Transcript Kevin Leehey M.D. Child, Adolescent, and Adult Psychiatry

Kevin Leehey M.D.
Child, Adolescent, and Adult Psychiatry
Board Certified
296-4280
leeheymd.com
Salpointe Catholic High School
Community of Concern
What’s Brain Got To Do With It ?
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Nature vs. Nurture
Nature means biology, inheritance, genetics.
Nurture means environment, experiences.
Color perception is almost purely genetic.
Ability to learn language is genetic. But what
language we learn is purely environmental.
Neither controls how we turn out in life. It’s
both, the interaction of nature and nurture.
The brain develops at a different rate than the
rest of the body.
Brain development allows physical,
intellectual, emotional, moral, and spiritual
development to occur.
The brain (biology, nature, genetics,
inheritance) must interact with and be shaped
by environment (experiences, nurture,
parenting) to develop normally.
Understanding the process of brain (and
body) development clarifies the need for
parenting.
Brain Development
If a child is not played with, interacted
with, nurtured, exposed to stimuli, or is
rarely touched he/she will develop a
25% smaller brain.
Experiences shape and reshape the
structure of the brain.
By the time a child is 6, his or her brain is 90 to
95 % of adult size.
Between age 6 and 12 neurons grow bushier by
each neuron adding dozens of connections based
on what is reinforced by learning and experience.
This is why such things as learning a second
language, riding a bike, swimming, learning to
play a piano, or to throw a ball are easier when
young and can last a lifetime.
Neuron connections peak at 11 in girls and 12 to
13 in boys.
Unused connections are further pruned out in the
teen years at the same time the white matter
protective coating around neurons called Myelin
Sheath cells increase.
The brain is becoming more efficient but
also losing its raw potential for learning
and ability to recover from trauma,
drugs, alcohol, or injury.
Synapses that are used often are kept
and reinforced.
Those that are not used are lost.
How you spend your time and the
experiences you have or don’t have
are critical.
The part of the brain that makes teens
responsible is still under construction.
Brain development proceeds from back to front
and bottom to top.
The Frontal Lobe, which controls impulses,
motivation, and judgement is the last to develop.
Teen’s inconsistent Melatonin production
contributes to irregular sleep patterns.
Normal Sleep Architecture
Neuron drawing; grown in lab; and
as occur in layers in brain
What is a memory ?
“A memory is merely the probability that
a certain group of neurons will fire again
in the same way”
Short term vs long term memory
Role of dreams
Hippocampus (temporal lobe)
Thus cramming and little sleep is poor
learning method
What and when you eat matters too
Normal Sleep Architecture
The left side of the brain is shown.
Source: Shaywitz – Overcoming Dyslexia
Phineas Gage
On 9/3/1848 at age 26, a 13 lb 3.5 feet long tamping iron
blasted through his left ventromedial prefrontal lobe. He
lived 12 more years but “Gage was no longer Gage”
A Neural Signature for Dyslexia
Under-activation of Neural Systems in the Back of the
Brain
Frontal (PFC, VMFC), Temporal (Limbic system - Hippocampus, Amygdala etc);
Basal Ganglia> Striatum> Nucleus Accumbens
Source: Shaywitz – Overcoming Dyslexia
Nucleus Accumbens is a collection of neurons within the Striatum with major role in
reward, pleasure, addiction, and more.
Amygdala is next to Hippocampus in the Temporal Lobe; is key for emotional learning,
fear conditioning and memory.
MFB = Medial Forebrain Bundle (collection of axons connecting these areas and more)
VTA = Ventral Tegmentum Area (in midbrain near basal ganglia)
drawing from Psychology Today
In Children, neither PFC (self control, impulse control, cognitive control) nor
Striatum (risk taking, pleasure seeking) have developed much.
In Adolescents the Striatum has developed but not the PFC.
Finally in Adults both Striatum and PFC have developed a balance.
Note the Striatum (includes Nucleus Acccumbens) develops in a spurt in
Adolescence while the PFC develops consistently but slower.
This is one reason why teens who know better get in a car with a drunk driver.
JAACAP Vol 49 Issue 12 pgs 1189-1201
A- sensation seeking and impulsivity with age
B – brain activity focused on reward (L) and effort needed for self
control (R)
JAACAP Vol 49 Issue 12 pgs 1189-1201
Neurobiology of the Adolescent Brain and Behavior : Implications for
Substance Use Disorders by BJ Casey PhD and Rebecca Jones MS
JAACAP Vol 49 Issue 12 Dec. 2010 pages 1189-1201
“…heightened vulnerability to risk taking
in adolescence ‘may be due to the
combination of relatively higher
inclinations to seek excitement and
relatively immature capacities for self
control…’ “
ADHD – Deficits in Brain Reward System JAMA 9/9/09 pgs 1084-91
“…Nucleus Accumbens and midbrain are 2 key regions
for reward and motivation …”
“…impaired dopamine reward pathway in ADHD”
“The reward deficits in ADHD are characterized by a
failure to delay gratification, impaired response to
partial schedules of reinforcement, and preference for
small immediate rewards over larger delayed rewards.”
This explains “why the attention deficits in ADHD are
most evident in tasks that are considered boring (tasks
or assignments that are not intrinsically rewarding.”
Dopamine reward deficit “…underlies the higher
vulnerability to substance abuse in this population.”
The interaction of Nature and Nurture
The Parenting you give to your child up to
18 to 25 years old is how the “Top –
Down” cognitive, human thinking brain’s
self control system develops and learns
to over ride and integrate the emotional
and sensation seeking animal brain’s
focus on impulses and pleasures of the
moment.
Thus you must parent.
You are the most powerful and important
environmental (“nurture”) force.
Remember it’s the interaction between nature
(biology) and nurture (environment) that
determines the outcome.
Parenting is “hands on” thru 11-13, “hands
around” thru 17-19, “hands under” thru 18-25,
then “hands off”.
Parenting is the building of character, instilling
values and self discipline, and teaching
independent living skills. This develops the brain.
The teen brain is more vulnerable to the
stimulating, damaging, and addicting
effects of nicotine, alcohol, and other drugs.
One in three teens who start smoking as a teen
will die of a tobacco related disease.
90% of adult smokers began as teens.
Almost 45% of kids who start drinking alcohol
by 13 will become alcoholic, while only 10% of
those who wait till 21 will.
Substance use in youth thus becomes hard
wired in as a tendency for life. This is in
addition to any genetic predisposition.
Healthy Subject
watching video of
using
Substance abuser in
remission watching
video of using
Computers can be trained to recognize what a person is thinking about by comparing
patterns of brain activation. For example, when a person thinks about hitting a tennis ball,
the supplementary motor area and other regions are activated (blue), but when the same
person thinks about moving from room to room, the parahippocampal place area and other
regions are activated (red).
(Reprinted) JAMA, January 19, 2011—Vol 305, No. 3 page 237
Bad things can happen to Good kids
Typically people don’t say, “I think I’ll
get a DUI and ruin lots of lives today.”
No one says or thinks, “Gee, today I’m
gonna drink, smoke, or use a drug so I
can become an alcoholic or addict.”
Causes of death ages 15-24 :
Accidents -primarily motor vehicle,
many are substance impaired.
Suicide
Homicide
These 3 account for 75% of all deaths in
our kids. Suicide and homicide are
mostly by guns and many are
substance impaired.
Suicide Rate for Age Group 15-19 by Year
AACAP NEWS
2011 Trends – Good
Teen birth rate lowest in 70 years
MVA deaths lowest in 60 years – safer
cars, DUI enforcement, attitude change
Teen use of methamphetamine, alcohol,
ecstasy, cocaine, cigarettes are slightly
down
Youth suicide rate is down again
2011 Trends – Bad
Drugs kill more than cars do in > 16 states
Prescription medicine and Marijuana
abuse continue to rise
Teens + College age use:
#1 alcohol, #2 marijuana, #3 cigarettes,
#4 “pills”= Adderall (stimulants), opiates,
benzos, DXM, Soma
Spice, K-2, synthetic (legal) cannabanoids
2011 Trends - Ugly
Smoke (Head) shops
Cigarettes, snuff, dip, chew, cigars, hookah.
Tobacco in all its forms is by far #1
preventable cause of death. Alcohol is #3
Opiates, Benzodiazepines, Ambien, Soma,
Stimulants (includes ADHD meds), DXM
Be aware, legal drugs + medicines are just
as dangerous to abuse as illegal drugs are
Marijuana, pot, grass, weed
Perceptual distortions
Short term memory loss
Apathy, lack of, motivation
Out of touch with own feelings, denial of sad,
mad, down, etc
The point of substance use is to alter feelings,
thoughts, perceptions, reality
Relationship problems
Self medication of MH and life problems
MJ can cause or worsen mental illness
Drugs now kill more people
than cars do in 16 states.
Safer cars; more opiates abuse
Drug related death rate doubled in 10 years.
8 states 2004; 12 in ‘05; 16 in ’06; ? now
Opiates (Vicodin, Oxycontin, oxy and
hydrocodone, methadone, heroin), Cocaine
MA, NH, RI, CT, NY, NJ, MD, PA, OH, MI, IL,
CO, NV,OR, UT, WA
Actual Causes of Preventable Deaths
Opiates and more…
Vicodin, Percodan, Percocet, methadone, oxycontin
Oxycontin 50 cents to $1/ mg
HEROIN - smoked, foil, $40/gram, IV
Benzos – Xanax “bars”, Klonopin, Ativan, Valium
Sleeping pills - Ambien
“Triple C’s”, “DXM”, Robitussin, dextromethorphan
Spice, K-2, Salvia, Head and Smoke shops; fake urine
ADHD medicine abuse, stimulants like Adderall
Meth, Crystal, methamphetamine
Soma, muscle relaxers
Ecstasy, “club drugs”, hallucinogens, PCP, Inhalants
Hookah, Shisha do contain nicotine
energy drinks – caffeine, guarana, taurine, Four Loco
Tobacco kills more than all drugs and alcohol
together.
Youth drink to get drunk - binge on as much
as possible as fast as possible. Drinking
games.
60% HS seniors have had intercourse.
>50% HS seniors drink regularly.
25% HS seniors smoke cigarettes.
33% HS seniors use other drugs
60% teens will try other drugs by end of HS
Parenting Tips
Don’t leave town and leave your teen home
alone. Don’t rent hotel rooms, etc for kids.
Cell phones make “flash” parties possible.
Don’t trust sleepovers and campouts.
Call other parents.
If you’re the host check what’s up.
Have your teen wake you up when they come
home. Talk to them, get close.
Seat belts, air bags, slower speeds, less
passengers, home before midnight, and safer
cars save lives.
Parenting Tips II :
Teen’s main source for alcohol and prescription
medicines to abuse is your and their friends’
homes.
2% of us over age 40 smoke marijuana daily.
Teens know homes where parents allow or give
alcohol, “weed”, other drugs, or sex to your kids.
If you want your kids to come out of their rooms
keep the electronics out.
Internet and gaming are best monitored out of
their bedrooms.
Parenting Tips III
Social networking (Facebook, MySpace, Twitter,
YouTube, etc) is here to stay. Check, know passwords,
teach what’s OK, not OK, why.
High schools now require internet, word processing.
College requires even more. Ensure they learn now –
with supervision.
Offer a phone, computer, gaming with features that fit
the age and developmental level of your child or teen.
Increase with age and trust. Agree on a plan of you
checking for appropriate use.
You can control calling, texting, internet use, hours,
phone numbers allowed and banned – all of it. All cell
companies have these controls – use them.
Parenting Tips IV
YOU are your child’s + teen’s #1 influence !
If they see you drunk/impaired/partying they are
33% more likely to drink or use.
If you say, imply, or even think it’s OK or
inevitable that they’ll drink or use, then they are
10X more likely to do so.
If you repeatedly (not nag) tell them not to, then
they are 10X less likely to drink or use.
Say “No”, Don’t try to be the “Cool” parents, and
don’t try to be your kids’ “Best Friends” !
Read the C of C booklet - it’s very useful !
Thank you and good luck…
Kevin Leehey M.D.
leeheymd.com
296-4280