Adolescent Health Outcomes: Mental Health

Transcription

1 Adolescent Health Outcomes: Mental Health Daniel S. Pine, MD Mood & Anxiety Disorders Program HUMAN SERVICES USA DEPARTMENT OF HEALTH &

2 We know Common problem behaviors are best viewed on a continuum Most problem behaviors start early Many early problems are transient Many problems are associated with distinct neural circuitry perturbations How to acutely reduce most early-appearing problems We don t know Where and how to separate normal from abnormal behavior variation Exactly how early problems really start How to distinguish problems likely to be transient How to use information on neural function to characterize individuals The long-term consequences of early treatment

3 We know Common problem behaviors are best viewed on a continuum Most problem behaviors start early Many early problems are transient Many problems are associated with distinct neural circuitry perturbations How to acutely reduce most early-appearing problems We don t know Where and how to separate normal from abnormal behavior variation Exactly how early problems really start How to distinguish problems likely to be transient How to use information on neural function to characterize individuals The long-term consequences of early treatment

4 We know problems are common, age-related, & dimensional Problems relate to risk-taking most problems remit; those that persist are significant problems have distinct neural circuitry perturbations how to acutely reduce most early-appearing problems

5 Adolescent Age & Rates of Depression Glied, S. et al. Arch Pediatr Adolesc Med 2002;156: Copyright restrictions may apply.

6 Age-Related Changes in Prevalence Current prevalence of clinical disorders: Percent Major Depression Overanxious Disorder Girls 10 to 13 years 14 to 16 years 17 to 20 years girls Percent Major Depression Overanxious Disorder Boys 10 to 13 years 14 to 16 years 17 to 20 years boys Cohen et al. (1993). J Child Psychol Psychiat, 34,

7 We know problems are common, age-related, & dimensional problems relate to risk-taking most problems remit; those that persist are significant problems have distinct neural circuitry perturbations how to acutely reduce most early-appearing problems

8 Mental Health & Risk-Taking Predictive relationships Conduct problems predicts Smoking & substance use Accidents and related impulsive behaviors Risky sexual behavior Major depression predicts Suicide and suicide attempts Substance abuse? Treatment effects on risk Conduct problems Early treatment is key Major depression Complex associations with suicide

9 United Stated Secular Trends Suicide, Age 10-to-19 Years, 1996 Through 2005 Bridge, J.A. et al. JAMA 2008; 300: Copyright restrictions may apply.

10 We know problems are common, age-related, & dimensional problems relate to risk-taking most problems remit; those that persist are significant problems have distinct neural circuitry perturbations how to acutely reduce most early-appearing problems

11 Children in the Community Study P. Cohen, J. Brook N=776 50% male Age=13.7 Range: 9-18 N=760 50% male Age=16.4 Range=11-20 N=716 50% male Age=22.1 Range=17-26 Randomly selected ( 80% participation) Assessed with parent/child DISC

12 Any Adolescent Anxiety Disorder & Any Adult Mood/Anxiety Disorder Disorder as Adults? Disorder as Adolescents? No Yes No Yes Pine et al. 1998, 2001, 2002

13 Any Adolescent Anxiety Disorder & Any Adult Mood/Anxiety Disorder Disorder as Adults? Disorder as Adolescents? No Yes No Yes Pine et al. 1998, 2001, 2002

14 Any Adolescent Anxiety Disorder & Any Adult Mood/Anxiety Disorder Disorder as Adults? Disorder as Adolescents? No Yes No Yes Pine et al. 1998, 2001, 2002

15 Any Adolescent Anxiety Disorder & Any Adult Mood/Anxiety Disorder Disorder as Adults? Disorder as Adolescents? No Yes No Yes Pine et al. 1998, 2001, 2002

16 Any Adolescent Anxiety Disorder & Any Adult Mood/Anxiety Disorder Disorder as Adults? Disorder as Adolescents? No Yes No Yes Pine et al. 1998, 2001, 2002

17 We know problems are common, age-related, & dimensional problems relate to risk-taking most problems remit; those that persist are significant problems have distinct neural circuitry perturbations how to acutely reduce most early-appearing problems

18 VISUAL CORTEX VISUAL THALAMUS AMYGDALA HEART RATE BLOOD PRESSURE MUSCLE LeDoux. Sci Am ;270:50.

19 Amygdalar Activation Exposure to Fearful Face VS. Bilateral Amygdala Activation Breiter et al. 1996; Whalen et al. 1998

20 Amygdala Response to Fear Faces in Adolescent Anxiety and MDD During Passive Viewing Signal Change (%) Controls MDD (w and w /o Anx) Anx alone Fearful vs. Happy Signal Change (%) Controls MDD alone Anx alone Fearful vs. Happy Passive-View ing 0.10 Signal Change (%) Controls MDD (w and w /o Anx) Anx alone Neutral Fearful Angry Happy Controls: n=47 Anxiety: n=17 MDD: n=27 (15 with anxiety) Face-Emotion Types Beesdo et al. in press

21 We know problems are common, age-related, & dimensional problems relate to risk-taking most problems remit; those that persist are significant problems have distinct neural circuitry perturbations

22 We know Common problem behaviors are best viewed on a continuum Most problem behaviors start early Many early problems are transient Many problems are associated with distinct neural circuitry perturbations How to acutely reduce most early-appearing problems We don t know Where and how to separate normal from abnormal behavior variation Exactly how early problems really start How to distinguish problems likely to be transient How to use information on neural function to characterize individuals The long-term consequences of early treatment

23 We don t know How to separate normal from abnormal Exactly how early problems really start How to distinguish problems likely to be transient How to use information on neural function The long-term consequences of early treatment

24 We don t know How to separate normal from abnormal Exactly how early problems really start How to distinguish problems likely to be transient How to use information on neural function The long-term consequences of early treatment

25 We don t know How to separate normal from abnormal Exactly how early problems really start How to distinguish problems likely to be transient How to use information on neural function The long-term consequences of early treatment

26 We don t know How to separate normal from abnormal Exactly how early problems really start How to distinguish problems likely to be transient How to use information on neural function The long-term consequences of early treatment

27 We don t know How to separate normal from abnormal Exactly how early problems really start How to distinguish problems likely to be transient How to use information on neural function The long-term consequences of early treatment

28 We don t know How to separate normal from abnormal Exactly how early problems really start How to distinguish problems likely to be transient How to use information on neural function The long-term consequences of early treatment

29 We know Common problem behaviors are best viewed on a continuum Most problem behaviors start early Many early problems are transient Many problems are associated with distinct neural circuitry perturbations How to acutely reduce most early-appearing problems We don t know Where and how to separate normal from abnormal behavior variation Exactly how early problems really start How to distinguish problems likely to be transient How to use information on neural function to characterize individuals The long-term consequences of early treatment