Schizophrenia is a chronic psychotic disorder with unknown etiology that causes cognitive impairment, affecting thinking, behavior, social function, sleep and dream content. This study considered the dream content of patients with schizophrenia, siblings of patients with schizophrenia, patients with psychiatric diagnoses other than schizophrenia, and a group of healthy controls. The aim of this study was to compare the dream content of patients with schizophrenia with dream content of individuals with other mental disorders, first degree relatives of patients with schizophrenia, and community controls.
Seventy-two patients were selected and placed in 4 groups. The first group consisted of 18 inpatients with schizophrenia whose medications were stable for at least four weeks; the second group consisted of 16 nonpsychotic mentally ill inpatients; the third group consisted of 18 individuals who were siblings of patients with schizophrenia; and the fourth group consisted of 20 healthy individuals in the community with no family history of mental or somatic disorders. The four groups were matched by age and gender. A 14-item dream content questionnaire was administered for all the participants, and the Positive and Negative Symptoms Scale (PANSS) was also administered for the two groups of hospitalized patients.
Results showed that there were significant differences in dream content among groups included friends acquaintances, females and colorful components. No significant differences were found between the positive and negative subscales of PANSS and any of the dream questionnaire subscales.
Our results suggest that there were a few changes in the dream content of the patients with schizophrenia compare to other groups.
Dream; Psychopathology; Schizophrenia
The dream is a unique psychodynamically informative instrument for evaluating the subjective correlates of brain activity during REM sleep. These include feelings, percepts, memories, wishes, fantasies, impulses, conflicts, and defenses, as well as images of self and others. Dream analysis can be used in a variety of clinical settings to assist in diagnostic assessment, psychodynamic formulation, evaluation of clinical change, and the management of medically ill patients. Dreams may serve as the initial indicators of transference, resistance, impending crisis, acting-out, conflict resolution, and decision-making. A clinically functional categorization of dreams can facilitate an understanding of psychopathology, psychodynamics, personality structure, and various components of the psychotherapeutic process. Examples of different types of dreams are provided to illustrate their relevance and use in various clinical situations.
Psychodynamic Psychotherapy; REM Sleep; Dreams
Limb amputation is followed, in approximately 90% of patients, by “phantom limb” sensations during wakefulness. When amputated patients dream, however, the phantom limb may be present all the time, part of the time, intermittently or not at all. Such dreaming experiences in amputees have usually been obtained only retrospectively in the morning and, moreover, dreaming is normally associated with muscular atonia so the motor counterpart of the phantom limb experience cannot be observed directly. REM sleep behaviour disorder (RBD), in which muscle atonia is absent during REM sleep and patients act out their dreams, allows a more direct analysis of the “phantom limb” phenomena and their modifications during sleep.
Dreams are a most remarkable experiment in psychology and neuroscience, conducted every night in every sleeping person. They show that our brain, disconnected from the environment, can generate by itself an entire world of conscious experiences. Content analysis and developmental studies have furthered our understanding of dream phenomenology. In parallel, brain lesion studies, functional imaging, and neurophysiology have advanced our knowledge of the neural basis of dreaming. It is now possible to start integrating these two strands of research in order to address some fundamental questions that dreams pose for cognitive neuroscience: how conscious experiences in sleep relate to underlying brain activity; why the dreamer is largely disconnected from the environment; and whether dreaming is more closely related to mental imagery or to perception.
This study investigates evidence, from dream reports, for memory consolidation during sleep. It is well-known that events and memories from waking life can be incorporated into dreams. These incorporations can be a literal replication of what occurred in waking life, or, more often, they can be partial or indirect. Two types of temporal relationship have been found to characterize the time of occurrence of a daytime event and the reappearance or incorporation of its features in a dream. These temporal relationships are referred to as the day-residue or immediate incorporation effect, where there is the reappearance of features from events occurring on the immediately preceding day, and the dream-lag effect, where there is the reappearance of features from events occurring 5–7 days prior to the dream. Previous work on the dream-lag effect has used spontaneous home recalled dream reports, which can be from Rapid Eye Movement Sleep (REM) and from non-Rapid Eye Movement Sleep (NREM). This study addresses whether the dream-lag effect occurs only for REM sleep dreams, or for both REM and NREM stage 2 (N2) dreams. 20 participants kept a daily diary for over a week before sleeping in the sleep laboratory for 2 nights. REM and N2 dreams collected in the laboratory were transcribed and each participant rated the level of correspondence between every dream report and every diary record. The dream-lag effect was found for REM but not N2 dreams. Further analysis indicated that this result was not due to N2 dream reports being shorter, in terms of number of words, than the REM dream reports. These results provide evidence for a 7-day sleep-dependent non-linear memory consolidation process that is specific to REM sleep, and accord with proposals for the importance of REM sleep to emotional memory consolidation.
► We present a theoretical review of sleep with a special focus on pontine-geniculate-occipital waves and what they tell us about sleep and consciousness. ► We review the nature and purpose of sleep in terms of protoconsciousness and predictive coding, using the free energy principle. ► By combining these theoretical perspectives, we discover answers to some fundamental questions: such as why is homeothermy suspended during sleep? Why is sleep necessary? Why are we not surprised by our dreams? What is the role of synaptic regression in sleep? ► In brief, we show that the brain can optimize itself during sleep by minimizing the statistical complexity of its model of the waking world. ► The implicit optimization processes are remarkably consistent with the known neurobiology of sleep and provide testable predictions about its functional anatomy.
This paper presents a theoretical review of rapid eye movement sleep with a special focus on pontine-geniculate-occipital waves and what they might tell us about the functional anatomy of sleep and consciousness. In particular, we review established ideas about the nature and purpose of sleep in terms of protoconsciousness and free energy minimization. By combining these theoretical perspectives, we discover answers to some fundamental questions about sleep: for example, why is homeothermy suspended during sleep? Why is sleep necessary? Why are we not surprised by our dreams? What is the role of synaptic regression in sleep? The imperatives for sleep that emerge also allow us to speculate about the functional role of PGO waves and make some empirical predictions that can, in principle, be tested using recent advances in the modeling of electrophysiological data.
AIM, activation, input-gating and modulation; REM, rapid eye movement; PGO, pontine-geniculate-occipital; LGB, lateral geniculate body; Sleep; Consciousness; Prediction; Free energy; Neuronal coding; Rapid eye movement sleep; Pontine-geniculate-occipital waves; Neuromodulation
Conventional wisdom has long held that the twitches of sleeping infants and adults are by-products of a dreaming brain. With the discovery of active (or REM) sleep in the 1950s and the recognition soon thereafter that active sleep is characterized by inhibition of motor outflow, researchers elaborated on conventional wisdom and concluded that sleep-related twitches are epiphenomena that result from incomplete blockade of dream-related cortical activity. This view persists despite the fact that twitching is unaffected in infants and adults when the cortex is disconnected from the brainstem. In 1966, Roffwarg and colleagues introduced the ontogenetic hypothesis, which addressed the preponderance of active sleep in early infancy. This hypothesis posited that the brainstem mechanisms that produce active sleep provide direct ascending stimulation to the forebrain and descending stimulation to the musculature, thereby promoting brain and neuromuscular development. However, this hypothesis and the subsequent work that tested it did not directly address the developmental significance of twitching or sensory feedback as a contributor to activity-dependent development. Here I review recent findings that have inspired an elaboration of the ontogenetic hypothesis. Specifically, in addition to direct brainstem activation of cortex during active sleep, sensory feedback arising from limb twitches produces discrete and substantial activation of somatosensory cortex and, beyond that, of hippocampus. Delineating how twitching during active sleep contributes to the establishment, refinement, and maintenance of neural circuits may aid our understanding of the early developmental events that make sensorimotor integration possible. In addition, twitches may prove to be sensitive and powerful tools for assessing somatosensory function in humans across the lifespan as well as functional recovery in individuals with injuries or conditions that affect sensorimotor function.
REM sleep; spontaneous activity; myoclonic twitching; sensorimotor; cortex; hippocampus; proprioception; REM behavior disorder
It is now well established that post-learning sleep is beneficial for human memory performance [1–5]. Meanwhile, human and animal studies demonstrate that learning-related neural activity is re-expressed during post-training non-rapid eye movement sleep (NREM) [6–9]. NREM sleep processes appear to be particularly beneficial for hippocampus-dependent forms of memory [1–3, 10]. These observations suggest that learning triggers the reactivation and reorganization of memory traces during sleep, a systems-level process that in turn enhances behavioral performance. Here, we hypothesized that dreaming about a learning experience during NREM sleep would be associated with improved performance on a hippocampus-dependent spatial memory task. Subjects (n=99) were trained on a virtual navigation task, and then retested on the same task 5 hours after initial training. Improved performance at retest was strongly associated with task-related dream imagery during an intervening afternoon nap. Task-related thoughts during wakefulness, in contrast, did not predict improved performance. These observations suggest that sleep-dependent memory consolidation in humans is facilitated by the offline reactivation of recently formed memories, and furthermore, that dream experiences reflect this memory processing. That similar effects were not seen during wakefulness suggests that these mnemonic processes are specific to the sleep state.
It is now well established that post-learning sleep is beneficial for human memory performance. At the same time, it has long been known that learning experiences influence the content of subsequent sleep mentation (i.e., “dreaming”). Here, we review evidence that newly encoded memories are reactivated and consolidated in the sleeping brain, and that this process is directly reflected in the content of concomitant sleep mentation, providing a valuable window into the mnemonic functions of sleep.
sleep; memory; dreaming; mentation; cognition; consolidation; default network; resting states
To relate sleep disturbances in Parkinson’s disease (PD) to hemispheric asymmetry of initial presentation.
Sleep disturbances are common in PD arising from the neurodegenerative process underlying the disease, which is usually lateralized at onset. Patients with left-side onset (LPD: right hemisphere dysfunction) exhibit reduced vigilance relative to those with right-side onset (RPD: left hemisphere dysfunction), leading us to hypothesize that sleep-related disturbances, particularly excessive daytime sleepiness, would be more severe for LPD than for RPD.
Thirty-one non-demented participants with PD (17 RPD and 14 LPD) and 17 age-matched control participants with chronic health conditions (CO) were administered the Parkinson’s Disease Sleep Scale and polysomnography was performed on a subset of the PD participants.
Both PD subgroups exhibited more nighttime motor symptoms than the CO group, but only LPD endorsed more nocturnal hallucinations and daytime dozing. Controlling for mood additionally revealed more vivid dreaming in LPD than RPD. There were no significant differences between LPD and RPD on measures of sleep architecture.
Increased dreaming, hallucinations, and daytime somnolescence in LPD may be related to changes in right-hemisphere neural networks implicated in the generation and control of visual images, arousal and vigilance. Our results underscore the need to consider side of onset in regard to sleep disturbances in PD.
Parkinson’s disease; hemiparkinsonism; sleep disturbances; hypersomnia
Single night sleep recordings in closed head injury patients 6 to 59 months after injury revealed less stage 1 and a greater number of awakenings compared to age matched controls. Neither the time spent in REM sleep nor the Wechsler Memory Quotient were related to complaints of decreased or absent dreaming following injury. The proportion of REM and number of awakenings, however, showed a moderate relationship to certain behavioural problems.
Different theories have been put forward during the last decade to explain the functional meaning of sleep and dreaming in humans. In the present paper, a new theory is presented which, while taking advantage of these earlier theories, introduces the following new and original aspects:
• Circadian rhythms relevant to various organs of the body affect the reciprocal interactions which operate to maintain constancy of the internal milieu and thereby also affect the sleep/wakefulness cycle. Particular attention is given to the constancy of natraemia and osmolarity and to the permissive role that the evolution of renal function has had for the evolution of the central nervous system and its integrative actions.
• The resetting of neuro-endocrine controls at the onset of wakefulness leads to the acquisition of new information and its integration within previously stored memories. This point is dealt with in relation to Moore-Ede’s proposal for the existence of a ’predictive homeostasis’.
• The concept of ‘psychic homeostasis’ is introduced and is considered as one of the most important states since it is aimed at the well-being, or eudemonia, of the human psyche. Sleep and dreaming in humans are discussed as important functions for the maintenance of a newly proposed composite state: that of ‘predictive psychic homeostasis’.
On the basis of these assumptions, and in accordance with the available neurobiological data, the present paper puts forward the novel hypothesis that sleep and dreaming play important functions in humans by compensating for psychic allostatic overloads. Hence, both consolatory dreams and disturbing nightmares can be part of the vis medicatrix naturae, the natural healing power, in this case, the state of eudemonia.
sleep and dream theories; predictive psychic homeostasis; evolutionary tinkering; homeostasis of internal milieu; circadian rhythms of peripheral organs
Activity in the prefrontal cortex may distinguish the meta-awareness experienced during lucid dreams from its absence in normal dreams. To examine a possible relationship between dream lucidity and prefrontal task performance, we carried out a prospective study in 28 high school students. Participants performed the Wisconsin Card Sort and Iowa Gambling tasks, then for one week kept dream journals and reported sleep quality and lucidity-related dream characteristics. Participants who exhibited a greater degree of lucidity performed significantly better on the task that engages the ventromedial prefrontal cortex (the Iowa Gambling Task), but degree of lucidity achieved did not distinguish performance on the task that engages the dorsolateral prefrontal cortex (the Wisconsin Card Sort Task), nor did it distinguish self-reported sleep quality or baseline characteristics. The association between performance on the Iowa Gambling Task and lucidity suggests a connection between lucid dreaming and ventromedial prefrontal function.
prefrontal cortex; lucid dreaming; Iowa gambling task; Wisconsin card sort task; dream cognition; metacognition; ventromedial prefrontal function; dorsolateral prefrontal function; meta-awareness; self-consciousness
Members of the Trypanosomatidae family comprise a large number of species that are causative agents of important diseases such as sleeping sickness, Chagas' disease and Leishmaniasis. These organisms are also of biological interest since they are able to change the morphology according to the environment where they live, through a process of reversible cell transformation, and possess structures and organelles that are not found in mammalian cells. This review analyses the process of transformation, which takes place during the life cycle of Trypanosoma cruzi in the vertebrate and invertebrate hosts. Special attention is given to the interaction of the parasite with vertebrate cells. In addition, the present knowledge of structures and organelles such as the nucleus, the plasma membrane, the sub-pellicular microtubules, the flagellum, the kinetoplast-mitochondrion complex, the peroxisome (glycosome), the acidocalcisome and the structures and organelles involved in the endocytic pathway, is reviewed from a cell biology perspective. The possible use of available data for the development of new anti parasite drugs is also discussed.
The authors hypothesized that representations of the Self (or the dreamer) in dreams would change systematically, from a prereflective form of Self to more complex forms, as a function of both age and sleep state (REM vs. non-REM). These hypotheses were partially confirmed. While the authors found that all the self-concept-related dream content indexes derived from the Hall/Van de Castle dream content scoring system did not differ significantly between the dreams of children and adults, adult Selves were more likely to engage in “successful” social interactions. The Self never acted as aggressor in NREM dream states and was almost always the befriender in friendly interactions in NREM dreams. Conversely, the REM-related dream Self preferred aggressive encounters. Our results suggests that while prereflective forms of Self are the norm in children’s dreams, two highly complex forms of Self emerge in REM and NREM dreams.
dreaming; self; NREM sleep; REM sleep
Dreaming is still a mystery of human cognition, although it has been studied experimentally for more than a century. Experimental psychology first investigated dream content and frequency. The neuroscientific approach to dreaming arose at the end of the 1950s and soon proposed a physiological substrate of dreaming: rapid eye movement sleep. Fifty years later, this hypothesis was challenged because it could not explain all of the characteristics of dream reports. Therefore, the neurophysiological correlates of dreaming are still unclear, and many questions remain unresolved. Do the representations that constitute the dream emerge randomly from the brain, or do they surface according to certain parameters? Is the organization of the dream’s representations chaotic or is it determined by rules? Does dreaming have a meaning? What is/are the function(s) of dreaming? Psychoanalysis provides hypotheses to address these questions. Until now, these hypotheses have received minimal attention in cognitive neuroscience, but the recent development of neuropsychoanalysis brings new hopes of interaction between the two fields. Considering the psychoanalytical perspective in cognitive neuroscience would provide new directions and leads for dream research and would help to achieve a comprehensive understanding of dreaming. Notably, several subjective issues at the core of the psychoanalytic approach, such as the concept of personal meaning, the concept of unconscious episodic memory and the subject’s history, are not addressed or considered in cognitive neuroscience. This paper argues that the focus on singularity and personal meaning in psychoanalysis is needed to successfully address these issues in cognitive neuroscience and to progress in the understanding of dreaming and the psyche.
dream; neurophysiological correlates of dreaming; dream functions; unconscious; personal meaning; neuroimaging; psychoanalysis
Human beings, like all living organisms, use energy ceaselessly with whatever they do. Nothing at all happens without spending some energy, not even a glance or a dream. The Author proposes that dreams happen automatically in sleep to help us release unresolved frustration energy and emotional dilemmas left over from the day before. Energy administration is the common denominator behind the manifold workings of dreams, as it is behind all operations of our consciousness in daytime, and this is far more important than one might at first suspect. In summary, if in waking reality the day prior to a dream, a specific sensory composition (a perception or picture) frustrates our mind such that the mind is unable or unwilling to accept this sensory composition, it forms and traps within us an emotional energy charge that lingers inside till that same night when the dream uses it in order to energize from memory analogous sensory components that form a spatiotemporally similar overall representational composition of the daytime waking event. This ends up as the dream we may remember the next day. For example, if in a real event yesterday a red apple between two green apples were in front of us and for some reason we were unable or unwilling to see and accept this perception, in a dream the next time we sleep, we may see promptly a red peach between two green peaches, which will be energized temporarily from our memory to serve the need of our psyche to represent the unprocessed emotion(s) and balance the tensions inside us. The dream always produces more acceptable symbolic perceptions for us to see or sense, and in doing so uses and releases at the same time the unacknowledged emotional energy inside us pending since yesterday's event.
Human beings; dreams; sense; memory; emotional energy; tensions
The effect of increasing doses of fenfluramine on dream patterns was studied in 20 patients receiving a reducing diet with or without a controlled dietary intake of vitamin C daily. The dream pattern was unchanged in six patients and dreams disappeared in another who normally dreamed often. In 13 patients dreams increased in frequency and intensity, and in five the dreams assumed frightening proportions. There was a significant straight-line relation between response and the size of the dose. When placebo tablets were given to four patients their dreams disappeared or assumed their pretreatment normal pattern. Absence of vitamin C from the diet did not significantly affect the dream pattern. That fenfluramine has dose-related cerebral effects should be remembered in patients with a history of mental illness.
The results of the NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation Survival Using Glucose Algorithm Regulation) trial were released last March. The primary outcome variable, 90-day mortality, was actually increased in patients randomly assigned to intensive insulin therapy, as compared with an intermediate target range for blood glucose. These findings, reflecting data collected in a set of more than 6,000 patients, clearly refute the external validity of tight glucose control. Future research will probably focus on several questions raised by the divergent results reported from investigations in the field of glucose control in the critically ill.
Background and the purpose of the study
sepsis is one of the most widespread and lethal disease in Intensive Care Units (ICU). Based on pathophisyology of sepsis, it seems that routine laboratory tests combined with analysis of pro-inflammatory cytokines plasma levels, help clinicians to have more information about disease progress and its correct management.
This was a prospective observational study to determine the predictive role of Tumor Necrosis Factor alpha (TNF-α), Interleukin (IL)-1β and IL-6 as three main pro-inflammatory cytokines and Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) as two scoring systems in mortality of critically ill patients with severe sepsis. Fifty and five patients with criteria of severe sepsis were included in this study. An exclusion criterion was post Cardiopulmonary Resuscitation (CPR) status. Cytokines (TNF-α, IL-1β and IL-6) were assayed in the first, third and seventh days in blood of patients.
Results and major conclusion
Among three measured cytokines, sequential levels of TNF-α and IL-6 showed significant differences between survivors and nonsurvivors. IL-6 had a good correlation with outcome and scoring systems during the period of this study. The areas under the receiver operating characteristic (AUROC) curve indicated that APACHE II (0.858, 0.848, 0.861) and IL-6 (0.797, 0.799, 0.899) had discriminative power in prediction of mortality during sequental measured days. Multiple logestic regression analysis identified that evaluation of APACHE II and TNF-α in the first day and APACHE II and IL-6 in the third and seventh days of severe septic patients are independent outcome predictors. Results of this study suggest that IL-6 and APACHE II are useful cytokine and scoring systems respectively in prediction of mortality and clinical evaluation of severe septic patients.
TNF-α; IL-1β; IL-6; APACHE; SOFA; Severe sepsis
Being denied admission to medical schools here isn't necessarily the end of the line for would-be Canadian doctors. The number of Canadians applying to medical schools in the Caribbean and Mexico is increasing, and graduates of some of them are winning respectable postgraduate training spots in the US, United Kingdom and even Canada. Milan Korcok looks at the calibre of these offshore medical schools and the impact they are having on training and accreditation in North America.
The aim of this study was to find out if the frequency of dream recall among neuropsychiatric patients on psychotropic drugs was significantly different from that of healthy individuals.
The study was done on 53 neuropsychiatric patients with different diagnoses who were on medication and 144 healthy individuals. The number of participants in each group who recalled their dreams and those who did not were compared and analyzed statistically for any significant difference.
Thirty-five out of the 53 neuropsychiatric patients and 133 out of the 144 healthy individuals were able to recall their dreams. A significantly (p < 0.001) higher proportion of the healthy individuals compared to neuropsychiatric patients on medications were able to recall their dreams.
This study has shown that neuropsychiatric patients on medications may have reduced dream episodes or that their ability to remember their dreams may be impaired. A combination of both factors is not unlikely. Thus, the patients have reduced dream recall frequency (DRF) compared to healthy subjects. There might also be individuals who do not dream.
Reasons; Unwillingness; Libyan; Deceased organs; Donation
This article assesses the extent to which under-represented minorities are entering medical school and whether the gap between them and other ethnic groups is narrowing. The issues of genesis of the problem, rationale for redress, assessment of current status, and mechanisms for reaching parity are examined. The current status of underrepresented minority applicants to medical school is made and mechanisms for catalyzing the effort to reach parity with other ethnic groups in the United States are presented.
The trophoblast transcription factor glial cell missing-1 (GCM1) regulates differentiation of placental cytotrophoblasts into the syncytiotrophoblast layer in contact with maternal blood. Reduced placental expression of GCM1 and abnormal syncytiotrophoblast structure are features of hypertensive disorder of pregnancy – preeclampsia. In-silico techniques identified the calcium-regulated transcriptional repressor – DREAM (Downstream Regulatory Element Antagonist Modulator) - as a candidate for GCM1 gene expression. Our objective was to determine if DREAM represses GCM1 regulated syncytiotrophoblast formation. EMSA and ChIP assays revealed a direct interaction between DREAM and the GCM1 promoter. siRNA-mediated DREAM silencing in cell culture and placental explant models significantly up-regulated GCM1 expression and reduced cytotrophoblast proliferation. DREAM calcium dependency was verified using ionomycin. Furthermore, the increased DREAM protein expression in preeclamptic placental villi was predominantly nuclear, coinciding with an overall increase in sumolylated DREAM and correlating inversely with GCM1 levels. In conclusion, our data reveal a calcium-regulated pathway whereby GCM1-directed villous trophoblast differentiation is repressed by DREAM. This pathway may be relevant to disease prevention via calcium-supplementation.
Academic medical school libraries are at different stages in implementing the recommendations of the Matheson report. Many have moved to higher-level tasks and are beginning to engage in the significant tasks described in the report; others are reviewing their future options. In the meantime, it is 6:00 P.M. of Mary Smith's first hospital day. How did we, as librarians, contribute to her diagnosis and treatment?