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Lecture 1

PSYC 3P68 Lecture 1: PSYC_3P68_D2_S1_2017_11_16_Lecture
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Department
Psychology
Course Code
PSYC 3P68
Professor
Dr.Cote

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Narcolepsy
What is Narcolepsy?
Chronic neurological disorder that causes iolutary sleep attacks
Age of onset: 15-30 years
Symptoms
Excessive Daytime
Sleepiness (EDS)
Sleep attacks
Cataplexy
Facial weakness, head drooping, knees buckling to the ground, may look like they
have passed out on the floor
usually triggered by strong emotions, this is because the brain areas that cause the
loss of muscle interact with those in emotion areas.
Sleep paralysis (parasomnia)
Unable to move or speak for brief period while waking up or just before falling asleep
Hypnagogic hallucinations (parasomnia)
Scary dreams or sounds reported as subject falls asleep\
Both of these represent the patient going right into REM sleep.
They are manifestation of the REM sleep atonia with rem and the dream like visions
of dreaming during sleep
Automatic behaviors
Prevalence: 1 in 2,000
Estimated that only 55% of
cases diagnosed
Time to diagnose often >10
years
Very insidious disease
By the time you get a
diagnosis the symptoms
usually very severe.
Impact on Quality of Life
Ca’t get a driers liese
Scholastic & work
performance; safety (driving)
History of Narcolepsy
- stimulant treatments;
- may mask the sleepiness, but not effective at treating underlying issues
- discovery of REM sleep, led to disoery of aother type of osiousess
- led of many more disorders being understood, and better diagnosed and treated.
- Canine Model of Narcolepsy
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- advance of genetic study
- blood test to see if positive for a particular marker
- led to hypothesis that narcolepsy was autoimmune disease
- problem with this is that the marker is not 100% specific.
- You could have marker and no narcolepsy, and could not have marker and still
have narcolepsy.
- Depletion of hypocretin cells in the hypothalamus
- orexin and hypothalamus roles still studied today
Diagnosis
Patient History
PSG (rule out other reasons for sleepiness like apnea)
MSLT (REM onsets)
How fast and how often you go into REM sleep
main diagnostic criterion for diagnosing narcolepsy
HLA typing (not diagnostic)
tightly associated with HLA (human leukocyte antigen), suggesting a possible
autoimmune mechanism
Hypocretin measurement (maybe in future)
Can measure concentration post-mortum
But so far no way to measure in living brains
Treatment
Must be multi-dimensional
Pharmacological
Behavioural
Supportive (socially)
Goals
improve EDS, eliminate sleep attacks, eliminate cataplexy, while minimizing side effects
many of the first treatments had terrible side effects
Pharmalogical Treatments
Stimulants
to improve alertness
E.g., Ritalin
Stimulates alertness which leads to wakefulness in this case
Symptoms: Headache, irritability, insomnia, irregular, heartrate
Antidepressants
to control cataplexy, hypnagogic hallucinations and sleep
paralysis
E.g, Prozac
Sodium Oxybate
For cataplexy and EDS
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find more resources at oneclass.com
Controversial because it cqan be used as adate rape drug, a lot of abuse
potential, but a good treatment for anrcolepsy
- Usually on some sort of cocktail of drugs as treatment plan
Modafinil (ProvigilTM) (approved in 1999)
improves alertness with few side effects and low abuse potential
does not act as a stimulant for other body systems
Recently being prescribed off label, may be prescribed to those with EDS, truck drivers
and similar jobs that require staying awake for long periods of time.
** No real pharmacologic solution to date. Narcolepsy continues to be an extremely debilitating
disorder **
Recent discoveries
I. 1999: the gene for canine narcolepsy is discovered
Genetic link found
Pursuit for human gene
Potential for gene therapy
II. 1998: the Hypocretin / orexin story begins
people with narcolepsy lack a chemical in the brain called hypocretin
hypocretin stimulates arousal and helps regulate sleep
Researchers: Siegel (UCLA);Mignot (Stanford)
Implications for Narcolepsy Patients
Narcolepsy is a neurological disease (disease of the brain)
Narcolepsy CAUSED by cell loss ut e do’t ko hat auses the ell loss
New diagnostic techniques may be developed
Advances in the power of MRI and in analysis techniques
Ways to boost hypocretin
Ways to prevent hypocretin loss
Can begin to treat causes, not just symptoms
Future Direction for Narcolepsy Research
Understanding why symptoms vary
Boost function of existing hypocretin cells
Stems cells may provide cure (distant future)
Inject healthy cells in the area, or hypocrite into area
Animal research: injecting hypocretin into veins of narcoleptic dogs
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Description
Narcolepsy What is Narcolepsy? Chronic neurological disorder that causes involuntary sleep attacks Age of onset: 1530 years Symptoms Excessive Daytime Sleepiness (EDS) Sleep attacks Cataplexy Facial weakness, head drooping, knees buckling to the ground, may look like they have passed out on the floor usually triggered by strong emotions, this is because the brain areas that cause the loss of muscle interact with those in emotion areas. Sleep paralysis (parasomnia) Unable to move or speak for brief period while waking up or just before falling asleep Hypnagogic hallucinations (parasomnia) Scary dreams or sounds reported as subject falls asleep Both of these represent the patient going right into REM sleep. They are manifestation of the REM sleep atonia with rem and the dream like visions of dreaming during sleep Automatic behaviors Prevalence: 1 in 2,000 Estimated that only 55 of cases diagnosed Time to diagnose often >10 years Very insidious disease By the time you get a diagnosis the symptoms usually very severe. Impact on Quality of Life Cant get a drivers license Scholastic work performance; safety (driving) History of Narcolepsy stimulant treatments; may mask the sleepiness, but not effective at treating underlying issues discovery of REM sleep, led to discovery of another type of consciousness led of many more disorders being understood, and better diagnosed and treated. Canine Model of Narcolepsy
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