Psychiatrist, Psychotherapist, Addiction Psychiatrist International Keynote Speaker Elements Behavioral Health % 3 years

Transcription

1 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood March 18-19, 2017 Christopher La Tourette La Riche, MD Psychiatrist, Psychotherapist, Addictio Psychiatrist Iteratioal Keyote Speaker Elemets Behavioral Health ADDICTIVE DISORDERS CO- OCCURING DISORDERS EARLY LIFE STRESS MOOD DISORDERS % 3 years LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

2 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

3 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood Addictive as Circuit Addictio is a primary, chroic disease of brai reward, motivatio, memory ad related circuitry. Disruptio i these circuits leads to the pathological pursuit of reward (by substace use) despite hazardous cosequeces. (ASAM ad NIDA) Psychiatric vs Neurological Disease Psychiatric vs. Neurological Disease Aimal Models i Addictio Cami N Egl J Med 2003 VTA LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

4 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood Blakemore (2008) Nat Rev Neurosciece Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

5 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood Epigeetic Chages The Neural Basis of Addictio: A Pathology of Motivatio ad Choice Am J Psychiatry. 2005;162(8): Shared Neural Pathway for Reward NALTREXONE Neurobiology of Addictio Focus. 2011;9(1): VIVITROL IS SHOWN TO HELP WITH OPIATES AND ALCOHOL IN: maitaiig abstiece improvig retetio i treatmet decreasig cravigs prevetig relapse (Gastfried, DR A N Y Acad Sci. 2011) LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

6 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood Past Year Substace Use: Adults with Major Depressio i 2012 (NSDUH 2012) Past Year Addictive disorders, Metal Illess (or both) (NSDUH 2012) Past Year Treatmet for both Co-ocurrig Patiets i 2012 (NSDUH 2012) Proportio (%) Lifetime rates of alcoholism i major psychiatric disorders moths likelihood (ORs) of a additioal SUD i Maia ad Hypomaia N= 42,000 (NESARC) Odds Ratio Maia Hypomaia 0 Regier DA et al. JAMA 1990;264: BP I BP II Schiz PD OCD Dysthymia MDD GP Diagosis BP=bipolar disorder, Schiz=schizophreia, PD=Paic disorder, OCD=obsessive compulsive disorder, MDD=major depressio, GP=geeral populatio AL= Alcohol, Dr=Drugs, DP=Depedece, AB=Abuse, GP=Geeral populatio 1 Grat et al, Arch Ge Psych 2004;61: LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

7 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood Hyper-hedoic Respose to Reward i Bipolarity Liam Maso et al. Brai 2014;brai.awu152 Shared Neural Pathway for Reward People with Bipolarity evaluate Risk more i the Nucleus Accumbes tha i Prefrotal Cortex Neurobiology of Addictio Focus. 2011;9(1): Liam Maso et al. Brai 2014;brai.awu152 MoodCheck for Bipolarity (BSDS) Pies/Ghaemi MoodCheck for Bipolarity (BSDS) Pies/Ghaemi LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

8 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood MoodCheck for Bipolarity (BSDS) Pies/Ghaemi SO FAR: MOOD DISORDERS ADDICTIVE DISORDERS CO-OCCURING DISORDERS NEUROBIOLOGY OF ADDICTION The Adverse Childhood Experieces Study ADDICTIVE DISORDERS CO- OCCURING DISORDERS EARLY LIFE STRESS MOOD DISORDERS Collaboratio betwee Kaiser Permaete s Departmet of Prevetive Medicie i Sa Diego ad the Ceter for Disease Cotrol ad Prevetio (CDC) The Adverse Childhood Experieces (ACE) Study Summary of Fidigs: Adverse Childhood Experieces (ACEs) are very commo ACEs are strog predictors of adult health risks ad disease ACEs are implicated i the 10 leadig causes of death i the U.S. I was actually stued ad I wept over what I saw. --ACE primary author Rob Ada, M.D. LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

9 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood & Categories of ACES ACE Evet, by Category Prevalece Score Addictio i family 27% +1 Metal Illess i family 19% +1 Domestic Violece 13% +1 Imprisoed Household Member 5% +1 Loss of / Separatio from paret 23% +1 Physical Abuse (by parets) 28% +1 Sexual Abuse (by ayoe) 21% +1 Psychological Abuse (by parets) 11% +1 Emotioal Neglect 15% +1 Physical Neglect 10% +1 LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

10 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood ACE Score ad Itraveous Drug Use 3.5 % Have Ijected Drugs or more ACE Score IMPAIRED MEMORY OF CHILDHOOD N = 8,022 p<0.001 LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

11 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood ORIGINALLY FOR PHYSICAL ILLNESSES TABLE Adverse Childhood Experiece* Categories Abuse of Child Recurret Severe Emotioal abuse Recurret Physical abuse Cotact Sexual abuse Trauma i Child s Household Eviromet ADDICTION IN HOUSEHOLD Paretal separatio or divorce Chroically depressed, emotioally disturbed or suicidal household member (MENTAL ILLNESS) Mother treated violetly Imprisoed household member Loss of paret (by death, by suicide, - or by abadomet) Neglect of Child Abadomet Child s basic physical ad/or emotioal eeds umet * Above types of ACEs are the heavy ed of abuse. Early Life Trauma ad High-Risk Health Behaviors Neurobiologic Effects of Trauma Disrupted euro-developmet Difficulty cotrollig ager-rage Halluciatios Depressio Paic reactios Axiety Multiple (6+) somatic problems Sleep problems Impaired memory Flashbacks Dissociatio Health Risk Behaviors Smokig Severe obesity Physical iactivity Suicide attempts Alcoholism Drug abuse 50+ sex parters Repetitio of origial trauma Self Ijury Eatig disorders Perpetrate iterpersoal violece Log-Term Cosequeces of Uaddressed Trauma (ACEs) Disease ad Disability Ischemic heart disease Cacer Chroic lug disease Chroic emphysema Asthma Liver disease Skeletal fractures Poor self rated health Sexually trasmitted disease HIV/AIDS Serious Social Problems Homelessess Prostitutio Deliquecy, violece, crimial behavior Iability to sustai employmet Re-victimizatio: rape, DV compromised ability to paret Itergeeratioal trasmissio of abuse Log-term use of health, behavioral health, correctioal, ad social services BRIDGING THE CHASM SLIDE FROM ACE POPULATION ATTRIBUTABLE RISK ACE Reductio reliably predicts simultaeous decrease i all of these coditios Family Policy Coucil 2012 LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

12 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood ACE Study POSSIBLE MECHANISMS Theories of Depressio Mooamie Hypothesis: Fuctioal deficit of Neurotrasmitters (biogeic amies SER, NE, DA) evideced by efficacy of Tricyclic atidepressats, MAO Ihibitors, SRIs Neuroedocrie/Chroic Stress hypothesis: Hypothalamic- Pituitary-Adreal dysfuctio ad dysregulatio of CRF-Cortisol circulatio Iflammatory Hypothesis: immue-mediated chages cotribute to depressio, icludig pro-iflammatory cytokies ad cytokie-sigalig pathways KEY ABBREVIATIONS 1) The Hypothalamus-Pituitary- Adreal Axis is also called the (Adreal Stress Axis) HPA AXIS Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

13 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood KEY ABBREVIATIONS Hypothalamus-Pituitary-Adreal Axis 2) The BIOCHEMICAL CASCADE that creates Cortisol is: CRF ACTH Hughes (2012) Nature Adapted from: McEwa B (2012), Protective ad damagig effects of mediators of stress ad adaptatio Miller et al (2009) Biol Psychiatry 65: LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

14 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood Stressor CRH ACTH Catecholamies Glucocorticoids CRF mimics symptoms of depressio i Rodets Eatig Reproductio SW sleep Groomig Neophobia (ovel eviro) Locomotor activity (familiar eviro) Behavioral despair Seizure/kidlig Locus coeruleus FR Pyramidal FR Glucoeogeesis Lipolysis Proteolysis Isuli resistace Iflammatio Immue fuctio Blood pressure Heart rate Blood sugar GI blood flow Geetics Early Adverse Life Evets Depressed adults showed equal respose to atidepressat ad psychotherapy Curret Life Stress CRF Behavioral Effects Biological Effects HPA Axis Activatio ANS Activatio N Egl J Med May Differetial resposes to psychotherapy versus pharmacotherapy i patiets with chroic forms of major depressio ad childhood trauma there may be importat differeces i the etiology ad pathogeesis of depressio i idividuals with ad without history of early trauma. PNAS (2003): PNAS (2003): LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

15 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood Guide to Alzheimer s Disease, (2009) Growdo ed. Videbech 2015 LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

16 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood LITHIUM HIPPOCAMPI 4 IMAGES IS THERE ANOTHER LINK BETWEEN A.C.E. AND LATER-LIFE: MOOD DISORDERS? ADDICTIVE DISORDERS? CORTICAL THICKNESS Bearde 2007 Measurig Cortical Thickess Cortical Thickess after Childhood Sexual Abuse Christie M. Heim, Ph.D.; Hele S. Mayberg, M.D.; Taja Mletzko, M.S.; Charles B. Nemeroff, M.D., Ph.D.; Jes C. Pruesser, Ph.D. Am J Psychiatry 2013 LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March

17 Child is Father of the Ma: Neurobiological Crossroads of Trauma, Addictio ad Mood Cortical Thickess after Childhood Sexual Abuse i Wome Christie M. Heim, Ph.D.; Hele S. Mayberg, M.D.; Taja Mletzko, M.S.; Charles B. Nemeroff, M.D., Ph.D.; Jes C. Pruesser, Ph.D. Am J Psychiatry 2013 Cortical Thiig i the Geital Sesory Cortex Choi 2009 Protect [the child] agaist processig the abusive experiece at a sesory level but may be implicated i the developmet of (future) behavioral problems Tomoda gives to airy othig a local habitatio ad a ame. --Shakespeare, A Midsummer Night s Dream Thak you! Christopher La Riche, MD LaRicheMD@gmail.com Coect o LikedI: likedi.com/i/larichemd LaRicheMD@gmail.com, Elemets Behavioral Health Lecture, Wisto-Salem, NC, March