Adolescence Flashcards
What is adolescence?
The stage of life between childhood and adulthood, when pubertal development begins (10-20yrs/10-25yrs)
List some cognitive/emotional changes which occur with adolescence
Emotional changes (mood swings) Reasoning becomes more abstract (e.g. thinking about morality) Greater self awareness Greater awareness of the world Development of identity Expression and regulation are affected
What is the precursor of puberty?
Adrenarche
What is adrenarche?
The development of axillary and pubic hair, oily skin, body odour and acne (essentially pre-puberty)
When does adrenarche happen in females and males?
Females: 6-9years
Males: 7-10years
A rise in which hormones causes adrenarche?
Adrenal 19-carbon steroid
DHEA (dehydroepiandrosterone)
DHEAS (dehydroepiandrosterone sulphate)
Summarise the role of the HPA on puberty
Hypothalamus produces GnRH
GnRH acts on pituitary
LH and FSH are produced
These act on the gonads.
What is the consequence of LH and FSH acting on the gonads in males and females?
MALES: Development of: Penis Pubic hair Testes Sperm production
FEMALES: Development of: Breasts Ovaries Uterus Egg production Menarche
What is the average age for a girl and a boy to hit puberty?
Girl - 12 years
Boy - 15 years
Describe the Tanner’s 5 stages of puberty in girls
Breast budding (8-13) Growth of pubic hair (8-14) Growth spurt (9.5-14.5) First period (10-16) Growth of underarm hair (10.5-16.5) Change in body shape (11-4.5) Breasts become adult sized (12.5-16.5)
Note: you can be pre-pubertal at aged 13 or fully pubertal at aged 13 - the normal range varies
Describe the pubertal changes as boys grow
Growth of scrotum and testes Change in voice Lengthening of penis Growth of pubic hair Growth spurt Change in body shape Growth of facial and underarm hair
What are the psychological changes linked to puberty?
Cognition e.g. morality
Identity (incl. gender identity)
Increased self-awareness
Affect expression and regulation (emotional regulation)
What are the familial social changes that occur with puberty?
Family - parental surveillance, confiding
Role of the parent changes during puberty
What are the social changes that occur with puberty amongst peers?
Peers become more important
More complex and hierarchical relationships form
Young people become more sensitive to acceptance and rejection
Romantic relationships
What social roles do post-pubertal teenagers start thinking about?
Education
Occupation
What other things can influence or affect teenagers?
School Work/unemployment Cultures e.g. social media, teen subculture, migration Housing/neighbourhood Poverty/affluence
What is the official name for the hypothesis where ‘growing teenagers’ actually behave in self-destructive ways?
Developmental mismatch hypothesis
What is the developmental mismatch hypothesis?
As grey matter changes to white matter, mismatch between cognitive control and integration of affect means that risk perception is poor, leading to risk behaviours.
List some high risk behaviours
Unprotected sex Delinquency (minor crime) Violence Self-harm Lack of hygiene
What is the ICD-10 criteria for anorexia nervosa?
Body weight at least 15% below expected weight (but no number given)
What is anorexia nervosa?
Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health)
What is associated with anorexia nervosa?
Endocrine disturbance
What are the four ‘p’s in psychiatric conditions?
Predisposing
Precipitation
Perpetuating
Protective
What factors should we consider when thinking about why a condition has come on?
Systematic
Familial
Individual
or biological, psychological and social
Give some examples of predisposing factors
Poor self image Bullying/teasing in childhood Culture/western society Childhood neglect Parents/role models with ED Obese parents Family pressure High-stress environment High achieving Genetics Obesity
List some precipitating factors
Bullying End of relationships/relationship changes Weight gain in puberty/sudden weight gain Adverse life events e.g. bereavement Change in diet Separation from parents Friends losing weight Social media comments Friends with MH disorders Comments from family members
Give some examples of perpetuating factors
Isolation Social media Feeling of control Bullying Lack of support Positive reinforcement Family/social circles Sporting success Admiration from friends Body dysmorphia
What are the traits or cognitive style of someone with AN?
Obessionality
Perfectionism
Deficits in social cognition
Inflexibility
Describe the cycle of AN
Diet
Weight loss (pt could recover at this stage)
Starvation-induced changes (could become chronic illness)
Increased anxiety, depression, obsessionality
(back to diet)
What happens at puberty which could precipitate AN?
Development of the brain
Hormonal changes
Stressful life events
Receptiveness to cultural values
Give some predictors of developing eating disorders
Earlier pubertal maturation Higher body fat Concurrent psychological problem Poor self image Specific cognitive phenotypes
What psychological changes are associated with AN and what else is this associated with?
Executive function deficits (also associated with ASD):
Weak central coherence i.e. global processing difficulties
Impaired set shifting
How would you assess someone with AN?
Family interview
Individual interview with child/adolescent
Physical examination
Gather data on growth
Further physical examination and investigations
What are the physical differential diagnoses for AN?
GI disorders e.g. Crohn’s
Metabolic disorders e.g. diabetes
Pituitary problems
What are the psychiatric differential diagnoses for AN?
Other eating disorders
Depression
Psychosis
OCD
What is conduct disorder?
Repetitive and persistent pattern of breaking the law/being anti-social for over 6 months - the frequency and severity is beyond age appropriate norms.
Give examples of behaviours in conduct disorder
Oppositional behaviour, defiance Tantrums Excessive levels of fighting or bullying, assault Running away from home Truancy (skipping school) Cruelty to animals Stealing Destructiveness to property Fire-setting
List the types of CD
CD confined to family context Unsocialised CD Socialised CD Oppositional CD Depressive CD Hyperkinetic CD
Compare the epidemiology of CD vs anti-social behaviour
Conduct disorder - commonest psychiatric disorder of childhood
Increases with age
Anti-social disorder - adolescent limited
Persistent throughout life
In which communities is CD more common?
Urban > rural
List some environmental, familial and child factors which could contribute to CD
Enviro - inner city
Family - inadequate parenting
Child - ADHD
List interventions for CD
Multi-system therapy: Home: -Manage underlying hyperactivity -Parenting programme School/life: -Cognitive problem-solving skills training -School interventions
Note: intervention should be targeted at major modifiable risk factors and should begin at an early age
What is CD a predictor of?
Antisocial disorder in adulthood Alcoholism Drug dependence Unemployment Relationship difficulties
What is depression?
Low mood, loss of enjoyment and loss of energy lasting for more than 2 weeks
List some other changes seen in depression
Appetite / weight gain or loss Sleep disturbance Loss of concentration Pessimistic, guilt ridden thoughts Low self esteem Low confidence Psychomotor agitation Loss of libido Self harm Suicide
Describe the presentation and course of the first type of pre-pubertal depression
Presentation is with comorbid behavioural problems, resembles children with CD
What is the first type of pre-pubertal depression associated with?
Parental criminality
Parental substance abuse
Family discord
What is the second type of pre-pubertal depression associated with?
High rates of anxiety
High rates of bipolar
Recurrence of depression in adolescence and adulthood
What is the aetiology of the second type of pre-pubertal depression?
Highly familial
What is the prognosis of the first type of PP-depression?
No increased risk of occurrence in adult life
What is adolescent depressive disorder and which group of people is this more common in?
Irritability instead of low mood
Somatic symptoms (in gut)
Social withdrawal
Seen especially in boys
When do psychotic symptoms occur, if at all, in adolescent depressive disorder?
After mid-adolescence (rare before this)
What are the short term and long term outcomes of adolescent depressive disorder?
Short term - persistence and recurrence
Long term - continuity into adolescence (40-70%) and adulthood (2-7x)
Impaired relationships
Impaired education
List some biological changes which increase vulnerability to depression
Genetics
Puberty
Brain growth
List some social changes which increase vulnerability to depression
Peers
Family
Social world
Relationships
What psychological or cognitive changes increase vulnerability to depression?
More intense, fluctuant moods
Developing idea of self and autonomy
What is the treatment for mild depression?
CBT (individual or group)
Interpersonal psychotherapy
What is the treatment for moderate/severe depression?
Antidepressants
CBT
Note: combined treatment shows highest rate of symptomatic remission
List the most significant cause of earlier puberty
Improved nutrition
What are the two subtypes of anorexia nervosa?
Restricting type
Binge eating/purge type
Which subtype of conduct disorder has the worst prognosis?
Unsocialised CD
