Adolescence and puberty Flashcards
Define adolescence
Period following the onset of puberty during which a young person develops from a child into an adult
What is the normal age of adolescence?
10-19 years
What are the main physical changes associated with adolescence in boys?
Growth of scrotum + testes Lengthening of penis Growth of pubic hair Growth spurt Change in body shape Growth of facial + underarm hair
Define puberty
Process of physical changes through which a child’s body matures into an adult body capable of sexual reproduction
How does puberty start?
- At ~ age 8, hypothalamus increases production of GnRH
- GnRH triggers anterior pituitary to release LH + FSH
- LH + FSH trigger testosterone production in testes + oestrogen production in ovaries
- Sex hormone release has effects: spermatogenesis, folliculogenesis, development of secondary sex characteristics
- Before puberty, the hypothalamus + pituitary are very sensitive to -ve fb signals from testosterone + oestrogen
- During puberty, sensitivity decreases to levels typically seen in adults
- This change allows an increase in production of testosterone + oestrogen that stimulates development of secondary sex characteristics
What is the normal age of onset of puberty?
Girls: 10
Boys: 12
How has the onset of puberty changed since the mid-19th century? What may be the reasons for this?
Age of onset consistently lowering
improved health care
improved socio-economic factors
What is menarche?
Onset of 1st menstrual cycle
What is adrenarche? How does adrenarche manifest clinically?
Occurs prior to onset of puberty
Increase in adrenal androgen production
Between ages 6-10
Appearance of axillary + pubic hair
What are the main areas of psychological development in adolescence?
Cognitive development e.g. abstract thinking
Identity e.g. own values
Increased self-awareness
Emotional expression + regulation
What are the main areas of normal social development in adolescence?
Friendships
Group formation + peer relationships
Parental conflict: adolescence strive for autonomy
What are the risk factors for anorexia nervosa?
Earlier pubertal maturation + higher body fat
Concurrent psychological problems e.g. Depression
Poor body image
Specific cognitive phenotypes
Which mood disorders accompany adolescent development?
Depression
Bioplar affective disorder
Psychotic depression
Mixed anxiety + depression
What are the aetiological and maintaining factors of depression?
Familial link: Depressed children more likely to have depressed parents/siblings + vice versa
Moderate heritability: twin studies
Genetic loading: Increase young person’s vulnerability to life events
Effects of family interaction, e.g. criticism
Life events, adversities, grief
What are the main features of conduct disorder?
Bullies, threatens or intimidates Initiates physical fights Loses temper + argues Stealing, breaking into cars/ houses Running away/ truanting
What are the psychotherapeutic interventions for psychological disorders during development?
Cognitive behavioural therapy
Interpersonal psychotherapy
Family therapy
Psychosocial intervention
What are the pharmacological interventions for psychological disorders during development?
Antidepressants (SSRIs)
Stimulants (ADHD)
Antipsychotics
What are the 2 theories for the onset of puberty?
Maturation of CNS affecting GnRH neurones (increased pulsatile release)
Altered set point to gonadal steroid -ve fb
What are the major hormones involved in puberty?
Neurokinin B + kisspeptin: present in same hypothalamic neurones; critical parts of control system that switches on GnRH
GnRH: stimulates gonadotrope cells of ant pit
LH: targets Leydig cells + thecal cells
FSH: targets ovarian follicles, Sertoli cells + spermatogenic tissue
Testosterone: from Leydig cells, primary androgen
Oestradiol: acts of ERs
IGF1: rises in response to GH, possible principle mediator of growth spurt
Leptin: from adipose tissue, primary target hypothalamus
What is anorexia nervosa?
Disorder characterised by deliberate weight loss, induced + sustained by the patient
What is conduct disorder?
Persistent failure to control behaviour appropriately within socially defined rules
What are the signs of developmental delay?
Children may present with developmental concerns either through
(i) identification of antenatal or postnatal risk factors
(ii) developmental screening
(iii) concerns raised by parents or other healthcare professionals
What are the main physical changes associated with adolescence in girls?
Breast budding Growth of pubic hair Growth spurt Menarche Growth of underarm hair Change in body shape
What hypothalamic hormones are involved in adrenarche and menarche?
A: CRH
M: GnRH
When does the growth spurt occur in boys and girls?
B: Late pubertal event
G: Early pubertal event
What is the developmental mismatch hypothesis?
Reward driven activities are ahead of cognitive + emotional ability to respond rationally to, cope with + think through risky activity, tends to result in miscalculated risks
List 3 predisposing factors of anorexia nervosa
Genetics
Perfectionism
Culture
List 3 precipitating factors of anorexia nervosa
Bullying
Severe food reaction
Friend with ED
List 3 perpetuating factors of anorexia nervosa
Feelings of control
Positive reactions to ED
Behavioural habit
List 5 symptoms of depression
Low mood Loss of enjoyment Loss of energy Appetite change Sleep change
What criteria need to accompany the symptoms of depression?
Pervasive nature of symptoms
Impairing daily life
Present for > 2 weeks
What are the associated problems of depression?
Increased risk of self harm
Anxiety + eating disorders
Substance misuse
Familial aggregation
What are the 2 main types of pre-pubertal depression?
- Presents with co-morbid behavioural problems, similar to CD, no increased risk of recurrence
- Familial, high rates of anxiety + BPD, recurrences as adult
How may adolescent depressive disorder present?
Irritability
Somatic complaints
Social withdrawal
What interventions are useful in treatment of conduct disorder?
Parenting programmes
Interventions at school
Managing underlying hyperactivity
What causes are associated with conduct disorder?
Child has difficult temperament e.g. inconsistent discipline
Genetic
Environment e.g. neighbourhood
