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curriculum Chương trình giảng dạy. Ex: Schools should update their curriculum to meet the demands of modern society. pedagogy Phương pháp giảng dạy. Ex: Modern pedagogy emphasizes student-centered learning. tuition fees Học phí. Ex: Many students are burdened by high university tuition fees. scholarship Học bổng. Ex: She received a full scholarship to study abroad. distance learning Học từ xa. Ex: Distance learning offers flexibility for working professionals. enroll in a course Ghi danh vào một khoá học. Ex: I decided to enroll in a course to improve my writing skills. literacy rate Tỷ lệ biết chữ. Ex: The government has made great efforts to improve the literacy rate in rural areas. academic performance Kết quả học tập. Ex: Poor nutrition can negatively affect a child’s academic performance. higher education Giáo dục bậc cao. Ex: Many believe higher education is key to a successful career. dropout rate Tỷ lệ bỏ học. Ex: The dropout rate in some developing countries is alarmingly high. continuous assessment Đánh giá liên tục. Ex: Continuous assessment encourages consistent study habits. vocational training Đào tạo nghề. Ex: Vocational training helps students gain practical skills for employment. compulsory education Giáo dục bắt buộc. Ex: In most countries, children must receive compulsory education until a certain age. tertiary education Giáo dục đại học/cao đẳng. Ex: Tertiary education opens up better job opportunities. learn by rote Học vẹt. Ex: Learning by rote is often criticized for not promoting deep understanding. interactive learning Học tương tác. Ex: Interactive learning makes lessons more engaging and effective. face-to-face classes Lớp học trực tiếp. Ex: Some students prefer face-to-face classes over online learning. extracurricular activities Hoạt động ngoại khoá. Ex: Extracurricular activities help develop teamwork and leadership skills. boarding school Trường nội trú. Ex: He spent five years in a prestigious boarding school in the UK. a well-rounded education Nền giáo dục toàn diện. Ex: A well-rounded education includes both academic
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Perception The process of organizing and interpreting sensory information to give meaning to our environment. Bottom-up processing An approach where perception starts with sensory input and works up to the brain's integration of this information. Top-down processing Information processing guided by higher-level mental processes, drawing on experience and expectations to construct perceptions. Schema A concept or framework that organizes and interprets information. Perceptual set A mental predisposition to perceive one thing and not another. Gestalt psychology Emphasizes that we often perceive the whole rather than the sum of the parts. Closure The perceptual tendency to mentally fill in gaps in a visual image to perceive objects as wholes. Figure and ground The organization of the visual field into objects (figures) that stand out from their surroundings (ground). Proximity The perceptual tendency to group together visual and auditory events that are near each other. Similarity The perceptual tendency to group together elements that seem alike. Attention The focusing of mental resources on select information. Selective attention The focusing of conscious awareness on a particular stimulus. Cocktail party effect The ability to focus auditory attention on a particular stimulus while filtering out other stimuli. Inattentional blindness Failing to see visible objects when attention is directed elsewhere. Change Blindness Failing to notice changes in the environment. Binocular depth cues Depth cues, such as retinal disparity, that depend on the use of two eyes. Retinal disparity A binocular cue for perceiving depth by comparing images from the retinas in the two eyes. Convergence A binocular cue for perceiving depth by the extent to which the eyes converge inward when looking at an object. Monocular depth cues Depth cues, such as interposition and linear perspective, available to either eye alone. Relative clarity A monocular cue for perceiving depth; hazy objects are seen as farther away than sharp, clear objects. Relative size A cue that allows determining the closeness of objects to an object of known size. Texture gradient A gradual change from coarse to fine texture signaling increasing distance. Linear perspective Parallel lines appear to converge with distance. Aptitude tests Tests designed to predict a person's future performance; aptitude is the capacity to learn. Fixed mindset The idea that we have a set amount of an ability that cannot change. Growth mindset The belief that one's skills and qualities can change and improve through effort and dedication. Explicit memory Memory of facts and experiences that one can consciously know and 'declare.' Episodic memory The collection of past personal experiences that occurred at a particular time and place. Semantic memory Memory for factual information. Implicit memory Retention independent of conscious recollection. Procedural memory A type of long-term memory of how to perform different actions and skills. Prospective memory Remembering to perform a planned action or recall a planned intention at some future point in time. Long-term potentiation An increase in a cell's firing potential after brief, rapid stimulation. Believed to be a neural basis for learning and memory. Working memory model A model that suggests that memory involves a series of active, temporary memory stores that manipulate information. Working memory A newer understanding of short-term memory that involves conscious, active processing of incoming auditory and visual-spatial information, and of information retrieved from long-term memory. Central executive The part of working memory that directs attention and processing. Phonological loop The part of working memory that holds and processes verbal and auditory information. Visuospatial sketchpad The part of working memory that holds visual and spatial information. Multi-store model A model of memory that suggests information passes through three stages: sensory memory, short-term memory, and long-term memory. Sensory memory The immediate, very brief recording of sensory information in the memory system. Iconic memory A momentary sensory memory of visual stimuli; a photographic or picture-image memory lasting no more than a few tenths of a second. Echoic memory A momentary sensory memory of auditory stimuli; if attention is elsewhere, sounds and words can still be recalled within 3 or 4 seconds. Short-Term Memory Activated memory that holds a few items briefly before the information is stored or forgotten. Long-Term Memory The relatively permanent and limitless storehouse of the memory system. Includes knowledge, skills, and experiences. Automatic processing Unconscious encoding of incidental information, such as space, time, and frequency, and of well-learned information. Effortful processing Encoding that requires attention and conscious effort. Encoding The processing of information into the memory system—for example, by extracting meaning. Storage The retention of encoded information over time. Retrieval The process of getting information out of memory storage. Levels of processing model The theory that deeper levels of processing result in longer-lasting memory codes. Shallow encoding Processing information based on its surface characteristics. Deep encoding Processing information based on its meaning and the significance of the information. Mnemonic devices Memory aids, especially those techniques that use vivid imagery and organizational devices. Method of loci A mnemonic device that involves imagining placing items around a room or along a route. Chunking-Grouping Organizing items into familiar, manageable units; often occurs automatically. Categories-Grouping Grouping information into categories that share common attributes. Hierarchies-Grouping Organizing items into a hierarchy, starting with general categories and working down to specific examples. Spacing effect The tendency for distributed study or practice to yield better long-term retention than is achieved through massed study or practice. Massed practice Cramming information all at once. It is less effective than spaced practice. Distributed practice Spacing the study of material to be remembered by including breaks between study periods. Serial position effect Our tendency to recall best the last and first items in a list. Primacy effect The tendency to remember information at the beginning of a body of information better than the information that follows. Recency effect The tendency to remember information that is presented last. Maintenance rehearsal Repeating information over and over to keep it active in short-term memory. Elaborative rehearsal A method of transferring information from short-term to long-term memory by making that information meaningful in some way. Memory retention The ability to retain information over time through the storage and retrieval of information. Autobiographical memory The memory for events and facts related to one's personal life story. Retrograde amnesia An inability to retrieve information from one's past. Anterograde amnesia An inability to form new memories. Alzheimer's disease A progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning. Infantile amnesia The inability to retrieve memories from much before age 3. Recall A measure of memory in which the person must retrieve information learned earlier, as on a fill-in-the-blank test. Recognition A measure of memory in which the person need only identify items previously learned, as on a multiple-choice test. Retrieval cues Stimuli that aid the recall or recognition of information stored in memory. Context-dependent memory The theory that information learned in a particular situation or place is better remembered when in that same situation or place. Mood-congruent memory The tendency to recall experiences that are consistent with one's current good or bad mood. State-dependent memory The theory that information learned in a particular state of mind (e.g., drunk, sober) is more easily recalled when in that same state of mind. The forgetting curve A graph showing retention and forgetting over time. Encoding failure The failure to process information into memory. Proactive interference The disruptive effect of prior learning on the recall of new information. Retroactive interference The disruptive effect of new learning on the recall of old information. Tip-of-the-tongue phenomenon The temporary inability to remember something you know, accompanied by a feeling that it's just out of reach. Repression The basic defense mechanism that banishes from consciousness anxiety-arousing thoughts, feelings, and memories. Misinformation effect Incorporating misleading information into one's memory of an event. Source amnesia Attributing to the wrong source an event we have experienced, heard about, read about, or imagined. Constructive memory The process by which memories are influenced by the meaning we give to events. Memory consolidation The neural storage of a long-term memory. Imagination inflation The increased confidence in a false memory of an event following repeated imagination of the event. Health Psychology A branch of psychology that focuses on how physical activities, psychological traits, and social relationships affect overall health and illness. Stress The process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging. Hypertension High blood pressure, often associated with stress, which can increase the risk of heart and kidney diseases and stroke. Immune Suppression Reduction in the effectiveness of the immune system, which can be caused by various forms of stress. Stressors Events or conditions in your surroundings that may trigger stress. Daily Hassles Everyday minor events that cause stress, such as traffic jams or overwhelming chores. Significant Life Changes Major life transitions like moving, leaving a job, or divorcing, which can be stressful. Catastrophes Unpredictable, large-scale events that cause significant stress and alter the lives of many people. Eustress (motivating) Positive stress which results from striving toward a challenging goal. Distress (debilitating) Negative stress that can make a person sick or keep a person from reaching a goal. Adverse Childhood Experiences (ACEs) Potentially traumatic events that occur in childhood and can have negative, lasting effects on health and well-being. General Adaptation Syndrome (GAS) The three-stage process (alarm, resistance, exhaustion) that describes the physiological changes the body goes through when under stress. Alarm Reaction Phase The initial reaction to a stressor, activating the body's defense systems. Resistance Phase The body's response after the initial shock of a stressful event, where the body attempts to return to normal functioning. Flight-Fight-Freeze Response A physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. Exhaustion Phase The third stage of the GAS, during which the body depletes its resources in responding to a prolonged stressor. Tend-and-Befriend Theory A theory that suggests people seek social support and tend to others in times of stress. Problem-focused Coping Strategies aimed at tackling the cause of stress in practical ways which directly tackle the problem causing the stress. Emotion-focused Coping Strategies aimed at relieving or managing the emotional distress associated with stress. Positive Psychology The scientific study of human strengths and virtues that enable individuals and communities to thrive. Subjective Well-being An individual's own assessment of their happiness and satisfaction with life. Resilience The ability to mentally or emotionally cope with a crisis or to return to pre-crisis status quickly. Posttraumatic Growth Positive psychological change experienced as a result of adversity and other challenges in order to rise to a higher level of functioning. Positive Emotions Feelings that engage us, elevate us, and promote growth and well-being. Gratitude A feeling of thankfulness and appreciation, especially in response to someone doing something kind or helpful. Signature Strengths & Virtues Character strengths and virtues that are personally fulfilling, intrinsic to one's identity, and contribute to the collective well-being. Categories of Virtues Broad categories that encompass character strengths, such as wisdom, courage, humanity, justice, temperance, and transcendence. Abnormal Psychology The study of psychological disorders, including their symptoms, etiology (i.e., their causes), and treatment. Clinical Psychology A branch of psychology that studies, assesses, and treats people with psychological disorders. Psychology Student Syndrome A phenomenon where psychology students begin to believe they have the disorders they are studying. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) The updated manual that describes and categorizes mental disorders in order to improve diagnoses, treatment, and research. International Classification of Mental Disorders (ICD) A standard diagnostic tool for epidemiology, health management, and clinical purposes. It is maintained by the World Health Organization (WHO) and covers a broad range of health conditions, including psychological conditions. Deviation In psychology, typically refers to departing from the norm, which can either be statistical, social, or functional in nature. Distress Negative stress that can lead to anxiety, depression, and potentially to physical problems. Dysfunction Abnormal functioning, as opposed to normal functioning, often used to refer to individual behaviors or the functioning of social systems. Eclectic Approach An approach to clinical practice that involves selecting the best treatment techniques from various disciplines based on the client's unique problems, strengths, and preferences. Behavioral Perspective Focuses on how we learn observable responses and how the environment impacts those responses. Psychodynamic Perspective Emphasizes the influence of the unconscious mind on behavior and the importance of childhood experiences. Humanistic Perspective Focuses on the importance of being your true self in order to lead the most fulfilling life. Cognitive Perspective Focuses on how we encode, process, store, and retrieve information. Evolutionary Perspective How the natural selection of traits promotes the perpetuation of one's genes. Sociocultural Perspective Examines how the social environments and cultural upbringing influence an individual's behavior and thoughts. Biological Perspective Explores the links between brain and mind, and how the body and brain enable emotions, memories, and sensory experiences. Biopsychosocial Model An integrated approach that incorporates biological, psychological, and social-cultural levels of analysis to better understand health and illness. Diathesis-Stress Model Suggests that a person may be predisposed for a psychological disorder that remains unexpressed until triggered by stress. Stigma Disapproval or discrimination against a person based on perceivable social characteristics that serve to distinguish them from other members of society. Anxiety Disorders Mental health disorders characterized by significant feelings of anxiety and fear. Specific Phobia An anxiety disorder characterized by irrational and persistent fear of a specific object, situation, or activity. Acrophobia Fear of heights. Arachnophobia Fear of spiders. Agoraphobia Fear of open or crowded spaces. Panic Disorder An anxiety disorder that consists of sudden, overwhelming attacks of terror. Ataque de nervios A cultural syndrome primarily seen in Latin Americans, involving symptoms of intense emotional upset, acute anxiety, fear, or anger. Social Anxiety Disorder A chronic mental health condition in which social interactions cause irrational anxiety. Taijin Kyofusho A Japanese culture-specific syndrome characterized by an intense fear that one's body, body parts, or bodily functions give others a negative impression. Generalized Anxiety Disorder An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal. Obsessive-Compulsive Disorders Disorders involving intrusive obsessions and compulsions which impede daily life. Obsessions Persistent ideas, thoughts, or impulses that are unwanted and inappropriate and cause marked distress. Compulsions Repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession. Hoarding Disorder A disorder characterized by the persistent difficulty discarding or parting with possessions, regardless of their actual value. Trauma and Stressor-Related Disorders Disorders related to the exposure to a traumatic or stressful event. Posttraumatic Stress Disorder A disorder characterized by failure to recover after experiencing or witnessing a terrifying event. Depressive Disorders Disorders that involve the presence of sad, empty, or irritable mood, accompanied by physical and cognitive changes that significantly affect the individual's capacity to function. Major Depressive Disorder A mood disorder causing a persistent feeling of sadness and loss of interest. Persistent Depressive Disorder A form of depression that is less severe than major depressive disorder but more chronic. Bipolar Disorder A disorder associated with episodes of mood swings ranging from depressive lows to manic highs. Bipolar Cycling The process of cycling through episodes of mania and depression in bipolar disorder. Bipolar I Disorder A type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode. Bipolar II Disorder A type of bipolar disorder marked by milder episodes of hypomania that alternate with periods of severe depression. Neurodevelopmental Disorders A group of conditions with onset in the developmental period, often before school age, that are characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning. Attention-Deficit/Hyperactivity Disorder (ADHD) A chronic condition including attention difficulty, hyperactivity, and impulsiveness. Autism Spectrum Disorder (ASD) A disorder that affects communication and behavior. Feeding and Eating Disorders Disorders characterized by abnormal or disturbed eating habits, which negatively affect a person's health. Anorexia Nervosa An eating disorder characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of body weight. Bulimia Nervosa An eating disorder characterized by binge eating followed by purging. Schizophrenic Spectrum Disorders A range of disorders that involve psychosis, including schizophrenia. Delusions False beliefs, often of persecution or grandeur, that may accompany psychotic disorders. Delusions of Persecution The belief that others are out to get one. Delusions of Grandeur A false belief that one is more important or influential than they really are. Hallucinations False sensory experiences, such as seeing something in the absence of an external visual stimulus. Disorganized Thinking A symptom of psychosis, manifested as illogical or incoherent thought and speech. Disorganized Speech A style of talking involving incoherence and a lack of typical logical patterns. Word Salad A confused or unintelligible mixture of seemingly random words and phrases. Disorganized Motor Behavior Includes a variety of unusual behaviors including problems with goal-directed behavior leading to difficulties performing activities of daily living. Catatonia A state of unresponsiveness to one's outside environment, usually including muscle rigidity, staring, and inability to communicate. Flat Affect A lack of emotional responsiveness. Dopamine Hypothesis The theory that schizophrenia results from an excess of dopamine activity. Positive Symptoms Symptoms of schizophrenia that are excesses of behavior or occur in addition to normal behavior; hallucinations, delusions, and disorganized speech. Negative Symptoms Symptoms of schizophrenia that are marked by deficits in functioning, such as apathy, lack of emotion, and slowed speech and movement. Dissociative Disorders Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Dissociative Amnesia A disorder characterized by the sudden and extensive inability to recall important personal information, usually of a traumatic or stressful nature. Dissociative Fugue A rare dissociative disorder in which a person loses awareness of their identity or other important autobiographical information and also engages in some form of unexpected travel. Dissociative Identity Disorder A disorder characterized by the presence of two or more distinct personality states. Personality Disorders Psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning. Cluster A Personality Disorders Odd, eccentric thinking or behavior (including paranoid, schizoid, and schizotypal personality disorders). Paranoid Personality Disorder Type of personality disorder characterized by extreme distrust and suspicion of others. Schizoid Personality Disorder A personality disorder characterized by persistent avoidance of social relationships and little expression of emotion. Schizotypal Personality Disorder A personality disorder characterized by severe social anxiety, thought disorder, paranoid ideation, derealization, transient psychosis, and often unconventional beliefs. Cluster B Personality Disorders Dramatic, overly emotional or unpredictable thinking or behavior (including antisocial, borderline, histrionic, and narcissistic personality disorders). Antisocial Personality Disorder A personality disorder characterized by a lack of conscience for wrongdoing, even toward friends and family. Histrionic Personality Disorder A personality disorder characterized by excessive emotionality and attention seeking. Narcissistic Personality Disorder A disorder in which a person has an inflated sense of self-importance. Borderline Personality Disorder A personality disorder characterized by severe instability in emotions and self-image, along with impulsive and reckless behavior. Cluster C Personality Disorders Anxious, fearful thinking or behavior, including avoidant, dependent, and obsessive-compulsive personality disorders. Avoidant Personality Disorder A personality disorder characterized by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Dependent Personality Disorder A personality disorder characterized by psychological dependence on other people. Obsessive-Compulsive Personality Disorder A personality disorder characterized by preoccupation with orderliness, perfection, and control. Deinstitutionalization The release of institutionalized individuals from institutional care to community-based care. Evidence-Based Interventions Treatments based on scientific evidence. Cultural Humility An approach to engagement across cultures emphasizing openness and self-awareness of one's own cultural identities. Therapeutic Alliance The relationship between a healthcare professional and a client. Conformity Adjusting one's behavior or thinking to coincide with a group standard. Normative Social Influence Influence resulting from a person's desire to gain approval or avoid disapproval. Social Norms Expected standards of conduct, which influence behavior. Social Comparison Evaluating one's abilities and opinions by comparing oneself to others. Relative Deprivation The perception that one is worse off relative to those with whom one compares oneself. Upward Social Comparison Comparing oneself with others who are better off. Downward Social Comparison Comparing oneself with others who are worse off. Informational Social Influence Influence resulting from one's willingness to accept others' opinions about reality. Obedience Following the directives of authority. Social Facilitation Improved performance on simple or well-learned tasks in the presence of others. Group Polarization The enhancement of a group's prevailing inclinations through discussion within the group. Groupthink The mode of thinking that occurs when the desire for harmony in a decision-making group overrides a realistic appraisal of alternatives. Bystander Effect The tendency for any given bystander to be less likely to give aid if other bystanders are present. Diffusion of Responsibility Diminished sense of responsibility among group members to act because others are seen as equally responsible. Social Loafing The tendency for people in a group to exert less effort when pooling their efforts toward attaining a common goal than when individually accountable. Deindividuation The loss of self-awareness and self-restraint occurring in group situations that foster arousal and anonymity. Attribution Theory The theory that we explain someone's behavior by crediting either the situation or the person's disposition. Dispositional Attributions Attributing behavior to the person's disposition and traits. Situational Attributions Attributing behavior to the environment. Explanatory Style A person's habitual way of explaining events, typically assessed along three dimensions: internal/external, stable/unstable, and global/specific. Optimistic Explanatory Style Explaining bad events as results of temporary, external causes. Pessimistic Explanatory Style Explaining bad events as results of stable, internal causes. Fundamental Attribution Error The tendency for observers, when analyzing others' behavior, to underestimate the impact of the situation and to overestimate the impact of personal disposition. Actor-Observer Bias The tendency to attribute one's own actions to external causes while attributing other people's behaviors to internal causes. Self-Serving Bias A readiness to perceive oneself favorably. Internal Locus of Control The perception that one controls one's own fate. External Locus of Control The perception that chance or outside forces beyond one's personal control determine one's fate. Altruism Unselfish regard for the welfare of others. Social Responsibility Norm An expectation that people will help those needing their help. Stereotype A generalized belief about a group of people. Confirmation Bias The tendency to interpret new evidence as confirmation of one's existing beliefs or theories. Belief Perseverance Clinging to one's initial conceptions after the basis on which they were formed has been discredited. Self-Fulfilling Prophecy A belief that leads to its own fulfillment. Prejudice An unjustifiable and usually negative attitude toward a group and its members. Discrimination Unjustifiable negative behavior toward a group and its members. Implicit Attitudes Attitudes that influence a person's feelings and behavior at an unconscious level. Just-World Phenomenon The tendency for people to believe the world is just and that people therefore get what they deserve. Out-Group Homogeneity Bias Perception of out-group members as more similar to one another than are in-group members. In-Group Bias The tendency to favor one's own group. Mere Exposure Effect The phenomenon that repeated exposure to novel stimuli increases liking of them. Ethnocentrism Evaluating other cultures according to the standards and customs of one's own culture. Collectivism Giving priority to the goals of one's group and defining one's identity accordingly. Multiculturalism The practice of valuing and respecting differences in culture. Superordinate Goals Shared goals that override differences among people and require their cooperation. Social Traps A situation in which conflicting parties, by each rationally pursuing their self-interest, become caught in mutually destructive behavior. Persuasion The process of creating, reinforcing, or changing people's beliefs or actions. Elaboration Likelihood Model A theory of how persuasive messages lead to attitude changes. Central Route of Persuasion Attitude change path in which interested people focus on the arguments and respond with favorable thoughts. Peripheral Route of Persuasion Attitude change path in which people are influenced by incidental cues, such as a speaker's attractiveness. Halo Effect The tendency to draw a general impression about an individual on the basis of a single characteristic. Foot-in-the-Door Technique The tendency for people who have first agreed to a small request to comply later with a larger request. Door-in-the-Face Technique The strategy of getting someone to agree to a modest request by first asking them to agree to a much larger request that they will likely turn down. False Consensus Effect The tendency to overestimate the extent to which others share our beliefs and behaviors. Cognitive Dissonance The theory that we act to reduce the discomfort we feel when two of our thoughts are inconsistent. Industrial-Organizational (I/O) Psychologists Psychologists who apply psychology's principles to the workplace. Instincts A complex behavior that is rigidly patterned throughout a species and is unlearned. Drive-Reduction Theory The idea that a physiological need creates an aroused tension state (a drive) that motivates an organism to satisfy the need. Homeostasis The tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level. Ghrelin Hormone secreted by an empty stomach; sends 'I'm hungry' signals to the brain. Leptin Hormone secreted by fat cells; when abundant, causes brain to increase metabolism and decrease hunger. Hypothalamus A neural structure lying below the thalamus; directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward. Pituitary Gland The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands. Belongingness The human emotional need to be an accepted member of a group. Arousal Theory The theory that people are motivated to maintain an optimal level of alertness and physical and mental activation. Yerkes-Dodson Law The principle that performance increases with arousal only up to a point, beyond which performance decreases. Sensation-Seeking Theory The search for experiences and feelings that are varied, novel, complex, and intense. Thrill Seeking Pursuing activities that provide a rush of adrenaline. Adventure Seeking Engaging in unusual and exciting activities. Disinhibition Acting impulsively, without considering the consequences. Boredom Susceptibility Tendency to experience boredom and frustration when not engaged in stimulating activities. Incentive Theory A theory that states that behavior is motivated by a desire for reinforcement or incentives. Extrinsic Motivation A desire to perform a behavior to receive promised rewards or avoid threatened punishment. Self-Determination Theory A theory of motivation that is concerned with the beneficial effects of intrinsic motivation and the harmful effects of extrinsic motivation. Intrinsic Motivation A desire to perform a behavior effectively for its own sake. Lewin's Motivational Conflicts Theory A theory that describes situations in which conflicting motivations produce indecision and difficulty. Approach-Approach Conflicts Conflict that results from having to choose between two attractive alternatives. Avoidance-Avoidance Conflicts Conflict that results from having to choose between two distasteful alternatives. Approach-Avoidance Conflicts Conflict that results when a single action or event has both attractive and unattractive features. Emotion A response of the whole organism, involving (1) physiological arousal, (2) expressive behaviors, and (3) conscious experience. Affect A broad range of feelings that people experience. Facial-Feedback Hypothesis The idea that facial expressions can influence emotions as well as reflect them. Display Rules Culturally determined rules about which nonverbal behaviors are appropriate to display. Elicitors Stimuli that trigger emotional responses. Broaden-and-Build Theory of Emotion Theory proposing that happiness predisposes us to think more openly. Universal Emotions Basic emotions that are expressed by all cultures around the world such as happiness, sadness, fear, disgust, anger, and surprise. Psychodynamic Theory A view that explains personality in terms of conscious and unconscious forces, such as unconscious desires and beliefs. Preconscious Mind The level of consciousness that is not currently in focal awareness. Unconscious Mind A reservoir of mostly unacceptable thoughts, wishes, feelings, and memories. Denial Psychoanalytic defense mechanism by which people refuse to believe or even to perceive painful realities. Displacement Defense mechanism that shifts sexual or aggressive impulses toward a more acceptable or less threatening object or person. Projection Defense mechanism by which people disguise their own threatening impulses by attributing them to others. Rationalization Defense mechanism that offers self-justifying explanations in place of the real, more threatening, unconscious reasons for one's actions. Reaction Formation Defense mechanism by which the ego unconsciously switches unacceptable impulses into their opposites. Regression Defense mechanism in which an individual faced with anxiety retreats to a more infantile psychosexual stage. Repression Defense mechanism by which anxiety-provoking thoughts and feelings are forced to the unconscious. Sublimation Defense mechanism by which people re-channel their unacceptable impulses into socially approved activities. Humanistic Psychology A historically significant perspective that emphasized the growth potential of healthy people. Unconditional Regard An attitude of total acceptance toward another person. Self-Actualizing Tendency The human motive toward realizing our inner potential. Social-Cognitive Theory Views behavior as influenced by the interaction between people's traits (including their thinking) and their social context. Reciprocal Determinism The interacting influences of behavior, internal cognition, and environment. Self-Concept All our thoughts and feelings about ourselves, in answer to the question, 'Who am I?' Self-Efficacy One's sense of competence and effectiveness. Self-Esteem One's feelings of high or low self-worth. Trait Theories Theories that endeavor to describe the characteristics that make up human personality in an effort to predict future behavior. Big Five Theory The theory that there are five basic personality traits: openness, conscientiousness, extraversion, agreeableness, and neuroticism (emotional stability). Personality Inventories A questionnaire (often with true-false or agree-disagree items) on which people respond to items designed to gauge a wide range of feelings and behaviors; used to assess selected personality traits. Factor Analysis A statistical procedure that identifies clusters of related items (called factors) on a test; used to identify different dimensions of performance that underlie one's total score. Openness to Experience One of the five factors; willingness to try new things and be open to new experiences. Conscientiousness One of the five factors; a tendency to show self-discipline, act dutifully, and aim for achievement. Extraversion One of the five factors; energy, positive emotions, and the tendency to seek stimulation and the company of others. Agreeableness One of the five factors; a tendency to be compassionate and cooperative rather than suspicious and antagonistic towards others. Behavioral Perspective Emphasizes learning and behavior in explaining thoughts, feelings, and actions. Associative Learning Making connections between events to learn. Habituation Becoming less responsive to a repeated stimulus. Classical Conditioning Pairing two stimuli to elicit a response. Unconditioned Stimulus (UCS) Naturally triggers a response without learning. Conditioned Stimulus (CS) Initially neutral, triggers a conditioned response. Acquisition Initial learning stage where a response is established. Extinction Diminishing of a conditioned response. Spontaneous Recovery Reappearance of an extinguished response after a pause. Stimulus Discrimination Ability to differentiate between stimuli. Stimulus Generalization Conditioned stimulus evokes similar responses. Higher-Order Conditioning Pairing a conditioned stimulus with a new one. Counterconditioning Uses conditioning to change responses to triggers. Taste Aversion Avoidance of food associated with discomfort. One-Trial Conditioning Learning with only one pairing of stimulus and response. Biological Preparedness Inclination to form associations between stimuli and responses. Operant Conditioning Learning through rewards and punishments. The Law of Effect Behaviors with favorable consequences are repeated. Reinforcement Strengthens behavior it follows. Primary Reinforcers Innately reinforcing stimuli satisfying biological needs. Secondary Reinforcers Gains reinforcing power through association. Punishment Event decreasing behavior it follows. Shaping Positive reinforcement of behavior patterns. Instinctive Drift Tendency to revert to instinctive behaviors. Fine Motor Coordination The ability to make small, precise movements, typically involving the coordination of the hands and fingers with the eyes. Gross Motor Coordination The ability to make large, general movements, such as crawling and walking. Maturation Biological growth processes that enable orderly changes in behavior, relatively uninfluenced by experience. Reflexes Automatic responses to sensory stimuli, like grasping a finger tightly with the hands. Rooting Reflex A baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple. Visual Cliff A laboratory device for testing depth perception in infants and young animals. Critical Periods Specific time periods during which an organism must experience stimuli in order to develop normally. Sensitive Periods Times in development when a person is particularly open to certain kinds of experiences. Imprinting The process by which certain animals form strong attachments during early life. Growth Spurt A rapid increase in growth during puberty. Puberty The period of sexual maturation, during which a person becomes capable of reproducing. Primary Sex Characteristics The body structures (ovaries, testes, and external genitalia) that make sexual reproduction possible. Secondary Sex Characteristics Nonreproductive sexual traits, such as female breasts and hips, male voice quality, and body hair. Menarche The first menstrual period. Spermarche The first ejaculation. Menopause The time of natural cessation of menstruation; also refers to the biological changes a woman experiences as her ability to reproduce declines. Sex The biologically influenced characteristics by which people define males and females. Gender The socially influenced characteristics by which people define men and women. Socialization The process by which people learn the norms, rules, and information of a culture or society. Jean Piaget A psychologist known for his study of cognitive development in children. Sensorimotor Stage The first stage in Piaget's theory of cognitive development, from birth to about 2 years of age, during which infants know the world mostly in terms of their sensory impressions and motor activities. Object Permanence The awareness that things continue to exist even when not perceived. Preoperational Stage The second stage in Piaget's theory, from about 2 to 7 years of age, during which a child learns to use language but does not yet comprehend the mental operations of concrete logic. Mental Symbols Internal depictions of information that the mind can manipulate. Chronosystem In Bronfenbrenner's theory, this system encompasses changes over time in child development. Authoritarian Parenting A parenting style characterized by high demands and low responsiveness. Parents with this style have very high expectations of their children, yet provide very little in the way of feedback and nurturance. Authoritative Parenting A parenting style characterized by high demands and high responsiveness. Parents with this style set limits and enforce rules but also listen to their children. Permissive Parenting A parenting style characterized by low demands with high responsiveness. These parents tend to be very loving, yet provide few guidelines and rules. Attachment Styles Patterns of attachment, defined by different ways of interacting and behaving in relationships. Secure Attachment An attachment style characterized by trust, a lack of concern with being abandoned, and the view that one is worthy and well liked. Insecure Attachment Attachment styles characterized by fear of abandonment and the feeling that one's needs might not be met. Avoidant Attachment An attachment style characterized by difficulty in learning to trust others. Anxious Attachment An attachment style where individuals are often anxious about the stability of their relationships. Disorganized Attachment An attachment style characterized by a lack of clear attachment behavior. Temperament A person's characteristic emotional reactivity and intensity. Separation Anxiety Emotional distress seen in many infants when they are separated from people with whom they have formed an attachment. Contact Comfort The physical and emotional comfort that an infant receives from being in physical contact with its mother. Parallel Play Activity in which children play side by side without interacting. Pretend Play Play involving imaginary people and situations; also called fantasy play, dramatic play, or imaginative play. Egocentrism The inability to differentiate between self and other. More specifically, it is the inability to understand that others have different feelings, desires, and perspectives from one's own. Imaginary Audience A concept in adolescent psychology where an individual believes that his or her behavior is the main focus of others' attention and concern. Personal Fable An adolescent's belief that they are unique and protected from harm. Social Clock The culturally preferred timing of social events such as marriage, parenthood, and retirement. Emerging Adulthood A phase of the life span between adolescence and full-fledged adulthood which encompasses late adolescence and early adulthood, generally ages 18 to 25. Stage Theory of Psychosocial Development (Erikson) Erik Erikson's theory that identifies eight stages through which a healthily developing human should pass from infancy to late adulthood. Trust vs. Mistrust The first stage of Erik Erikson's theory of psychosocial development. This stage occurs between birth and approximately 18 months of age. During this stage, the infant learns if they can trust the world to fulfill their needs. Autonomy vs. Shame and Doubt The second stage of Erik Erikson's stages of psychosocial development. This stage occurs between the ages of 18 months to approximately 3 years. The child learns to be independent and confident or experiences shame and doubt about their abilities. Initiative vs. Guilt The third stage of Erik Erikson's stages of psychosocial development. This stage occurs during the preschool years, between the ages of 3 to 5 years. Children begin to assert control and power over their environment. Industry vs. Inferiority The fourth stage of Erik Erikson's stages of psychosocial development. This stage occurs between the ages of 5 and 12 years. Children learn to cope with new social and academic demands, success leads to a sense of competence, while failure results in feelings of inferiority. Identity vs. Role Confusion The fifth stage of Erik Erikson's stages of psychosocial development. This stage occurs during adolescence, from about 12-18 years. During this stage, adolescents explore their independence and develop a sense of self. Intimacy vs. Isolation The sixth stage of Erik Erikson's theory of psychosocial development. This stage occurs during young adulthood between the ages of approximately 19 and 40 years. Young adults need to form intimate, loving relationships with other people. Generativity vs. Stagnation The seventh stage of Erik Erikson's theory of psychosocial development. This stage takes place during middle adulthood between the ages of approximately 40 and 65. Individuals establish careers, settle down within relationships, begin families, and develop a sense of being a part of the bigger picture. Integrity vs. Despair The eighth and final stage of Erik Erikson's stages of psychosocial development. This stage occurs during old age and is focused on reflecting back on life. Adverse Childhood Experiences (ACEs) Potentially traumatic events that occur in childhood (0-17 years), such as experiencing violence, abuse, or neglect, witnessing violence in the home or community, and having a family member attempt or die by suicide. Achievement (adolescent development) In the context of identity development, this term refers to the successful integration of various aspects of self-concept, based on explorations of roles, values, and beliefs. Diffusion (adolescent development) A status of identity development where an individual has not yet experienced a crisis or made any commitments. They are undecided and uninterested in occupational and ideological choices. Foreclosure (adolescent development) A status of identity development where an individual has made a commitment without experiencing a crisis. This occurs when people commit to roles or values without exploring alternatives. Moratorium (adolescent development) A status of identity development where an individual is in the midst of a crisis but whose commitments are either absent or are only vaguely defined. Racial/Ethnic Identity An individual's awareness and experience of being a member of a racial or ethnic group, including the degree to which one's cultural, historical, and social aspects of identity are embraced. Sexual Orientation An inherent or immutable enduring emotional, romantic, or sexual attraction to other people. Religious Identity An individual's sense of belonging to a religious group, along with the importance of this group membership as it pertains to one's sense of self. Occupational Identity How a person identifies themselves based on their job or career choices and how they feel those roles impact their personal identity. Familial Identity The part of an individual's identity that is formed by the relationships they have with their family members. Possible Selves The aspect of oneself that includes all the ideas of what one might become, what one hopes to become, and what one is afraid of becoming. Evolutionary Perspective A way of looking at human behavior that emphasizes the role of natural selection and survival of the fittest in shaping our actions. Natural Selection A process where organisms better adapted to their environment tend to survive and produce more offspring. Nature Refers to the genetic or hereditary influences on behavior and traits. Nurture Refers to the environmental influences that shape behavior and traits after conception. Twin Studies Research that compares the similarities between identical and fraternal twins to understand the influence of genetics versus environment. Adoption Studies Studies that compare adopted children to their adoptive and biological parents to understand genetic and environmental influences. Family Studies Research that examines behavioral patterns or genetic markers across generations within families. Heredity The passing on of physical or mental traits genetically from one generation to another. Genetic Predisposition The increased likelihood of developing a particular disease or behavior based on a person's genetic makeup. Eugenics A controversial historical movement aimed at improving the genetic composition of the human race. Cerebral Cortex The outermost layer of the brain involved in high-level functions such as thought, language, and memory. Association Areas Parts of the brain that integrate different types of information from the senses and link it with stored memories. Lobes of the Brain Regions of the brain differentiated by their functions, including frontal, parietal, occipital, and temporal lobes. Frontal Lobes Areas of the brain involved in complex processes like reasoning, planning, and emotion. Prefrontal Cortex The part of the frontal lobes directly behind the forehead, involved in decision-making and self-control. Executive Functioning Higher-level cognitive processes including thinking, planning, and problem-solving. Motor Cortex The part of the brain that controls voluntary movements. Parietal Lobes Areas of the brain that process sensory information such as touch, temperature, and pain. Somatosensory Cortex A part of the parietal lobes that processes sensory input from various body areas. Occipital Lobes The part of the brain that processes visual information. Temporal Lobes Areas of the brain involved in processing auditory information and encoding memory. Corpus Callosum A large band of neural fibers that connects the left and right cerebral hemispheres and allows communication between them. Brainstem The central trunk of the brain continuing downward to form the spinal cord. Medulla The base of the brainstem that controls vital life-sustaining functions like heartbeat and breathing. Reticular Activating System A network of neurons in the brainstem that plays a role in waking and sleep. Cerebellum A part of the brain at the back of the skull that coordinates and regulates muscular activity. Limbic System A complex system of nerves and networks in the brain, controlling basic emotions and drives. Reward Center Brain regions that regulate the experience of pleasure, particularly related to survival and reward. Thalamus A structure deep within the brain that relays sensory signals to the cerebral cortex. Hypothalamus A small region at the base of the brain that directs several functions, including temperature regulation and energy maintenance. Pituitary Gland A gland at the base of the brain that controls growth and development. Hippocampus A part of the limbic system involved in learning and memory. Amygdala A structure in the limbic system involved in emotion, particularly fear and aggression. Nervous System The network of nerve cells and fibers that transmits nerve impulses between parts of the body. Central Nervous System The part of the nervous system consisting of the brain and spinal cord. Peripheral Nervous System All the nerves that lie outside the brain and spinal cord. Autonomic Nervous System The part of the nervous system responsible for control of the bodily functions not consciously directed, like breathing and the heartbeat. Sympathetic Nervous System The part of the autonomic nervous system that prepares the body for rapid action in emergencies. Parasympathetic Nervous System The part of the autonomic nervous system that calms the body and conserves energy. Somatic Nervous System The part of the peripheral nervous system associated with voluntary control of body movements via skeletal muscles. Neurons The basic working units of the brain, specialized cells that transmit information to other nerve cells, muscle, or gland cells. Glial Cells Cells in the nervous system that support, nourish, and protect neurons. Motor Neurons Neurons that carry outgoing information from the brain and spinal cord to the muscles and glands. Sensory Neurons Neurons that carry incoming information from the sensory receptors to the brain and spinal cord. Interneurons Neurons within the brain and spinal cord that communicate internally and intervene between the sensory inputs and motor outputs. Reflex Arc A neural pathway that controls a reflex action. Neural Transmission The process by which neurons communicate with each other by sending electrical or chemical signals. Threshold The level of stimulation required to trigger a neural impulse. Action Potential A neural impulse; a brief electrical charge that travels down an axon. All-or-Nothing Principle The rule that neurons are either on or off. Depolarization A change in a cell's membrane potential, making it more positive. Refractory Period A period immediately following stimulation during which a nerve or muscle is unresponsive to further stimulation. Resting Potential The state of the neuron when not firing a neural impulse. Reuptake A neurotransmitter's reabsorption by the sending neuron. Multiple Sclerosis (MS) A disease in which the immune system eats away at the protective covering of nerves. Myasthenia Gravis A chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles. Neurotransmitters Chemicals transmitting information across synapses to dendrites of receiving neurons. Excitatory Neurotransmitters Chemical messengers increasing the likelihood of neuron firing an action potential. Glutamate An excitatory neurotransmitter strengthening synaptic connections between neurons. Inhibitory Neurotransmitters Chemical messengers decreasing the likelihood of neuron firing an action potential. GABA A major inhibitory neurotransmitter in the brain. Dopamine A neurotransmitter influencing movement, learning, attention, and emotion. Serotonin A neurotransmitter affecting mood, hunger, sleep, and arousal. Endorphins Neurotransmitters influencing the perception of pain or pleasure. Substance P A neurotransmitter involved in transmitting pain messages to the brain. Acetylcholine A neurotransmitter enabling learning, memory, and triggering muscle contraction. Hormones Chemicals produced by glands regulating activities of different body cells. Ghrelin A hormone stimulating appetite, increasing food intake, and promoting fat storage. Leptin A hormone helping regulate energy balance by inhibiting hunger. Melatonin A hormone regulating sleep-wake cycles. Oxytocin A hormone acting as a neurotransmitter, influencing social behavior and emotion. Adrenaline A hormone released in response to physical or mental stress. Norepinephrine A hormone and neurotransmitter involved in arousal and fight-or-flight response. Plasticity The brain's ability to change and adapt due to experience. Split Brain Research Studies on patients with severed corpus callosum to understand brain hemisphere functions. Contralateral Hemispheric Organization Arrangement where the brain's right hemisphere controls the left side of the body and vice versa. Hemispheric Specialization Control of distinct functions by the brain's right and left hemispheres. Linguistic Processing Brain functions involved in understanding and producing language. Broca's Area Frontal lobe area directing muscle movements involved in speech. Broca's Aphasia Condition from damage to Broca's area causing impaired speaking and writing. Opioids A class of drugs including heroin and prescription pain relievers. Heroin An opioid drug made from morphine, derived from opium poppy plants. Tolerance Diminishing drug effect with regular use, necessitating larger doses. Addiction Compulsive craving for drugs or behaviors despite adverse consequences. Withdrawal Symptoms post cessation of drug intake in addicted individuals. Sensation Reception and representation of stimulus energies by sensory receptors. Transduction Conversion of stimulus energies into neural impulses in sensation. Perception Organization and interpretation of sensory information for object recognition. Absolute Threshold Minimum stimulus energy to detect a stimulus 50% of the time. Just-noticeable Difference Smallest difference in stimulus intensity detectable by a sense. Sensory Adaptation Decrease in sensitivity to constant stimulation levels. Weber's Law Principle that stimuli must differ by a constant proportion for detection. Synesthesia Condition where one sense is perceived as if by additional senses. Retina Light-sensitive eye surface with rods, cones, and neural processing layers. Blind Spot Point where optic nerve exits the eye, lacking receptor cells. Visual Nerve Nerve transmitting neural impulses from the eye to the brain. Lens Transparent eye structure behind the pupil, aiding image focus. Accommodation Process of lens shape change for focusing on near or far objects. Nearsightedness Clear vision for close objects but blurry for distant ones. Farsightedness Clear vision for distant objects but blurry for close ones. Photoreceptors Rods and cones in the retina converting light into neural signals. Rods Photoreceptors detecting black, white, and gray for peripheral vision. Cones Photoreceptors concentrated for daylight vision, color, and detail. Trichromatic Theory Theory of three color receptors in the retina for color perception. Opponent-process Theory Theory of opposing processes in color vision enabling perception. Psychology the scientific study of mental processes and behavior. Mental Processes Thoughts, feelings, and motives that each of us experiences privately but that cannot be directly observed. Behavior Any action that people can observe or measure Confirmation Bias The tendency to favor information that confirms your existing beliefs. Hindsight Bias The feeling after something happens that you knew it was going to happen. Overconfidence Being more confident than correct; overestimating the accuracy of your beliefs. Empirical Evidence Information from experiments or observations rather than theories. Scientific Method A step-by-step method for conducting research. Hypothesis A prediction that you can test through study and experimentation. Falsifiable Something that can be proven wrong through tests. Peer Review The process of having other experts examine your work to check its validity. Replication Repeating a study to see if the same results are obtained. Reliability The consistency of a research study or measuring test. Validity The accuracy of a test or research to measure what it claims to measure. The American Psychological Association (APA) A major organization for psychologists in the United States. Research Design The plan for a research study, determining how to collect and analyze data. Methodology The specific procedures or techniques used to identify, select, process, and analyze information about a topic. Quantitative Data Data that can be counted or measured and given a numerical value. Qualitative Data Data that describes qualities or characteristics. Likert Scales A scale used to represent people's attitudes or feelings; respondents specify their level of agreement to a statement. Structured Interviews Interviews where everyone is asked the same questions in the same way. Survey Technique A method of gathering information by asking questions to people. Wording Effect How the way a question is phrased can influence the answers given. Social Desirability Bias: The tendency of respondents to answer questions in a manner that will be viewed favorably by others. Naturalistic Observation Watching behaviors occur naturally without interfering. Case Study A detailed examination of a single subject or group. Correlational Research A study that investigates the relationship between two variables to determine if they vary together. Third Variable Problem A situation where an unseen variable affects the results of a study. Scatterplot A graph in which the values of two variables are plotted along two axes, the pattern of the resulting points revealing any correlation present. Correlation Coefficient A number between -1 and 1 that describes the strength and direction of a relationship between variables. Positive Correlation A relationship where if one variable increases, the other does too. Negative Correlation A relationship where if one variable increases, the other decreases. Experimental Method: A method where the researcher manipulates one variable to see if it affects another. Independent Variable The variable that is changed or controlled in a scientific experiment. Dependent Variable The variable that is tested and measured in a scientific experiment. Confounding Variable An extra variable that wasn't accounted for that could affect the results of an experiment. Operational Definitions Clearly defining how you will measure your variables in research. Experimental Group The group in an experiment that receives the variable being tested. Control Group The group in an experiment that does not receive the test variable. Random Assignment Assigning participants to experimental and control groups by chance, which helps ensure that any differences observed after the treatment are due to the treatment and not a preexisting difference. Placebo Effect A change in a participant's illness or behavior that results from a belief that the treatment will have an effect, rather than the actual treatment. Experimenter Bias When a researcher's expectations influence the outcome of a study. Single-Blind Study When the participants do not know whether they are receiving the treatment or not. Double-Blind Study When neither the participants nor the researchers know who is receiving a particular treatment. Placebo Condition A condition in which participants receive a placebo instead of the actual treatment. Sample A group of subjects selected from a larger population for study. Representative Sample: A randomly chosen sample of subjects from a larger population that accurately reflects the characteristics of the larger population. Random Sample A sample that fairly represents a population because each member has an equal chance of being included. Sample Bias A sample that does not accurately represent the population from which it was drawn. Generalizability The extent to which research findings can be applied to larger populations. Statistics The science of collecting, analyzing, presenting, and interpreting data. Descriptive Statistics Statistics that summarize data, such as mean or standard deviation Inferential Statistics: Statistics used to infer the properties of a population, based on a sample of data. Measure of Central Tendency: A statistical measure that describes the center of a data set; includes mean, median, and mode. Mean The average of a set of numbers. Median The middle number in a set of numbers arranged in order. Mode The number that appears most frequently in a data set. Range The difference between the highest and lowest values in a data set. Normal Curve A bell-shaped curve that shows data distribution; most scores fall near the middle. Regression to the Mean The phenomenon that extreme values in data tend to be closer to the average on subsequent measurements. Positive Skew When more scores fall on the low side of the scale and tail on the high side. Negative Skew When more scores fall on the high side of the scale and tail on the low side. Standard Deviation A measure of how spread out numbers are around the mean. Percentile Rank The percentage of scores in a distribution that a specific score is greater than. Bimodal Distribution A distribution of data with two modes or peaks. Statistical Significance The likelihood that a result from data collected by an experiment is not due to chance. Effect Sizes A measure of the strength of the relationship between two variables. Meta Analysis A method of combining data from many different research studies. Institutional Review Boards (IRB) Groups of people responsible for reviewing proposed research to ensure that it is ethical. Informed Consent Permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Informed Assent Agreement by a minor or other not able to give legal consent to participate in the activity. Confidentiality Keeping information given by participants in a research study private. Deception Misleading participants about the true purpose of a study or the events that will transpire. Confederates Actors who take part in a study pretending to be real participants. Debriefing Explaining to participants at the end of a study the true purpose of the study and exactly what transpired.
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The American Sleep Disorders Association, in 1990, initiated a 5 year process to develop the widely used International Classification of Sleep Disorders (ICSD). The original ICSD listed 84 sleep disorders, each with descriptive details and specific diagnostic, severity, and duration criteria. The ICSD had 4 major categories: (1) dyssomnias, (2) parasomnias, (3) disorders associated with medical or psychiatric disorders, (4) "proposed" sleep disorders. The ICSD has since been revised twice. The second edition, ICSD-2 was released in 2005 which contains a list of 77 sleep disorders. That new list was broken down into 8 sub-categories: (1) Insomnia; (2) Sleep-related breathing disorder; (3) Hypersomnia not due to a sleep related breathing disorder; (4) Circadian rhythm sleep disorder; (5) Parasomnia; (6) Sleep-related movement disorder; (7) Isolated Symptoms, apparently normal variants, and unresolved issues; and (8) Other sleep disorders. A third edition of the ICSD was released in 2014. The major clinical divisions were unchanged in the third edition from the 2nd version, but there was an addition of variations in the diagnostic criteria for pediatric patients with obstructive sleep apnea, and there was a heading of Developmental Issues added to each section of disorders that have developmentally-specific clinical features in order to aid physicians in diagnosing those patients (specifically 9-CM and 10 CM). Sleep Disorders Categories The ICSD-3 lists about 77 sleep disorders which are divided into the following categories: Insomnia Sleep-related breathing disorder Central Disorders of Hypersomnolence Circadian rhythm sleep disorder Parasomnias Sleep-related movement disorder Some of the above categories have a section for isolated Symptoms, apparently normal variants, and unresolved issues Other sleep disorders There are some other sleep disorders that are divided into two appendices of the ICSD-2 manual. They are as follows: Sleep Related Medical and Neurological Disorders; and ICD-10-CM Coding for Substance-induced Sleep Disorders Study the disorders listed under each of the above categories until you have a good idea of what is included in each. There is a complete list of all the current classified sleep disorders in chapter 27, beginning on page 476 of your Sleep Disorders Medicine, 4th edition textbook. Insomnias Insomnias are disorders that usually produce complaints of not enough sleep, poor quality of sleep. Patient perception can play a role in the complaints. Occasionally, a patient may perceive that they are getting poor quality or not enough sleep even though they may be getting what we think is a normal night’s rest. Insomnias are defined by a repeated difficulty initiating sleep, not sleeping long enough, or poor quality sleep regardless of the amount of sleep time. Primary insomnia would not be due to another sleep disorder. If another sleep disorder such as OSA is causing the insomnia, then we call that secondary insomnia. These disorders may require medical treatment if they are long-lasting. Temporary insomnia due to a stressful situation or life event may correct itself with time. The types of insomnia are covered on pages 476 and 480 of your textbook. Sleep-Related Breathing Disorders These are disorders that involve disordered respiration, or breathing during sleep. These may be obstructive or not. There can be various causes of both. Central apnea syndromes include Cheyenne-Stokes breathing pattern and high-altitude periodic breathing. Cheyenne-Stokes is usually associated with either congestive heart failure or a traumatic brain injury which would actually be called secondary Central Sleep Apnea because it is secondary to another problem. It can also occur due to extreme old age, or a “worn-out” heart (a pacemaker may be needed for this type of patient). You will see patients like this occasionally. Primary Central Sleep Apnea has no apparent cause but still results in an irregular breathing pattern. These patients are not necessarily good candidates for CPAP because their breathing problem may not involve an obstruction. If not, you will likely see an increase in the number or length of central apneas after placing them on CPAP. There are newer PAP technologies that have been developed in recent years that do have some effect on the regulation of these types of patients’ breathing pattern but may show limited success in extending life expectancy. The obstructive type of breathing disorders, on the other hand, do respond well to treatment. These will likely make up the vast majority of patients that you will encounter in the sleep laboratory. Refer to pages 476 and 481 for more detailed examples of these disorders. Central Disorders of Hypersomnolence If you break down the word “hypersomnia” into its root terms as you did in medical terminology, it should be apparent that these disorders involve excessive sleepiness. However, the excessive sleepiness cannot be the result of another class of disorder. If a patient has another such disorder, that disorder must be effectively treated before a diagnosis of hypersomnia not due to a sleep-related breathing disorder can be made. These patients may have nights of uninterrupted sleep, but they still have unintended or unwanted lapses into sleep during the day. There can be many different causes of this; some of which are very interesting. Narcolepsy and Kleine-Levin Syndrome fall into this category along with some neurologic or psychiatric disorders. Circadian Rhythm Sleep Disorder Circadian rhythm sleep disorders are sleep disorders related to the internal clock of the human body resulting in an irregular sleep-wake cycle. Patients with these sleep disorders have circadian rhythms that make it difficult for them to function in society. The three extrinsic circadian rhythm sleep disorders are the time zone change syndrome, shift work sleep disorder, and irregular sleep-wake pattern (secondary circadian rhythm disorders). Three intrinsic circadian rhythm sleep disorders are delayed sleep phase syndrome, advanced sleep phase syndrome, and non-24-hour sleep-wake disorder (primary circadian rhythm disorders). For Circadian Rhythm disorders, refer to page 482 of your textbook. Time Zone Change Syndrome (Jet Lag Syndrome): Jet lag is experienced as a result of eastward or westward jet travel, after crossing several time zones, disrupting synchronization between the body's inner clock and its external cues. Symptoms do not occur after north-south travel. jet lag symptoms consist of difficulty in maintaining sleep, frequent arousals, and excessive daytime somnolence. Delayed Sleep Phase Syndrome: The ICSD-2 defines delayed sleep phase syndrome (DSPS) as a condition in which a patient's major sleep episode is delayed in relation to a desired clock time. This delay causes symptoms of sleep-onset insomnia or difficulty awakening at the desired time. Typically, patients go to sleep late (between 2:00 am and 6:00 am) and awaken during late morning or afternoon hours (between 10:00 am and 2:00 pm). Patients cannot function normally in society due to disturbed sleep schedules. Patients may try hypnotic medications or alcohol in attempts to initiate sleep sooner. DSPS patients may be treated by the use of chronotherapy (intentionally delays sleep onset by 2-3 hours on successive days until the desired bedtime has been achieved) or phototherapy (exposure to bright light on awakening). Advanced Sleep Phase Syndrome: Advanced sleep phase syndrome is characterized by patients going to sleep in the early evening and wake up earlier than desired in the morning (2:00 am-4:00 am). Because the patients have early morning awakenings, they experience sleep disruption and daytime sleepiness if they don't go to sleep at early hours. ASPS is most commonly seen in elderly individuals. Diagnosis is based upon sleep logs and characteristic actigraphic recordings made over several days. Chronotherapy may be used to treat ASPS; however, this therapy is not as successful in ASPS as in DSPS. Bright light exposure in the evening has been successful in delaying sleep onset. Non-24-Hour Sleep-Wake Disorder: Also known as Non-entrained, free running, or hypernychthemeral syndrome, is a disorder characterized by a patient's inability to maintain a regular bedtime and a sleep onset that occurs at irregular hours. Patients display increases in the delay of sleep onset by approximately one hour per sleep-wake cycle, causing an eventual progression of sleep onset through the daytime hours and into the evening. These individuals fail to be entrained or synchronized by usual time cues such as sunlight or social activities. This disorder is extremely rare and is most often associated with blindness. Parasomnia The parasomnias are a class of sleep disorders associated with arousals, partial arousals, and sleep stage transitions. They are dysfunctions (including movements and behaviors) that are associated with sleep, or that occur during sleep. Most parasomnias occur during delta sleep or slow wave sleep, although some can occur during any stage. REM Behavior Disorder, Nightmare Disorder, and Recurrent Isolated Sleep Paralysis are also included in this group although they are all associated with REM sleep. Rem Behavior Disorder (RBD) may involve a very drastic or sometimes violent dream enactment. Approximately 88% of known cases are in males. Elderly patients (over the age of 60) make up a high percentage of known cases (60%). RBD is now considered to be a possible indication of a future neurodegenerative disease such as Parkinson’s. Around 50% of patients with REM parasomnias also have some type of central nervous system disorder, and almost 10% have a psychiatric disorder. The treatment for these disorders is usually limited to securing the environment, but can also include the prescription of clonazepam. Think of parasomnias as things that patients may also do while sleeping, excluding movement disorders (other than RBD) which used to be included in this category as well. Examples would be Night Terrors, Nightmares, Hallucinations, Sleepwalking, or Enuresis (bed-wetting), etc. Parasomnias are covered in your text book on pages 482 - 484. Sleep-Related Movement Disorders Bruxism: Bruxism (teeth grinding) occurs most commonly in individuals between ages 10 and 20 years and is commonly noted in children with mental retardation or cerebral palsy. Bruxism is noted most prominently during NREM stages I and II and REM sleep. Episodes are characterized by stereotypical tooth grinding and are often precipitated by anxiety, stress, and dental disease. Occasionally, familial cases have been described. Usually, no treatment is required, but in extreme cases, dental reconstruction and appliances such as mouth guards may be needed. Periodic Limb Movement Disorder: Periodic limb movement disorder (PLMD, or PLMS for Periodic Limb Movements in Sleep) is a common sleep disorder affecting approximately 34% of people over the age of 60 years. PLMD can be defined as repetitive, involuntary limb movements during sleep. These movements are seen mostly in stage II sleep, and not in REM sleep due to muscle atonia in REM. The criteria for the leg movements to qualify as PLMS, the leg movements must last from 0.5 seconds to 5 seconds in duration each, there must be a gap of 5 to 90 seconds between each one, and there must be a cluster of at least 4 of these movements. Symptoms of PLMS often include frequent EEG arousals, fragmented sleep architecture, daytime sleepiness, and a disturbed bed partner. Treatment of PLMS usually includes medications. However, if the leg movements are related to respiratory events, they usually disappear when the respiratory events are corrected via CPAP, BiPAP, dental appliances, etc. The most common medications used to treat PLMS include Clonazepam, Dopamine Agonists, Anticonvulsants, and Opiates. Restless Legs Syndrome: Restless Legs Syndrome (RLS) is a disorder that causes discomfort in the legs and an irresistible urge to move them. This scenario can occur while the patient is asleep or awake. Patients often describe this discomfort as an itching, crawling, or creeping sensation in their legs. RLS is a common disorder, and affects more than 5% of the total population. Most RLS patients begin having symptoms before the age of 20, and continue to have these symptoms throughout their lives. Most patients with RLS also have PLMS. The most common treatments for these disorders are medications, including benzodiazepines, dopamine, opiates, and alpha-adrenergic blockers. Nocturnal Leg Cramps: Nocturnal leg cramps are intensely painful sensations that are accompanied by muscle tightness occurring during sleep. These spasms usually last for a few seconds but sometimes persist for several minutes. Cramps during sleep are generally associated with awakening. Many normal individuals experience nocturnal leg cramps. Causes remain unknown. Local massage or movement of the limbs usually relieves the cramps. Rhythmic Movement Disorder: Rhythmic movement disorder occurs mostly in infants younger than 18 months of age, is occasionally associated with retardation, and is rarely familial. It is comprised of three characteristic movements: head rolling, headbanging, and body rocking. These episodes are usually not remembered once the person awakens. It affects approximately three times as many males as females. Treatment for rhythmic movement disorder usually includes behavior modification, benzodiazepines, and antidepressants. Rhythmic movement disorder is a benign condition, and usually, the patient outgrows the episodes. Other rhythmic movement disorders can be related to the use of a drug or substance, or to another medical condition. Isolated Symptoms, Apparently Normal Variants, and Unresolved Issues This category includes disorders that are borderline normal or are normal variants. These include such examples as long sleeper, short sleeper, hypnic jerks, and other types of twitching or jerking movements that may only occur at sleep onset or in newborns. You have probably seen someone display a hypnic jerk as they fell asleep, or you may have woken yourself jerking because you felt like you were falling. Things like snoring or sleep-talking could be included in this case if they are not causing symptoms of insomnia or excessive daytime sleepiness but are disturbing to the patient or other people. Other Sleep Disorders A diagnosis in this category gives the physician an option for when the diagnosis may not be clear or too unusual to clearly fit into one of the other categories. This diagnosis may often be used as a temporary diagnosis until the actual cause of the disorder is determined. Environmental Sleep Disorder could be something in the surrounding environment, such as a barking dog, that is disturbing the patient's sleep enough to cause symptoms. Appendix A: Sleep-Related Medical and Neurological Disorders This category includes disorders that sometimes occur unrelated to sleep, but are related to sleep in these cases. Examples are sleep-related epilepsy, headaches, Sleep-related Myocardial Ischemia, or gastroesophageal reflux. Fibromyalgia used to be included in this section. While fibromyalgia is not necessarily a disorder that is only related to sleep, it can cause arousals, or disruptions of the patient's sleep and is a common diagnosis of patients that you will see. Appendix B: Other Psychiatric/Behavioral Disorders Frequently Encountered in the Differential Diagnosis of Sleep Disorders This section includes mood disorders, anxiety disorders, schizophrenia, or any other psychiatric diagnosis that may affect the patient's quality of sleep. Therefore, you will also likely see patients who have been referred by a psychiatrist on occasions. Intrinsic and Extrinsic Sleep Disorders These are terms that were previously used to differentiate between disorders that originated from within the body and those that were caused by something in the outside environment. However, I think that you could still see these terms again, so I think it is a good idea for you to be familiar with this terminology. INTRINSIC DISORDERS Intrinsic disorders include various types of insomnia and restless legs syndrome. Narcolepsy and recurrent hypersomnia are disorders of excessive sleepiness. Hypersomnolence can also be caused by narcolepsy, apnea, sleep disordered breathing, or periodic limb movements in sleep. EXTRINSIC DISORDERS Extrinsic sleep disorders include those that originate or develop from causes outside the body. Some of these dyssomnias found within this category include: conditions of inadequate sleep hygiene, altitude insomnia, food allergy insomnia, nocturnal eating, limit-setting sleep disorder, and sleep-onset association disorder. Sleep apnea is a disorder that commonly afflicts more than 12 million people in the United States. The word apnea is of Greek origin and means "without breath." Patients diagnosed with sleep apnea will literally stop breathing numerous times while they are asleep. The apneas on average can last from ten seconds to longer than a minute. These events can occur hundreds of times during a single night of sleep. Obstructive sleep apnea (OSA) is the most common type of apnea found within the category of sleep disordered breathing. OSA is caused by a complete obstruction of the airway, while partial closure is referred to as a hypopnea. The hypopnea is characterized by slow, shallow breathing. There are three types of apneas: obstructive, central, and mixed. So, sleep disordered breathing may be due to an airway obstruction (OSA), an abnormality in the part of the brain that controls respiration (central sleep apnea), or a combination of both ( mixed sleep apnea). This lesson will concentrate on obstructive sleep apnea. OSA occurs in approximately two percent of women and four percent of men over the age of 35. Check out this video for a good example of an OSA patient: Sleep Apnea - Hard to Watch... (Links open in a new window. Right click on link and choose "open in a new window") Obstructive Sleep Apnea sufferers are not always the ones that you would expect. Check out this video of an Asian woman, especially near the end: Sleep Apnea Causes of Obstructive Sleep Apnea The exact cause of OSA is difficult to pinpoint. The site of obstruction in most patients is the soft palate, extending to the region at the base of the tongue. There are no rigid structures, such as cartilage or bone, in this area to hold the airway open. When a patient is awake, muscles in the region keep the passage open. However, a patient who tests positive for OSA will experience a collapsing of the airway when they are asleep. Thus, the obstruction occurs, and the patient awakens to open the airway. The arousal from sleep lasts only a few seconds, but brief arousals disrupt continuous sleep. When the sleep architecture is fragmented, the patient will be prevented from obtaining SWS and REM sleep ( these stages of sleep are needed by the body to replenish its strength ). Once normal breathing is restored, the person falls asleep only to repeat the cycle throughout the night. Typically, the frequency of waking episodes is somewhere between 10 and 60. A patient with severe OSA may have more than 100 waking episodes in a night of sleep. Often, the OSA patient will complain of nonrestorative sleep and excessive daytime sleepiness. Risk Factors The primary risk factor for OSA is excessive weight gain. The accumulation of fat on the sides of the upper airway causes it to become narrow and predisposed to closure when the muscles relax. Age is another prominent risk factor. Loss of muscle mass is a common occurrence associated with the aging process. If muscle mass decreases in the airway, it may be replaced with fat, leaving the airway narrow and soft. Men have a greater risk for OSA. Male hormones can cause structural changes in the upper airway. Below are other common predisposing factors associated with OSA: Anatomic abnormalities, such as a receding chin Enlarged tonsils and adenoids ( the main causes of OSA in children) Family history of OSA ( However, there has been no medically documented facts stating a generic inheritance pattern ) Use of alcohol and sedative drugs, which relax the musculature in the surrounding upper airway Smoking, which can cause inflammation, swelling, and narrowing of the upper airway Hypothyroidism, acromegaly, amyloidosis, vocal cord paralysis, post-polio syndrome, neuromuscular disorders, Marfan's syndrome, and Down syndrome Nasal and sinus congestion or problems Symptoms of OSA The nightly disruption and fragmentation of normal sleep architecture will cause the patient to experience the feeling of nonrestorative sleep. The most common complaint from someone who suffers from OSA is excessive daytime sleepiness (EDS) . The numerous disruptions and arousals will prevent the patient from obtaining a continuous deep sleep. Thus, the individual could also be prone to automobile accidents, personality changes, decreased memory, impotence, and depression. Patients are rarely aware or recall the frequent awakenings that occur following the obstructive episodes. EDS may be mild, moderate, or severe. Some patients will complain of falling asleep in a non stimulating environment, such as reading a book or a newspaper in a quiet room. Severe OSA patients may complain of falling asleep in a stimulating environment, such as during business meetings, eating, or casual conversation. One of the most dangerous scenarios is patients who suffer from OSA can fall asleep behind the wheel. Patients will often complain of feeling like they have not slept at all no matter of the length of time in bed. The same holds true for napping. Other indicators or symptoms of possible OSA include morning headaches and frequent urination during the night. Physical signs that coincides with characteristics of OSA patients include snoring, witnessed apneic episodes, and obesity. Not every individual who snores will test positive for OSA, but most patients who have OSA will snore with moderate to loud levels. Hypertension is prevalent in patients with OSA, although the exact relationship is unclear. It has been medically proven that treating OSA can significantly lower blood pressure. Complications The most prevalent complication for patients who suffer from OSA is a diminished quality of life due to chronic sleep deprivation and previous described symptoms. Coronary artery disease, cerebral vascular accidents (strokes), and congestive heart failure are being evaluated to define the exact nature of their connection to OSA. Still, it has documented that there is a relation between these complications and OSA. Obstructive sleep apnea aggravates congestive heart failure (CHF) by placing stress on the heart during sleep. Statistics show there is a high prevalence of OSA in patients with CHF. Central sleep apnea may be prominent in patients with CHF. Diagnosis The most universal method for diagnosing OSA is to have the patient undergo a sleep study. The technical name for the procedure is nocturnal polysomnograph. The first priority with any procedure is patient safety. A thorough analysis of the information gathered prior to beginning the test will give the technician an opportunity to determine the reason for testing, to verify all necessary monitoring parameters, and to determine the possible need for ancillary equipment. The technician must be aware of any precautions or special patient needs during testing. An understanding and knowledge of the signs, symptoms, and findings of a variety of sleep disorders and sleep related breathing disorders is necessary to ensure patient safety and recording requirements during polysomnography testing. Various medical problems will be encountered with the patients undergoing a sleep study. Examples of these complications include: asthma, COPD, cardiac arrhythmias, carbon dioxide narcosis, and abnormal breathing. Numerous cardiac arrhythmias may occur and they include: asystole, ventricular tachycardia or fibrillation, bigeminy, trigeminy, multi-focal PVC's, heart blocks, atrial fibrillation, bradycardia, or tachycardia associated with sleep apnea. Some of these cardiac arrhythmias are life threatening and require technician intervention. Others are relatively benign and require only that the technician watch the patient closely. Thus, all polysomnography technicians will be required to be certified in Basic Life Support. The polysomnography testing will include recording of multiple physiological parameters in sleep. These parameters usually include EEG, EKG, eye movements, respiration, muscle tone, body position, body movements, and oxygen saturation. The electroencephalogram (EEG) measures brain electrical activity. The brain activity during different stages of sleep as compared to wake is distinctly different. The electrooculogram (EOG) monitors eye movements and allows the examiner to determine REM sleep and wake. The electromyogram (EMG) monitors muscle tone, and the EMG helps to differentiate REM sleep from wake because the muscles relax to a state of paralysis in REM sleep. The electrocardiogram (EKG or ECG) monitors heart rate and graphs the electrical signal as it is conducted through the heart. Respiratory effort belts are placed around the patient's chest and abdomen to detect and record the rising and falling movements associated with respiration. A pulse oximeter is attached to the finger to record oxygen saturation levels in the blood. Leg leads or electrodes are attached to record leg movements which may determine the patient has periodic limb movement disorder. A thermistor is used to monitor breathing. Obstructive sleep apnea is diagnosed if the patient has an apnea/hypopnea index (AHI) of 5 or greater an hour. The respiratory disturbance index (RDI) is sometimes used in place of the AHI and essentially refers to the same data. However, in the recent past, RDI was an index that also included the number of respiratory effort related arousals(RERAS) per hour in addition to the hypopneas and apneas. Some sleep centers may still do this, but most are currently not scoring the RERAS due to non-coverage of insurance. An RDI from five to ten per hour would be a positive finding for OSA as well. Clinically speaking, an obstructive apnea is defined as a complete cessation of airflow for 10 seconds or more with persistent respiratory effort. An obstructive hypopnea is defined as a partial reduction in airflow of at least 30 percent followed by a drop in SaO2 of at least 3% or an arousal from sleep, or an alternate definition of 50 percent reduction in nasal pressure airflow signal followed by at least a 4% drop in SaO2(desaturation). Medicare still requires the 4% drop in SaO2 for their patients, but the first definition is recommended by the American Academy of Sleep currently. SaO2 refers to the amount of Oxygen in the blood being carried by the red blood cells. This will always drop when a patient stops breathing. The many physiological measurements taken usually enable the physician to diagnose or reasonably exclude OSA. Certain scenarios may prove a more difficult diagnosis. Such as, a patient who may have mild OSA at home, or only after using certain medications or alcohol but does not experience any episodes during the sleep study. Thus, the sleep study results must be interpreted with the entire clinical picture in mind. Another condition, called upper airway resistance syndrome, cannot be seen on polysomnography. This syndrome is characterized by repetitive arousals from sleep that probably result from increasing respiratory effort during narrowing of the upper airway. These patients suffer the same sleep disruption and deprivation as other sleep apnea patients. In such cases, the only alarming indicator that is recorded is the recurrent arousals. Ultimately, patients suffering from upper airway resistance syndrome may not test positive for OSA with standard polysomnography testing. Treatment A patient suffering from OSA has several treatment options that include: weight reduction, positional therapy, positive pressure therapy, surgical options, and oral appliances. Significant weight loss has shown tremendous improvement and possible elimination of OSA. The amount of weight a patient needs to lose to achieve noticeable benefits varies. However, one will not need to achieve "ideal body weight" to see improvement. Positional therapy is a method of treatment used to treat patients whose OSA is related to body positioning during sleep. A OSA patient who sleeps flat on their back, or in supine position, will experience worse symptoms in general. This type of therapy has its limits, but some patients have experienced benefits. Some of the strategic methods include: a sock filled with tennis balls is sewn into their shirt to make it uncomfortable for the sleeper to lie on their back, and positional pillows to assist in sleeping on their side. Positive pressure therapy is one of the most if not the best methods of treatment for obstructive sleep apnea. There are three different types of devices: continuous positive airway pressure (CPAP), autotitration, and bi-level positive airway pressure. CPAP, the more common of the three therapy modes, is the most prescribed method of treatment for OSA. A facial or nasal mask is worn by the patient while they sleep. The mask is connected to the CPAP machine with tubing. Positive air pressure is delivered from the machine to the mask and continues to the upper airways establishing a "pneumatic splint" that prevents collapsing of the airways. Autotitration devices are designed to provide the minimum necessary pressure at any given time and change that pressure as the needs of the patient change. Bi-level positive airway pressure differs from the CPAP by reducing the level of positive pressure upon exhalation. Oral appliances are another avenue a patient can try as a therapeutic device. Generally, there are two categories, mandibular advance devices and tongue-retaining devices. Mandibular advance devices are similar to athletic mouth guards. They differ in the mold for the lower teeth is advanced further forward than the mold for the upper teeth. This will cause the jawbone to remain forward and prevent the collapse of the airway. It is effective in mild cases of OSA, particularly if the patient's OSA is positional. Tongue-retaining devices also resemble an athletic mouth guard. It acts as a suction cup and is placed between the upper and lower teeth. The tongue is positioned forward and obstructions caused by the tongue should be minimized. First described in 1981, CPAP therapy has become the most preferred treatment for patients with OSA. CPAP flow generators or machines maintain a constant, controllable pressure to prevent blockage of the upper airway. The positive air pressure travels through the nostrils by a nasal or facial mask. This airflow holds the soft tissue of the uvula, palate, and pharyngeal tissue in the upper airway in position so the airway remains open while the patient progresses into deeper stages of sleep and REM sleep. The CPAP device can be described as a "pneumatic splint." Variations to the CPAP machine are available to help with compliance. BPAP, Bi-PAP or bi-level positive airway pressure is another option for treatment. Those three are one and the same. They are just different ways that you might see this term. The AASM guidelines uses "BPAP" in their protocol publications. BiPAP is a trademarked term by a company named Respironics. Anyway, most of the problems patients experience with CPAP are caused by having to exhale against a high airway pressure. Because the air pressure required to prevent respiratory obstruction is typically less on expiration than on inspiration, Bi-PAP machines are designed to detect when the patient is inhaling and exhaling and to reduce the pressure to a preset level on exhalation. Patients with severe OSA may require maximum levels of pressure to eliminate the obstructive apnea. Bi-PAP may be the chosen method of treatment with this scenario, and Bi-PAP may be used when the patient has more than one respiratory disorder. Regardless of the mechanism used, the goal of the technician should always be to titrate the machine to the lowest possible pressure to eradicate the sleep apnea. Each individual patient with OSA will present a different scenario for the attending polysomnography technician. The sleep study with positive airway pressure titration will need to achieve the optimal pressure for the specific patient. The sleep study with CPAP/Bi-PAP will show not only when the respiratory events have ceased, but also when the arousals from the respiratory events occur. The ultimate goal for the technician during a titration process is to achieve the minimal optimum pressure to eliminate all obstructive events and snoring during all stages of sleep and all body positions while sleeping. Compliance Mask fitting is an essential element of a patient's success with positive airway pressure therapy since it affects compliance and effectiveness of treatment. The higher pressures used during CPAP/Bi-PAP therapy can cause a significant air leak with the mask. The leak can also emerge from the patient's mouth if they are using a mask that doesn't cover the mouth. This can startle a new CPAP user. The leak can wake the patient from sleep. Thus, the mask stability is tested with higher pressures. Higher pressures may also require tighter head gear to maintain an adequate seal. Adversely, this will contribute to the discomfort from wearing the mask. When selecting a CPAP mask the following factors should be considered: comfort quality of air seal convenience quietness air venting CPAP/Bi-PAP machines are also available with humidity. Nasal congestion and dryness are very common complaints with positive airway pressure therapy. Humidification can also be heated. These features have proven to help with patient compliance. Ultimately, the biggest obstacle with compliance is getting patients to comply with their own treatment. Without the patient's willingness to use it, CPAP will not provide effective therapy. Studies have shown that CPAP compliance varies from approximately 65% to 85%. The bottom line for the patient to experience the benefits and relief of complaints is they must use the machine on a nightly basis. Information regarding the degree to which a patient is compliant with CPAP is essential for assessment of therapeutic impact. If problems persist after implementation of CPAP, the causes could include: delivery of insufficient pressure to maintain upper airway patency during sleep misdiagnosis of the etiology of the individual's symptoms failure to use the device for a sufficient duration on a regular basis Possible Side Effects The principal side effects with CPAP/Bi-PAP use include: contact dermatitis nasal congestion rhinorrhea dry eyes mouth leaks nose bleeds (rare) tympanic membrane rupture (very rare) chest pain aerophagia (the excessive swallowing of air, often resulting in belching) pneumoencephalitis (air in the brain, which is extremely rare, reported in a patient with a chronic cerebral spinal fluid leak) claustrophobia smothering sensation Actions can be taken to counteract some of the side effects. Nasal congestion or dryness often can be reduced or eliminated with nasal sprays or humidification. Rhinorrhea can be eliminated with nasal steroid sprays or ipratropium bromide nasal sprays. Epistaxis (nose bleeds) is usually due to dry mucosa and can be treated with humidification. Skin irritation can be combated with different mask materials. Dry eyes are usually caused by mask leaks and can be eliminated by changing to a better fitting mask. Attempts to reduce claustrophobic complaints have resulted in the patient using nasal pillows or prongs as opposed to the nasal or facial mask. Mouth leaks can be reduced or eliminated by using a chin strap. A small number of patients complain of chest pain or discomfort with CPAP use. This can probably be attributed to increased end-expiratory pressure and the consequent elevation of resting lung volume, which stretches wall muscles and cartilaginous structures. The resulting sensation that is created is due to chest wall pressure that persists through the hours of wakefulness. Any complaints of chest pain should always be taken seriously. However, if the complaint by the patient on CPAP proves to be nondiagnostic, Bi-PAP therapy may prove to be an option since expiratory pressure can be reduced. Sometimes it pays for the technologist to develop some psychological skills in order to convince the patient to use the device. I have found that a patient who doesn't seem to believe they need CPAP tends to change her/his mind when they see the data that shows him not breathing. Keep in mind that your patients can't see themselves sleep. They may also not be aware of all the possible complications of OSA down the road. Another area of concern for OSA patients using CPAP/BPAP devices is the negative effects on arterial blood gases and oxyhemoglobin saturation. Studies have reported severe oxyhemoglobin desaturation during nasal CPAP therapy in a hypercapnic (elevated levels of carbon dioxide in the blood) sleep apnea patients. Studies have also shown significant oxygen desaturations with CPAP administration with supplemental oxygen. The exact cause has yet to be determined. This occurrence may be due to the following factors: worsening hypoventilation related to the added mechanical impedance to ventilation associated with exhalation against increased pressure increased dead-space ventilation a decrease in venous return and cardiac output due to increased intrathoracic pressure during CPAP administration in patients with impaired right or left ventricular function and inadequate filling pressure One more possibility is when the optimal pressure setting has not been reached yet. Therefore, a ten second apnea may have turned into a 90 second hypopnea. The patient may not arouse from sleep as quickly to get a breath since the airway is not completely closing off as it was without therapy. This should improve once enough pressure is added, however. Despite the above scenarios and problematic experiences, CPAP/Bi-PAP administration has been reported to improve awake arterial blood gases in OSA patients with hypercapnia and cor pulmonale. Traditional and Evolving Methods of Initiating CPAP/BPAP Different methods have been established for implementation of positive airway pressure therapy. Traditionally, patients have undergone a technician attended PSG-monitored trial of CPAP. Split-night studies are now conducted more frequently. Home CPAP trials is another avenue that is being investigated. Use of predictive formulas to estimate or establish optimal level for CPAP therapy has been investigated. Each scenario has advantages and disadvantages. CPAP Therapy of Nonapneic SDB There are numerous documentations of patients with congestive heart failure (CHF) suffering from sleep-disordered breathing (SDB). Most often the respiratory events will be central in nature (no effort, brain not sending signal to breathe) resembling Cheyne-Stokes respiration (CSR). CSR is defined as a breathing pattern characterized by regular "crescendo-decrescendo" fluctuations in respiratory rate and tidal volume. The presence of SDB was associated with sleep-fragmentation and increased nocturnal hypoxemia. The conclusions from the findings are stated below: There is a high prevalence of daytime sleepiness in patients with CSR in conjunction with CHF. Patients with CHF who also have CSR have a higher mortality than patients who have CHF without CSR. CSR, AHI (apnea/hypopnea index), and the frequency of arousals were correlated with mortality. Furthermore, research has found CPAP has been noteworthy and effective on breathing in patients with CHF and CSR. The results of several studies showed an increase in cardiac output and stroke volume and a reduction in left ventricular wall tension during application of CPAP. The improvements seen in CHF patients with CSR regarding cardiac function during sleep is believed to carry over to wakefulness. Possible factors contributing to the improvements seen include: sleep-related reduction of left ventricular transmural pressure improved oxygenation during sleep reduced sympathetic nervous system activation during sleep CPAP machines have become a lot more sophisticated during the past decade. One of these updates is the ability of some machines to generate an algorithm that can predict the next breath of these central sleep apnea patients. These machines will adjust how much air is delivered during each breath based on this prediction. This has the effect of making the breathing pattern more consistent. You may see this denoted as Auto-SV, or servo-ventilation. We will talk about this more later, but I just wanted you to be aware that there are more sophisticated machines for patients with CHF and irregular breathing patterns that are not due to obstructions. Effects of Altitude Changes and Alcohol Consumption Older CPAP machines will not adjust to changes in altitude. As altitude increases, the older CPAP devices will deliver progressively lower than prescribed pressure. The more modern devices will detect altitude changes and make the appropriate adjustments. The polysomnography technician would benefit from information regarding a patient relocating from a high altitude location to lower altitude or vice versa if there are complaints of the CPAP therapy being nontherapeutic. Alcohol consumption can present further complications for a patient suffering from OSA. Alcohol suppresses the arousal response. The patient may experience a greater frequency and duration of apneas and hypopneas and increased snoring. Excessive alcohol use also increases sleep fragmentation. Taking a sedative can cause these effects to be imitated or exacerbated. Still, there are reports stating moderate alcohol consumption did not significantly alter the level of pressure required to eliminate the obstructive events. Nonetheless, OSA patients should avoid alcohol
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