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RDA > Adolescence > Flashcards

Adolescence Flashcards

1
Q

What is adolescence?

A

The stage of life between childhood and adulthood, when pubertal development begins (10-20yrs/10-25yrs)

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2
Q

List some cognitive/emotional changes which occur with adolescence

A 
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
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3
Q

What is the precursor of puberty?

A

Adrenarche

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4
Q

What is adrenarche?

A

The development of axillary and pubic hair, oily skin, body odour and acne (essentially pre-puberty)

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5
Q

When does adrenarche happen in females and males?

A

Females: 6-9years
Males: 7-10years

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6
Q

A rise in which hormones causes adrenarche?

A

Adrenal 19-carbon steroid
DHEA (dehydroepiandrosterone)
DHEAS (dehydroepiandrosterone sulphate)

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7
Q

Summarise the role of the HPA on puberty

A

Hypothalamus produces GnRH
GnRH acts on pituitary
LH and FSH are produced
These act on the gonads.

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8
Q

What is the consequence of LH and FSH acting on the gonads in males and females?

A 
MALES:
Development of:
Penis
Pubic hair
Testes
Sperm production
FEMALES:
Development of:
Breasts
Ovaries 
Uterus 
Egg production 
Menarche
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9
Q

What is the average age for a girl and a boy to hit puberty?

A

Girl - 12 years

Boy - 15 years

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10
Q

Describe the Tanner’s 5 stages of puberty in girls

A 
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

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11
Q

Describe the pubertal changes as boys grow

A 
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
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12
Q

What are the psychological changes linked to puberty?

A

Cognition e.g. morality
Identity (incl. gender identity)
Increased self-awareness
Affect expression and regulation (emotional regulation)

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13
Q

What are the familial social changes that occur with puberty?

A

Family - parental surveillance, confiding

Role of the parent changes during puberty

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14
Q

What are the social changes that occur with puberty amongst peers?

A

Peers become more important
More complex and hierarchical relationships form
Young people become more sensitive to acceptance and rejection
Romantic relationships

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15
Q

What social roles do post-pubertal teenagers start thinking about?

A

Education

Occupation

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16
Q

What other things can influence or affect teenagers?

A 
School
Work/unemployment 
Cultures e.g. social media, teen subculture, migration
Housing/neighbourhood 
Poverty/affluence
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17
Q

What is the official name for the hypothesis where ‘growing teenagers’ actually behave in self-destructive ways?

A

Developmental mismatch hypothesis

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18
Q

What is the developmental mismatch hypothesis?

A

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.

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19
Q

List some high risk behaviours

A 
Unprotected sex 
Delinquency (minor crime)
Violence
Self-harm
Lack of hygiene
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20
Q

What is the ICD-10 criteria for anorexia nervosa?

A

Body weight at least 15% below expected weight (but no number given)

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21
Q

What is anorexia nervosa?

A

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)

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22
Q

What is associated with anorexia nervosa?

A

Endocrine disturbance

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23
Q

What are the four ‘p’s in psychiatric conditions?

A

Predisposing
Precipitation
Perpetuating
Protective

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24
Q

What factors should we consider when thinking about why a condition has come on?

A

Systematic
Familial
Individual

or biological, psychological and social

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25
Q

Give some examples of predisposing factors

A 
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
26
Q

List some precipitating factors

A 
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
27
Q

Give some examples of perpetuating factors

A 
Isolation 
Social media
Feeling of control 
Bullying
Lack of support
Positive reinforcement 
Family/social circles 
Sporting success
Admiration from friends 
Body dysmorphia
28
Q

What are the traits or cognitive style of someone with AN?

A

Obessionality
Perfectionism
Deficits in social cognition
Inflexibility

29
Q

Describe the cycle of AN

A

Diet
Weight loss (pt could recover at this stage)
Starvation-induced changes (could become chronic illness)
Increased anxiety, depression, obsessionality
(back to diet)

30
Q

What happens at puberty which could precipitate AN?

A

Development of the brain
Hormonal changes
Stressful life events
Receptiveness to cultural values

31
Q

Give some predictors of developing eating disorders

A 
Earlier pubertal maturation 
Higher body fat 
Concurrent psychological problem 
Poor self image
Specific cognitive phenotypes
32
Q

What psychological changes are associated with AN and what else is this associated with?

A

Executive function deficits (also associated with ASD):

Weak central coherence i.e. global processing difficulties
Impaired set shifting

33
Q

How would you assess someone with AN?

A

Family interview
Individual interview with child/adolescent
Physical examination
Gather data on growth
Further physical examination and investigations

34
Q

What are the physical differential diagnoses for AN?

A

GI disorders e.g. Crohn’s
Metabolic disorders e.g. diabetes
Pituitary problems

35
Q

What are the psychiatric differential diagnoses for AN?

A

Other eating disorders
Depression
Psychosis
OCD

36
Q

What is conduct disorder?

A

Repetitive and persistent pattern of breaking the law/being anti-social for over 6 months - the frequency and severity is beyond age appropriate norms.

37
Q

Give examples of behaviours in conduct disorder

A 
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
38
Q

List the types of CD

A 
CD confined to family context
Unsocialised CD
Socialised CD
Oppositional CD
Depressive CD
Hyperkinetic CD
39
Q

Compare the epidemiology of CD vs anti-social behaviour

A

Conduct disorder - commonest psychiatric disorder of childhood
Increases with age

Anti-social disorder - adolescent limited
Persistent throughout life

40
Q

In which communities is CD more common?

A

Urban > rural

41
Q

List some environmental, familial and child factors which could contribute to CD

A

Enviro - inner city
Family - inadequate parenting
Child - ADHD

42
Q

List interventions for CD

A 
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

43
Q

What is CD a predictor of?

A 
Antisocial disorder in adulthood 
Alcoholism 
Drug dependence 
Unemployment 
Relationship difficulties
44
Q

What is depression?

A

Low mood, loss of enjoyment and loss of energy lasting for more than 2 weeks

45
Q

List some other changes seen in depression

A 
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
46
Q

Describe the presentation and course of the first type of pre-pubertal depression

A

Presentation is with comorbid behavioural problems, resembles children with CD

47
Q

What is the first type of pre-pubertal depression associated with?

A

Parental criminality
Parental substance abuse
Family discord

48
Q

What is the second type of pre-pubertal depression associated with?

A

High rates of anxiety
High rates of bipolar
Recurrence of depression in adolescence and adulthood

49
Q

What is the aetiology of the second type of pre-pubertal depression?

A

Highly familial

50
Q

What is the prognosis of the first type of PP-depression?

A

No increased risk of occurrence in adult life

51
Q

What is adolescent depressive disorder and which group of people is this more common in?

A

Irritability instead of low mood
Somatic symptoms (in gut)
Social withdrawal

Seen especially in boys

52
Q

When do psychotic symptoms occur, if at all, in adolescent depressive disorder?

A

After mid-adolescence (rare before this)

53
Q

What are the short term and long term outcomes of adolescent depressive disorder?

A

Short term - persistence and recurrence
Long term - continuity into adolescence (40-70%) and adulthood (2-7x)
Impaired relationships
Impaired education

54
Q

List some biological changes which increase vulnerability to depression

A

Genetics
Puberty
Brain growth

55
Q

List some social changes which increase vulnerability to depression

A

Peers
Family
Social world
Relationships

56
Q

What psychological or cognitive changes increase vulnerability to depression?

A

More intense, fluctuant moods

Developing idea of self and autonomy

57
Q

What is the treatment for mild depression?

A

CBT (individual or group)

Interpersonal psychotherapy

58
Q

What is the treatment for moderate/severe depression?

A

Antidepressants
CBT

Note: combined treatment shows highest rate of symptomatic remission

59
Q

List the most significant cause of earlier puberty

A

Improved nutrition

60
Q

What are the two subtypes of anorexia nervosa?

A

Restricting type

Binge eating/purge type

61
Q

Which subtype of conduct disorder has the worst prognosis?

A

Unsocialised CD

RDA (13 decks)

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