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Year 2 LCRS RDA > 6: Adolescence > Flashcards

6: Adolescence Flashcards

1
Q

What is adolescence?

When is it?

A

phase between childhood & adulthood

  • Start: may be begining of puberty
  • end: artificially (curtural dependant) about 18 (new definition: 10-25)
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2
Q

What is Adrenarche?

When and why does it start?

A

Precursor of Puberty (role is still uncertain)

  • Starts
    • Females: 6-9 years
    • Males: 7-10 years
  • Rise in adrenal 19- carbon steroid production, dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS).
  • Manifests clinically as the appearance of axillary and pubic hair, usually about age 8.
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3
Q

What are the main physical changes in adolescence in females?

A
  • growth of pubic hair
  • growth spurt
  • menarche (first period)
  • development of breastsa
  • change in body shape
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4
Q

What are the main physical changes in adolescence in males?

A
  • growth of pubic and underarm hair
  • development of testicles and penis
  • beard growth
  • growth spurt
  • Change in body shape
  • change in voice
    *
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5
Q

What is the normal onset of adolescence in boys and girls

A

often = begin of puberty (but might be 10-25)

  • Begining
    • Girls: 8-13
    • Boys 10-13 1/2
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6
Q

Explain how and why there was a change in onset of puberty in boys and girls

A

It decreased

  • main factor thought to be: nutrition
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7
Q

What are the main endocrine changes associated with puberty?

A
  1. Adrenarche
    1. production of sex steroids in adrenals driven by ACTH production
  2. Pruberty
    1. sex steroid production in gonads driven by GnRH secretion
      1. increase in estrogen
      2. increase in androgens
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8
Q

Explain growth patterns in girls and boys in puberty

A

Normally: Girls have growth spurt earlyer at begining of puberty

Boys have growth spurt later in puberty

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9
Q

What are the main psychological changes in puberty?

A

Cognition e.g. morality
Identity
Increased self-awareness
Affect expression and regulation

And also

  • social changes
    *
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10
Q

What are the normal social changes puberty?

A

Decrease of family and increase in importance of peer group (+wider social peer group)

  • Peers have a higher influence which can also go wrong if teenagers experience rejection
  • Teenagers also develop social role, occupatione etc.
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11
Q

Explain the development mismatch hypothesis (in puberty)

A
  • There is a constant development cognitice regulation and control
  • But a fast development of dopaminergic activity and sensation seeking

–> Leads to risky behaviour due to miscalculation of risk

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12
Q

Explain the biological changes in the brain of teenagers

A
  1. Thickening of Cortex
  2. Thinning of cortex
    1. –> transformaiton of grey to white matter with use of neurons
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13
Q

What are the main features of Anorexia Nervosa?

A
  1. Restriction of energy intake –> significantly low body weight in the context of age, sex, developmental trajectory and physical health
  2. Fear of gaining weight or becoming fat
    • does not have to be vocalised (behaviour is enough)
  3. Lack of recognition of low body weight and disturbane in shape/weight perception
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14
Q

Explain the Etiology of Anorexia Nervosa

A

Many factors are involved!

  • Genetics and prenatal factors (e.g. hormones) influence trait and cognigitve style. Expecially endangered if
    • obsessionality
    • perfectionalist
    • deficits in social cognition
    • inflexibility
  • Leading to dieting behaviour, weight loss, starvation, and an increase in anxiety and depression
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15
Q

Explain the outcome and treatment for anorexia nervosa

A
  • 80% recover after 5 years
  • 20% chronic type
  • High mortality rate: 5-10% of which 1 in 5 is suicide
  • Treatment
    • Family intervention
    • For abnormal eating attitudes and depression: cognitive behavioural therapy.
    • Small % need admission for weight restoration
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16
Q

Summarise the range of mood dirsorders in adolescence

A
  1. Depression
    1. Low mood/sadness
    2. Loss of enjoyment (anhedonia)
    3. Loss of energy
      1. Seen in
        * changes to appetite, sleep, concentration, libido, self esteem etc.
  2. Many Subtypes
    1. repressive episode (only once) vs recurrent depression
    2. bipolar depression
    3. Psychotic depression, Atypical depression, Seasonal affective disorder (SAD), Inflammatory subtype
17
Q

What are the associated problems with depression in adolescence?

A
  • Increased risk of self-harm
  • Association with anxiety disorders; eating disorders [females];conduct problems; substance misuse
  • Familial aggregation (genetic and learning)
18
Q

What are the two types of pre-pubertal depression?

A
  1. No recurrent risk in adult life
    • common to present with co-morbit behavioural problems
    • no familar connection
  2. Risk of Recurrence in adult life
    • less common
    • highly familiar pattern
    • high rates of anxiety and bipolar disorders
19
Q

What is adolescent depressive disorder?

A
  • Irritability instead of sadness/low mood Especially in boys
  • Somatic complaints and social withdrawal are common
  • Psychotic symptoms rare before mid-adolescence
20
Q

What are the different types of adolescent depressive disorder?

A

Defined by time-frame

  • short term
    • High rates of persistence and recurrence (20% in 1 yr)
  • long term
    • Significant continuity to adolescence and adulthood (40-70%)
      • Impairment relationships/education in adulthood
21
Q

What is the aetiology of depressions in adulthood?

A
22
Q

Summarise the treatment plan for depression

A
  • Mild depression
    • Cognitive behavioural therapy [Individual or group]
    • Interpersonal psychotherapy for adolescents
    • Brief Psychosocial Intervention
  • Moderate-Severe Depression
    • Antidepressants e.g. SSRI’s: fluoxetine • Could be SSRI + CBT
    • Combined treatment–> highest rate of symptomatic remission in 37% combined vs 20% fluoxetine alone (March et al., 2004)
23
Q

What are possible causes for depression?

A
  • Familial aggregation; genetic factors known
  • Effects of family interaction e.g. criticism
  • Life events, adversities
    • physical closeness
    • peers, rejection, bullying
    • exams
  • Endocrine disorders
24
Q

What are other terms for conduct disorders?

A

Persistent failure to control behaviour appropriately within socially defined rules.

  • antisocial behaviour
  • offending
25
Q

Name some examples of signs of conduct disorders

A
  • Oppositional behaviour, defiance
  • Tantrums
  • Excessive levels of fighting or bullying, assault Running away from home
  • Truancy
  • Cruelty to animals
  • Stealing
  • Destructiveness to property
  • Fire-setting
26
Q

What are the developmental factors that have to be taken into consideration in a child with conduct disorders?

A
  • Changes in family relationships – less direct surveillance, physical closeness, joint activities
  • Peers – increased involvement with peers; may amplify antisocial behavior
  • Experimentation and risk taking – rule violation, drugs & alcohol, petty offending frequent.
27
Q

Summarise the epidemiology of conduct disorders

A
  • 4% at ages 5-10 years; 6% at ages 10-15 years; overall 5% at ages 5-15 years.
  • Higher in deprived inner-city areas
  • Boys: girls 3:1
  • Age of onset may vary

Associated with

  • Larger family size
  • lower socio-economic status
28
Q

Summarise the possible cuases for conduct disorders

A
  • Genetic – weak
  • Child – difficult temperament
  • Environment:
    • Family
      • poor parenting, discord, lack warmth, inconsistent discipline, coercive interaction, aggression
    • Wider environment
      • poor schools
      • neighbourhoods
29
Q

What are the outcomes of Conduct disorders?

A
  • poorer outcome with more problems in child, and family
  • Risk of antisocial personality disorder in males
  • Range of emotional and personality disorders in females
30
Q

How can someonw interve in a child/ teenager with conduct disorder?

A
  • For child – problem solving skills.
  • Parent training
  • Family intervention
  • Address problems across contexts e.g. in school

Year 2 LCRS RDA (11 decks)

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