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Case 10 pt 2 By: Roshini Perera TABLE OF CONTENTS Sleep Personality 01 theories 02 Brain chduring 03 development Stigma 04 Sleep 01 (22b) Importance of sleep Hormone production Restoration (immune, (GH, prolactin/cortisol, wound healing) TSH) • Waste clearance (e.g. beta- amyloid) Mental health and Memory behaviour SBA What is the circadian A Suprachiasmatic nucleus pacemaker? B Thalamus C Cerebellum D Medulla E Cortex SBA The circadian rhythm is A Suprachiasmatic nucleus the clock that regulates sleep. What is the circadian pacemaker? B Thalamus C Cerebellum The Suprachiasmatic nucleus is in the hypothalamus D Medulla E Cortex Hormones involved in sleep Melatonin peak at Increase sleep around 4am pressure Melatonin Orexin Adenosine GABA Stages of sleep BATS Drink Blood Beta Awake Alpha Wakefulness Theta N1 Sleep spindles and K N2 complexes NREM Delta N3 Beta REM Hypnic jerks Sleep disorders = normal Insomnia • Primary= isolated insomnia • Secondary= due to co-mordities or medication • Decreased sleep quantity/ quality 3 times a week for > 3 months • Tx= sleep hygiene, medication (short term), CBT Obstructive sleep apnoea • Blockage of upper airway. Seen in obesity • Tx= CPAP Restless leg syndrome • Constant urge to move legs at rest that is relieved with activity • Tx= good sleep hygiene, dopamine agonists, codeine for pain Parasomnia REM NREM • REM sleep • Sleep walking behaviour • Sleep eating/ disorder drinking etc. • Nightmares • Night terrors Hypersomnia • Excessive daytime sleepiness • Involuntary sleep Narcolepsy • Cataplexy • Low orexin • Hypersomnia Kleine- • Hyperphagia Levin • Hypersexuality episodes HIGH YIELD FACTS Zeitgebers= an environmental agent or event that is a cue in the regulation of the circadian rhythm e.g. darkness Adenosine increases sleep Caffeine blocks adenosine A2A receptors in the brain to help you stay awake One cycle of sleep is 90 minutes 12 Personality 02 theories (H10) What is personality? ● Refers to the combination of characteristics or qualities that form an individual’s distinctive character ● Personality has been shown to predict a wide range of important life outcomes: ○ Academic achievement ○ Occupational functioning ○ Social functioning e.g. relationships ○ Physical functioning ○ Physical health including mortality ○ Mental health Types of theories Biological & Trait theories • Heritable traits Behavioural theories • Where individual's response to an external stimulus shapes behaviour Social learning theories • Cognitive expectations Psychodynamic theories • Unconscious mild and childhood experience • Focus is on unconscious motivation, sex, aggression and unconscious conflicts Humanistic theories • Freewill and individual experience Type theories • Refers to psychological classification of different "types" of people e.g. introverts and extraverts SBA What personality theory A Biological & trait theories is described below: All people belong to one B Behavioural theories of a number of classes/ categories of personality C Social learning theories D Psychodynamic theories E Type theories SBA What personality theory A Biological & trait theories is described below: All people belong to one B Behavioural theories of a number of classes/ categories of personality C Social learning theories D Psychodynamic theories E Type theories Five Factor Model Factor (OCEAN) Qualities Brain structures associated and its impact Openness - Having wide-ranging interests, being creative, - Dorsolateral prefrontal cortex imaginative, intellectually curious, insightful - Better coping strategies Conscientiousness - Being organised, thoughtful, scrupulous, - Dorsolateral prefrontal cortex meticulous, dependable, self-disciplined. - Positive health behaviours (e.g. reduced rates of smoking) Extraversion - Gregariousness, assertiveness, excitement - Prefrontal cortex + amygdala seeking, warmth, enthusiasm, sociable, positive - Harmful health behaviours e.g. emotions, emotionally expressive smoking and drug Agreeableness Compliant, trusting, empathic, sympathetic, friendly, - Increased volume in the posterior cooperative. cingulate cortex. - Good adherence to treatment Neuroticism Anxiety, emotional instability, tension, moodiness, - Serotonin activity in the thalamus easily upset. and activity in the insular cortex. - Anxiety and depressive disorders SBA What factor in the Five A Openness Factor model would this represent; I get chores B Conscientiousness done right away? C Extraversion D Agreeableness E Neuroticism SBA What factor in the Five A Openness Factor model would this represent; I get chores B Conscientiousness done right away? C Extraversion D Agreeableness E Neuroticism 03 Brain changes during development (H8) SBA Adolescence is divided A +/-11-14 years into 3 categories; Early, mid and late B +/- 15-17 years adolescence. At what age does the mid adolescence occur? C +/- 18-21 years D +/- 13-18 years E +/- 21-23 years SBA Adolescence is divided A +/-11-14 years into 3 categories; Early, mid and late B +/- 15-17 years adolescence. At what age does the mid adolescence occur? C +/- 18-21 years D +/- 13-18 years E +/- 21-23 years Adolescence ● What is adolescence? A stage of development where there are physical, cognitive, behavioural and social changes ● Storm and stress view- a difficult period for adolescents and those around them: ○ Conflict with parents ○ Mood disruptions ○ Risk behaviour 3 categories: ● • Early adolescence (± 11 – 14 years) ● • Mid adolescence (± 15 – 17 years) ● • Late adolescence (± 18 – 21 years) Adrenarche vs Gonadarche ● Occurs between 6-9 years in females ● Occurs between 8-14 years in females and 1 year later in males and 9-15 years in males ● Activation ofhypothalamic pituitary ● Initiated by reactivation of the hypothalamic pituitary gonadal axis adrenal (HPA) axis for adrenal ● LH & FSH à gonadal maturational production changes=> secretion of oestrogen & ● Increase of adrenal androgens (DHEA & DHEAS) contributes to the testosterone development of secondary sexual characteristics & changes in sweat glandsActivation of the growth axis Girls 12 years Growth hormones => linear growth spurts Boys 14 years ● PROLONGED activation of HPA axis, e.g. in children in adverse environments, and suppress GH secretion Effects of the sex steroid hormone on behaviour Area of brain Effect on behaviour Hypothalamus Reproductive behaviours Visual cortex, amygdala. Reorganisation of sensory & hippocampus association regions Nucleus accumbens, Motivation & reward-related dopaminergic pathways to behaviour prefrontal cortex SBA What condition(s) is A Depression early-life stress and childhood trauma B Anxiety disorders associated with? C Psychosis D All of the above SBA What condition(s) is A Depression early-life stress and childhood trauma B Anxiety disorders associated with? C Psychosis D All of the aboveWhat are the chronic effects of stress on the brain & behaviour? Echildhood trauma and HPA dysfunction disorders, psychosis Structural changes White matter • Steady linear increase in volume • Synapse pruning (elimination) Grey matter • Increase pre puberty then decrease post puberty • Motor & sensory systems mature earlier • Then amydala and hippocampus • Prefrontal cortex later Cognitive development during adolescence Adolescence More executive capability Maturation of prefrontal Decision making vs risk & Changes in cognitive cortex reward functioning due to structural development of cortical regions- synaptic pruning & axonal myelination Greater control & D(in frontal regions) and coordination of thoughts ibetween regions ofty increasing rapid and behaviours, prefrontal cortex & certain connectivity metacognition, long-term areas of limbic system planning & self-evaluation Dual systems of adolescent risk taking Pre-frontal • Executive functions cognitive • Matures gradually control network • Reward seeking Subcortical • Rapidly remodelled in early motivational changes during pubertyl drive network Adolescence and psychiatric conditions ● Start in adolescence due to: ○ Genetic anomalies or exaggerations of maturation process ○ Biological factors e.g. hormonal changes ○ Early development experiences ○ Stress exposure (interaction between HPA axis and glucocorticoids ○ Environmental factors ○ Psychosocial factors SBA What happens to white A Rapid increase matter during development B Steady increase C Rapid decrease D Steady decrease E Increase then decrease SBA What happens to white A Rapid increase matter during development? B Steady increase C Rapid decrease D Steady decrease E Increase then decrease HIGH YIELD FACTS Grey matter increases before puberty and then decreases after puberty Adrenarche is the the maturation of the adrenal glands that takes place during adolescence Adrenarche involves the HPA axis (Hypothalamus pituitary adrenal axis) Gonadarche refers to the earliest gonadal changes of puberty and involves the HPG axis (hypothalamus pituitary gonadal axis) 38 04 Stigma (H11) Effect of stigma, discrimination and social exclusion 1) Increased participation 2) Mental distress, increased 3) Reduced help-seeking, restriction & disability likelihood of depression, treatment, uptake and internalised stigma anxiety & other disorders adherence 5) Limited resources for NTD 4) Poor prognosis and management Negative treatment outcomes, high attitudes amongst health visibility of illness care staff.=> low training levels and poor quality of treatment Mental capacity act What makes someone have capacity? • Understand relevant info capacity • Retain the info long enough to make the decision • Weigh info • Communicate the decisionTHANK YOU! Please feed in the feedback form! DO YOU HAVE ANY QUESTIONS? PereraKD@cardiff.ac.uk QR CODE @chips_cardiff CREDITS: This presentation template was created by Slidesgo, and includes icons by Flaticon and i fographics & images by Freepik