Adolescents are different Emotional intelligence Dr Srinivasa S

Adolescents are different Emotional intelligence Dr. Srinivasa S. R. R. Y Professor and HOD Department of Psychiatry KMC, Warangal

WINDOWS OF Opportunity AND susceptibility – Plasticity of human brain

Neurodevelopment: through adolescence”, Vulnerable“continues periods: From eescence is both progressive and regressive • • • Proliferation Migration Differentiation Synaptogenesis Myelination Apoptosis • During critical developmental periods “activity as well as toxic exposure” can alter brain structure. (Timing) (Rice. Critical periods of vulnerability for the developing nervous system. EHP, 2000, 108 (3): 520)

• Genes provide the “blue-print” for the architecture • Form is sculpted by the “environment and experience” • The brain produces 2 -3 times the full adult complement of neurons. • >50% eliminated before birth

• Abnormal neuronal migration - epilepsy, MR, motor impairments and dyslexia • Synapses – 3 Crore per sec. (2 -4 months) • Neurons – 25000 per min. (2 nd trimester)

• Experience exerts a maximum effect on development– Sensitive period Experience must be present for the formation of appropriate connections – Critical period “Brain adapts the basic circuitry to the environment”. Good support - Increased expression of “trophic factors” • Neglect/Exposure to stress vs Environmental enrichment

Understanding childhood – children are not just “small”adults…. .

Dynamic developmental physiology • Xenobiotics handled differently by an immature body • Barriers not fully developed

Absorption: The demands of rapid growth and development: • higher breathing rate, caloric and water intakes • enhanced absorption and retention of nutrients For example: GI absorption of lead in toddler: 40– 70% of oral dose (1/3 retention) GI absorption of lead in non-pregnant adult: 5– 20% (1% retention) Ref: • ATSDR Case study on lead (www. atsdr. cdc. gov/HEC/CSEM/lead/index. html). Children are different and differently vulnerable

1. Transplacental and breast feeding 2. Exploratory behaviours : Hand-mouth, non-nutritive ingestion 3. Stature and living zones, microenvironments: Location – lower to the ground; high surface area to volume ratio 4. Children do not understand danger : Pre-ambulatory; adolescence – “high risk” behaviours

Maternal exposure matters: • Breast milk: DDT, DDE, PCBs, TCDD (dioxins), nicotine, lead, methylmercury, alcohol are being detected in cow’s milk and breast milk.

Environmental insults - impact is more on children - but how is our environment!!! How our Environment is waging– chemical war on children……

WHO ESTIMATES: Lead-15 -20% mental • In developing countries retardation - caused by exposure to lead. • Burden of disease for lead poisoning is 20 X higher than for asthma, and 120 X higher than for cancer

• For each 1 µg/d. L increase of BLL the IQ decrease is 0. 25– 0. 5 • Child - 70% - Lungs and GI system & pregnancy also-70% • In chronic exposure the main deposits (90%) are in the bone, with very slow elimination (25 yrs) Deposits enter blood during pregnancy Exposure now impact later

Model for NDDs

Dilution is not the solution

Chemical War on children • large predator fish have the highest levels of mercury and the lowest levels of omega 3 fatty acids, while small fish have the lowest levels of mercury and the highest levels of omega 3 fatty acids. Reference: Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA. 2006, 296: 1885 -99

• Nearly a billion pounds of these neurotoxicants were emitted into the air and surface water, --- inhaled, absorbed or otherwise ingested through our food and water supplies. • Thirty-seven pesticides registered for use on foods are neurotoxic organophosphates. Chemical war on children – sea of neurotoxins

Polyhalogenated compounds act on thyroid • Thyroid hormones are essential for normal brain development in utero to the first 2 years postpartum Deficiency - POTENTIAL IMPACT ON BRAIN DEVELOPMENT

Endocrine disrupting chemicals • (EDCs) endocrine disrupting chemicals, e. g. Alter endogenous hormonal regulation and alter weight homeostasis, which may lead to weight gain by increased volume of adipose tissue. Elobeid MA, Allison DB. Putative environmental-endocrine disruptors and obesity: A review. Curr Opin Endocrinol Diabetes Obes. 2008, 15(5): 403– 408

http: //dx. doi. org/10. 1016/S 2213 -8587(16)30107 -3 • Maternal obesity increases the risk of autism/cerebral palsy and other neurodevelopmental abnormalities in children – Through “epigenetic processes” like alterations in DNA Methylation… • Obesity in women – growing (20% obese by 2025) Lancet study

Effects of endocrine disruptors • Estrogenic, anti-estrogenic, anti-androgenic, anti-thyroid, anti-progestin • Excess of female births in a region after toxic chemical spill of TCDD (Italy) • Epigenetic heritable alterations!

• Mycotoxins, DDT, DDE, PCBs and phthalates have been associated DDT, DDE, PCBs and phthalates, drugs with estrogen activity (OCPs) have been associated with early puberty. Precocious puberty

Differential maturation Teenager’s brain • Brain areas, concerned with motivation and reward seeking, are myelinated and mature before the prefrontal cortex which performs the executive functions of restraint and selfcontrol. • This disparate of myelination can explain the impulsivity of adolescence (Casey et al. 2008).

Peer-group influence • birds of a feather do flock together • Family, schools constant – moving towards the peers most important change

• At least 20 % of young people will experience some form of mental illness (UNICEF). • Half of all lifetime cases of mental illness begin by age 15 and three-quarters by age 24.

Emotions • What are emotions? • Why are they required? • What is emotional intelligence?

Emotions Anxiety: Pupils –Dilate; tongue –dry; chocking in the throat; reeling sensation; confusion; tremors; restlessness; biting lips; palpitations; breathlessness; thirst; increased frequency of bowel and bladder; multiple aches and pains; goose bumps; you cannot perform sexually ……… There is no system in the body that is not affected!!!

EMOTIONS EFFECT THE ENTIRE BODY • William Beaumont: link between gut and mind - observed his patient’s gastro-cutaneous fistula in 16 th Century– “any emotional change was accompanied by a change in gastric secretions and motility”.

Psychiatry is the study of the supercomputer called “brain” Input (Sense organs) CPU (Brain - Processing ) Out put (Response)

Processing • Neurons : 1012 • Nerves: 1016 (Wires) • Messengers: Electricity, Neurotransmitters, Second messenger system • Circuits do matter!

Hippocampus Cerebral cortex Amygdala Association cortex Hypothalamus

Brain Plasticity Eric Richard Kandel -2000 – Noble prize Biology of learning and memory: APLYSIA CALIFORNEA – Sea Mollusk with “Visible Neuron” Repeatedly stimulate a neuron – Its synapses, branches, proteins increase “PSYCHOLOGICAL STIMULATION” CHANGES BRAIN STRUCTURE AND ITS WIRING

Psychology becomes biology MIND BECOMES MATTER • computer – “ 01”(Binary system) • Brain – Electricity, neurochemicals

Managing emotions • • • emotional intelligence (EQ) Being happy, making others happy SUCCESS in life Winning friends Leadership Low mental illness

Critical learning period • CRITICAL WINDOW: BIRTH TO 18 YEARS OF AGE – BRAIN IS MOST PLASTIC DURING THIS PERIOD – CAN BE MOULDED • PARENTING AND SCHOOLS; OTHER ENVIRONMENT…. • SECURITY, LOVE AND AFFECTION, ENCOURAGEMENT, SUPPORT, EDUCATION, NUTRITIONAL DIET, PHYSICAL EXCERCISES…. .

Addiction is a disease • The pleasure centre in the brain gets stimulated by an addicting drug almost 600 times than it gets stimulated with a biryani packet (WHO) • Alcohol and Nicotine • Other substances – Ecstacy, Nitrazepam, LSD….

Why we get angry? what happens? • Desire Could not achieve Mind becomes blank Frustration Anger loss of judgment (uncontrolled) violent behavior/impulsive behavior (homicides, loss of property, suicide, crime, verbal and physical aggression) expressing anger in a healthy, non-abusive and nonthreatening way.

Communication-critical • Mental illnesses are disorders of communication! • Communication: 1. Kinesic 2. Lexical 3. Somatic…. Important to put the other person at ease. Listening skills

Skill development • • Assertiveness (saying no) Handling stress Planning Motivation Positive cognitions Appreciation (Convincing skills) Accepting failure Self-esteem

Explain –Interpersonal skills • Poor communication is the cause of aggressive reactions • Give time • Vicarious learning • Interference to be handled (Cell phones, internet and TV) • Peer relationships • Love making, handling breakups • Behavioral change (steps)

Study skills Concepts Become capable, success runs behind you Time management Using multiple senses(Reading skills) Coping examination anxiety (Relaxation exercises) • Group work • • •

Conflict resolution skills (a) Focus on the problem and not the person (b) Talk to the person directly and not use other people to carry messages or interpret meanings (c) Listen (d) Use I-statements (e) Do not jump to conclusions (f) Take a timeout: when the conflict is elevated to a point of extreme anger and frustration, it is helpful to take a break and give a gap before resuming communication (g) Apologize if you have done something wrong or hurt someone (h) Work at resolution by arriving at a mid-point (i) Come up with ideas so that the same situation does not repeat itself. (j) Agree to disagree

• What does not work? (What does work? ) Yelling (Negotiation) • Refusing to change or compromise (Mediation) • Refusing to work out the conflict (Looking at both sides) • Name calling (A win–win attitude) • Hitting (Listening) • Walking out (Timeout) • Belittling (Relaxed attitude)

Tips of building healthy relationships • 1. Build trust in yourself and others: be reliable, responsible and dependable • 2. Always try and keep channels of communication open • 3. Communicate emotions and disagreements • 4. Follow through with promises made • 5. Use respectful words, avoid verbal abuse/belittling words • 6. Build effective boundaries by understanding your and the other’s values. State them clearly • 7. Spend time adequately with all different relationships such as friends, romantic friends, parents and siblings.

Happiness • Money gives comforts, but comforts may not give happiness…. . • From social centeredness to individualistic society – transition • 6 friends for happiness