- Email: [email protected]
SLEEP
963
bolised, its duration of action is appropriate for a drug It produces little cardiorespiratory of this type. depression and, unlike other intravenous induction agents, it does not cause histamine released.5 Whether it will present a serious challenge to thiopentone
depends on many factors such as the mode of presentation, the incidence of involuntary muscle movement, and the
cost.
SLEEP A SYNTHETIC anabolic purpose has lately been gaining ground as an answer to the age-old question of the function of sleep. This hypothesis is supported by the results of research in the West and Japan, and it was discussed at a symposium at the Central MiddleSecretion of human growth hormone sex Hospital. (H.G.H.) is increased in stage 3 and 4 sleep6 (exception the obese), and the amount of stage-4 sleep depends on the length of previous sleep deprivation. There seems to be no output of H.G.H. in the absence of stage 3 or 4 sleep. This hormone is known to promote protein synthesis; and peaks of mitotic activity in skin, bone-marrow, liver, reticuloendothelial system, and pineal have been shown at this time.’ Athletes, after exercise, have more stage 3 and 4 sleep, with increased secretion of H.G.H. and diminished catabolic-steroid secretion. Even 1 hour’s sleep deprivation is associated with increased H.G.H. secretion in subsequent sleep, and the proportion of stage 3 and 4 sleep-time increases
concomitantly. Other hormones are also sleep-dependent-e.g., prolactinand luteinising hormone 9 (and testosterone in early puberty). Diminished slow-wave sleep has been reported in hypothyroidism, and some hyperthyroid children have shown more stage 3 and 4 sleep-
time.
During rapid-eye-movement (R.E.M.) sleep cerebral blood-flow increases, presumably because an active
anabolic process
needs more oxygen. Here it is interthe esting high proportion of R.E.M. sleep in neonates (50%) and the rapid fall-off in old age (6%) and in the presenile and senile dementias. The mentally retarded show less R.E.M. sleep. R.E.M. sleep increases after poisoning-for instance, with diazepam. In the U.S.S.R., electrodes implanted into the brains of cats have enabled brain protein and R.N.A. synthesis to be measured, and the results are consistent with the hypothesised anabolic function for sleep in the brain. to note
Sleep disturbances in psychiatric patients are difficult evaluate. Newer studies have failed to support the classical endogenous-versus-reactive dichotomy in sleep pattern. Terminal insomnia reported by depressives can probably be accounted for by the primary dysphoria, whereas patients with anorexia nervosa, who also tend to wake early, seldom complain of this.
to
5.
Doenicke, A., Lorenz, W., Beigl, R., Bezecny, H., Uhlig, G., Kalmar, L., Praetorius, B., Mann, G. Br. J. Anœsth. 1973, 45, 1097. 6. Sassin, J. F., Parker, D. C., Mace, J. W., Gotlin, R. W., Johnson, L. C., Rossman, L. G. Science, 1963, 165, 513. 7. Fischer, L. B. Br. J. Derm. 1968, 80, 75. 8. Sassin, J. F., Frantz, A. G., Kapen, S., Weitzman, E. D. J. clin. Endocr. Metab. 1973, 37, 436. 9. Boyar, R., Funkelstein, J., Roffwarg, H., Kapen, S., Weitzman, E., Hellman, L. New Engl. J. Med. 1972, 287, 582.
Normal sleep lasts on average 7¼ hours. 25% of psychiatric patients have 5 hours’ sleep or less, particularly psychoneurotics, psychopaths, and alcoholics. Affective changes associated with anger are also associated with less sleep than normal. Depressives tend to wake early, but whereas constitutional depressives may also go to bed early, neurotic depressives tend to delay falling asleep and thus have even less sleep. Patients with anxiety and agitation sleep and awake late and may have more hours actually asleep than a normal population. Early waking in anorexia nervosa may be related to metabolic change because weightloss and terminal insomnia are positively correlated. The anabolic hypothesis for sleep function is not inconsistent with the theories of the psychodynamic
schools. The
content
of the dream is
a
main
concern
disciplines, and dream content is variably interpreted as wish-fulfilling, problem-solving, conflict-enlightening, and distorted by symbolism. To the psychoanalyst, perhaps, the fullest wakefulness occurs at times of greatest maturity; with the ability to be fully in touch with the demands of external reality and the ability to perceive this as consistent with internal realities, phantasies, and conflicts.
in these
THE FUTURE OF PSYCHIATRY
APPLICATIONS of learning theory to psychiatry have yielded substantial advances in the treatment of mental disorder. Learning theory is an essential part of the psychologist’s training, and it is right and proper that psychologists have been intimately involved in the development of these new techniques in psychiatry. By and large, psychologists and psychiatrists have collaborated well in these ventures, and the notion that clinical psychologists should merely test patients and not treat them belongs to the past. The publication of a pamphlet1 suggesting a radical splitting of clinical psychology and psychiatry into separate areas of influence is therefore a little jarring. But this is not fringe psychology; the author is Prof. Hans Eysenck, and his comments have to be taken seriously. He " loss of analyses the reasons for psychiatry’s and that concludes it is direction ", suffering from " and an depersonalisation identity crisis, from split and possible schizophrenia as well, and personality is only surgery likely to save the patient ". After this complex diagnostic formulation he suggests a simple solution. Psychiatrists are medically trained but have no knowledge of learning theory and are therefore not fitted to care for patients with neuroses or who have disorders which are primarily behavioural in origin. The clinical psychologist, who is well trained in clinical methods and has specialist knowledge of behavioural disorders, should therefore be primarily responsible for such patients, and the remainder, mainly psychotic patients with schizophrenic and affective psychoses (of presumed medical origin), should be treated by the psychiatrist. He discusses the cost-effectiveness of this dichotomy in some detail, even suggesting " sending around the country mobile 1. The Future of
1975. £0.65.
Psychiatry. By
H.
J. EYSENCK. London: Methuen,
bolised, its duration of action is appropriate for a drug It produces little cardiorespiratory of this type. depression and, unlike other intravenous induction agents, it does not cause histamine released.5 Whether it will present a serious challenge to thiopentone
depends on many factors such as the mode of presentation, the incidence of involuntary muscle movement, and the
cost.
SLEEP A SYNTHETIC anabolic purpose has lately been gaining ground as an answer to the age-old question of the function of sleep. This hypothesis is supported by the results of research in the West and Japan, and it was discussed at a symposium at the Central MiddleSecretion of human growth hormone sex Hospital. (H.G.H.) is increased in stage 3 and 4 sleep6 (exception the obese), and the amount of stage-4 sleep depends on the length of previous sleep deprivation. There seems to be no output of H.G.H. in the absence of stage 3 or 4 sleep. This hormone is known to promote protein synthesis; and peaks of mitotic activity in skin, bone-marrow, liver, reticuloendothelial system, and pineal have been shown at this time.’ Athletes, after exercise, have more stage 3 and 4 sleep, with increased secretion of H.G.H. and diminished catabolic-steroid secretion. Even 1 hour’s sleep deprivation is associated with increased H.G.H. secretion in subsequent sleep, and the proportion of stage 3 and 4 sleep-time increases
concomitantly. Other hormones are also sleep-dependent-e.g., prolactinand luteinising hormone 9 (and testosterone in early puberty). Diminished slow-wave sleep has been reported in hypothyroidism, and some hyperthyroid children have shown more stage 3 and 4 sleep-
time.
During rapid-eye-movement (R.E.M.) sleep cerebral blood-flow increases, presumably because an active
anabolic process
needs more oxygen. Here it is interthe esting high proportion of R.E.M. sleep in neonates (50%) and the rapid fall-off in old age (6%) and in the presenile and senile dementias. The mentally retarded show less R.E.M. sleep. R.E.M. sleep increases after poisoning-for instance, with diazepam. In the U.S.S.R., electrodes implanted into the brains of cats have enabled brain protein and R.N.A. synthesis to be measured, and the results are consistent with the hypothesised anabolic function for sleep in the brain. to note
Sleep disturbances in psychiatric patients are difficult evaluate. Newer studies have failed to support the classical endogenous-versus-reactive dichotomy in sleep pattern. Terminal insomnia reported by depressives can probably be accounted for by the primary dysphoria, whereas patients with anorexia nervosa, who also tend to wake early, seldom complain of this.
to
5.
Doenicke, A., Lorenz, W., Beigl, R., Bezecny, H., Uhlig, G., Kalmar, L., Praetorius, B., Mann, G. Br. J. Anœsth. 1973, 45, 1097. 6. Sassin, J. F., Parker, D. C., Mace, J. W., Gotlin, R. W., Johnson, L. C., Rossman, L. G. Science, 1963, 165, 513. 7. Fischer, L. B. Br. J. Derm. 1968, 80, 75. 8. Sassin, J. F., Frantz, A. G., Kapen, S., Weitzman, E. D. J. clin. Endocr. Metab. 1973, 37, 436. 9. Boyar, R., Funkelstein, J., Roffwarg, H., Kapen, S., Weitzman, E., Hellman, L. New Engl. J. Med. 1972, 287, 582.
Normal sleep lasts on average 7¼ hours. 25% of psychiatric patients have 5 hours’ sleep or less, particularly psychoneurotics, psychopaths, and alcoholics. Affective changes associated with anger are also associated with less sleep than normal. Depressives tend to wake early, but whereas constitutional depressives may also go to bed early, neurotic depressives tend to delay falling asleep and thus have even less sleep. Patients with anxiety and agitation sleep and awake late and may have more hours actually asleep than a normal population. Early waking in anorexia nervosa may be related to metabolic change because weightloss and terminal insomnia are positively correlated. The anabolic hypothesis for sleep function is not inconsistent with the theories of the psychodynamic
schools. The
content
of the dream is
a
main
concern
disciplines, and dream content is variably interpreted as wish-fulfilling, problem-solving, conflict-enlightening, and distorted by symbolism. To the psychoanalyst, perhaps, the fullest wakefulness occurs at times of greatest maturity; with the ability to be fully in touch with the demands of external reality and the ability to perceive this as consistent with internal realities, phantasies, and conflicts.
in these
THE FUTURE OF PSYCHIATRY
APPLICATIONS of learning theory to psychiatry have yielded substantial advances in the treatment of mental disorder. Learning theory is an essential part of the psychologist’s training, and it is right and proper that psychologists have been intimately involved in the development of these new techniques in psychiatry. By and large, psychologists and psychiatrists have collaborated well in these ventures, and the notion that clinical psychologists should merely test patients and not treat them belongs to the past. The publication of a pamphlet1 suggesting a radical splitting of clinical psychology and psychiatry into separate areas of influence is therefore a little jarring. But this is not fringe psychology; the author is Prof. Hans Eysenck, and his comments have to be taken seriously. He " loss of analyses the reasons for psychiatry’s and that concludes it is direction ", suffering from " and an depersonalisation identity crisis, from split and possible schizophrenia as well, and personality is only surgery likely to save the patient ". After this complex diagnostic formulation he suggests a simple solution. Psychiatrists are medically trained but have no knowledge of learning theory and are therefore not fitted to care for patients with neuroses or who have disorders which are primarily behavioural in origin. The clinical psychologist, who is well trained in clinical methods and has specialist knowledge of behavioural disorders, should therefore be primarily responsible for such patients, and the remainder, mainly psychotic patients with schizophrenic and affective psychoses (of presumed medical origin), should be treated by the psychiatrist. He discusses the cost-effectiveness of this dichotomy in some detail, even suggesting " sending around the country mobile 1. The Future of
1975. £0.65.
Psychiatry. By
H.
J. EYSENCK. London: Methuen,