what do you remember before?...

Rey-Osterreith Complex Figure** Given picture.. look at.. take-away.. draw picture by memory... Visual-Spatial Test

Rorscach Inkblot Test (projective personality)
MMPI (Minnesota Multiphasic Personality Inventory??) (Objective personality)

WAIS (intelligence test)

Symbol Digit Modalities Test ??? SDMT (Attention test)
Logical Memory (short story) memory in contextual setting

Neurological: Basic, general cpg. functions.. *PHYSICAL* function ???
NeuroPSYCHOlogical exam: **in-depth** assessment cog. function beyond general
-- designed to inhibit compensatory techniques***

Look at Reliability (consistency) vs. Validity (does it measure what it is supposed to)

****Assessment GOALS:
- strengths/weaknesses
- Use Baseline to look for improvement
- differentiate from other abnormal behavior

Estimates of Premorbid functioning:
intelligence, education
*WAIS (vocab. subtest.. adults most common??)
*NART (list of words where pronunciation isn't standard???)

Categories ASSESS:
Know (penetrating), Think (concussion), No reason to believe but behavior indicates (AD)

1 - BATTERY APPROACH -- standardized.. Halstead-Reitan**?? .. Fixed # of tests measure diff. areas..
2 - PROCESS APPROACH - individualized.. good for case studies, not general pop.
hypthesize area, then focus on that

Expressing Assessment (data)
Norms (age, edu, gender, intellectual, education)
Statistical (Z scores, SD) .. (person's score - mean)/SD .. SS ... (Z * 15) + 100

DIFFERENTial approach
PATTERN approach

Factors of influence (age, education, gender, handedness,
motivation:arousal, med, malingering---- what goes with this???

**Rerouting (axonal to another neuron
**Sprouting (axons develop to neighboring neurons)
**Denervation Supersensitivity (neuron becomes super-sensitive to neurotransmitters)??

Monkey Study (use fingers, sensory region develops)
Violinists (those who play and don't.. enlarge area for those fingers used)
Juggling.. ??? shows practice changes organization...??

high plasticity for kids - knock out 1 hem and they're still good!
Prob develops * language
2-3 yrs. age
1-2 yrs. recovery

3-5 yrs. age?? YES
2-3 yrs. recovery after aphasis

6+ yrs
more diff. to recover

Factors influence recovery: location, extent, time, age, intelli/edu., gender (fem. better), personality/attitude.. motivation
***LESION MOMENTUM (how quickly it happened.. ex: tumors)

.. hospital until stabalize.. no life threat
skilled nursing facility if not ready for rehabilitation
otherwise rehabilitation (still some disorientation/confusion)
.. teach individual get involved, help fam. learn how to help.. many different roles:
OT - daily living.. stuff.. hygiene.. etc
PT - physical, endurance, strength..
RT - communication/social gatherings .. mobility and daily skills (safety, money management)
Speech therapist.. reading writing, aphasia?

--improve functioning (optimal)
***NEUROPSYCHOLOGICAL EVALUATIONS (-standard tests AND ecologically valid - task analysis, paper/pencil... WATCH person do in-context: CONTEXT DRIVEN*, COG. RETRAINING)

**NEW INTENSIVE TREATMENT in rehabilitation
??? "constraint induced treatment".. force them to use whatever is disables.. mostly motor.. some language .. takes mo. to yrs.. shows remarkable success