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Rob's RDA > Adolescence and puberty > Flashcards

Adolescence and puberty Flashcards

1
Q

What is growth due to

What is adolescence

A

Gonadal steroids (in particular androgens)

+ other hormones such as GH (somatotrophin) from anterior pit.

Adolescence: Adolescence refers to the period of development that occurs between ages 12-18 years.

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2
Q

How does the onset of puberty occur

A

Theories

  1. Maturation of the CNS affecting GnRH neurones (increased pulsatile release)
  2. Altered set point to gonadal steroid negative feedback
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3
Q

What might trigger maturation of CNS

A

Unclear….

BUT THERE IS EARLIER PUBERTY NOW:

Improved health care

Improved socio-economic factors (photoperiod and nutrition)

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4
Q

Outline Altered set point to gonadal steroid negative feedback

A

Initially:

  • Low gonadal steroids
  • But high sensitivity to these in negative feedback on pituitary/hypothalamus
  • So low gonadotrophins

THEN, the sensitivity of the hypothalamus/pituitary to the gonadal secretions reduces, so

  • Unchanged gonadal steroids results in
  • Increased gonadotrophins (because the same amount of gonadal hormone has a lower negative feedback action because of the reduced sensitivity of the hypothalamus and pituitary)
  • Gonadal hormones therefore increase (because of the increased GnRH and gonadotrophins)

The feedback further decreases until there are adult levels, whihc involve much higher hormone leves

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5
Q

What is menarche

A

the first occurrence of menstruation.

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6
Q

What has happened to age at menarche

A

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.

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7
Q

How has body weight at menarche changed?

A

body weight at menarche has remained relatively constant at approximately 47kg.

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8
Q

What is adrenarche and what is it due to

A

Role: It’s like the precurosr to puberty

Rise in adrenal 19- carbon steroid production,
dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS)

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9
Q

When is adrenarche in males and females

A
  • Females: 6-9 years

* Males: 7-10 years

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10
Q

T/F adrenarche marks the beginning of puberty

A

F… it’s the precursor to it.

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11
Q

What does adrenarche manifest as

A

• Manifests clinically as the appearance of axillary and pubic hair,
usually about age 8

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12
Q

Outline endocrinology of adrenarche

A

HPA axis

CNS and Hypothalamus stimulated leading to CRH

CRH leads to adenohypophysis ACTH release.

ACTH causes DHEA and DHEAS release from the zona reticularis

Leads to axillary, groin hair and acne

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13
Q

Outline endocrinology of puberty

A

HPG (not HPA like adrenarche)

CNS and hypothalamus releasing GnRH, pituitary releases LH/FSH. Menarche/sperm production and release of androgen and estrogen

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14
Q

What do oestrogen and androgen cause development of

A

ANDROGEN:

  • penis, pubic hair and testes
  • Also pubic, armpit hair and acne

ESTROGEN:
-breasts, ovaries, uterus

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15
Q

Why can extremely skinny women have periods stopping

A

Because leptin stimulates release of GnRH from the hypothalamus VIA increased kisspeptin release (which stimulates the GnRH neurones)

So if low leptin due to low body fat, then periods stop

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16
Q

Is menarche a single event

A

It is defined as such,

however periods take 3 cycles to be classed as fully established, so not clear cut

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17
Q

When do girls and boys have their growth spurts

Is this reflective of the rest of their development

A

Girls around age 12/13

Boys arund 15

Yes- girls are around 2 years ahead developmentally!

The boy growth spurt is also larger than the girls

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18
Q

What is the tanner scale

A

Scale to assess how advanced puberty is.

Based on:
i. Penile development
ii Breast development
iii. Growth of pubic hair

Each of these is rated 1-5 for development. 1 is pre-pubertyal and 5 is fully developed

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19
Q

What has the earlier age of puberty been down to

What is the normal age of puberty commencing for boys and girls

A

Improvement of diet

However obesity and overweight can lead to early onset of puberty

The average age for girls to begin puberty is 11, while for boys the average age is 12

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20
Q

Psychological changes in puberty

A

Cognition e.g. morality

Identity

Increased self-awareness

Affect expression and regulation (i.e. can you speak about how you feel, and then turn off those feelings)

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21
Q

T/F the psychological and biological development are not interlinked

A

F they are highly interrelated

Some hormones are required for proper cognition (oxytocin)

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22
Q

T/F menarche is early in the developmental process

A

F it’s quite late (the child is quite developed at this point)

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23
Q

Social changes in puberty

A

• Family - parental surveillance, confiding

Peers
• Increased importance
• More complex & hierarchical
• More sensitive to acceptance & rejection
• Romantic relationships

Social role- education, occupation etc.

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24
Q

What changes in terms of importance of reationships in puberty

A

Changes from importance of parents to peers.

This is why some autism traits are only realised in puberty, when it is important to develop relationships with those outside of family when peers become primary relationships

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25
Q

Why is onset of mental health conditions often in pubery

A

Again because of this change in primary relationship from parents to support

And social support strognly associated with metnal health

And more sensitive to acceptance and rejection (because of infreased self awareness)

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26
Q

What are the wider cultural influences on puberty

A

• School
• Work
• Culture (“teen” subculture; migration/culture)
• Social influences eg unemployment, poverty/affluence, housing,
neighbourhood effects

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27
Q

What happens with brain during development

A

Grey matter volume = decreases from 6 yrs to adolescence & there is a linear increase in white matter at about 20 years

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28
Q

Outline developmental mismatch

A

Adolescence is a time of risk taking

Yes because of increased Regulatory/ Cognitive
control
Integration of affect

But Sensation seeking activity sharpy increases up to 17 years old and then decreases again

The area between these two lines is the risk taking activity

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29
Q

Examples of risk in adolescence

A 
Sex
Delinquency
Violence
Self-harm
Disease control
30
Q

When do mental health problems start

A

3/4 by the age of 24

1/2 by the age of 14

31
Q

Outline differences between comparing yourself to others between boys and girls with mental health conditions

A

Boys with mental health conditions no more likely to compare themselves to others than boys without condiitons

Girls with metnal health conditions almost 2X more likely to compare themsleves to others than girls without metnal health conditions

32
Q

Which is the relaionship between mental health sidorders and age

A

Most increase in frequency from 2-19

Emotional disorders, behaioural disorders and any disorders increases

Hyperractiity and ‘less common disorders’ (e.g. autism) more common at younger age

33
Q

Cardinal features of anorexia nervosa

A

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.

34
Q

Good way to think about these diseases

A

INDIVIDUAL,
FAMILY,
SOCIETY

And then predisposing, precipitating, perpetuating and protective

35
Q

Predisposing factors for eating disorder

A

Genetics, culture, media, family history, pre-morbid weight, high stress, self image, role model

36
Q

Precipitating factors for eating disorder

A

Social exclusion

37
Q

Maintaining factors of eating disorder

A

Isolation, feeling of control, social media

38
Q

What are adolescent eating disorders associated with

A
  • Earlier pubertal maturation, & higher body fat
  • Concurrent psychological problem e.g. depression
  • Poor body image
  • Specific cognitive phenotypes
39
Q

What executive functional deficits are occurring in anorexia nervosa

A

Anorexia Nervosa associated with autism spectrum disorder

There is weak central coherence in EDs (global processing issues)

Impaired set shifting

i.e. can’t see the bigger pircutre

40
Q

What do psychological implications of puberty vary according to

A

gender and cultural background.

41
Q

Outline the difference in psychologiclal implications of puberty for different gender

A

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

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.

42
Q

Outline the differences in the psychologicla implications of puberty depending on culturral background

A

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.

43
Q

Implications of body weight dissatisfcation

A
  1. Urge to reduce weight
  2. Dieting/weight control measures
  3. This may induce dysphoria and repeated attempts to control weight
  4. Risk of ED increased
44
Q

What proportion of anorexia nervosa cases are male

A

Approx 10% cases or less male.

45
Q

Causes of anorexia nervosa

A

Genetic predisposition, perfectionist temperament, specific subcultures, childhood abuse and adversities; perhaps higher social class.

46
Q

Outcome for anorexia nervosa

A

Community: 50% recover after 5 years

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

47
Q

Treatment for anorexia nervosa

A

Family intervention

For abnormal eating attitudes and depression: cognitive behavioural therapy.

Small % need admission for weight restoration

48
Q

Depression in adolescence symptoms

A

Affective – sadness, loss of enjoyment, irritability

Cognitive – self-blame, hopelessness, guilt

Biological – disturbed sleep, reduced appetite

May reach threshold for disorder

49
Q

Developmental considerations in depression

A

Endocrine change

Changes in family relationships

Peers

Responsibilities and hassles

50
Q

How can endocrine change affect depression

A

especially female may increase risk low mood

51
Q

How can change in family dynamics in puberty affect depression

A

physical closeness, joint activities, family conflict

52
Q

How can peers in puberty affect depression How can change in family dynamics in puberty affect depression

A

increased involvement with peers; peer rejection and conflict

53
Q

How can Responsibilities and hassles in adolescence affect depression

A

life events, exams, etc

54
Q

What affects more anorexia or depression

A

Depression is 0.5-2%

anorexia 0.1%

55
Q

Causes of depression

A

Familial aggregation; genetic factors known
Effects of family interaction e.g. criticism
Life events, adversities

56
Q

Prognosis of depression

A

Prepubertal onset – better prognosis

Primary care: 2-3 months duration

In specialist CAMHS: 6-9 months

Small number in adolescence – bipolar (mania, hypomania)

57
Q

Treatmnet for depression

A

Cognitive behavioural therapy

Interpersonal psychotherapy

Family intervention for associated family problems

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

58
Q

Define conduct disorder

A

Persistent failure to control behaviour appropriately within socially defined rules.

59
Q

Clinical features of conduct disorder in the child

A

looses temper and argues

defies adult requests or rules

bullies, fights or intimidates,

stealing, breaking into cars or houses,

destroys property

running away, truanting

60
Q

Developmental considerations for conduct disorder- family relationships

A

less direct surveillance, physical closeness, joint activities

61
Q

Developmental considerations for conduct disorder- peers

A

increased involvement with peers; may amplify antisocial behavior

62
Q

Developmental considerations for conduct disorder-experimentation and risk taking

A

rule violation, drugs & alcohol, petty offending frequent.

63
Q

Prevalence of conduct disorder

A

4% at ages 5-10 years; 6% at ages 10-15 years; overall 5% at ages 5-15 years.

64
Q

Where and among whom is conduct disorder more prevalnet

A

Higher in deprived inner-city areas

Boys: girls 3:1

Variable age of onset

65
Q

What is conduct disorder assocated wth

A

Larger family size

lower socio-economic status

66
Q

Causes of conduct disorder

A

Genetic
Child
Wider environment

67
Q

Causes of conduct disorder- genetic

A

Weak

68
Q

Causes of conduct disorder- child

A

Family – poor parenting, discord, lack warmth,inconsistent discipline, coercive interaction, aggression

69
Q

Causes of conduct disorder- wider environment

A

poor schools

neighbourhoods

70
Q

Outcome or conduct disorder

A

Poorer outcome with more problems in child, and family

Risk of antisocial personality disorder in males

Range of emotional and personality disorders in females

71
Q

Interventions for conduct disorder

A

For child – problem solving skills.

Parent training

Family intervention

Address problems across contexts e.g. in school

Rob's RDA (10 decks)

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