摘要:

Anxious arousals originate from all sleep stages and can be classified as: a) stage 4 night terrors; b) rapid eye movement (REM) nightmares; c) stage 2 awakenings; and d) hypnagogic nightmares. We have confirmed Broughton's finding that the night terror, the most severe type of episode, does not occur in sleep but as part of the “arousal response,” a complex of autonomic discharge and behavioral symptoms. The full blown night terror is a fight-flight episode combining sleep utterances, sleep walking and hallucinated or delusional mental content associated with terror.There is a significant positive correlation between intensity of night terror and the amount of delta sleep preceding arousal,e.g.,stage 4 arousals designated as night terrors are preceded by longer periods of stage 4 than arousals of lesser intensity (p<.05). About two-thirds of both stage 4 and night terrors occurs in the first non-REM (NREM) period. The night terror arises out of physiologically quiescent sleep as indicated by the normal or slightly less them normal cardiorespiratory rates during the first NREM period and absence of skin resistance changes prior to the attack.The night terror is ushered in by sudden loud piercing screams, the subject passing into an aroused state characterized by alpha rhythm, motility, often somnambulism, intense autonomic discharge (precipitous doubling or even tripling of heart rate, great increase in respiratory amplitude, marked decrease in skin resistance), brief duration (1 to 3 minutes), varying degrees of amnesia for the episode, and rapid return to sleep. The night terror is a much more severe phenomenon than the REM nightmare although the latter is far more frequent. The nightmare occursin REM sleep,is characterized by slight autonomic fluctuations, compared to the night terror, and, in half of instances, a “desomatization” of the anxiety response, that is, absence of its physiological concomitants. The REM state is physiologically activated to begin with, constituting a preparation for fright, possibly a buffer against the extreme terror of the stage 4 variety.The important problem of the triggering mechanisms of the night terror remains unsolved: whether the attack is precipitated by ongoing mental content during delta sleep, or represents a psychosomatic “arousal response“ (Broughton). The fact that it can be induced artificially by sounding a buzzer speaks in favor of the latter, the finding of significant mental content in favor of the former. The night terror is not a dream but a symptom emerging from stage 3-4 sleep, associated with a rift in the ego's capacity to control anxiety.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Study of the admission characteristics of 143 patients admitted to an alcoholic clinic showed them to be a heterogeneous population with apparently different reasons for failing to persevere in treatment.Immediate dropouts(those who failed to return after the first visit), who comprised 17.5 per cent of the patients, were most likely to live alone and had suffered the least impairment of their capacity. They were also characterized by ambivalence about initiating treatment and were anxious, depressed, and not abstinent on admission.Rapid dropouts(those who dropped out after 1 to 4 weeks of treatment) accounted for 25.9 per cent of patients and were marked by high levels of anxiety, depression, and somatic and psychosomatic symptoms.Slow dropouts(those who dropped out during the 2nd to 5th months of treatment) had lower levels of education and were likely to have alcoholic relatives. On the other hand,clinic attenders(those who attended ≥ 6 months) accounted for only 26.6 per cent of patients. They tended to be relatively highly motivated, mildly symptomatic and socially intact individuals without a family history of alcoholism who were not markedly ambivalent about treatment.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

In order to test whether electrosleep is an effective therapeutic procedure, its effects were assessed on the most common of sleep disorders, sleep onset insomnia. The present research was designed to avoid the inadequacies of previous investigations by a) using a double blind procedure; b) using objective evaluation procedures (EEG recordings); and c) using the recommended number and distribution of treatments. Additionally, subjective sleep evaluation and personality-psychopathology data were obtained.Ten volunteers with objectively established insomnia were randomly assigned to one of two experimental conditions. These conditions were electrosleep treatment and simulated electrosleep treatment. Initially, each subject (S) spend 3 successive nights in the sleep laboratory for the EEG-EOG monitoring of his night-time sleep patterns. This was followed by a series of 24 daytime “treatments,rdquo; each 15 minutes in duration. Following this phase, each S again spent 2 nights in the sleep laboratory, at which time post-treatment effects were measured. After 14 no-treatment days, each S returned to the sleep laboratory for follow-up measurement.On the basis of EEG measures, the actual treatment group exhibited a statistically significant decline in the latency of sleep onset, percentage of total bed time awake, and percentage of total sleep time in stage 1 sleep. A significant increase in the percentage of total sleep time in stage 4 and total delta sleep was found. Additionally, subjectively reported latencies of sleep onset declined significantly. These post-treatment results were maintained at follow-up. Significant differences were not found in the simulated treatment group.Possible group differences in age, chronicity of insomnia, psychopathology, sex, participation in psychotherapy, placebo reactivity and suggestibility arc discussed in terms of a “selective” placebo effect. These alternatives are discounted before concluding that electrosleep is truly an effective therapeutic procedure in the treatment of sleep onset insomnia.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Since the late 1940s investigators in Russia and Europe have reported that electrosleep therapy is effective for the full spectrum of psychiatric disorders and many “psychophysiological” disorders, such as acid-peptic disease, essential hypertension, neurodermatitis etc. Few of these studies are controlled, and to date there is a paucity of double blind, controlled inquiries to aid the clinician in objective evaluation of the indications, contraindications, efficacy, and mode of application for this somatic therapy.A recent controlled study indicates that electrosleep therapy is effective for patients with prominent symptoms of anxiety, insomnia and depression. Our study was designed to test on a double blind, controlled basis the efficacy of electrosleep therapy on patients with chronic (more than 2 years) psychiatric illness unresponsive to current treatment modalities in which the prominent symptoms were anxiety, insomnia, and depression with no evidence of medical illness that could account for these symptoms.All patients received a comprehensive, systematic, diagnostic research interview with diagnoses based on criteria for scoring symptoms positive (Appendix 1) and criteria for each psychiatric syndrome involved (Appendix 2). Patients were randomly assigned to one of two groups. Group I patients received 10 active electrosleep treatments followed by 10 sham treatments over a 4-week period. Group II patients received 10 sham electrosleep treatments, followed by 10 active electrosleep treatments over a 4-week period. The Electrosone-50 unit was used and the treatments were identical to those described by Rosenthal and Wulfsohn (5).Frequent, double blind, objective and subjective ratings were done to assess clinical improvement. Follow-up ratings were done on a monthly basis for 6 months, except as noted in the paper. Results of the study clearly indicate that active electrosleep treatments have a significant improving effect on sleep, anxiety, and depression, with improvement in psychosocial adjustment. Follow-up data are less impressive. One patient sustained remission; all other patients who initially responded relapsed during the 1st month. Of these, only 2 responded to a further intensive course of electrosleep therapy, and have subsequently done well with maintenance treatments. Patients diagnosed as having primary depression consistently did worse with active electrosleep treatment.On the basis of our findings, electrosleep therapy appears to have limited value for patients with a chronic psychiatric illness manifested by prominent anxiety, depression, and insomnia. However, some patients may do better with this therapy than with other current treatment modalities. In patients will primary depression, electrosleep therapy should be used with caution, and may be contraindicated.Clearly this is a preliminary study and further systematic clinical and physiological investigation must be done before efficacy and clinical indications are established.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

An experiment is described in which memory functioning is investigated in two comparable groups of epileptics. This study was undertaken with the aim of discriminating between the performance of temporal lobe and centrencephalic epileptics on the Wechsler Memory Scale (WMS) and of contributing some information concerning cerebral functioning and organization. The short term memory deficit which is thought to be associated with temporal lobe epilepsy is studied in relation to a secondary distraction task.Experimental groups are comprised of 30 subjects with chronic unilateral temporal lobe epilepsy and 30 chronic centrencephalic epileptics. A further group of 23 normal subjects is used to control for the effects of the distraction task on the memory test.The results indicate that a general memory impairment can be related to the temporal lobes. However, more detailed analysis of the data reveals that the only specific area of memory functioning in which the temporal lobe epileptics are markedly inferior to the centrencephalic epileptics is immediate recall of narrative texts. That is, the temporal lobe epileptics have particular difficulty in retaining meaningful verbal material even in the immediate present. Other subtests of the WMS do not discriminate effectively between the two epileptic groups and do not contribute significant information about the nature of the memory impairment.The performance of both epileptic groups on the WMS is adversely affected by a divided attention situation, but the distraction task does not significantly differentiate between them.An attempt is made to relate these findings to theories of cognitive functioning within the brain and to other empirical findings. A tentative hypothesis, based on an assumption of subictal discharge is proposed to explain the disturbance of memory functioning in temporal lobe epileptics. It is contended that a frequent, minimal electrical discharge disturbs the course of memory functioning in the stages of registration and consolidation by sensitizing the temporal lobe cortex (particularly the hippocampal zone) to the effects of external distraction and by directly disrupting the mechanisms involved in the consolidation of new information.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Chronic alcoholics were administered the Wisconsin Card Sorting Test. It was found that those subjects who admitted to an alcoholism history of greater than 10 years were impaired at set persistence, set shifting, and error utilization relative to normal controls, while those subjects who described themselves as alcoholic for a period of less than 10 years were deficient in only set persistence. Neither group of alcoholics were impaired in their ability to identify simple concepts or in learning to learn capacity. The manifest behavioral deficits arc consistent with the anatomical and neurological evidence for a frontal-limbic focus of pathology in chronic alcoholism.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID