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Yellowbrick Blog

Psychiatric Hospitalization & Safety: Inpatient, or In the Patient?

David Baron, MD

A recent article in the LA Times “How to Reduce Suicides on the Psychiatric Ward” offered a perspective on how to “keep patients on inpatient units safe.”  This blog, and alternative perspective, is derived from 30 years as a practicing psychiatrist and currently Medical Director of Yellowbrick, a national psychiatric treatment center for adolescents and emerging adults in Evanston, Illinois.

The subject of suicide is complicated, so I will address three points:

  1. Reported numbers of suicide attempts and suicides that take place on inpatient psychiatric units are likely an underestimate
  2. While much can be done to reduce inpatient suicides, there is also compelling reason to sadly conclude they cannot be entirely prevented
  3. This is because popular, and to a large extent professional, beliefs about where safety originates, are both skewed and incorrect.

In the Joint Commission article quoted by the LA Times, from November 2018, 48.5 to 64.9 suicides on inpatient units annually in the US between 2014 and 2015 were estimated.  A prior study about five years ago estimated 1850 per year. Clearly these cannot both be correct, especially with a known increase in suicides over the last decade. Reporting of suicide by hospitals is voluntary; there is no agency with authority to require this information. Continue reading Psychiatric Hospitalization & Safety: Inpatient, or In the Patient?

The Brain On Porn

An article published 12/29/2019 in Neuroscience News highlights the concerns generated by the prevalence of pornography viewing. According to statistics published by the major site, PornHub, over 33.5 billion site visits occurred during 2018 alone. Pornhub reports 70% of users are men and 70% of U.S. adults ages 18-30 visit a porn site at least once a week. Given that this is also the window of brain maturation into adulthood, research has focused on what if any brain changes are associated with porn use. A 2014 JAMA article by Kuhn and Gallinat was among the first to sound the alarm regarding maladaptive changes in those areas of the brain regulating sexual arousal, reward seeking, novelty seeking and compulsive behavior patterns.

Continue reading The Brain On Porn

U.S. Surgeon General’s Advisory: Marijuana Use and the Developing Brain

U.S. Department of Health & Human Service
Office of the Surgeon General
Content last reviewed on August 29, 2019

I, Surgeon General VADM Jerome Adams, am emphasizing the importance of protecting our Nation from the health risks of marijuana use in adolescence and during pregnancy. Recent increases in access to marijuana and in its potency, along with misperceptions of safety of marijuana endanger our most precious resource, our nation’s youth.

KNOW THE RISKS. TAKE ACTION. PROTECT OUR FUTURE.

Background

Marijuana, or cannabis, is the most commonly used illicit drug in the United States. It acts by binding to cannabinoid receptors in the brain to produce a variety of effects, including euphoria, intoxication, and memory and motor impairments. These same cannabinoid receptors are also critical for brain development. They are part of the endocannabinoid system, which impacts the formation of brain circuits important for decision making, mood and responding to stress1.

Marijuana and its related products are widely available in multiple forms. These products can be eaten, drunk, smoked, and vaped2. Marijuana contains varying levels of delta-9-tetrahydrocannabinol (THC), the component responsible for euphoria and intoxication, and cannabidiol (CBD). While CBD is not intoxicating and does not lead to addiction, its long-term effects are largely unknown, and most CBD products are untested and of uncertain purity3.

Marijuana has changed over time. The marijuana available today is much stronger than previous versions. The THC concentration in commonly cultivated marijuana plants has increased three-fold between 1995 and 2014 (4% and 12% respectively)4. Marijuana available in dispensaries in some states has average concentrations of THC between 17.7% and 23.2%5. Concentrated products, commonly known as dabs or waxes, are far more widely available to recreational users today and may contain between 23.7% and 75.9% THC6.

Continue reading U.S. Surgeon General’s Advisory: Marijuana Use and the Developing Brain

Suicide Deaths Are a Major Component of the Opioid Crisis that Must Be Addressed

By on

September is National Suicide Prevention Awareness Month. In observance, our two institutes, the National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH), are taking this opportunity to highlight a dimension of the opioid crisis that receives too little attention—the links between opioid use, opioid use disorder (OUD), and suicide.

We’ve heard a lot about the opioid epidemic, and the rising toll it is taking on our communities. In 2017, 47,600 people died from overdoses involving prescription or illicit opioids. But the opioid overdose epidemic is not limited to people with opioid addiction who accidentally take too much of a pain reliever or unknowingly inject a tainted heroin product. Concealed in the alarming number of overdose deaths is a significant number of people who have decided to take their own life.

It can be challenging to discover the true relationship between suicide and drug use. In the absence of a suicide note, it is difficult to assess the intentions of an individual who has died of an overdose, other than circumstantially. Also, the intentions of someone with OUD who overdoses may not always be clear-cut. In a study last year of current and past overdose experiences among patients seeking treatment in a Flint, Michigan emergency department, 39% of those whose worst overdose had involved an opioid or sedative reported wanting to die or not caring about the risks; another 15% reported they were unsure of their intentions.

Continue reading Suicide Deaths Are a Major Component of the Opioid Crisis that Must Be Addressed

Going off to and at College: Parents and Emerging Adults in Transition

going off to collegeJennifer Dunitz-Geiringer, JD, MSW
Education and Career Specialist
Yellowbrick

It is the best of times and it is the worst of times – as parents and emerging adults approach the weeks leading up to post-secondary educational “launches,” the hallmark of these relationships is uncertainty and unpredictability. Just as every person is unique, so too is every parent/child relationship. Therefore, it is important to honor not only the needs of each individual involved in the transition, it is equally important to honor the nature of the relationship itself and to set expectations about that relationship going forward that are realistic and mutually agreed upon.

Continue reading Going off to and at College: Parents and Emerging Adults in Transition

Survey Reveals Factors Behind Millennial Burnout

Now that millennials are well into adulthood, the topic of “burnout” – a sense of chronic physical and mental exhaustion – has been surfacing in the news. Recently, the World Health Organization classified burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

We were curious to dig deeper into the millennial burnout phenomenon, so we surveyed more than 2,000 millennials between the ages of 23 and 38 to ask them how burnout affects them in the workplace as well as in their everyday life. Respondents also told us the top factors they believe lead to burnout and how they cope with the symptoms.

Continue reading Survey Reveals Factors Behind Millennial Burnout

THE ADOLESCENT BRAIN, OR… “WHAT WAS SHE THINKING!?”

Adolescent Brain

By David H. Baron, MD, Medical Director, Yellowbrick
This article appears in Evanston Womens Magazine

Kaitlyn was an “A” student. A very well-behaved child through kindergarten, grade school and most of middle school. She played soccer, had friends, was loving and lovable with her family, teachers and social circle. Always had a flair for the dramatic and started getting parts in school plays in 5th grade.

Until age 14.

Freshman year of high school, a lot changed. New social setting, new school, new teachers who didn’t know her. She had a growth spurt that made her suddenly tall and lanky, a little physically awkward: a target for bullying.

Kaitlyn isolated herself. She stopped making new friends, generally got a lot quieter. Her time and whereabouts became more mysterious. “Where were you all afternoon,” her Mom would ask.

“Hangin’.”

“Hangin’ where, with whom?”

“Friends.”

“Which friends?”

“You wouldn’t know them, stop interrogating me!” (she storms out and slams the door)

Then one weekend, Kaitlyn, the lovable, rule-following “A” student, got stopped by the police for speeding. In her friend’s father’s Porsche. Without a license. At 90 miles an hour.

No drugs, no serious mental illness (though professional help may well be needed). Kaitlyn was suffering from a temporary but potentially severe neurological disruption, known as having a teenager’s brain.

Why do teens sometimes make terrible judgments? Why does a seemingly gifted young person, with a stellar academic record, behave…well…, so stupidly at times? As any parent of a teen knows, sometimes their obliviousness to risk is stupendous. Kaitlyn’s story makes for a great Lifetime movie—when it’s not about your kid.

There’s a reason for all this: the process of teenage brain development. Adolescent brains are neurochemical battle zones. While hormones rage, wreaking havoc on a teen’s body shape and size, sex drive, skin, voice, and as a result, her relationship to herself, the brakes for the impulsive momentum this creates haven’t fully developed into adult form. That seat of judgment, the “pause button” for acting without thinking, is in the frontal lobe (technically the left dorsolateral prefrontal cortex). On average that part of the brain isn’t fully developed in teens. It won’t be until well into their 20’s.

Stanford neuroscientist Dr. Robert M. Sapolsky explains:

“…adolescence [is the time] when someone is most likely to kill, be killed, leave home forever, invent an art form, help overthrow a dictator, ethnically cleanse a village, devote themselves to the needy, become addicted, marry outside their group, transform physics, have hideous fashion taste, break their neck recreationally, commit their life to God, mug an old lady, or be convinced that all of history has converged to make this moment the most consequential… In other words, it’s the time…of maximal risk taking, novelty seeking…. All because of that immature frontal cortex.”1

So, the next time your teen behaves in a way that makes you feel crazy, whatever else you do to help, remember that in a few years their frontal lobe will be more mature, and hopefully, so will they.

1Sapolsky, Robert M. (2017) Behave: The Biology of Humans at Our Best and Worst. New York, NY: Penguin Press, page 155.

Fitting In

What does it mean to fit in? We spend all of high school obsessing over it (or pretending not to obsess over it), all in the name of trying to find a community we belong to. But it also goes far beyond high school and affects us way into adulthood. So much of our lives are consumed with just trying to find a place where we feel like we’re comfortable, happy, and safe—and this sense of community looks different to everyone.

We wanted to take a closer look at what it means to fit in and how we feel when we find a community to engage with, which is why we surveyed 2,000 people to better understand how a sense of community affects us from high school through adulthood. Here’s what our survey had to say.

Fitting In 1

Continue reading Fitting In

Tech and Mental Health

Mental health is an important part of a balanced wellness plan. Although seeking out care for mental health has been taboo in the past, this attitude is changing—especially as technology is playing a larger role in how we get support for our mental and physical wellness, particularly with phone and tablet applications.

Let’s take a look at some of the most popular mental health applications over time, and what these apps have to offer to help us improve our mental health. Continue reading Tech and Mental Health

Pressure & Youth Sports Study

Youth sports can offer a wide variety of positive benefits, such as team-building, personal commitment, friendly competition, and exercise. However, youth sports can make some children feel overwhelmed, under pressure, and like a failure for what is supposed to be a fun, important learning experience. We surveyed 1,000 Americans to get a sense of how rampant the pressure to succeed is within youth sports, as well as see what kind of effect it has had on people throughout their lives.

Continue reading Pressure & Youth Sports Study