ppt
DESCRIPTION
TRANSCRIPT
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 11
Stress Disorders,Stress Disorders,Sleep DisordersSleep Disorders
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 22
Stress DisordersStress Disorders
Stress (response)Stress (response): physiological and : physiological and behavioural reaction caused by the behavioural reaction caused by the perceptionperception of of aversive or threatening stimuli (Cannon, 1921).aversive or threatening stimuli (Cannon, 1921).
StressorsStressors: Environmental triggers of stress: Environmental triggers of stress PTSD requires an identifiable stressor for PTSD requires an identifiable stressor for
diagnosisdiagnosis Often the association between the stressor and Often the association between the stressor and
the stress response is not clearthe stress response is not clear
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 33
Stress ResponseStress Response
Fight or flight response:Fight or flight response: mobilization of resources to mobilization of resources to prepare us to face stressorsprepare us to face stressors• Effects of the Hypothalamic-Pituitary-Adrenal axisEffects of the Hypothalamic-Pituitary-Adrenal axis
Mobilization of energy in face of the stressors includes:Mobilization of energy in face of the stressors includes:1.1. Activation of sympathetic nervous system Activation of sympathetic nervous system
• increased heart rate, increased muscular contractions, increased heart rate, increased muscular contractions, increased blood pressure, decreased digestion/metabolismincreased blood pressure, decreased digestion/metabolism
2.2. Adrenal hormones are releasedAdrenal hormones are released• EpinephrineEpinephrine• Norepinephrine (activation of NE receptors in brain)Norepinephrine (activation of NE receptors in brain)• Steroid stress hormones (cortisol)Steroid stress hormones (cortisol)
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 44
Stress ResponseStress Response
1. Norepinephrine 1. Norepinephrine • Stressful situations (e.g. social isolation in rats) will Stressful situations (e.g. social isolation in rats) will
increase release of NE increase release of NE • hypothalamus, frontal cortex, and lateral basal forebrain hypothalamus, frontal cortex, and lateral basal forebrain
including portions of amygdala including portions of amygdala (Yokoo et al., 1990, Cenci et al., (Yokoo et al., 1990, Cenci et al., 1992; van Bockstaele et al., 2001)1992; van Bockstaele et al., 2001)
• Downregulation of the alpha-2 receptor in response to Downregulation of the alpha-2 receptor in response to hight NE levelshight NE levels
2. Serotonin2. Serotonin• 5HT is 5HT is decreaseddecreased• Raphe nucleus, frontal areas involved in extinctionRaphe nucleus, frontal areas involved in extinction
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 55
Stress ResponseStress Response
3. Glucocorticoids and corticotropin releasing hormone (CRH)3. Glucocorticoids and corticotropin releasing hormone (CRH) Receptors throughout the brain (and rest of body)Receptors throughout the brain (and rest of body) Controlled by the hypothalamus, CRH serves as a Controlled by the hypothalamus, CRH serves as a
neuromodulator in the limbic system, periaqueductal gray neuromodulator in the limbic system, periaqueductal gray matter, locus coeruleus, and amygdalamatter, locus coeruleus, and amygdala
Injection of CRH into rats’ brains induces fear reactions Injection of CRH into rats’ brains induces fear reactions (Britton et al., 1982)(Britton et al., 1982)
Antagonists of CRH reduce anxiety caused by stressors Antagonists of CRH reduce anxiety caused by stressors (Heinrichs et al., 1994)(Heinrichs et al., 1994)Heightened activation of sympathetic nervous Heightened activation of sympathetic nervous systemsystem
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 66
1. Sufficient sensory information is present for assessment.
Vermetten & Bremmer, 2002
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 77
2. Assessment based on access to prior experience.
Vermetten & Bremmer, 2002
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 88
3. Encode memory of (potential) threat.
Vermetten & Bremmer, 2002
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 99
4. Access to neuroendocrine, autonomic, motor responses.
Vermetten & Bremmer, 2002
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 1010
PTSD: Prevalence, InfoPTSD: Prevalence, Info
Prevalence: 5-10% (U.S), higher in war-torn Prevalence: 5-10% (U.S), higher in war-torn areasareas
Three themes of PTSD:Three themes of PTSD:
1.1. Re-experiencing of stressful eventRe-experiencing of stressful event
2.2. Avoidance of stimuliAvoidance of stimuli
3.3. Persistent, increased arousal Persistent, increased arousal
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 1111
PTSD: Prevalence, InfoPTSD: Prevalence, Info In adults, traumatic events occur more often to In adults, traumatic events occur more often to
men, but PTSD is 4 times more common in women men, but PTSD is 4 times more common in women (Fullerton et al., 2001)(Fullerton et al., 2001)
In children:In children:
1.1. Loss of acquired language skillsLoss of acquired language skills
2.2. Regression of toilet trainingRegression of toilet training
3.3. Somatic complaints (stomachaches or headaches)Somatic complaints (stomachaches or headaches)
Delayed onset of PTSD often occurs for chronic Delayed onset of PTSD often occurs for chronic abuseabuse
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 1212
PTSD: DSM-IV CriteriaPTSD: DSM-IV Criteria
A. The person has been exposed to a traumatic event in which both of the following have been present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 1313
PTSD: DSM-IV CriteriaPTSD: DSM-IV Criteria
B. The traumatic event is persistently re-experienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 1414
PTSD: DSM-IV CriteriaPTSD: DSM-IV Criteria
(3) acting or feeling as if the traumatic event were recurring sense of reliving the experience illusions, hallucinations, and dissociative flashback
episodes young children: trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 1515
PTSD: DSM-IV CriteriaPTSD: DSM-IV Criteria
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (three or more of the following):
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 1616
PTSD: DSM-IV CriteriaPTSD: DSM-IV Criteria
(5) feeling of detachment or estrangement from others
(6) restricted range of affect unable to have loving feelings
(7) sense of a foreshortened future does not expect to have a career, marriage,
children, or a normal life span
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 1717
PTSD: DSM-IV CriteriaPTSD: DSM-IV Criteria
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep (2) irritability or outbursts of anger (3) difficulty concentrating (4) hypervigilance (5) exaggerated startle response
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 1818
PTSD: DSM-IV CriteriaPTSD: DSM-IV Criteria
E. Duration of the disturbance is more than one month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if: Acute: if duration of symptoms is less than 3 months Chronic: if duration of symptoms is 3 months or more
Specify if: With Delayed Onset: if onset of symptoms is at least 6 month
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 1919
Health effects of long term stressHealth effects of long term stress
Chronic stressChronic stress is thought to be most is thought to be most problematic for long-term healthproblematic for long-term health
Acute traumatic stressAcute traumatic stress, in a few cases, may be , in a few cases, may be equally as devastating equally as devastating
(e.g. war, natural disasters, rape, witnessing (e.g. war, natural disasters, rape, witnessing murder)murder)• Exacerbation of initial traumatic eventExacerbation of initial traumatic event
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 2020
Health effects of long term stressHealth effects of long term stress
Selye (1976) – long-term effects of stress are Selye (1976) – long-term effects of stress are caused by chronic release of glucocorticoidscaused by chronic release of glucocorticoids• Increased blood pressureIncreased blood pressure• Damage to muscle tissueDamage to muscle tissue• Steroid diabetesSteroid diabetes• InfertilityInfertility• Inhibition of growthInhibition of growth• Inhibition of inflammatory responsesInhibition of inflammatory responses• Suppression of immune system Suppression of immune system
Loss of brain tissueLoss of brain tissue• Elevated levels of CRH in women and men with PTSD Elevated levels of CRH in women and men with PTSD
(Yehuda, 2001)(Yehuda, 2001)
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 2121
NeuropathologyNeuropathology
volume loss of hippocampus in veterans with volume loss of hippocampus in veterans with combat-induced PTSD (Bremner et al., 1995)combat-induced PTSD (Bremner et al., 1995)
• brain degeneration occurred in people who had brain degeneration occurred in people who had been subjected to torture been subjected to torture (Jensen et al., 1982)(Jensen et al., 1982) – – note: not by experimentersnote: not by experimenters
• Loss is proportional to amount of combat Loss is proportional to amount of combat exposure (Gurvits et al. 1996)exposure (Gurvits et al. 1996)
• Similar effects in those exposed to severe Similar effects in those exposed to severe childhood abuse (Bremner et al, 1999)childhood abuse (Bremner et al, 1999)
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 2222
Sleep DisordersSleep Disorders
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 2323
Sleep DisordersSleep Disorders
1 in 8 Canadians suffer from a Sleep Disorder1 in 8 Canadians suffer from a Sleep Disorder May or may not be related to stressMay or may not be related to stress May be related to undersleeping or oversleepingMay be related to undersleeping or oversleeping Often comorbid with anxiety or depressionOften comorbid with anxiety or depression No age limits for definitionNo age limits for definition Often undiagnosed or untreated for yearsOften undiagnosed or untreated for years Can have profound impact on physical and Can have profound impact on physical and
mental healthmental health
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 2424
What is normal sleep?What is normal sleep?
1.1. WakingWaking Beta waves: 13-40 Hz, low amplitude, asynchronousBeta waves: 13-40 Hz, low amplitude, asynchronous Alpha waves: 8-13 Hz, higher amplitude (when meditative Alpha waves: 8-13 Hz, higher amplitude (when meditative
or relaxed).or relaxed).
2. Stages 1 and 2 (Light sleep)2. Stages 1 and 2 (Light sleep) Theta waves: 4-7 HzTheta waves: 4-7 Hz May not be aware that you fell asleepMay not be aware that you fell asleep
3. Stages 3 and 4 (Heavy sleep)3. Stages 3 and 4 (Heavy sleep) Delta waves: < 4HzDelta waves: < 4Hz Sleep walking and talkingSleep walking and talking
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 2525
What is normal sleep?What is normal sleep?
4. Rapid eye movement (REM) sleep4. Rapid eye movement (REM) sleep Return of alpha and beta activity, like waking statesReturn of alpha and beta activity, like waking states Darting eye movementsDarting eye movements Dramatic loss of muscle tone--effectively paralyzedDramatic loss of muscle tone--effectively paralyzed DreamingDreaming
Stage 1 to REM = 90 minutesStage 1 to REM = 90 minutes As night progresses, amount of REM sleep increases and As night progresses, amount of REM sleep increases and
stage 3-4 sleep decreasesstage 3-4 sleep decreases
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 2626
What is normal sleep?What is normal sleep?
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 2727
Disorders of sleepDisorders of sleep
1.1. InsomniaInsomnia2.2. NarcolepsyNarcolepsy3.3. REM Sleep Behaviour DisorderREM Sleep Behaviour Disorder4.4. Problems associated with slow wave sleepProblems associated with slow wave sleep
• Inability to sleep at night produces many of the same Inability to sleep at night produces many of the same symptoms as the stress response--sleep is critical for symptoms as the stress response--sleep is critical for neural “recovery”neural “recovery”
• Hallmark of all sleep disorders is an inability to maintain Hallmark of all sleep disorders is an inability to maintain normal wakefulness during the day: normal wakefulness during the day: Excessive daytime Excessive daytime sleepiness (EDS)sleepiness (EDS)
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 2828
InsomniaInsomnia
Feeling that you are not getting enough sleep, Feeling that you are not getting enough sleep, often associated with anxietyoften associated with anxiety
May be difficulty falling asleep or early waking, May be difficulty falling asleep or early waking, often associated with depressionoften associated with depression
Hard to define as people differ in sleep needsHard to define as people differ in sleep needs Often treated with drugs although majority of Often treated with drugs although majority of
patients do not undergo a sleep studypatients do not undergo a sleep study Most drugs are barbiturates which affect GABA Most drugs are barbiturates which affect GABA
receptors (perhaps in reticular activating receptors (perhaps in reticular activating formation)formation)
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 2929
NarcolepsyNarcolepsy
Neurological disorder characterized by sleep at Neurological disorder characterized by sleep at inappropriate times (sleep attack)inappropriate times (sleep attack)• Overwhelming urge to sleep particularly in monotonous Overwhelming urge to sleep particularly in monotonous
conditionsconditions• Sleep appears normal and lasts 2-5 minutesSleep appears normal and lasts 2-5 minutes• Person (temporarily) feels refreshedPerson (temporarily) feels refreshed
CataplexyCataplexy: muscular paralysis while fully awake (similar to : muscular paralysis while fully awake (similar to paralysis during REM)paralysis during REM)• Usually triggered by strong emotion or sudden physical effortUsually triggered by strong emotion or sudden physical effort
Hypnagogic hallucinations:Hypnagogic hallucinations: seeing and hearing things as seeing and hearing things as one is falling asleep. one is falling asleep.
Often skip slow wave sleep at night and move directly to Often skip slow wave sleep at night and move directly to REM from wakingREM from waking
Caused by low levels or absence of a peptide hypocretin in Caused by low levels or absence of a peptide hypocretin in lateral hypothalamus (Saper et al., 2001)lateral hypothalamus (Saper et al., 2001)
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 3030
REM Sleep Behaviour DisorderREM Sleep Behaviour Disorder
Typically we are paralyzed during REM sleepTypically we are paralyzed during REM sleep In some people, this paralysis does not occur, and In some people, this paralysis does not occur, and
they act out their dreams without awarenessthey act out their dreams without awareness Not necessarily the same as sleepwalking, Not necessarily the same as sleepwalking,
although this may be a componentalthough this may be a component Associated with neurodegenerative disorders Associated with neurodegenerative disorders
(such as Parkinson’s)(such as Parkinson’s) Can be associated with brain damage to pons, Can be associated with brain damage to pons,
reticular activating formation (Culebras and reticular activating formation (Culebras and Moore, 1989)Moore, 1989)
Symptoms are opposite to those of cataplexySymptoms are opposite to those of cataplexy
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 3131
Slow-wave sleepSlow-wave sleep
Usually occur during stage 4, when a person is difficult to Usually occur during stage 4, when a person is difficult to rouse but not dreamingrouse but not dreaming
Include:Include:• Bedwetting (nocturnal enuresis)Bedwetting (nocturnal enuresis)• Sleepwalking (somnambulism)Sleepwalking (somnambulism)• Night terrors (pavor nocturnis)Night terrors (pavor nocturnis)
All of these tend to occur more frequently in children – they All of these tend to occur more frequently in children – they usually grow out of theseusually grow out of these
No association with other mental health disordersNo association with other mental health disorders Not sure of neurobiology as it is difficult to do sleep studies Not sure of neurobiology as it is difficult to do sleep studies
with childrenwith children
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 3232
NeuropathologyNeuropathology
Wake-sleep cycles are regulated by brainstem Wake-sleep cycles are regulated by brainstem structuresstructures
1.1. Thalamic nuclei (which receive direct visual input Thalamic nuclei (which receive direct visual input from the LGN)from the LGN)
a.a. Suprachiasmatic nucleus: circadian clockSuprachiasmatic nucleus: circadian clock
b.b. Ventrolateral preoptic nucleus: wakefulness and Ventrolateral preoptic nucleus: wakefulness and vigilancevigilance
2. Other areas2. Other areas
a.a. Raphe nucleus (pons): general arousalRaphe nucleus (pons): general arousal
b.b. Locus coeruleus: vigilance, arousalLocus coeruleus: vigilance, arousal
PSY4080 6.0DPSY4080 6.0D Stress Disorders, Sleep DisordersStress Disorders, Sleep Disorders 3333
NeuropathologyNeuropathology
A host of different medications are used to A host of different medications are used to increase vigilance and altertnessincrease vigilance and altertness
a.a. Epinephrine and its agonists Epinephrine and its agonists
b.b. Other monoaminergic agonists: MethylphenidateOther monoaminergic agonists: Methylphenidate
c.c. Acetylcholine antagonists: CaffeineAcetylcholine antagonists: Caffeine
Most medications with sedative effects focus on Most medications with sedative effects focus on increasing GABA concentrations increasing GABA concentrations (benzodiazepines, barbiturates)(benzodiazepines, barbiturates)