Reviews And Selected Updates

Natural Insomnia Program

Latest Cures for Insomnia

Get Instant Access

Ancoli-Israel S: Sleep problems in older adults: Putting myths to bed. Geriatrics 1997;52:20-30. Chokroverty S: Sleep and degenerative neurologic disorders. Neurol Clin 1996;14:807-826. Mahowald MW: Diagnostic testing. Sleep disorders. Neurol Clin 1996;14:183-200.

Moore RY: Circadian rhythms: Basic neurobiology and clinical applications. Ann Rev Med 1997;48:253-266. Schneck CH, Mahowald MW: REM sleep parasomnias. Neurol Clin 1996;14:697-720.

Siegel JM: Brainstem mechanisms generating REM sleep. In Kryger MH, Roth T, Dement WC (eds): Principles and Practice of Sleep Medicine, 2nd ed. London, W.B. Saunders, 1994, pp 16-25.

PreviousNext

REFERENCES

1. Aserinsky E, Kleitman N: Regularly occurring periods of eye motility and concomitant phenomena during sleep. Science 1953;118:273-274

2. Carskadon MA, Dement WC: Normal human sleep. In Kryger MH, Roth T, Dement WC (eds): Principles and Practice of Sleep Medicine, 2nd ed. London, W.B. Saunders 1994, pp 16-25.

3. McCarley RW: Neurophysiology of sleep: Basic mechanisms underlying control of wakefulness and sleep. In Chokroverty S (ed): Sleep Disorders Medicine. Boston, Butterworth-Heinemann 1994, pp 17-3 6.

4. Rechtschaffen A, Kales AA.: A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles: UCLA Brain Information Service/Brain Research Institute, 1968.

5. Diagnostic Classification Steering Committee, American Sleep Disorders Association: The International Classification of Sleep Disorders. Lawrence, Kansas, Allen Press, Inc., 1990.

6. Chokroverty S: An approach to a patient with sleep complaints. In Chokroverty S (ed): Sleep Disorders Medicine. Boston, Butterworth-Heinemann, 1994, pp 181-18 6.

7. Naylor MW, Aldrich MS: Approach to the patient with disordered sleep. In Kryger MH, Roth T, Dement WC (eds): Principles and Practice of Sleep Medicine. Philadelphia, W.B. Saunders Company, 1994, pp 413-4 17.

8. Carskadon MA. Patterns of sleep and sleepiness in adolescents. Pediatrician 1990;17:5-12

9. Czeisler CA, Moore-Ede MC, Coleman RM: Rotating shift work schedules that disrupt sleep are improved by applying circadian principles. Science 1982;217:460-463

10. Allen SR, Seiler WO, Stahelin HB, et al: 72-hour polygraphic and behavioral recordings of wakefulness and sleep in a hospital geriatric unit: Comparison between demented and non-demented patients. Sleep 1987;10:143-159

11. Sadeh A, Hauri PJ, Kripke DF, Lavie P: The role of actigraphy in the evaluation of sleep disorders. Sleep 1995;18:288-302

12. Buysse DJ, Reynolds CF, Monk TH, et al: The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213

13. Carskadon MA, Brown ED, Dement WC: Sleep fragmentation in the elderly: Relationship to daytime sleep tendency. NeurobiolAging 1982;3:321-327

14. Hauri P: The Sleep Disorders. Kalamazoo, MI, Upjohn, 1982.

15. Oswald I: Sudden bodily jerks on falling asleep. Brain 1959;82:92-103

16. Chokroverty S: Sleep, breathing, and neurological disorders. In Chokroverty S (ed): Sleep Disorders Medicine. Boston, Butterworth-Heinemann, 1994, pp 295-33 5.

17. Trenkwalder C, Walters AS, Hening WA: Periodic limb movements and restless legs syndrome. Neurol Clin 1996;14:629-650

18. Schenk CH, Bundie SR, Patterson AL, Mahowald MW: Rapid eye movement sleep behavior disorder. jama 1987;257:1786-1789

19. Aldrich MS: Narcolepsy. Neurology 1992;42(Suppl 6):34-43

20. Ondo W, Jankovic J: Restless legs syndrome: Clinicoetiologic correlates. Neurology 1996;47:1435-1441

21. Goldfarb LG, Petersen RB, Tabaton M, et al: Fatal familial insomnia and familial Creutzfeld-Jakob disease: Disease phenotype determined by a DNA polymorphism. Science 1992;258:806-808

22. Bliwise DL: Sleep in normal aging and dementia. Sleep 1993;16:40-81

23. Horne J: Why We Sleep: The Functions of Sleep in Humans and Other Mammals. New York, Oxford University Press, 1988.

24. Borbly AA, Baumann F, Brandeis D, et al: Sleep deprivation effects on sleep stages and EEG power density in man. Electroenceph Clin Neurophysiol 1981;51:483-49 .

25. Moorcroft WH: Comments on the symposium and an attempt at synthesis. BehavBrain Res 1995;69:207-210

26. Rechtschaffen A, Bergmann BM: Sleep deprivation in the rat by the disk-over-water method. Behav Brain Res 1995;69:55-63

27. Horne JA, Reid AJ: Night-time sleep EEG changes following body heating in a warm bath. Electroencephalogr Clin Neurophysiol 1985;60:154-15'.

28. McGinty D, Szymusiak R: Keeping cool: A hypothesis about the mechanisms and functions of slow wave sleep. Trends Neurosci 1990;13:480-487

29. Finkelstein JW, Roffwarg HP, Boyar RM, et al: Age related change in twenty-four hour spontaneous secretion of growth hormone. J Clin Endocrinol Metab 1972;35:665-670 .

30. Krueger JM, Obal F Jr, Kapas L, Fang J: Brain organization and sleep function. Behav Brain Res 1995;69:177-185

31. Giuditta A, Ambrosini MV, Montagnese P, et al: The sequential hypothesis of the function of sleep. Behav Brain Res 1995;69:157-166

32. Miller JD, Morin LP, Schwartz WJ, Moore RY: New insights into the mammalian circadian clock. Sleep 1996;19:641-667

33. Murphy PJ, Campbell SS: Physiology of the circadian system in animals and humans. J Clin Neurophysiol 1996;13:2-16

34. Brzezinski A: Melatonin in humans. n Engl J Med 1997;336:186-195

35. Jankel WR, Niedermeyer E: Sleep spindles. J Clin Neurophysiol 1985;2:1-35

36. Siegel JM: Brainstem mechanisms generating REM sleep. In Kryger MH, Roth T, Dement WC (eds): Principles and Practice of Sleep Medicine, 2nd ed. Philadelphia: W.B. Saunders, 1994, pp 125- 44.

37. Culebras A: Update on disorders of sleep and the sleep-wake cycle. Psychiatric Clin North Am 1992;15:467-489 .

38. Jones BE: Paradoxical sleep and its chemical structural substrates in the brain. Neuroscience 1991;40:637-656

39. Hobson JA, Lydic R, Baghdoyan HA: Evolving concepts of sleep cycle generation: From brain centers to neuronal populations. Behav Brain Sci 1986;9:371-448

40. Garcia-Rill E: The pedunculopontine nucleus. Prog Neurobiol 1991;36:363-389

41. Cartwright RD: Dreams and their meaning. In Kryger MH, Roth T, Dement WC (eds): Principles and Practice of Sleep Medicine. London, W.B. Saunders, 1994, pp 400-4 6.

42. American Sleep Disorders Association Report: Practice parameters for the use of actigraphy in the clinical assessment of sleep disorders. Sleep 1995;18:285-287

43. American Sleep Disorders Association: The clinical use of the multiple sleep latency test. Sleep 1992;15:268-276

44. Standards of Practice Committee of the American Sleep Disorders Association: Practice Parameters for the use of portable recording in the assessment of obstructive sleep apnea. Sleep

1994;17:372-377

45. Hauri P: Case Studies in Insomnia. New York, Plenum Medical Book Company, 1991.

46. Alberto J, Silva CE, Chase M, et al: Special report from a symposium held by the World Health Organization and the World Federation of Sleep Research Societies: An overview of insomnias and related disorders-recognition, epidemiology and rational management. Sleep 1996;19:412-416

47. Edinger JD, Fins AI, Goeke JM, et al: The empirical identification

of insomnia subtypes: A cluster analytic approach. Sleep 1996;19:398-411

48. Spielman AJ, Nunes J, Glovinsky PB: Insomnia. Neurol Clin 1996;14:513-543

49. Regestein QR, Monk TH: Delayed sleep phase syndrome: A review of its clinical aspects. Am J Psychiatry 1995;152:602-608

50. Thase ME, Kupfer DJ, Ulrich RF: Electroencephalographic sleep in psychotic depression. Arch Gen Psychiatry 1986;43:886-893

51. Hudson JI, Lipinski JF, Frandenburg FR, et al: Electroencephalographic sleep in mania. Arch Gen Psychiatry 1988;45:267-273

52. Gierz M, Campbell SS, Giullin JC: Sleep disturbances in various nonaffective psychiatric disorders. Psychiatric Clin North Am 1987;10:565-58■.

53. Novak M, Shapiro CM: Drug-induced sleep disturbances. Focus on nonpsychotropic medications. Drug Saf 1997;16:133-149

54. Lavie P: The touch of Morpheus: Pre-20th century accounts of sleepy patients. Neurology 1991;41:1841-1844

55. Guilleminault C: Disorders of excessive sleepiness. Ann Clin Res 1985;17:209-219. Guilleminault C: Idiopathic central nervous system hypersomnia. in Kryger mh, Roth t, Dement wc (eds): Principles and practice of sleep medicine. Philadelphia, W.B. Saunders, 1994, pp 562-56 6

PreviousNext

Joseph H. Friedman

Clinical History

Anatomy of Mood, Emotion, and Thought

Chapter 3 - Mood, Emotion, and Thought

Limbic System

Amygdala

Temporal Lobe

Frontal Cortex

Subcortical Structures

Pharmacological Neuroanatomy

Examination of Mood, Emotion, and Thought

Directed Neurological Examination

Associated Neurological Findings

Associated Medical Findings

Evaluation Guidelines

Clinical Syndromes

Affective Disorder Syndromes

Pseudobulbar Palsy

Psychotic Syndromes Apathy Syndromes

Anxiety and Obsessive-Compulsive Disorder Syndromes

Impulse Dyscontrol and Aggression Syndromes

Altered Sexuality Syndromes

General Management Goals

Affective Disorder Syndromes

Psychotic Syndromes

Anxiety and Obsessive-Compulsive Disorder Syndromes Impulse Dyscontrol and Aggression Syndromes Reviews and Selected Updates References

Mood is defined as "the sustained internal emotional state of a person" [ii and is broadly divided into three realms: elevated, normal, or depressed. There are an enormous number of subclassifications within each of these subdivisions, and normal mood includes several gradations of elevation or depression. Affect generally refers to the external expression of emotional content and may coincide or be at odds with a patient's mood. The terms mood congruent and mood incongruent are used to describe these forms of emotional or affective expressions. Some authors use the term affect to describe a subject's emotional state at a particular instant, [2 but this is a more obscure usage. Two basic mood abnormalities, depression and mania, are recognized, and these occur on a continuum from normal to the clearly pathological. While minor symptoms may be an extension of normal sadness or elation, more severe symptoms are associated with discrete syndromes (affective disorders) that appear to differ qualitatively from normal processes. Depression is defined as a morbid sadness, dejection, or melancholy, whereas mania is a disordered mental state of extreme excitement. Both have accompanying emotional and cognitive and motoric features.

Emotional experience connotes the whole range of human feelings, including anxiety, fear, apathy, euphoria, depression, sadness, anger, and grief as well as how the person experiences these various feelings, which are not mutually exclusive. Thus, most individuals constantly experience a wide variety of feelings of variable intensities that vary over time. Emotional expression, or affect, may be mood congruent, accurately reflecting the person's inner state, or incongruent, when the subject appears to be very happy or sad but in fact feels quite the opposite. Emotional expression has an enormous range, which is obviously wider in some people than in others. This range may be normal, expanded, or restricted, allowing little chance for either happy or sad emotions to be displayed. When expansive, emotional expression is amplified at both ends of the mood spectrum. Flattened affect is a lack of emotional display, and labile affect is an emotional state that changes rapidly and is out of proportion to changes in the situation. It is important to note that emotional experience and emotional expression are quite different. One can appear to be emotionally detached and have little concern or interest in the situation, when in fact one is greatly moved. Such a discordance between apparent and true emotion may be highly adaptive in some situations and cultures and not at all pathological.

Other terms involved in disorders of emotion and mood include apathy, which is a lack of feeling or indifference. Abulia is a general behavioral slowing and lowered activity that may be associated with an inability or refusal to speak. Akinetic mutism is defined as the presence of a condition in which the patient appears awake and may follow the examiner with his or her eyes but lacks spontaneous motor and verbal responses. Anxiety is an uncomfortable and unjustified sense of apprehension that may be diffuse and unfocused and is often accompanied by physiological symptoms. An anxiety disorder connotes significant distress and dysfunction due to the anxiety. Fear can also produce the symptoms of anxiety, but, in contrast to anxiety, its cause is obvious and understandable.

Thought is in many ways unrelated to mood or emotions. Thought is evaluated in terms of the "process" or mechanics of thinking and also in terms of the content. In schizophrenia, one deals with "loosened" thought processes. Psychosis is a broad term defined variably in different places, but generally it implies a severe mental illness characterized by a loss of contact with reality leading to severe impairments in personal and social functioning. Psychosis is distinguished from delirium, in which there is an impairment of consciousness associated with an organic cause.

Hallucinations, hallucinosis, illusions, and delusions are terms that are frequently misused, leading to incorrect diagnoses, particularly by nonpsychiatrists. Hallucinations are false sensations that arise without a stimulus. Visual hallucinations appear real and are seen clearly in the light. They may be unformed like geometric shapes, or formed, simulating people, animals, or objects. Auditory hallucinations are sounds, such as voices or music, that are indistinguishable from real sounds. Hallucinosis refers to the presence of hallucinations in an otherwise normal mental state, without confusion, disorientation, or psychosis. Generally, hallucinations are experienced as real, whereas in hallucinosis the sensations are quickly interpreted as false. Hallucinations occur in every sensory realm, so that smells, taste, tactile sensations, and so on, may all occur. Illusion refers to an altered or misperceived sensation that is transformed, such as perceiving a lamp as a person. Delusion refers to a false and irrational belief that is unalterable by rational discourse. Typical delusions may include grandiosity, in which the patient believes he or she has great powers, or paranoia, in which the patient believes he or she is being followed. Hallucinations and delusions occur in a wide variety of psychoses including manic-depression and organic states.

Hallucinations and delusions are considered positive symptoms, meaning that they are extra or additional features superimposed upon normal behavior. This concept was pioneered by Hughlings Jackson, who considered positive symptoms a "release" phenomenon, in which inhibitory control is lost. [3] Other positive symptoms include bizarre behavior, pressured speech, and thought disorder. In contrast, negative symptoms refer to loss of affect, diminished thought, anhedonia (diminished interest and enjoyment), and diminished attention. Jackson attributed negative symptoms to a loss of neurons leading to a direct loss of function. [3]

Obsessive thoughts are unwanted and bothersome recurrent ideas, images, and impulses that intrude upon a patient and cannot be pushed out of consciousness. A compulsion is an irresistible need to perform an activity. Obsessions and compulsions usually go together. Rituals are a sequence of stereotyped behaviors that must be performed and often have a symbolic meaning.

PreviousNext

Was this article helpful?

0 0
Eliminating Stress and Anxiety From Your Life

Eliminating Stress and Anxiety From Your Life

It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.

Get My Free Ebook


Post a comment