5. Adolescence

Question 1

What is adolescence?

Answer 1

Phase between childhood and adulthood (10-19)

Question 2

Why is the ending of adolescence not clear?

Answer 2

• 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

Question 3

What changes occur in adolescence?

Answer 3

• Cognitive/emotional changes
• Family - challenging rules, less confiding
• Endocrine and physical changes
• Social chaanges - peer activities and influences

Question 4

When is the average age of marriage and childbirth?

Answer 4

• Marriage - 30
• Childbirth - 34

(used to be 18 and 19 in mid 1900s)

Question 5

What is adrenarche and what does it involve?

Answer 5

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

Question 6

How does adrenarche manifest clinically?

Answer 6

Appearance of axillary and pubic hair

Question 7

How do the hypothalamic hormones differ in adrenarche and puberty?

Answer 7

• Puberty - GnRH

* Adrenarche - CRH

Question 8

How is body fat related to GnRH?

Answer 8

Leptin can stimulate the hypothalamus to release GnRH

this is why anorexic girls don’t have periods

Question 9

What are the 5 stages of puberty?

Answer 9

1) Before puberty
2) Axillary hair growth
3) Pubic hair growth
4) Breast, penis and gonadal growth
5) After puberty

Question 10

Why has the age of puberty decreased over the last 100 years?

Answer 10

Improvements in diet

Question 11

How does cortical thickness change with age?

Answer 11

• 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)

Question 12

What influences risk taking in adolescence?

Answer 12

• Developmental mismatch
• Dopaminergic activity outweights regulatory cognitive control
• However, dopaminergic activity decreases around 18

Question 13

What is anorexia nervosa?

Answer 13

• 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

Question 14

What can cause anorexia nervosa?

Answer 14

• Psychological e.g. perfectionism
• Social e.g. cultural variations
• Biological e.g. hormonal changes
• External e.g. life events

Question 15

What are the symptoms of anorexia nervosa?

Answer 15

• Restricted dietary choice
• Excessive exercise
• Induced vomiting and purgation
• Use of appetite suppressants and diuretics

Question 16

Why psychiatric disorder has the highest mortality rate?

Answer 16

Anorexia nervosa

Question 17

How can anorexia nervosa be treated?

Answer 17

• Psychological - family therapy and CBT

* Physical - admissions, NG tube

Question 18

Why can depression occur in children under the age of 5?

Answer 18

Separated from attachment figure

Question 19

Is there a familial link with depression?

Answer 19

Moderate heritability

Question 20

How long does major depression last?

Answer 20

6-9 months

Question 21

Does pre-pubertal depression have a better prognosis?

Answer 21

Yes

Question 22

What is conduct disorder?

Answer 22

• Child equivalent of anti-social personality disorder
- defiance against authority
- aggressiveness
- antisocial behaviours
• Impairment in every day functioning
• Impacts the child's life

Question 23

Where is conduct disorder more common?

Answer 23

• Deprived inner-city areas
• Male children
• Associated with lower socio-economical status and large family size

Question 24

What are the causes of conduct disorders?

Answer 24

• Genes (not strong)
• Parental psychiatric disorder
• Parental criminality
• Sexual abuse
• School factors
• Wider social influences

Question 25

How can conduct disorders be treated?

Answer 25

• Child focused - behaviour modification etc.
• Family focused (biggest impact)
• Pharmacological - antidepressants, stimulants, melatonin (for sleep), antipsychotics