Mental disorders are diagnosable conditions characterized by changes in thinking, mood, or behavior (or some combination of these) that can cause a person to feel stressed out and impair his or her ability to function. As with symptoms of physical illness, symptoms of mental disorders occur on a spectrum from mild to severe. Adolescents with mental disorders, however, often have to bear the special burden of the societal stigma associated with their condition. This burden sometimes prevents adolescents and their families from acknowledging illness and from seeking support and effective treatment for it.
Adolescents are biologically prone to have mood swings because the hormonal changes associated with the ongoing development of their brains. Nonetheless, it is still important to recognize when behaviors seem out of the ordinary. When psychological symptoms cause major emotional distress or interfere substantially with daily life and social interactions over a period of time, professional evaluation is warranted, just as it is with any serious illness. It is vital to look for signs such as persistent irritability, anger, or social withdrawal, as well as major changes in appetite or sleep.
Adolescence is a time when many mental disorders first arise; in fact, more than half of all mental disorders and problems with substance abuse begin by age 14, and three—quarters of these difficulties begin by age 24. An estimated one in five adolescents will have a diagnosable disorder. Among the more common anxiety disorders are depression, obsessive-compulsive disorder (OCD), social anxiety disorder, post-traumatic stress disorder (PTSD), and phobias. Adolescents can also develop attention-deficit/hyperactivity disorder (ADHD) causing them to have difficulty paying attention, controlling impulses, and staying organized.
Mental disorders take a toll on adolescents, their parents, and friends, and contribute significantly to health care costs. The consequences can be short or long-term. Indeed, most mental disorders diagnosed among adults began during adolescence, although other mental disorders experienced by adolescents may diminish by early adulthood if they are treated. Adolescents with mental disorders are at increased risk of getting caught up in harmful behaviors, such as substance abuse, violence, and unprotected sexual activity. This is why getting treatment, as early as possible, is so important.
PTSD and Application in Criminal Court from an Expert’s Perspective – Dr. Ryan Hall
The purpose of this lecture is to discuss concepts of PTSD and how it may be applied in a criminal/legal setting. The attendees will be educated about how the condition is diagnosed, factors that are often applicable to criminal court situations, areas of agreement and disagreement between experts, how to approach a case in order to be able to provide supporting documentations for experts’ testimony.
“A Checklist for Parents with Children with Mental Health Problems” by the Royal College of Psychiatrists. Download here.
“For Teachers: Children’s Mental Health Disorder Fact Sheet for the Classroom” by Bridges4Kids. Download here.
“Abnormal Amygdala Resting-State Functional Connectivity in Adolescent Depression” by Kathryn R. Cullen, Melinda K. Westlund, Bonnie Klimes-Dougan, Bryon A. Mueller, Alaa Houri, Lynn E. Eberly, and Kelvin O. Lim, JAMA Psychiatry (2014)
Importance: Major depressive disorder (MDD) frequently emerges during adolescence and can lead to persistent illness, disability, and suicide. The maturational changes that take place in the brain during adolescence underscore the importance of examining neurobiological mechanisms during this time of early illness. However, neural mechanisms of depression in adolescents have been understudied. Research has implicated the amygdala in emotion processing in mood disorders, and adult depression studies have suggested amygdala-frontal connectivity deficits. Resting-state functional magnetic resonance imaging is an advanced tool that can be used to probe neural networks and identify brain-behavior relationships.
Objective: To examine amygdala resting-state functional connectivity (RSFC) in adolescents with and without MDD using resting-state functional magnetic resonance imaging as well as how amygdala RSFC relates to a broad range of symptom dimensions.
Design, Setting, and Participants: A cross-sectional resting-state functional magnetic resonance imaging study was conducted within a depression research program at an academic medical center. Participants included 41 adolescents and young adults aged 12 to 19 years with MDD and 29 healthy adolescents (frequency matched on age and sex) with no psychiatric diagnoses.
Main Outcomes and Measures: Using a whole-brain functional connectivity approach, we examined the correlation of spontaneous fluctuation of the blood oxygen level–dependent signal of each voxel in the whole brain with that of the amygdala.
Results: Adolescents with MDD showed lower positive RSFC between the amygdala and hippocampus, parahippocampus, and brainstem (z >2.3, corrected P < .05); this connectivity was inversely correlated with general depression (R = −.523, P = .01), dysphoria (R = −.455, P = .05), and lassitude (R = −.449, P = .05) and was positively correlated with well-being (R = .470, P = .03). Patients also demonstrated greater (positive) amygdala-precuneus RSFC (z >2.3, corrected P < .05) in contrast to negative amygdala-precuneus RSFC in the adolescents serving as controls.
Conclusions and Relevance: Impaired amygdala-hippocampal/brainstem and amygdala-precuneus RSFC have not previously been highlighted in depression and may be unique to adolescent MDD. These circuits are important for different aspects of memory and self-processing and for modulation of physiologic responses to emotion. The findings suggest potential mechanisms underlying both mood and vegetative symptoms, potentially via impaired processing of memories and visceral signals that spontaneously arise during rest, contributing to the persistent symptoms experienced by adolescents with depression. Read the full article.
“Interaction of the ADRB2 Gene Polymorphism With Childhood Trauma in Predicting Adult Symptoms of Posttraumatic Stress Disorder” by Israel Liberzon, Anthony P. King, Kerry J. Ressler, Lynn M. Almli, Peng Zhang, Sean T. Ma, Gregory H. Cohen, Marijo B. Tamburrino, Joseph R. Calabrese, Sandro Galea, JAMA Psychiatry (2014)
Importance: Posttraumatic stress disorder (PTSD), while highly prevalent (7.6% over a lifetime), develops only in a subset of trauma-exposed individuals. Genetic risk factors in interaction with trauma exposure have been implicated in PTSD vulnerability.
Objective: To examine the association of 3755 candidate gene single-nucleotide polymorphisms with PTSD development in interaction with a history of childhood trauma.
Design, Setting, and Participants: Genetic association study in an Ohio National Guard longitudinal cohort (n = 810) of predominantly male soldiers of European ancestry, with replication in an independent Grady Trauma Project (Atlanta, Georgia) cohort (n = 2083) of predominantly female African American civilians.
Main Outcomes and Measures: Continuous measures of PTSD severity, with a modified (interview) PTSD checklist in the discovery cohort and the PTSD Symptom Scale in the replication cohort.
Results: Controlling for the level of lifetime adult trauma exposure, we identified the novel association of a single-nucleotide polymorphism within the promoter region of the ADRB2 (Online Mendelian Inheritance in Man 109690) gene with PTSD symptoms in interaction with childhood trauma (rs2400707, P = 1.02 × 10−5, significant after correction for multiple comparisons). The rs2400707 A allele was associated with relative resilience to childhood adversity. An rs2400707 × childhood trauma interaction predicting adult PTSD symptoms was replicated in the independent predominantly female African American cohort.
Conclusions and Relevance: Altered adrenergic and noradrenergic function has been long believed to have a key etiologic role in PTSD development; however, direct evidence of this link has been missing. The rs2400707 polymorphism has been linked to function of the adrenergic system, but, to our knowledge, this is the first study to date linking the ADRB2 gene to PTSD or any psychiatric disorders. These findings have important implications for PTSD etiology, chronic pain, and stress-related comorbidity, as well as for both primary prevention and treatment strategies. Read the full article.
“Role of the Medial Prefrontal Cortex in Impaired Decision Making in Juvenile Attention-Deficit/Hyperactivity Disorder” by Tobias U. Hauser, Reto Iannaccone, Juliane Ball, Christoph Mathys, Daniel Brandeis, Susanne Walitza, MD; Silvia Brem, JAMA Psychiatry (2014)
Importance: Attention-deficit/hyperactivity disorder (ADHD) has been associated with deficient decision making and learning. Models of ADHD have suggested that these deficits could be caused by impaired reward prediction errors (RPEs). Reward prediction errors are signals that indicate violations of expectations and are known to be encoded by the dopaminergic system. However, the precise learning and decision-making deficits and their neurobiological correlates in ADHD are not well known.
Objective: To determine the impaired decision-making and learning mechanisms in juvenile ADHD using advanced computational models, as well as the related neural RPE processes using multimodal neuroimaging.
Design, Setting, and Participants: Twenty adolescents with ADHD and 20 healthy adolescents serving as controls (aged 12-16 years) were examined using a probabilistic reversal learning task while simultaneous functional magnetic resonance imaging and electroencephalogram were recorded.
Main Outcomes and Measures: Learning and decision making were investigated by contrasting a hierarchical Bayesian model with an advanced reinforcement learning model and by comparing the model parameters. The neural correlates of RPEs were studied in functional magnetic resonance imaging and electroencephalogram.
Results: Adolescents with ADHD showed more simplistic learning as reflected by the reinforcement learning model (exceedance probability, Px = .92) and had increased exploratory behavior compared with healthy controls (mean [SD] decision steepness parameter β: ADHD, 4.83 [2.97]; controls, 6.04 [2.53]; P = .02). The functional magnetic resonance imaging analysis revealed impaired RPE processing in the medial prefrontal cortex during cue as well as during outcome presentation (P < .05, family-wise error correction). The outcome-related impairment in the medial prefrontal cortex could be attributed to deficient processing at 200 to 400 milliseconds after feedback presentation as reflected by reduced feedback-related negativity (ADHD, 0.61 [3.90] μV; controls, −1.68 [2.52] μV; P = .04).
Conclusions and Relevance: The combination of computational modeling of behavior and multimodal neuroimaging revealed that impaired decision making and learning mechanisms in adolescents with ADHD are driven by impaired RPE processing in the medial prefrontal cortex. This novel, combined approach furthers the understanding of the pathomechanisms in ADHD and may advance treatment strategies. Read the full article.
“Early Detection Crucial for ASD Treatment” by Linda Peckel, Psychiatry Advisor (2017)
The most significant obstacle to effective treatment of autism is late detection. Early diagnosis is the key to success in helping a child with autism, but it is likely to be delayed by as much as two years in children from disadvantaged or minority families. However, universal autism screening at 18 and 24 months can significantly close this gap in access. Read the full article.
“Autism is Detectable in Brain Scans Long Before Symptoms Appear, New Study Says” by Josh Hafner, USA TODAY (2017)
New research suggests that autism may be detectable within a child’s first year of life. Researchers at the University of North Carolina used brain scans to predict with 80 percent accuracy whether certain children would develop autism. This research could lead to earlier and better interventions for children. Read the full article.