8 - Adolescence and Puberty Flashcards
What is growth in puberty due to?
Is due to the GONADAL STEROIDS (particularly ANDROGENS) working in conjunction with other hormones, particularly SOMATOTROPHIN (Growth Hormone) from the adenohypophysis
How does the onset of puberty happen?
TWO THEORIES - ONSET OF PUBERTY
Maturation of the CNS affecting GnRH neurones (increased pulsatile release)
Altered set point to gonadal steroid negative feedback
What might trigger the maturation of the CNS?
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?)
How has the average age of menarche changed over time?
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.
What is the relationship between body weight and age of menarche?
Population studies suggest that body weight at menarche has remained relatively constant at approximately 47kg.
Summarise the role of Kisspeptin in puberty
What effect do the changes of puberty tend to have on boys?
For boys: the changes of puberty e.g. increased height, and musculature are welcomed, and are associated with increased status and athletic prowess.
What effect do the changes of puberty tend to have on girls?
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.
How can the opinion of puberty vary between cultures?
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.
What implications can body shape dissatisfaction have on behaviour?
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.
What are the cardinal features of anorexia nervosa?
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.
Outline the epidemiology of anorexia
Approx 0.5-1% adolescent females.
Approx 10% cases or less are male.
What are the causes of anorexia?
Genetic predisposition
Perfectionist temperament
Specific subcultures
Childhood abuse and adversities
Perhaps higher social class
What tends to be the outcomes of anorexia?
Community sample: 50% recover after 5 years
Clinic samples: after 1 year 37% recover; 25% weight gain but not menstruating; 37% underweight, symptoms.
How is anorexia treated?
Family intervention
For abnormal eating attitudes and depression: cognitive behavioural therapy.
Small % need admission for weight restoration
What symptom cluster can be defined as depression?
SYMPTOM CLUSTER
Affective – sadness, loss of enjoyment, irritability
Cognitive – self-blame, hopelessness, guilt
Biological – disturbed sleep, reduced appetite
May reach threshold for disorder
What developmental considerations are there in the context of depression in puberty?
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
Outline the epidemiology of depressive disorder
2-5% adolescents
What are the causes of depressive disorder?
Familial aggregation; genetic factors known
Effects of family interaction e.g. criticism
Life events, adversities
What is the prognosis of depressive disorder?
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)
What interventions can be used for depressive disorder?
Cognitive behavioural therapy
Interpersonal psychotherapy
Family intervention for associated family problems
Antidepressants – selective serotonin reuptake inhibitors e.g. fluoxetine for moderate – severe depression.
What is conduct disorder?
Persistent failure to control behaviour appropriately within socially defined rules.
Outline the clinical features of conduct disorder
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
What developmental considerations should be accounted for in conduct disorder?
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.
Outline the epidemiology of conduct disorder
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
What are the causes of conduct disorder?
- Genetic – weak
- Child – difficult temperament
* Family – poor parenting, discord, lack warmth, inconsistent discipline, coercive interaction, aggression - Wider environment
- poor schools
- neighbourhoods
What are the outcomes of conduct disorder?
Poorer outcome with more problems in child, and family
Risk of antisocial personality disorder in males
Range of emotional and personality disorders in females
What interventions can be used for conduct disorder?
For child – problem solving skills.
Parent training
Family intervention
Address problems across contexts e.g. in school
