Youth Mental Health and 22q11

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1 Youth Mental Health and 22q11 Cameron S. Carter M.D. Director Center for Neuroscience U.C. Davis Early Diagnosis & Preventative Treatment Clinic (EDAPT) UC Davis Department of Psychiatry of Mental Health

2 Psychiatric Disorders are Common Up to one third of all adults will have a life9me experience of mental disorder Less that 30% will get treatment

3 Psychiatric disorders are developmental 80% will have earliest signs and symptoms before 18 years Children with developmental disorders have increased rates of psychiatric symptoms The symptoms are part of their developmental disorder and will respond to evidence based treatments

4 BRITISH JOURNAL OF PSYCHIATRY (2005), 186, 115^120 Adolescents and young adults with 22q11 deletion syndrome: psychopathology in an at-risk group KATE D. BAKER and DAVID H. SKUSE Group t or w 21 22q11 deletion syndrome (n¼25)( Controls (n¼25) Gender (male : female) 15 : : Age in years : mean (s.d.) 16.4 (2.0) 16.0 (2.9) Estimated IQ : mean (s.d.) 66 (15) 74 (16) All P40.05.

5 Table 2 DSM^IVdiagnoses and dimensional symptom counts Disorder Number of diagnoses w 2 Mean dimensional symptom count (s.d.) Mann^ Whitney U 22q11 deletion syndrome Controls 22q11 deletion syndrome Controls ADHD, inattentive subtype * 6.6 (3.1) 3.4 (3.2) 3.1** Anxiety disorder * 1.2 (2.0) 0.2 (0.9) 2.8* Separation anxiety 0 0 Social anxiety 0 1 Overanxious 8 1 Phobia 2 0 Mood disorder ** 2.7 (2.4) 0.3 (0.9) 4.4** Dysthymia 4 0 Major depression 3 0 Hypomania 2 0 Manic episode 0 0 Obsessive^compulsive disorder (1.5) 0.1 (0.4) 2.0* Conduct disorder (0.4) 0.3 (0.6) 1.4 ADHD, attention-deficit/hyperactivity disorder. *P50.05; **P50.01.

6 From: High Rates of Schizophrenia in Adults With Velo-Cardio-Facial Syndrome Arch Gen Psychiatry. 1999;56(10): doi: /archpsyc Date of download: 5/16/2014 Copyright 2014 American Medical Association. All rights reserved.

7 What is Psychosis? A Brain Based Neurodevelopmental Disorder Can be related to a serious mood disorder (depression, bipolar disorder) or a primary psycho9c disorder Most Striking are the Posi9ve Symptoms - Hallucina9ons, Delusions, Thought Disorder However, there are also Nega9ve Symptoms - Loss of interest, energy, pleasure, withdrawal And Cogni9ve Impairments - problems in aren9on, problem solving and memory That Predict Func9onal Outcome - not responsive to current medica9on - poten9al for cogni9ve remedia9on

8 How does Psychosis Develop? Positive symptoms Negative symptoms Risk for relapse At Risk phase 1 week-1 year Acute psychosis 1 week-1 month Recovery phase 6-36 months

Biological Complexity Multiple systems impacted at multiple levels!

changes, sulcal & ventricular enlargement Functional-Physiologic:

Cellular-Molecular: NT systems abnormalities à altered receptor

9 Biological Complexity Multiple systems impacted at multiple levels! Structural-Anatomical: cortical gray matter reduction, subcortical changes, sulcal & ventricular enlargement Functional-Physiologic: reduced or irregular activation during various cognitive tasks Cellular-Molecular: NT systems abnormalities à altered receptor distributions, increased cell density, decreased/aberrant connections between cells

10 Early Intervention Rationale Duration of untreated psychosis is associated with poor outcome Early in illness treatment response is robust Loss of function and treatment resistance follow repeated relapses Early intervention can improve functional outcome Tailored treatment pathways and therapies for early treatment and rehabilitation The EDAPT & SacEDAPT Programs

Duration of Untreated Psychosis and Rate of Relapse % Patients Relapse-Free 90 80 70 60 50 40 30 20 10 0 Short DUP, N=31 (treatment <1 year after psychosis onset)

11 Duration of Untreated Psychosis and Rate of Relapse % Patients Relapse-Free Short DUP, N=31 (treatment <1 year after psychosis onset) Long DUP, N=22 (treatment >1 year after psychosis onset) # Months after treatment entry Adapted from Crow et al. (1986). Brit J. Psychiatry, 148,

12 Psychosis Prodrome Period of early clinical signs that individual is at higher risk, but not always destined, for psychosis Typically occurs during adolescence or early adulthood between ages (average age 17-18) Average duration of 1-3 years Likely association with brain maturation Onset may be earlier for men than women

13 Non-specific signs of prodromal psychosis A clustering of the following: A significant deterioration in the ability to cope with life events and stressors Decrease in work or school performance Decreased concentration and motivation Withdrawal from family and friends Decrease in personal hygiene

14 Specific signs of risk for psychosis Attenuated/subthreshold psychotic symptoms Marked changes in behavior, thoughts and emotions, such as: Unusual perceptual experiences Heightened perceptual sensitivity Magical thinking Unusual fears Disorganized or digressive speech Uncharacteristic, peculiar behavior a whiff of psychosis The EDAPT & SacEDAPT Programs

15 Careful Assessment is Needed These symptoms CAN look similar to: Depression or Anxiety Substance Abuse Reaction to abuse or trauma Attention Deficit Hyperactivity Disorder Reaction to family stress Learning Disabilities Pervasive Developmental Disorders

Schizophrenia Research 118 (2010) 118 121 Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.

2 deletion syndrome Joel Stoddard a,, Tara Niendam b, Robert Hendren c, Cameron Carter b, Tony J. Simon a a 22q11.

16 Schizophrenia Research 118 (2010) Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www. elsevier. com/ locate/ schres Brief report Attenuated positive symptoms of psychosis in adolescents with chromosome 22q11.2 deletion syndrome Joel Stoddard a,, Tara Niendam b, Robert Hendren c, Cameron Carter b, Tony J. Simon a a 22q11.2DS n=20 Age (years) 15.1 (4.3), Median (IQR), range Female 70% SES 48.9 (14.0) Mean (SD) FSIQ 76.2 (10.9) Mean (SD) GAF 58.8 (10.8) Mean (SD)

17 22q11.2DS n=20 Diagnosis Current n (%) Lifetime n (%) Any disorder 15 (75) 18 (90) PDD NOS 5 (25) 5 (25) ADHD 6 (30) 7 (35) ODD 1 (5) 1 (5) Tourette's disorder 1 (5) 1 (5) Enuresis 2 (10) 6 (30) Alcohol dependence 1 (5) 1 (5) Any anxiety 11 (55) 12 (60) SAD 1 (5) 4 (20) GAD 4 (20) 4 (20) OCD 1 (5) 4 (5) Panic disorder 0 (0) 1 (5) PTSD 1 (5) 1 (5) ASD 1 (5) 2 (5) Social phobia 2 (10) 5 (25) Specific phobia 6 (30) 7 (35) Anxiety disorder NOS 2 (10) 2 (10) Any mood 3 (15) 5 (25) MDD 2 (10) 4 (20) Depressive disorder NOS 1 (5) 1 (5) Adj. disorder with depressed mood 0 (0) 1 (5) a Data are presented as the number of adolescents who met criteria for a

18 Stoddard et al (10%) met arenuated posi9ve syndrome criteria 8 more had some evidence of arenuated symptoms but we do not know the significance of this

19 What are effec*ve treatments? Biological Factors Medication Substance use management Cognitive/Psychological Factors Cognitive Therapy Cognitive Remediation Skills Training Supported Education/Employment Peer/Family Support Environmental/Family Factors Family Therapy

20 Entry Criteria for EDAPT Clinic Ages 12-25, IQ> 70, no medical illness/injury affecting cognition Drug use Ok, but no dependence Recent onset of psychosis (within the past year) includes affective and non-affective psychosis or Attenuated positive symptoms or Recent deterioration in youth with a parent/sibling with a psychotic disorder Also serve Mood/Bipolar Disorder (with attenuated or psychotic features)

21 EDAPT Offers: Phone consultation Support for professionals like you! Comprehensive Psychiatric Assessment Case Management Psychoeducation Crisis management & Problem Solving Groups: Multifamily Group Family Support Group SAMM Peer Support Group Support from Peer & Family Advocate Supported Education/Employment Medication Management Monitoring and support for 2 years The EDAPT & SacEDAPT Programs

22 Contact Information EDAPT & SacEDAPT Phone Consultation Hours: 9:00am 5:00pm M-F EDAPT referrals: Jane Dube SacEDAPT Referrals: Markie

9/29/2011 TRENDS IN MENTAL DISORDERS. Trends in Child & Adolescent Mental Health: What to look for and what to do about it. Autism Spectrum Disorders

9/29/2011 TRENDS IN MENTAL DISORDERS. Trends in Child & Adolescent Mental Health: What to look for and what to do about it. Autism Spectrum Disorders Trends in Child & Adolescent Mental Health: What to look for and what to do about it. Jason J. Washburn, Ph.D., ABPP Director, Center for Evidence-Based Practice TRENDS IN MENTAL DISORDERS Autism Spectrum