Welcome. Inside The Teen Brain: Adolescence and Mental Health. Inside The Teen Brain: Adolescence and Mental Health. Peter M. Lake, M.D.

Transcription

1 Welcome Rogers treats children, adolescents and adults with: Anxiety disorders Mood disorders Eating disorders Substance-use use disorders rogershospital.org Inside The Teen Brain: Peter M. Lake, M.D. Medical Director: Rogers Memorial Hospital Oconomowoc Child and Adolescent Services Oconomowoc Child & Adolescent Center Rogers Memorial Hospital 1

2 Overview of Presentation Teen brain development and adolescent behavior Our mental health care crisis Common problems and diagnoses (With stories and cartoons throughout the talk) Phase, Hormones & Behavior National Institute of Mental Health (NIMH) 1991 present Dr. Jay Giedd Chief of Brain Imaging Child Psychiatry Division Longitudinal study of 1,800 children Receive an MRI scan every two years Participating study sites: UCLA, Harvard, Montreal Neurologic Institute Rogers Memorial Hospital 2

3 NIMH Study Findings Extensive structural changes occur well past puberty Piaget: Formal Operational Thinking Erikson: Identity versus Role Diffusion Mahler: Separation Individuation The brain is far from mature until age Cartoon Break Rogers Memorial Hospital 3

4 Adolescent Behavior Characteristics: Emotional Outbursts Reckless Risk Taking Rule Breaking Sex, Drugs and Rock n Roll Two Main Factors: Raging Hormones Lack of Brain Development (mature, cognitive controls) Brain Development Facts At six months gestation, maximum brain density is reached During final trimester, dramatic pruning occurs to eliminate unnecessary cells (Autism?) At birth, baby has almost all of neurons By age 6, child has 90 95% of adult brain size Rogers Memorial Hospital 4

5 Brain Development Facts (cont.) First Wave of Pruning - Prenatal Alters the number of neurons Second Wave of Pruning - Adolescence Alters the number of connections (synapses) between neurons Affects highest mental functions Caution: Construction Ahead! Brain Development Facts (cont.) Gray Matter Peaks Girls age 11 Boys age 12 ½ Thins at rate of 0.7% per year until the early 20s White Matter Mylein sheaths (insulation) Thickens until around age 40 Rogers Memorial Hospital 5

6 Brain Development Facts (cont.) Final result Fewer, but faster, connections More efficient machine Trade off Loses some of the raw potential for learning and the ability to recover from trauma Use It or Lose It Gerald Edelman - Neuroscientist Survival of the Fittest: Practicing Piano Taxicab Drivers Buffalo Theory (more on this later) Too Early to Tell about Effects of Diet Video Games Alcohol, Drugs, Nicotine Rogers Memorial Hospital 6

7 Cartoon Break Construction Anatomy Brain Development: Proliferation o and pruning occurs from back to front Back: Region that mediates direct contact with environment Next: Regions that coordinate those functions (e.g., light in bathroom) Last: Prefrontal Cortex Rogers Memorial Hospital 7

8 Construction Anatomy (cont.) Cerebellum Physical Coordination More sensitive to environment than heredity Supports higher learning activities Mathematics Music Advanced Social Skills This is the only part of the brain that keeps growing well into your 20 s Construction Anatomy (cont.) Basal Ganglia Secretary to the Prefrontal Cortex Prioritizes information Tightly connected to Prefrontal Cortex Almost simultaneously growing and pruning Active in small and large motor movements Preteen exposure to music and sports is important Rogers Memorial Hospital 8

9 Construction Anatomy (cont.) Amygdala Emotional center Primal fear rage Gut reactions Processes most of the emotional information in teens* * Adults depend more on the Prefrontal Cortex (which is not yet fully developed in teens) Construction Anatomy (cont.) Nucleus Accumbens Within frontal cortex Directs motivation (to seek rewards) Pineal Gland At base of the brain Produces melatonin (More on this later ) Rogers Memorial Hospital 9

10 Construction Anatomy (cont.) Prefrontal Cortex The CEO handles the Executive Functions Area of sober second thoughts Last part of brain to mature Grows during preteen years Shrinks during teen pruning for more efficient i connections Construction Anatomy (cont.) Prefrontal Cortex Executive Functions Planning Setting Priorities Organizing Thoughts Suppressing Impulses Weighing g Consequences Take-Home Message: This is the final part of the brain to grow up and is the part capable of deciding to finish homework and take out the trash before calling friends. Rogers Memorial Hospital 10

11 Cartoon Break Raging Hormones Impact on Brain Development: Not as closely linked as once thought! (proceeds whether early or late onset of puberty) During Puberty Sex hormones surge into bloodstream triggering body (and limbic system) changes Adrenal glands release testosterone-like hormones attach to brain receptors that regulate mood and excitability Melatonin levels take longer to rise regardless of exposure to light or activity level Rogers Memorial Hospital 11

12 Raging Hormones Impact on Brain Development: The limbic system = emotional center A tinderbox in adolescence Feelings reach flashpoint earlier Seek intense situations (thrills) This is why teens feel the need to Leave the nest Explore the world Find a partner Developmental Gap Parts of the brain responsible for sensation flooded with hormones Parts of brain for exercising judgment still under construction Risky Business No brakes! Wacky behaviors Shaky judgments Rogers Memorial Hospital 12

13 Motivation and Sleep Impact on Brain Development: Motivation Dopamine main neurotransmitter Involved in motivation and reinforcing behavior Nucleus Accumbens Located within frontal cortex Directs motivation to seek rewards High excitement or low effort Consequences Immediate + Tangible Motivation and Sleep Impact on Brain Development: Sleep Pineal Gland Produces melatonin Increases as nighttime approaches Takes longer to rise in adolescents than in adults Regardless of light Take Home Message: The brain program for nighttime starts later for adolescents Rogers Memorial Hospital 13

14 Ethical Considerations Driver s License AVIS Car Rental Insurance (not until age 25) Armed Services Death Penalty Shape Up or Ship Out Mentality Teenagers are still in training and need: Time management skills Organizational skills Patience and love Pruning Problems Brain Development and Mental Health Concerns Depression and Suicide Attention Deficit/Hyperactivity Disorder (ADHD) Substance Abuse Eating Disorders Obsessive-Compulsive Disorder (OCD) Tourette Syndrome Schizophrenia Rogers Memorial Hospital 14

15 Mental Health Crisis The US Surgeon General s Report: 10 to 15 million children have a diagnosable disorder 1 out of 10 are seen for evaluation Suicide is the 3 rd leading cause of death in teenagers (2 nd in Wisconsin) Shortage of Child & Adolescent Psychiatrists Mental Health: A Report of the Surgeon General (1999) Depression Rogers Memorial Hospital 15

16 Depression Up to 10% of adolescent males Up to 15% of adolescent females Depression Warning Signs Frequent sadness, tearfulness, crying Hopelessness Decreased interest in activities Inability to enjoy previous favorite activities Persistent boredom, low energy Social isolation, poor communication Low self-esteem, guilt Extreme sensitivity to rejection or failure Increased hostility, irritability, anger Difficulty with relationships Physical complaints (head/stomach aches) School absences or poor performance Poor concentration Weight loss/gain Change in sleep Agitation, shouting, complaining Suicidal thoughts Self destructive behavior, conduct problems Drug, alcohol, sexual activity Rogers Memorial Hospital 16

17 Cartoon Break Depression Natural History 20 40% of children relapse within two years 70% relapse by adulthood 20 40% adolescent depression may develop Bipolar Disorder Prepubertal onset increases risk for any mental disorder Teenagers at risk for depression Rogers Memorial Hospital 17

18 Cartoon Break Suicide 200% increase in suicide rates over the last several decades Age specific mortality rates (1996) Age per 100,000 Age per 100,000 Age per 100,000 20% high school students have seriously considered suicide 8% of those who have seriously considered suicide have attempted suicide 90% of suicide victims have a diagnosable mental illness Statistics from the American Foundation for Suicide Prevention Rogers Memorial Hospital 18

19 Suicide Rates Between 1979 and 1992, Native American males have a suicide rate of 62.0 per 100,000 White Males per 100, per 100,000 African American Males per 100,000 per 100,000 Suicide Risk Factors Substance Abuse Firearms in Home Loss of Loved One (includes break-ups) Trauma Depression Chaotic Home Previous Attempts Rogers Memorial Hospital 19

20 Cartoon Break ADHD One of the most common mental disorders: 3 5% of children diagnosed Probably found in 7 10% of children Three Hallmark symptoms: Inattention Hyperactivity Impulsivity Onset occurs before age 7 Causes severe impairment socially and academically At increased risk for depression and substance abuse (40 50% marijuana users) Rogers Memorial Hospital 20

21 ADHD Myths and Misconceptions: Attention t Span Hyperactive Just a Phase Diet/Allergies Famous People with ADHD include: Albert Einstein Alexander Graham Bell Tom Cruise Whoopi Goldberg Magic Johnson Charles Schwab Kinko s Copies and Jet Blue Airlines CEOs Cartoon Break Rogers Memorial Hospital 21

22 Substance Abuse National Institute on Drug Abuse (NIDA) Monitoring i the Future Study Annual survey conducted by the University of Michigan 50,000 secondary students at 402 public and private schools Monitors past month, year, and lifetime use Substance Abuse Good News: Sharp increase in drug use since 1992 Since 2001, 19% decline in past month use Cigarette use lowest in survey history Bad News: 50% report having tried illicit drugs by end of high school Prescription pain killers (Vicodin, Oxycotin) Starting in 2002, up to a 10% increase in past year use Increased inhalant use among 8 th graders National Institute on Drug Abuse (NIDA) Monitoring the Future: national survey results on drug use, 1975-present Rogers Memorial Hospital 22

23 Substance Abuse More Bad News: 62% of HS and 28% of MS students attend schools where drugs are sold, kept and used 41% increase since times more likely to use marijuana if told by a peer it s not morally wrong 6 times more likely to use marijuana if parents are a little upset rather than extremely upset Marijuana is easier to buy than beer Substance abuse is twice as high when smoking is allowed National Institute on Drug Abuse (NIDA) Monitoring the Future: national survey results on drug use, 1975-present Cartoon Break Rogers Memorial Hospital 23

24 Substance Abuse and Depression: A Chicken Egg Relationship Treatment centers report that: 80 90% have co-morbid depression, anxiety Self-medication theory (social anxiety, depression) 40 50% of marijuana users have ADHD American Journal of Preventive Medicine (2005) Boys: High correlation between marijuana use, binge drinking and likelihood of depression Girls: High correlation between alcohol/drug use or sexual experimentation and likelihood of depression Substance Abuse and Brain Development Dopamine is abundant and active in the adolescent brain Rapid changes in dopamine receptors in midbrain i project to nucleus accumbens Nucleus accumbens is immature Directs motivation to seek rewards Involved in drug reinforcement and reward Genes + Environment + Brain Development (so it s not just peer pressure) Rogers Memorial Hospital 24

25 Cartoon Break Eating Disorders In America, it is estimated that 1 4% of all women have an eating disorder Considered female disorders, but increasing in males 1:10 (within wrestlers, 7 10x) Third most common chronic mental illness in adolescence Related to other health risks (Tobacco, alcohol, marijuana, sexual activity and suicide) Extensive physical ramifications (anemia, amenorrhea, heart, gastrointestinal, osteoporosis, muscle mass, dental) Highest death rate of all mental illness Average onset is ages 13 to 18 Rogers Memorial Hospital 25

26 Eating Disorders Anorexia Nervosa About 1% of adolescent females Weight loss Ideal body weight Body image distortions Diet, over-exercise Vomiting Abuse of laxatives, diuretics, enemas Causes are unknown Perfectionists, overachievers Low self-esteem Overly critical People pleasers Depressed, abused, anxious Eating Disorders Bulimia Nervosa 1 3% of adolescents Normal weight can be hidden for years Secretive, uncontrolled binges followed by purges Binges can occur daily, weekly or occasionally Triggered by stress, boredom, depression Half of all anorexics also have bulimia Rogers Memorial Hospital 26

27 Eating Disorders Binge Eating Disorder 0.7 4% of population Newly recognized disorder Repeated uncontrolled eating Often begins with weight loss (Affects 15 50% of participants in weight control programs) Key features Feeling out of control during binge Followed by guilt, depression, disgust Cartoon Break Rogers Memorial Hospital 27

28 To Treat or Not to Treat? Key Factors to Consider: 1. Impairment Academically Socially Home relations 2. Multimodal Treatment American Academy of Child and Adolescent Psychiatry: Medicine - Never be used alone. Seven Rules for Parents 1. What You Do Matters 2. You Can t Be Too Loving 3. Stay Involved 4. Adapt Your Parenting 5. Set Limits 6. Foster Independence 7. Explain Your Decisions By Laurence Steinberg, PhD Professor of Psychology at Temple University Rogers Memorial Hospital 28

29 In Conclusion Thank you Five Locations in Wisconsin Valley Road Oconomowoc West Lincoln Avenue West Allis 406 Science Drive, Suite 110 Madison th Street Kenosha 4600 Schroeder Drive Brown Deer rogershospital.org Rogers Memorial Hospital 29