Clinical reasoning: a 14-year-boy with spells of somnolence and cognitive changes

A revisionist approach to Jean Piaget's theory of cognitive development has brought new insights that challenge and reinterpret his established ideas. Piaget proposed that the formal operational stage, emerging in adolescence, represents the culmination of cognitive maturity. During this stage, individuals are said to develop abstract thinking, engage in systematic problem-solving, and show a form of egocentrism, believing others are as preoccupied with their behavior as they are...

Narcolepsy is a chronic sleep disorder characterized by pervasive, uncontrolled sleepiness and other sleep disturbances. One of its hallmark symptoms is an abrupt transition to REM sleep upon falling asleep, which causes symptoms typically associated with this phase to occur unexpectedly during wakefulness. These include the following symptoms, which typically last from a minute or two to half an hour.

REM Sleep Behavior Disorder (RBD) is a sleep disorder characterized by the absence of muscle paralysis that normally occurs during the REM phase of sleep. This absence allows individuals to physically act out their dreams, which are often vivid and disturbing. Common behaviors exhibited during episodes include kicking, punching, and yelling. These actions can be dangerous, potentially leading to injuries for the person with RBD or their bed partner.
RBD is significantly associated with...

The formal operational stage, as described in Piaget's cognitive development theory, begins around age 11 and extends into adulthood. It marks the emergence of advanced cognitive abilities that differentiate adolescent and adult thinking from those of younger children. This stage is characterized by abstract reasoning, hypothetical-deductive reasoning, and a more complex understanding of self and others.
Abstract Reasoning and Hypothetical-Deductive Thinking
Unlike the concrete operational...

Somnambulism, commonly known as sleepwalking, involves individuals engaging in activities ranging from simple walking to more complex behaviors such as driving. Sleepwalking typically occurs during the slow-wave sleep stages 3 and 4 early in the night when the person is not dreaming, contradicting the myth that sleepwalkers are acting out their dreams.
Factors that increase the likelihood of sleepwalking include sleep deprivation and alcohol consumption. Contrary to common beliefs, it is safe...

Sleep is an essential physiological process vital to maintaining overall well-being. The reticular activating system (RAS), a network of neurons in the brainstem, regulates wakefulness and sleep. While it may seem passive, sleep consists of distinct cycles, each with its unique characteristics and functions. Two key sleep phases are non-rapid eye movement (NREM) and  rapid eye movement (REM).
NREM Sleep
NREM sleep comprises four progressive stages that seamlessly merge: