Download The Road To A Brain Healthy Life: What`s Normal, What`s Not

The Road To A Brain Healthy Life:
What's Normal, What's Not:
Teenagers
Melissa P. Lopez-Larson, M.D.
Child, Adolescent and Adult Psychiatrist
Psychiatrist: Round Valley Clinic, Park City
Adjunct Assistant Professor, University of Utah
Teenager Years – The Perfect Storm
• On average 12 to 22 years of age
• Transition period to adulthood
• Hormonal fluctuations –steroid hormones impact brain
development with limbic structures seeing an increase in
sex hormones prior to full frontal lobe development
• Robust brain development changes during this time leading
to growth in cognitive, emotional and social domains
• Critical time period for development and often the time of
increased risk for mental health issues
Brain Health and Development
Genes
Hormones
Experiences/Environ
ment
Hormonal Changes during Puberty
Dynamic Mapping of Gray Matter Changes During
Cortical Development: Childhood to Early Adulthood
Statistical extrapolation of time lapse sequence
(Gogtay et al., 2004)
Cortico-Limbic Circuits: Top-Down Modulation of
Affective Processes
Prefrontal Cortex
Executive
function/
Inhibition
Amygdala/hippocampus
Typical Personality and Behavioral Changes
• Mild to moderate mood lability and sensitivity
• Challenging of authority and limit testing
• Peer influence stronger than parental influence
• Higher risk behaviors than typical for given Teen
• Experimentation – try on new roles/personalities;
drugs and alcohol
• Gradual changes over the course of teenage years
• More self-conscious
General warning signs
• Abrupt changes in personality and attire
• Isolation – from parents and/or peers
• Refusing to talk openly with parents
• Abrupt changes in peer group
• Poor appetite or restricting food intake
• Sleeping to little or to much
• Obsession with social media
General warning signs
• High risk behaviors – excessive alcohol and drug use,
stealing, lying, legal issues
• Moderate to severe irritability including any aggression
• Severe oppositionality and unwillness to follow any rules
• Decline in school grades and/or school refusal
• Quitting sports or other activities they use to enjoy
• Increase in physical complaints, i.e. Stomach aches,
headaches, pain, etc…
Teens at Increased Risk
• Any prior history of mental health or learning issues as a
child, i.e. anxiety, ADHD, depression
• Bullying including past and present
• Family history of mental health issues
• Major transitions or stressful events in life (even if positive)
• parental divorce
• geographical move
• change in schools
• loss of a loved one
• the more transitions the higher the risk
Teens at Increased Risk
•
History of trauma/abuse including witnessing abuse or
domestic violence
• Can include sibling-on-sibling violence
•
History of head injury/concussions
•
History of chronic medical conditions: diabetes,
ulcerative colitis, etc…
•
Use of drugs and alcohol****
•
Remember each teen is different and what is a warning
sign in one is not in another.
Warning Signs of Depression in Adolescents
• Depressed or down mood
• Mood lability: crying and irritability
• Isolation – including parents and peers –although
usually will still hang out with friends
• Loss of interest in previously enjoyed activities
• Sleeping to much or not enough
• Increased or decrease in appetite with weight changes
Warning Signs of Depression in Adolescents
• Suicidal statements or gestures or other parasuicidal
behaviors
• Excessive guilt
• Expression of hopelessness or negativity about the
future
• Often has overlapping symptoms with anxiety
• Increase in drug and alcohol use
Warning signs of Anxiety in Adolescents
• Excessive worrying about everything
• Fear of being judged
• Perfectionism
• Social anxiety – few friends/isolation
• Irritability
• School refusal
• Having to have things “a certain way” and ritualistic or
repetitive behaviors
Warning signs of Bipolar Disorder
• Severe mood swings lasting days to weeks: “highs and
lows”
• Very high risk and out of control behaviors
• Increase in drug and alcohol use
• Grandiosity
• More social, more ideas and projects, etc
• Pressured and fast speech
• Lack of need for sleep
Warning Signs of Psychotic Disorder
• Auditory and visual hallucinations
• Severe withdrawal and isolation with few to no friends
• Paranoia
• Disorganized or confused thinking
• School refusal and poor grades
• Poor hygiene
• Increase in drug and alcohol use
Warning Signs of an Eating Disorder
• Drastic changes in eating patterns – more restrictive
• Eating alone
• Going to the bathroom shortly after meals
• Increase or excessive exercise regimen
• Pre-occupied by appearance and spending a lot of
time in front of mirror
• Wearing baggy clothing
• Poor self-image
Warning Signs of Addiction Issues
• Change in personality and mood
• More irritable and defiant
• Use of substances by him/herself
• Legal issues
• Lying and stealing behaviors
• Can mimic many different mental health issues and
can increase risk for mental health issues.
• Often is comorbid with other mental health issues.
General Tips for Parents
• Be vigilant and if you are worried then you probably
should be
• Keep lines of communication open
• Listen- don’t rush to fix things
• Model behavior you would like to see in your teen
• Set firm boundaries
Tips for Parents
• Pick your battles wisely
• Consequences for breaking certain house rules should
be enforced but communicating why is important – not
just “because I said so”
• Consistency
• Don’t be afraid to ask for help: friends, family,
pediatrician, clergy, school counselors, teachers, etc…
• In general 2 or more warning signs should prompt an
evaluation by a professional
Available Treatment Options
• Outpatient
1. Individual – CBT, supportive, interpersonal therapy –
specialize in working with teens
2. Group therapy – can be very helpful for Teens given the
increased importance of peer relationships
3. Mediation management
• Intensive Outpatient/Day Treatment
• Residential – long and short-term and therapeutic day schools
• Inpatient hospitalization
• Specific treatment programs: Addiction, eating disorders,
behavioral disorders
Summary
•
Adolescence is a “Perfect Storm” with hormonal and brain
changes occurring around the time of a major transition
period in ones life.
•
Recognizing age-appropriate versus potential warning
signs for underlying mental health issues – Teen specific
•
When in doubt ask for help – if you are worried then you
are probably right.
•
Talk openly about mental health issues with kids, family,
friends, etc… to help reduce stigma, get support, info, etc.
•
Sources of additional information: Connect, NAMI, NIMH
Questions?