8 - Adolescence and Puberty

Question 1

What is growth in puberty due to?

Answer 1

Is due to the GONADAL STEROIDS (particularly ANDROGENS) working in conjunction with other hormones, particularly SOMATOTROPHIN (Growth Hormone) from the adenohypophysis

Question 2

How does the onset of puberty happen?

Answer 2

TWO THEORIES - ONSET OF PUBERTY

Maturation of the CNS affecting GnRH neurones (increased pulsatile release)

Altered set point to gonadal steroid negative feedback

Question 3

What might trigger the maturation of the CNS?

Answer 3

ANSWER IS UNCLEAR

However there is evidence of a secular trend towards earlier puberty which suggests environmental factors :

• improved health care
• improved socio-economic factors (photoperiod? nutrition?)

Question 4

How has the average age of menarche changed over time?

Answer 4

Evidence that age at menarche has decreased over the last 150 years.

Over the last 3-4 decades it seems to have levelled off – or it could even be increasing again.

Question 5

What is the relationship between body weight and age of menarche?

Answer 5

Population studies suggest that body weight at menarche has remained relatively constant at approximately 47kg.

Question 6

Summarise the role of Kisspeptin in puberty

Answer 6

Question 7

What effect do the changes of puberty tend to have on boys?

Answer 7

For boys: the changes of puberty e.g. increased height, and musculature are welcomed, and are associated with increased status and athletic prowess.

Question 8

What effect do the changes of puberty tend to have on girls?

Answer 8

For girls: the changes of puberty e.g. increased adiposity are may be associated with ambivalent feelings, in view of the negative attitudes to plumpness, and ambivalent feelings about onset menarche.

Question 9

How can the opinion of puberty vary between cultures?

Answer 9

Cultural variation:

White English girls are more negative about body shape and weight than African Caribbean girls.

Negative attitudes increase as weight and body mass index increase.

Question 10

What implications can body shape dissatisfaction have on behaviour?

Answer 10

Body shape dissatisfaction increases the urge to reduce weight.

This may be brought about by dieting or other weight controlling methods.

Reduced weight may induce dysphoria ( unhappiness) and repeated attempts to control weight.

It also significantly increases the risk of an eating disorder including anorexia nervosa.

Question 11

What are the cardinal features of anorexia nervosa?

Answer 11

Body weight maintained 15% below expected wight, or BMI < 17.5.

Weight loss is self-induced

Psychopathology – dread of fatness, and preoccupation with this.

Endocrine disturbance: amenorrhoea, or delayed growth and puberty in younger sufferers.

Question 12

Outline the epidemiology of anorexia

Answer 12

Approx 0.5-1% adolescent females.

Approx 10% cases or less are male.

Question 13

What are the causes of anorexia?

Answer 13

Genetic predisposition

Perfectionist temperament

Specific subcultures

Childhood abuse and adversities

Perhaps higher social class

Question 14

What tends to be the outcomes of anorexia?

Answer 14

Community sample: 50% recover after 5 years

Clinic samples: after 1 year 37% recover; 25% weight gain but not menstruating; 37% underweight, symptoms.

Question 15

How is anorexia treated?

Answer 15

Family intervention

For abnormal eating attitudes and depression: cognitive behavioural therapy.

Small % need admission for weight restoration

Question 16

What symptom cluster can be defined as depression?

Answer 16

SYMPTOM CLUSTER

Affective – sadness, loss of enjoyment, irritability

Cognitive – self-blame, hopelessness, guilt

Biological – disturbed sleep, reduced appetite

May reach threshold for disorder

Question 17

What developmental considerations are there in the context of depression in puberty?

Answer 17

Endocrine change – especially female may increase risk low mood

Changes in family relationships –physical closeness, joint activities, family conflict

Peers – increased involvement with peers; peer rejection and conflict

Responsibilities and hassles: life events, exams, etc

Question 18

Outline the epidemiology of depressive disorder

Answer 18

2-5% adolescents

Question 19

What are the causes of depressive disorder?

Answer 19

Familial aggregation; genetic factors known

Effects of family interaction e.g. criticism

Life events, adversities

Question 20

What is the prognosis of depressive disorder?

Answer 20

Major depression: Duration

In specialist CAMHS settings: 6-9 months

Primary care: 2-3 months

High risk recurrence

Prepubertal onset – better prognosis

Small number in adolescence – bipolar (mania, hypomania)

Question 21

What interventions can be used for depressive disorder?

Answer 21

Cognitive behavioural therapy

Interpersonal psychotherapy

Family intervention for associated family problems

Antidepressants – selective serotonin reuptake inhibitors e.g. fluoxetine for moderate – severe depression.

Question 22

What is conduct disorder?

Answer 22

Persistent failure to control behaviour appropriately within socially defined rules.

Question 23

Outline the clinical features of conduct disorder

Answer 23

Child

• looses temper and argues
• defies adult requests or rules
• bullies, fights or intimidates,
• stealing, breaking into cars or houses, destroys property
• running away, truanting

Question 24

What developmental considerations should be accounted for in conduct disorder?

Answer 24

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.

Question 25

Outline the epidemiology of conduct disorder

Answer 25

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

Question 26

What are the causes of conduct disorder?

Answer 26

1. Genetic – weak
2. Child – difficult temperament
   * Family – poor parenting, discord, lack warmth, inconsistent discipline, coercive interaction, aggression
3. Wider environment

• poor schools
• neighbourhoods

Question 27

What are the outcomes of conduct disorder?

Answer 27

Poorer outcome with more problems in child, and family

Risk of antisocial personality disorder in males

Range of emotional and personality disorders in females

Question 28

What interventions can be used for conduct disorder?

Answer 28

For child – problem solving skills.

Parent training

Family intervention

Address problems across contexts e.g. in school