adolescence Flashcards
define adolescence
phase between childhood and adulthood (expanding from 10-25 y/o)
what may be start of adolescence
pubertal development
4 key constructs that change significantly during adolescence
cognitive/emotional changes (hormonally driven, identitiy and self-awareness), peers (increase importance), family (challenge rules), biology (puberty, growth)
puberty, marriage and childbirth: 1950 vs now
now earlier puberty, later marriage and childbirth
what is adrenarche
before puberty and associated with appearance of axillary and pubic hair around 8 y/o
what drives adrenarche
adrenal glands to produce DHEA and DHEAS (not gonadal)
when does adrenarche happen
in females 6-9 y/o, in males 7-10 y/o
adrenal production pathway (adrenarche)
hypothalamus -> CRH -> pituitary -> ATCH -> adrenal cortex -> DHEA (development of pubic hair, armpit hair and acne in females, along with androgens)
gonadal production pathway (puberty)
hypothalamus -> GnRH -> pituitary -> LH/FSH -> gonads -> sperm/ovary production, androgen production (development of pubic hair, penis and testes in males) and oestrogen production (development of breasts, ovaries and uterus in females)
pattern of growth in puberty for boys and girls
girls do it 2 years earlier (12 vs 14), but wide variation; for girls, growth spurt is early pubertal event, but for boys it is a late pubertal event
why has age of puberty reduced over past centuries
improved nutrition
4 psychological changes in adolescence
cognition (morality), identity, increased self-awareness, affect expression and regulation
3 social changes in adolescence (deficits core to mental health)
family (parental surveillance, confiding), peers (increased importance, heirarchy, romantic), social role (education, occupation etc.)
4 wider social influences in adolescence
school, work, culture, social influences (e.g. unemployment, poverty, housing etc.)
describe what happens to cortex in brain development
thickens, then thins again
what does crossover from grey matter to white matter (pruning) account for and why
fail to calculate risks as mismatch between dopminergic pathways for reward and regulatory congnitive control
examples of risks in pruning
sex, delinquency, violence, self-harm, disease control
link of brain development with mental health
most in adolescence; 1/10 between 5-16 have diagnosable condition; 1/2 of all mental health problems established by 14; 3/4 all mental health problems established by 24
when do emotional orders emerge vs behavioural, hyperactivity and less common disorders
later on (between 17-19 y/o), vs younger
DSM-5 criteria for anorexia nervosa (no absolute normal low weight, but only mental health condition with weight; highest mortality of psychiatric disorders)
restriction of energy intake relative to requirements so significantly low body weight in context; intense fear of gaining weight/becoming fat; disturbance in experience of weight/shape, undue influence of weight/shape on self-evaluation, or persistent lack of recognition of seriousness of low body weight (not amenorrhoea as affects all)
2 subtypes of anorexia nervosa
restricting, binge-eating/purge
formulation framework for mental health conditions
predisposing, precipitating, perpetuating, protective; focuses on individual, family and systemic, or biological, psychological and social
what increases likelihood of suffering from anorexia nervosa
complex combination of psychiatric and somatic (genetic and hormonal) risk factors
what are adolescent eating problems associated with
earlier pubertal maturation and higher body fat, concurrent psychological problem e.g. depression, poor body image, specific cognitive phenotypes
why are anorexia nervosa and autistic spectrum disorder associated
when starved, become more narrow-minded (don’t see bigger picture), so difficult to separate effects of starvation from predisposing phenotype
2 main drivers for eating disorders and obesity
dieting and body image satisfaction
treatment for young people with eating disorders if they have parental/carer support
focussed family therapy in conjoint, separated or multifamily format (as outpatient; if too sick, as day patient following brief admission for medical stabilisation)
prognostic factor for anorexia nervosa
duration of illness (earlier the better)
concepts of depression: dimension
more symptoms you have, more impaired you’re likely to be (continuum)
concepts of depression: category
either depressed or not
3 core symptoms of depression
low mood/sadness, loss of enjoyment (anhedonia), loss of energy
what can depression manifest as
changes to appetite, sleep, concentration, pessimistic thoughts, self-esteem, libido, psychomotor agitation, self harm
diagnostic threshold for depression
symptoms pervasive (behave differently but feel same in different contexts), impairing and for >2 weeks
subcategories of depression based on severity
mild, moderate, severe
subcategories of depression based on course
depressive episodes, recurrent depression, dysthymia, bipolar, pyschotic, atypical, seasonal affective disorder, inflammatory
what is depression associated with
increased risk of self-harm; association with anxiety disorders, eating disorders, substance misuse etc.; familial aggregation
2 main types of pre-pubertal depression
brought on by low mood with co-morbid behavioural problems (associated with family circumstances and other types of anti-social behaviour, with no recurrence in adulthood), and pure depressive (highly familial with recurrence in adulthood)
what can adolescent depressive disorder look like
irritability instead of sadness, somatic complaints and social withdrawal (psychotic symptoms rate before mid-adolescence)
adolescent depressive disorder: short term outcome
high rates of persistence and recurrence
adolescent depressive disorder: long term outcomes
significant continuity adolescence into adulthood, with impaired relationships and education
what influences vulnerability to depression
biological changes, social changes, life events (e.g. losses), psychological and cognitive emotional changes
3 treatments for mild depression
cognitive behavioural therapy, interpersonal psychotherapy for adolescents, brief psychosocial intervention
2 treatments for moderate-severe depression
antidepressants e.g. SSRIs, cognitive behavoural therapy and antidepressant
what is anti-social behaviour defined by
society
what is delinquency/offending defined by
law
what is conduct disorder defined by
psychiatry
what is conduct disorder (commonest psychiatric disorder of childhood that increases with age and is more common in urban areas)
repetitive and persistent (>6 months) pattern of behaviour, with frequency and severity beyond age appropriate norms; usually adolescent-limited
examples of conduct disorder behaviours
oppositional behaviour, tantrums, excessive fighting, running away from home, truancy, cruelty to animals, stealing, destroying, arson
types of conduct disorder
socialised (with peer group), unsocialised (alone - worse prognosis feature)
3 factors affecting conduct disorder
child factors e.g. ADHD, family factors e.g. inadequate parenting, environmental factors e.g. inner city
describe intervention of conduct disorder
target at major modifiable risk factors, early, manage underlying hyperactivity, parenting programmes, cognitive problem-solving skills training, interventions at school, multi-systemic therapy
what is conduct disorder a predictor of (importance of prevention)
antisocial personality disorder in adulthood, alcoholism and drug dependence, unemployment and relationship difficulties
