Download - Nervous system part 3
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Nervous System Part 3
• Presented By –
• Prof.Dr.R.R.Deshpande
(M.D in Ayurvdic
Medicine & M.D. in
Ayurvedic Physiology)
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
• professordeshpande@g
mail.com
7/2/2016 Prof.Dr.R.R.Deshpande 1
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Sharir Kriya -- Paper 1 –Part B –Point 4
• Presented By –
• Prof.Dr.R.R.Deshpande (M.D in Ayurvdic
Medicine & M.D. in Ayurvedic Physiology)
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
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Sharir Kriya Paper 1-Part B –Set 2
• Presented By –
• Dr.R.R.Deshpande
• Prof & HOD
• CARC ,Pune 44
7/2/2016 Prof.Dr.R.R.Deshpande 3
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Sharir Kriya Hand Book –
1st to last year BAMS
• Best for Fast Revision
• Paper 1,Paper 2
• Practicals
• Instruments
• Histology
• IMP Schlok
• All basics of
Dodha,Dhatu & Mala
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Sharikriya Paper Practical Book
• As per Very New Syllabus formed By CCIM IN 2012
• Ayurvedic Practicals like Prakruti,sara,Agni
• Modern Haematological Practicals
• CNS & CVS Examination
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Clinical Examination
• Systemic Examination
of 8 systems
• Ayurvedic Srotas
Examination
• Clinical significance of
Lab Tests &
Radiology,USG,2D
Echo
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Sharir Kriya Paper 1
• Book in English
• Total CCIM Syllabus
covered
• Chaukhamba Sanskrit
Pratisthan Publication
• Popular Nationwide &
In Germany also
• Dosha & Prakruti
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Sharir Kriya Paper 2
• Book in English
• Total CCIM Syllabus
covered
• Chaukhamba Sanskrit
Pratisthan Publication
• Popular Nationwide &
In Germany also
• Dhatu,Mala
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Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
• http://www.youtube.com/user/deshpande1
959
• http://www.slideshare.net/rajendra9a/
• http://www.mixcloud.com/jamdadey/
7/2/2016 Prof.Dr.R.R.Deshpande 9
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Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top or on your mobile . Copy Following Link & Paste as Web address –URL
• http://professordeshpande.blogspot.in
• http://professordrdeshpande.blogspot.in/
• http://www.mixcloud.com/rajendra-deshpande
• https://soundcloud.com/professor-deshpande
7/2/2016 Prof.Dr.R.R.Deshpande 10
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Memory ( Smruti in Ayurved)
• Memory is the ability to recall past
experienced or information
• Memory is also retention of learned
materials
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Memory 2
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Anatomical aspect of Memory
• The parts of the brain, associated with
memory are -----
• Association cortex of the frontal, parietal,
occipital, temporal lobes
• Limbic system (Hippocampus,
amygdaloid nucleus), Diencephalon.
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Limbic system
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Anatomical aspect of Memory
• There exists synapse for memory coding
• There are 2 separate pre synaptic
terminals (primary pre synaptic terminal &
facilitator terminal)
• When sensory terminal is stimulated
with facilitator terminal, signals remain
strong for few months or few years
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Physiological aspect of memory
• Memory is stored in brain, by the alteration
of synaptic transmission.
• Through facilitation memory storage is
enhanced. This process is called as
memory sensitization
• Through in habituation, memory storage
is attenuated or decrease in strength.
This is negative memory
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Memory 3
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Types of memory
• Short term memory is the temporary
ability to recall a few pieces of information
• Long term memory last for days to years.
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Types of memory
• In short term memory number of pre
synaptic terminals & size of terminals are
increased
• In long term memory neuronal circuit is
rein forced by constant activity, memory
is consolidated & encoded (at
Hippocampus & Papez circuit).
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Types of memory
• Experimental studies of memory &
learning are carried out in the Sea snail,
called as Aplysia.
• Eric Kandel is the pioneer to use Aplysia
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Chemical or molecular aspect of memory
• Memory Ingram is a process through
which memory is facilitated & stored in the
brain (by structural & biochemical
changes)
• This is memory trace.
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Stages of Memory
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Chemical or molecular aspect of memory
• Neurotransmitter serotonin plays a major
role in molecular basis of facilitation.
Calcium ions increase the release of
serotonin.
• Habituation is due to passive closure of
calcium channels of terminal membrane.
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Consolidation of memory
• This is the process through which short
term memory is converted in to a long
term memory.
• Rehearsal of same information again &
again accelerates & potentiates this
transformation process.
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Consolidation of memory
• Long term potentiation (LTP) is related
with memory, neurotransmitter glutamate
stimulates release of nitric oxide (No) from
the post synaptic neurons
• NO is responsible for induction of LTP.
• Acetylcholine (Ach) also play an
important role in memory
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Consolidation of memory
• In Alzheimer’s disease, there is a depletion of
some part of brain region, where Ach is
synthesized
• Nucleic acids are also related with long term
memory
• DNA & RNA store information DNA persist for
lifetime of the cell
•
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Consolidation of memory
• If RNA formation is inhibited, long term
memory will not occur
• RNA synthesis depends up protein
synthesis
• So there is relation of Protein with
Memory
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Clinical significance
• 1) Amnesia - this is loss of memory.
• Anterograde amnesia occurs due to
lesion in Hippocampus.
• There is failure to generate new long term
memories.
• In Retrograde amnesia, there is problem
to recall past remote memory
• It happens in temporal lobe syndrome.
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Retrograde Amnesia
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Clinical significance
• 2) Dementia –
• In addition to loss of memory, there is
progressive loss of intellect, emotional
control, social behavior & motivation
• This is common after the age of 65.
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Causes of Amnesia & Dementia
• Most common is Alzheimer’s disease.
• Other causes are
• Hydrocephalus
• Parkinson’s
• Viral encephalitis
• HIV, Hypothyroidism
• Cushing’s syndrome • Alcoholic intoxication
• Poisoning by high dose of barbiturates,
• Heavy metals.
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Alzheimer’s disease • This is progressive neurodegenerative disease.
• Death of neurons are in cerebral hemispheres
Hippocampus & pons.
• Due to deficiency of enzyme Choline acetyl
transferase, there is less synthesis of Ach.
• Due to degeneration of locus seruleus, synthesis
of nor epinephrine decreases.
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Alzheimer's Brain
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Alzheimer’s disease • Patient suffers from loss of recent memory, lack
of thinking & judgment. There are personality
changes.
• Further psychiatric features developed. Motor
functions are affected.
• Patient lives vegetative life without thinking
power. At moment no treatment is available.
• Physostigmine inhibits cholinesterase. This
gives moderate improvement
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Learning
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Learning
• Learning is a process, to acquire new
information.
• It is of 2 types –
•
• Non associative learning
• Associative learning.
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Learning 2
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Non associative learning
• Non associative learning is a response of
a person to only one type of stimulus
• It is based on Habituation & Sensitization
• Habituation is, getting used to something,
to which a person is constantly expose
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Non associative learning
• After some time a person is Habituated to
the stimulus & ignores it
• Sensitization is a process, by which the
body is made to become more sensitive to
a stimulus.
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Non associative learning
• This is amplification of response
• When same stimulus is combines with
another pleasant or unpleasant stimulus,
the person becomes more sensitive to
original stimulus.
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Non associative learning
• Eg. While driving on the road a person is
familiar to regular traffic sounds
• But if one day a person hears screaming,
he gets shocked or sensitized with this
stimulus.
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Learning 4
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Associative learning
• This is a complex process
• This is learning about relations between 2
or more stimuli at a time
• The example is conditioned reflexes
• This is the acquired reflex, which required
learning, memory & recall of previous
experiences.
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Associative learning
• They are of 2 types ---
• Classical conditioned reflexes &
• Instrumental conditioned reflexes
• Very famous example of classical
conditioned reflex is demonstrated by the
classical Bell - Dog experiment, done by
Ivan Pavlov
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Bell Dog Experiment
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Learning 5
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Instrumental conditioned reflexes
• To develop these type of reflexes the
animal is taught to perform some task in
order to obtained a reward or to avoid a
punishment
• Learning & memory are the
physiological basis of conditioned
reflexes.
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Instrumental conditioned reflexes
• So, learning is the ability to acquire skills
through instructions or experience
• Capability for change with learning is
called as plasticity
• This is the ability to change behavior in
response to stimuli from the external &
internal environments.
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Motivation
• Motivation is the psychological feature that
arouses an organism to act towards a desired
goal & elicits, controls, & sustains certain goal
directed behaviors
• It can be considered a driving force; a
psychological drive that compels an action
toward a desired goal
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Self Motivation
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Motivation
• For example, hunger is a motivation that
elicits a desire to eat
• Motivation has been shown to have roots
in physiological, behavioral, cognitive, &
social areas.
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Motivation
• Motivation may be rooted in a basic
impulse to optimize well - being, minimize
physical pain & maximize pleasure
• It can also originate from specific physical
needs such as eating, sleeping/ resting, &
sex
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Theories & models
• Intrinsic & extrinsic motivation
• Motivation can be divided into 2 types
• Intrinsic (internal) motivation &
• Extrinsic (external) motivation
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Intrinsic motivation
• Intrinsic motivation refers to motivation
that is driven by an interest or enjoyment
in the task itself
• Exists within the individual rather than
relying on external pressures or a desire
for reward
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Intrinsic motivation
• Students who are intrinsically motivated
are more likely to engage in the task
willingly as well as work to improve their
skills
• Which will increase their capabilities
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Intrinsic motivation
• Students are likely to be intrinsically motivated
if they:
• Attribute their educational results to factors
under their own control, also known as
autonomy
• Believe they have the skills which will allow them
to be effective agents in reaching their desired
goals without relying on luck
• Are interested in mastering a topic, not just in
achieving good grades.
• in
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Motivation 2
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Extrinsic motivation
• Extrinsic motivation refers to the
performance of an activity in order to
attain an outcome
• Extrinsic motivation comes from outside
of the individual
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Extrinsic motivation
• Common extrinsic motivations are –
• Rewards (for example money or grades)
for showing the desired behavior &
• The threat of punishment following
misbehavior
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Extrinsic motivation
• Competition is in an extrinsic motivator
because it encourages the performer to
win & to beat others, not simply to enjoy
the intrinsic rewards of the activity
• A cheering crowd & the desire to win a
trophy are also extrinsic incentives
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Comparison of
intrinsic & extrinsic motivation
• Social psychological research has
indicated that extrinsic rewards can lead
to----
• Over justification and
• A subsequent reduction in intrinsic
motivation.
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Self - control
• The self - control aspect of motivation is
increasingly considered to be a subset of
emotional intelligence
• It is suggested that although a person
may be classed as highly intelligent, they
may remain unmotivated to pursue
intellectual endeavors
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Drives
• Basic drives could be sparked by
deficiencies such as hunger, which
motivates a person to seek food
• Whereas more subtle drives might be the
desire for praise & approval, which
motivates a person to behave in a manner
pleasing to others.
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7/2/2016 Prof.Dr.R.R.Deshpande 64
Incentive theory
• Studies show that if the person receives
the reward immediately, the effect is
greater, & decreases as delay lengthens
• Repetitive ‘Action – Reward’ combination can cause the action to become habit.
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Incentive theory
• Motivation comes from 2 sources
• Oneself & from other people
• These 2 sources are called as ---
• Intrinsic motivation & extrinsic
motivation, respectively.
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7/2/2016 Prof.Dr.R.R.Deshpande 66
Escape - seeking model
• Escapism & seeking are major factors
influencing decision making.
• Escapism is a need to break away from a
daily life routine, turning on the television
& watching an adventure film
• whereas Seeking is -- desire to learn,
turning on the television to watch a
documentary.
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7/2/2016 Prof.Dr.R.R.Deshpande 67
Need theories
• Motivation, as defined by Pritchard &
Ashwood ------
• This is the process used to allocate
energy to maximize the satisfaction of
needs
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7/2/2016 Prof.Dr.R.R.Deshpande 68
Herzberg's 2 - factor theory
• "Respect for me as a person" is -----
• One of the top motivating factors at any
stage of life
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7/2/2016 Prof.Dr.R.R.Deshpande 69
Herzberg distinguished between
• Motivators --- eg. challenging work,
recognition, responsibility which give
positive satisfaction and
• Hygiene factors -- eg. status, job security,
salary and fringe benefits that do not
motivate if present, but, if absent, result in
demotivation.
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7/2/2016 Prof.Dr.R.R.Deshpande 70
Motivator - Hygiene Theory
• The name Hygiene factors is used
because, like hygiene, the presence will
not make you healthier, but absence can
cause health deterioration
• The theory is sometimes called the
"Motivator - Hygiene Theory" and/or "The
Dual Structure Theory. "
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7/2/2016 Prof.Dr.R.R.Deshpande 71
Physiology of sleep
• Limbic System
• Certain components of the cerebral
hemisphere & diencephalon constitute the
limbic (Limbus = Border) system
• Research work shows -- its association
with a control of visceral functions as a
primary area for emotional expression
& outlets.
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Sleep 1
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7/2/2016 Prof.Dr.R.R.Deshpande 73
Limbic System(IMP regions)
• 1) Cortex (Limbic Lobe) - Largest components
are Para - hippocampal & Cingulate Gyri (both
gyri of cerebral hemispheres) & Hippocampus,
which extends into the floor of the lateral
ventricle
• 2) Dentate Gyrus
• 3) Amygdaloid body (Amygdala) 4) Septal
Nuclei
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7/2/2016 Prof.Dr.R.R.Deshpande 74
Limbic System
• 5) Mammillary bodies of the
hypothalamus
• 6) Anterior nucleus of the hypothalamus
• 7) Olfactory bulbs
• 8) Bundles of interconnecting myelinated
axons.
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7/2/2016 Prof.Dr.R.R.Deshpande 75
Limbic System
• The Limbic System is a wishbone
shaped group of structures that encircles
the brain stem & functions in the
Emotional aspects of behavior related to
survival
• The Hippocampus, together with portions
of the cerebrum also functions in Memory.
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7/2/2016 Prof.Dr.R.R.Deshpande 76
Limbic System
• Memory impairment results from lesions in
the limbic system
• Experiments on the limbic system of the
monkeys & other animals indicate that the
Amygdaloid Nucleus assumes a major
role in controlling the overall pattern of
behavior.
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7/2/2016 Prof.Dr.R.R.Deshpande 77
Limbic System
• Limbic System is associated with Pleasure & Pain
• Stimulation of the perifornical nuclei of the
hypothalamus results in a behavioral pattern called
Rage
• The animal assumes a defensive posture - extending its
claws, raising its tail, hissing, spitting, growling &
opening its eyes wide. Stimulating other areas of the
limbic system results in an opposite behavioral pattern -
docility, tameness & affection.
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7/2/2016 Prof.Dr.R.R.Deshpande 78
Limbic System
• Limbic system assumes a primary function
in emotions such as pain, pleasure, anger,
rage, fear, sorrow, sexual feelings, docility
& affection
• Hence called as Visceral or Emotional
Brain
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7/2/2016 Prof.Dr.R.R.Deshpande 79
Sleep
• Definition –
• A state of consciousness, that differs from
alert wakefulness, by a loss of critical
reactivity, to events in the environment &
accompanied by a profound alteration in
the function of the brain.
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7/2/2016 Prof.Dr.R.R.Deshpande 80
Sleep
• Rhythm - One sleep period in 24 hours
• It also depends on habit
• Commonly, sleep occurs during the
period of rest i.e. - at night
• In night workers, day sleeping is the habit.
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7/2/2016 Prof.Dr.R.R.Deshpande 81
Sleep
• Requirement - Varies inversely with age
•
• New born baby - 16 - 20 Hours
• Children - 12 - 14 Hours
• Adults - 7 - 9 Hours
• Old age - 5 Hours
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7/2/2016 Prof.Dr.R.R.Deshpande 82
Sleep
• Curve –
• 1) In adults - Max. depth at the end of 1st
hour.
• 2) In children - 2 max. periods -
• a) Between 1st & 2nd hour.
• b) Between 8th & 9th hour.
• (No dreams during deep sleep.)
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7/2/2016 Prof.Dr.R.R.Deshpande 83
Physiological responses during sleep
• 1) C. V. S. - Pulse ↓, B. P. ↓ • 2) RS - Rate ↓ • 3) B. M. R. - ↓
•
• 4) Secretions - Salivary & lacrimal - ↓ • Gastric - ↑ or unaltered • Sweat - ↑
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7/2/2016 Prof.Dr.R.R.Deshpande 84
Physiological responses during sleep
• 5) Muscles - Relaxed.
• 6) Eyes -- Eye - balls - roll up & out
• (Due to flaccid external ocular muscles),
• Eye lids - come closer (due to drooping of the
upper lids),
• Pupils – contracted
• 7) CNS - EEG = Appearance of δ waves, • Deep Reflexes - ↓, Babinski - Extensor
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7/2/2016 Prof.Dr.R.R.Deshpande 85
Different stages during sleep
• 1) Light sleep = Rapid Eye Movement
Sleep (REM Sleep) = Rhomben - cephalic
sleep - During this stage, high incidence of
penile erection & grinding of teeth
(Bruxism)
• 2) Non Rapid Eye Movement Sleep
(NREM Sleep) = Slow Wave Sleep.
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Sleep Types
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Sleep Cycle
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Sleep stages Graph
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7/2/2016 Prof.Dr.R.R.Deshpande 89
Causes of sleep
• 1) Howell's Theory of Cerebral Ischaemia
• The drowsiness after food is due to splanchnic
vasodilatation, fall of B. P. & consequent
cerebral ischaemia.
• 2) Biochemical theories
• a) Acetylcholine - Acetylcholine is closely related
to functional integrity of the nervous system. It is
claimed that sleep is due to the accumulation of
Acetylcholine in the cerebral cortex.
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7/2/2016 Prof.Dr.R.R.Deshpande 90
Causes of sleep
• b) Hypnotoxin - Some scientists claim that
hypnotoxin, which is liberated from the brain
tissue, produces sleep.
• c) Lactic Acid - During fatigue, lactic acid
accumulates in the tissues. Lactic acid
depresses the activities of the cerebral cortex.
(But what is real ? - In fatigue, there is often
sleeplessness & oxidation of lactic acid occurs
which supplies energy to the brain, which
disapprove this theory.)
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7/2/2016 Prof.Dr.R.R.Deshpande 91
Causes of sleep
• 3) Kleitman's Theory
• More acceptable than others. Due to reduction
of muscle tone & discharge of less afferent
impulses, cerebral cortex remain inactive.
• Fatigue of the muscle with consequent reduction
of transmission of afferent impulses to the
cerebral cortex & thereby keeping it inactive
seems to be a plausible factor in the production
of sleep.
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Sleep position & Personality
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7/2/2016 Prof.Dr.R.R.Deshpande 93
Pathology
• Insomnia –
• Abnormal wakefulness or inability to sleep
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Insomnia
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7/2/2016 Prof.Dr.R.R.Deshpande 95
Effects of insomnia
• (Symptoms observed, when subjects keep
awake for 60 - 114 hours) –
• Equilibrium – disturbed
• Neuromuscular fatigue
• mental concentration difficult &
inaccurate
• Threshold for pain – lowered
• Babinski - Extensor
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Complications of Insomnia
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Effect of Sleep deprivation
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Insomnia 2
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7/2/2016 Prof.Dr.R.R.Deshpande 99
Dreams
• Dreams are successions of images, ideas,
emotions, and sensations that occur
involuntarily in the mind during certain
stages of sleep.
• The content & purpose of dreams are not
definitively understood
• Dreams have been a topic of scientific
speculation, philosophical & religious interest.
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7/2/2016 Prof.Dr.R.R.Deshpande 100
Dreams
• The scientific study of dreams is called
Oneirology
• Scientists believe that, in addition to
humans, certain birds & the majority of
mammals also dream.
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7/2/2016 Prof.Dr.R.R.Deshpande 101
Dreams
• Dreams mainly occur in the rapid - eye
movement (REM) stage of sleep - when brain
activity is high & resembles that of being awake
• REM sleep is revealed by continuous
movements of the eyes during sleep
• Dreams may occur during other stages of sleep,
however, these dreams are not memorable
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7/2/2016 Prof.Dr.R.R.Deshpande 102
Dreams
• Dreams can last for a few seconds, or as long as
twenty minutes
• People are more likely to remember the dream
if they are awakened during the REM phase
• The average person has about 3 to 5 dreams
per night, but some may have up to 7 dreams in
1 night
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Dreams
• The dreams tend to last longer as the
night progresses
• During a full 8 - hour night sleep, 2
hours of it is spent dreaming
7/2/2016 Prof.Dr.R.R.Deshpande 103
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7/2/2016 Prof.Dr.R.R.Deshpande 104
Dreams
• In modern times, dreams have been seen as a
connection to the unconscious
• They range from normal & ordinary to bizarre
• Dreams can have varying natures, such as
frightening, exciting, magical, melancholic,
adventurous, or sexual
• Dreams can at times make a creative thought
occur to the person or give a sense of
inspiration.
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7/2/2016 Prof.Dr.R.R.Deshpande 105
Dreams
• Dream interpretations date back to 5000 - 4000
BC.
• The Austrian neurologist Sigmund Freud, who
developed the discipline of psychoanalysis,
wrote extensively about dream theories &
interpretations.
• He explained dreams as manifestations of our
deepest desires & anxieties, often relating to
repressed childhood memories or obsessions.
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7/2/2016 Prof.Dr.R.R.Deshpande 106
Cultural meaning
• The Mesopotamians believed that the soul, or
some part of it, moves out from the body of the
sleeping person & actually visits the places &
persons the dreamer sees in his sleep.
• Ancient Egyptians believed that dreams were
like oracles, bringing messages from the gods.
• They thought that the best way to receive divine
revelation was through dreaming & thus they
would induce dreams.
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7/2/2016 Prof.Dr.R.R.Deshpande 107
Cultural meaning
• The Greeks shared their beliefs with the
Egyptians on how to interpret good &
bad dreams, & the idea of incubating
dreams.
• Greek philosopher, Aristotle (384 - 322
BC) believed dreams caused physiological
activity. He thought dreams could analyze
illness and predict diseases.
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7/2/2016 Prof.Dr.R.R.Deshpande 108
Dynamic psychiatry
• Freudian view of dreams
• In the late 19th century, psychotherapist
Sigmund Freud developed a theory that
the content of dreams is driven by
unconscious wish fulfillment.
• Freud called dreams the "royal road to the
unconscious".
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Dynamic psychiatry
• Freudian view of dreams
• He theorized that the content of dreams
reflects the dreamer's unconscious mind &
specifically that dream content is shaped
by unconscious wish fulfillment.
• He argued that important unconscious
desires often relate to early childhood
memories & experiences
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7/2/2016 Prof.Dr.R.R.Deshpande 110
The neurobiology of dreaming
• Accumulated observation has shown that
dreams are strongly associated with rapid
eye movement sleep.
• During REM sleep, the release of the
neurotransmitters norepinephrine,
serotonin & histamine is completely
suppressed
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7/2/2016 Prof.Dr.R.R.Deshpande 111
Dreams in animals
• REM sleep & the ability to dream seem to
be embedded in the biology of many
organisms that live on Earth.
• All mammals experience REM.
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Dreams in animals
• The range of REM can be seen across
species:
• Dolphins experience minimum REM,
• While humans remain in the middle &
• The opossum & the armadillo are among
the most prolific dreamers.
7/2/2016 Prof.Dr.R.R.Deshpande 112
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7/2/2016 Prof.Dr.R.R.Deshpande 113
Other hypotheses on dreaming
• There are many other hypotheses about
the function of dreams, including:--
• Dreams allow the repressed parts of the
mind to be satisfied through fantasy
while keeping the conscious mind from
thoughts that would suddenly cause one to
awaken from shock.
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7/2/2016 Prof.Dr.R.R.Deshpande 114
Other hypotheses on dreaming
• Freud suggested that bad dreams let the brain
learn to gain control over emotions resulting
from distressing experiences.
• Jung suggested that dreams may compensate
for one - sided attitudes held in waking
consciousness.
• Ferenczi proposed that the dream, when told,
may communicate something that is not being
said outright
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7/2/2016 Prof.Dr.R.R.Deshpande 115
Relationship with medical conditions
• There is evidence that certain medical
conditions (normally only neurological
conditions) can impact dreams
• For instance, some people with
synesthesia have never reported entirely
black & white dreaming, & often have a
difficult time imagining the idea of
dreaming in only black & white
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7/2/2016 Prof.Dr.R.R.Deshpande 116
Relationship with medical conditions
• Therapy for recurring nightmares
• Often associated with posttraumatic stress
disorder –
• Can include imagining alternative
scenarios that could begin at each step of
the dream.
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7/2/2016 Prof.Dr.R.R.Deshpande 117
Electro - Encephalography - EEG
• This is the recording of electrical activity
along the scalp.
• EEG measures voltage fluctuations,
resulting from ionic current, flows within
the neurons of brain.
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EEG Electrode placement
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7/2/2016 Prof.Dr.R.R.Deshpande 119
Electro - Encephalography - EEG
• EEG = recording of brains spontaneous
electrical activity for 20 - 40 min recorded with
multiple electrodes, placed on scalp.
• This is the main diagnostic test for epilepsy.
• It is also helpful in the diagnosis of coma,
encephalopathies & brain death.
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Electro - Encephalography - EEG
• It is also used in the studies of sleep &
sleep disorders (recording is done for 1 full
night)
• EEG was first line method to diagnose
tumors, stroke & other focal brain
disorders.
• This use is decreased with the advent
of MRI & CT
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7/2/2016 Prof.Dr.R.R.Deshpande 121
Source of EEG activity
• Electrical charging of brain is maintained by
neurons.
• Neurons are constantly exchanging ions with
the extracellular surrounding.
• When wave of ions reaches the electrodes on
scalp, they can push or pull electrons on the
metal of electrodes.
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Source of EEG activity
• The difference in push or pull voltages
between any 2 electrodes can be
measured by a voltmeter.
• Recording these voltages for particular
time gives EEG.
7/2/2016 Prof.Dr.R.R.Deshpande 122
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7/2/2016 Prof.Dr.R.R.Deshpande 123
Source of EEG activity
• Scalp EEG activity shows oscillations at
a variety of frequencies.
• These oscillations have characteristic
frequency ranges.
• These ranges are associated with different
states of brain functioning (like waking
state & various sleep stages.)
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7/2/2016 Prof.Dr.R.R.Deshpande 124
Clinical use of EEG
• 1) To distinguish epileptic seizures from
other types of convulsions like
psychogenic nonepileptic fits, cyncope or
fainting.
• 2) To differentiate organic encephalopathy
or delirium from psychiatric syndromes like
catatonia.
• 3) This is an adjuvent test for brain death.
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Clinical use of EEG
• 4) To make prognosis of comatose
patients.
• 5) To decide whether to reduce
antiepileptic drugs.
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7/2/2016 Prof.Dr.R.R.Deshpande 126
Clinical use
• Sometimes a routine EEG is not sufficient & EEG is
constantly recorded during actual epileptic fit.
• This is done to differentiate-
• 1) Between epileptic fits from non epileptic convulsions.
•
• 2) To identify the character of seizure for giving
different types of treatments.
• 3) To localize the region from the brain where a seizure
originates (for work up of possible seizure surgery)
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7/2/2016 Prof.Dr.R.R.Deshpande 127
EEG can be used
to monitor certain procedures
• 1) To monitor the depth of anesthesia.
• 2) This is indirect indicator of cerebral
perfusion in carotid end arterictomy
• First human EEG recording was obtained
by Han’s Burger in 1924.
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7/2/2016 Prof.Dr.R.R.Deshpande 128
EEG can be used
to monitor certain procedures
• EEG does not involve exposure to high
intensity magnetic field as in MRI
• It also does not involve exposure to radio
- ligends unlike positron emission
tomography.
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7/2/2016 Prof.Dr.R.R.Deshpande 129
EEG - limitations & disadvantages
• 1) Lower resolution (MRI) can directly
display areas of brain which are active,
while EEG requires intense interpretation
to decide which areas are activated by a
particular response
• 2) EEG determines neural activity, which
occurs below cortex of brain very poorly
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7/2/2016 Prof.Dr.R.R.Deshpande 130
EEG - limitations & disadvantages
• 3) Unlike PET & MRS, EEG can not
identify specific locations at which various
neurotransmitters drugs can be found
•
• 4) Takes a long time to connect a patient
to EEG (precise placements of many
electrodes around head - Less time for
MRI etc.)
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7/2/2016 Prof.Dr.R.R.Deshpande 131
Method for EEG
• Recording is obtained by placing
electrodes on scalp with a conductive gel
or paste
• (after preparing scalp area by light
abrasion to reduce impedance due to
dead skin cells)
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Method for EEG
• Electrodes are attached to individual wire,
19 electrodes with earthlings are used
• In neonates they are less in number
• Each electrode is connected to one input
of differential amplifier
• Digital EEG signal is stored electronically
& can be filtered for display.
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7/2/2016 Prof.Dr.R.R.Deshpande 133
Method of EEG
• Adult human EEG signal is about 10 μv - 100 μv in amplitude
• EEG is read by neurologist
•
• EEG is described in terms of rhythmic
activity & transients
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7/2/2016 Prof.Dr.R.R.Deshpande 134
Wave patterns in EEG
• 1) Delta waves (δ)
• Frequency range up to 4 Hz. Highest in
amplitude & shortest wave. It is seen in adults, in
slow wave sleep, also seen in babies.
• Pathologically, it may be seen locally with sub
cortical lesions & in general distribution with
metabolic encephalopathy, hydrocephalus
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7/2/2016 Prof.Dr.R.R.Deshpande 135
Wave patterns in EEG
• 2) Theta waves (θ)
• Range from 4 - 7 Hz.
• Seen normally in young children or in
drowsiness.
• Also seen during meditation.
• Pathologically same like δ waves.
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7/2/2016 Prof.Dr.R.R.Deshpande 136
Wave patterns in EEG
• 3) Alpha waves (α) • Frequency 8 - 12 Hz. Seen in posterior
region of head on both the sides
• It emerges with closing of eyes & with
relaxation & attenuates with eye opening
or mental exertion.
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7/2/2016 Prof.Dr.R.R.Deshpande 137
Wave patterns in EEG
• 4) Beta waves ( )
• Range from 12 - 30 Hz.
• Beta activity is closely linked to motor
behavior & alternated during active
movements
• It may be absent or reduced in areas of
cortical damage
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7/2/2016 Prof.Dr.R.R.Deshpande 138
Wave patterns in EEG
• 5) Gamma waves ( )
• Range from 30 - 100 Hz
• They are seen in certain cognitive or
motor functions
• EEG varies with age & also state of mind
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EEG Waves
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7/2/2016 Prof.Dr.R.R.Deshpande 140
EEG during sleep
• 1) Stage I seep - increase in θ (Theta) frequency.
• 2) Stage II sleep - characterized by spindles.
Range - 12 - 14 Hz.
• 3) Stage III & IV sleep - called as (slow wave
sleep). Presence of δ (delta) frequencies (non
rapid eye movements)
• Stage III & IV sleep = NREM
• The EEG in REM sleep is similar to awake EEG.
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7/2/2016 Prof.Dr.R.R.Deshpande 141
Physiology of Temperature Regulation
• Birds & mammals (Man) are warm
blooded animals or homeothermic animals
• Body temperature is maintained at a
constant level, irrespective of the
environmental temperature
• Amphibians & reptiles are poikilo thermic
or cold blooded animals
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7/2/2016 Prof.Dr.R.R.Deshpande 142
Physiology of Temperature Regulation
• Temperature can be measured in the
mouth, axilla, rectum
• Rectal temperature is higher than oral
• oral is higher than axillary temperature
• Normal oral temperature varies between
96.4 to 99.10F
• core temperature of the body is 100F in
human being.
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7/2/2016 Prof.Dr.R.R.Deshpande 143
Physiology of Temperature Regulation
• Physiological variation of body
temperature can occur as per ----
• Age, sex,
• Diurnal variation,
• After meals, exercise,
• Sleep, emotion,
• Menstrual cycle.
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Physiology of Temperature Regulation
• Hyperthermia or fever is abnormal
increase in the body temperature
• Fever is mostly caused by bacteria &
there toxins & viruses
• Decrease body temperature is called as
hypothermia.
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7/2/2016 Prof.Dr.R.R.Deshpande 145
Physiology of Temperature Regulation
• Normal body temperature is maintained by
the hypothalamus, with the help of ---
• Heat loss centre (situated in pre optic
nucleus of anterior hypothalamus) &
• Heat gain centre. (situated in posterior
hypothalamic nucleus)
• The hypothalamic thermostat is in the pre
optic area.
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7/2/2016 Prof.Dr.R.R.Deshpande 146
Physiology of Temperature Regulation
• Body temperature is depend on the
metabolic rate of the body
• Metabolic rate is affected by ---
• Exercise, the nervous system, hormones,
ingestion of food, age, sex, climate, sleep
& malnutrition.
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7/2/2016 Prof.Dr.R.R.Deshpande 147
Physiology of Temperature Regulation
• Heat is retained in the body through ---
• Vasoconstriction, sympathetic stimulation,
skeletal muscle contraction & thyroid
hormone production
• Heat loss occur through ----
• Radiation, evaporation, conduction &
convection
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Temperature Regulation
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7/2/2016 Prof.Dr.R.R.Deshpande 149
Physiology of Temperature Regulation
• Radiation is the transfer of heat from a
warmer object to a cooler object, without
physical contact
• Evaporation is the conversion of liquid to
a vapor
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Physiology of Temperature Regulation
• Conduction is the transfer of body heat to
a substance or object in contact with the
body
• Convection is transfer of body heat by a
liquid or gas, between areas of different
temperatures
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Heat Loss
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Heat Loss Mechanism
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7/2/2016 Prof.Dr.R.R.Deshpande 153
Mechanism of temperature regulation
• 1) When body temperature increases,
temperature regulation occur by 2
mechanisms –
• a) promotion of heat loss
• b) prevention of heat production.
• Promotion of heat loss occur, by
increasing the secretion of sweat
(Diaphoretic ,internal medicine)
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Mechanism of temperature regulation
• By inhibiting sympathetic centers in
posterior hypothalamus (it causes
coetaneous vasodilatation, causing
excessive sweating)
• Heat loss centre prevents heat production
by inhibiting, shivering & metabolic
reactions.
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7/2/2016 Prof.Dr.R.R.Deshpande 155
Physiology of Temperature Regulation
• 2) What happens when body
temperature decreases? –
• Temperature is brought back to normal by
preventing heat loss & promotion of heat
production.
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7/2/2016 Prof.Dr.R.R.Deshpande 156
Heat production is promoted by
following ways
• 1) Shivering –
• Heat gain centre stimulates the primary
motor centre for shivering, when
enormous heat is produced, because of
severe muscular activities
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7/2/2016 Prof.Dr.R.R.Deshpande 157
Heat production is promoted by
following ways
• 2) Metabolic reactions are increased -
sympathetic centers are activated by heat
gain centre
• They stimulate secretion of adrenaline &
nor adrenaline
• Adrenaline accelerates cellular metabolic
activities.
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Heat production is promoted by
following ways
• Also hypothalamus secretes thyrotropin
releasing hormone, which releases TSH
• Thyroxin accelerates the metabolic
activities.
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7/2/2016 Prof.Dr.R.R.Deshpande 159
Heat production is promoted by
following ways
• 3) Chemical thermo genesis –
• Heat is produced by metabolic activities,
induced by hormones
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7/2/2016 Prof.Dr.R.R.Deshpande 160
Practical importance
• If temperature regulation is disturbed, 2
problems can arise –
• Hyperthermia or fever
• Hypothermia
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7/2/2016 Prof.Dr.R.R.Deshpande 161
Fever - 3 types
• Mild Fever --- ------------- 98.5 to 100.4 F
• Low grade fever ----------- 100.4 to 102.2 F
• Moderate grade fever ----- 102.2 to 104 F
• High grade fever ------------- 104 to 107.6 F
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Causes of fever
• Infection
• Hyperthyroidism
• Brain lesion
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Clinical features of fever
• Warm body ,Headache, sweating,
• Shivering,
• Muscle pain,
• Dehydration,
• Weakness.
• In high grade fever there is convulsions,
confusion, irritability & hallucinations.
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Heat Stroke
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Treatment of Hyperthermia
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Hypothermia - 3 types
• Mild hypothermia ---------- 95 to 91.4 F
• Moderate hypothermia ---91. 4 to 87.8 F
•
• Severe hypothermia -------below 87.8 F
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Causes or hypothermia
• Exposure to cold temperature
• Immersion in cold water
• Hypothyroidism
• Drug abuse
• Lesion in hypothalamus
• Haemorrhage in pons.
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Clinical features of hypothermia
• In mild hypothermia ---
• Uncontrolled intense shivering,
• Pain
• Discomfort.
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Hypothermia
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Hypothermia Symptoms
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Clinical features of hypothermia
• In moderate hypothermia --
• Shivering stops but muscles become stiff
• Mental confusion,
• Shallow respiration,
• Weak pulse,
• Low BP.
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Clinical features of hypothermia
• In sever hypothermia ---
• Weakness & exhaustion
• Skin becomes bluish gray
• Eyes are dilated
• Person loses consciousness
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Prof.Dr.R.R.Deshpande
• Sharing of Knowledge
• FOR
• Propagating Ayurved
7/2/2016 173 Prof.Dr.R.R.Deshpande