5. Adolescence Flashcards
What is adolescence?
Phase between childhood and adulthood (10-19)
Why is the ending of adolescence not clear?
- UN defines that children <18
- However, some girls can end puberty at age 13 - so physiologically an adult
- Can also be pre-pubertal at 13
What changes occur in adolescence?
- Cognitive/emotional changes
- Family - challenging rules, less confiding
- Endocrine and physical changes
- Social chaanges - peer activities and influences
When is the average age of marriage and childbirth?
- Marriage - 30
- Childbirth - 34
(used to be 18 and 19 in mid 1900s)
What is adrenarche and what does it involve?
Stimulation of adrenal glands to produce certain hormones - precursor of puberty
- Females: 6-9 years
- Males: 7-10 years
• Rise in adrenal 19-carbon steroid production, DHEA and DHEAS
How does adrenarche manifest clinically?
Appearance of axillary and pubic hair
How do the hypothalamic hormones differ in adrenarche and puberty?
- Puberty - GnRH
* Adrenarche - CRH
How is body fat related to GnRH?
Leptin can stimulate the hypothalamus to release GnRH
this is why anorexic girls don’t have periods
What are the 5 stages of puberty?
1) Before puberty
2) Axillary hair growth
3) Pubic hair growth
4) Breast, penis and gonadal growth
5) After puberty
Why has the age of puberty decreased over the last 100 years?
Improvements in diet
How does cortical thickness change with age?
- Massive changes between 7 and 13 - some areas grow whilst others shrink
- Cortical thickness peaks at age 9 - due to synaptic pruning (redundant parts are removed)
What influences risk taking in adolescence?
- Developmental mismatch
- Dopaminergic activity outweights regulatory cognitive control
- However, dopaminergic activity decreases around 18
What is anorexia nervosa?
• Deliberate weight loss
• Most common in adolescent girls and young women
• Dread of putting on weight
• Patients impose a low weight threshold
• In pre-pubertal patients:
- Girls: breasts don’t develop, delayed period onset
- Boys: gentials remain juveline
What can cause anorexia nervosa?
- Psychological e.g. perfectionism
- Social e.g. cultural variations
- Biological e.g. hormonal changes
- External e.g. life events
What are the symptoms of anorexia nervosa?
- Restricted dietary choice
- Excessive exercise
- Induced vomiting and purgation
- Use of appetite suppressants and diuretics
Why psychiatric disorder has the highest mortality rate?
Anorexia nervosa
How can anorexia nervosa be treated?
- Psychological - family therapy and CBT
* Physical - admissions, NG tube
Why can depression occur in children under the age of 5?
Separated from attachment figure
Is there a familial link with depression?
Moderate heritability
How long does major depression last?
6-9 months
Does pre-pubertal depression have a better prognosis?
Yes
What is conduct disorder?
• Child equivalent of anti-social personality disorder - defiance against authority - aggressiveness - antisocial behaviours • Impairment in every day functioning • Impacts the child's life
Where is conduct disorder more common?
- Deprived inner-city areas
- Male children
- Associated with lower socio-economical status and large family size
What are the causes of conduct disorders?
- Genes (not strong)
- Parental psychiatric disorder
- Parental criminality
- Sexual abuse
- School factors
- Wider social influences
How can conduct disorders be treated?
- Child focused - behaviour modification etc.
- Family focused (biggest impact)
- Pharmacological - antidepressants, stimulants, melatonin (for sleep), antipsychotics
