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Year 2 - LCRS - RDA > Adolescence & early adulthood (02.03.2020) > Flashcards

Adolescence & early adulthood (02.03.2020) Flashcards

1
Q

What is adolescence?

A
  • phase between childhood &
    adulthood
  • Pubertal development may be start of adolescence
  • expanding to 10-25?
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2
Q

Adulthood definition

A
  • Adulthood: legally, culturally variable

* UN: children < 18 years

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3
Q

4 main categories of changes that happen from childhood to adulthood?

A
  • Cognitive/Emotional
  • Peers
  • Biology
  • Famlily
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4
Q

Cognitive/emotional changes that occur in the transition form childhood to adulthood?

A
  • emotional change
  • Reasoning - more abstract
  • Greater knowledge / awareness of world
  • Identity – of self, family, ethnicity
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5
Q

Peer changes that occur in the transition form childhood to adulthood?

A
  • Peer activities / confiding
  • Sexual relationships
  • Peer group influences
    values and behaviour (pro / anti -social)
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6
Q

Biological changes that occur in the transition form childhood to adulthood?

A
  • puberty/endocrine changes - secondary physical growth
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7
Q

Family changes that occur in the transition form childhood to adulthood?

A
  • challenging rules
  • discipline needs reasoning
  • less confiding and intimacy in parents.
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8
Q

Adrenarche

A
  • precursor of puberty

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

  • Rise in adrenal 19- carbon steroid production, dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS).
  • Manifests clinically as the appearance of axillary and pubic hair, usually about age 8.
  • Role uncertain -?Precursor to puberty
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9
Q

Endocrine control of puberty and adrenarche

A

??????????? fill this in

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10
Q

Female and Male age difference in puberty

A
  • girls usually 2 years ealrier

- in females the growth spurt is an early event in puberty and in males it is a late event.

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11
Q

Tanner stages of Puberty

A
  • wide ranges for things to occur
  • different for boys and girls
  • looks at hair (pubic and armpit) as well as development of secondary genital characteristcs.)
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12
Q

How has the age of puberty changed over the years?

A
  • decreased (17 -> 12)
  • due to better nutrition
  • due to obesity
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13
Q

Psychological changes

A
  • Cognition e.g. morality, higher levels of cognitive thinking
  • Identity (incl. gender identlty, religious beliefs)
  • Increased self-awareness
  • Affect expression and regulation
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14
Q

Social Changes in adolescence

A

• Family - parental surveillance, confiding

  • Peers
    • Increased importance
    • More complex & hierarchical
    • More sensitive to acceptance & rejection
    • Romantic relationships
  • Social role – education, occupation, etc

=> these are often factors that contribute to mental health problems.

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15
Q

Wider Social Influences

A
  • School
  • Work
  • Culture (“teen” subculture; migration/culture)
  • now also social media (re less sleep, exercise; cyberbullying, not time spent but how harmful it is is critical)
  • Social influences eg unemployment, poverty/affluence, housing, neighbourhood effects
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16
Q

Brain development In adolescence

A
  • pruning
  • Grey, white & dopaminergic pathway changes increase vulnerability to risk taking
  • there is a mismatch between….. rewatch
  • reward driven activities are more dominant then the regulatory, cognitive control integration (the risk assessment is wrong, they do not take more risks)
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17
Q

What is the link with mental health?

A
  • in young children

- in adolescence a majority of mental health problems begin to manifest

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18
Q

Self awareness/comparison to others

A
  • girls are far more vulnerable to social media effects then boys (comparing themselves to others)
  • mental health disorders make it worse
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19
Q

Name some disorders that commonly start in adolescence

A
  • Anorexia nervosa
  • Mood disorders
  • Antisocial behaviour
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20
Q

When do emotional disorders usually show?

A

17-19 years of age mainly

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21
Q

Anorexia nervosa

A
  • A. Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health.
  • B. Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain.
  • C. Disturbance in experience of weight/shape, undue influence of wt/shape on self-evaluation, or persistent lack of recognition of seriousness of low body weight
  • D.Amenorrhoea NOT in DSM-5!
  • Subtypes: Restrictingvs.Binge-eating/Purge

This is the only eating disorder where weight is a category.

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22
Q

What is the biggest risk factor for eating disorders?

A
  • being female (boys have the same feelings but are less likely to act on them (I,e, diet)
  • males tend to want more muscle weight
  • after that, dieting behaviour.
23
Q

Prediction of Eating Problems

A

• Adolescent eating problems (symptoms) associated with:

  • Earlier pubertal maturation, & higher body fat
  • Concurrent psychological problem e.g. depression (negative feelings, hating oneself, others, the world)
  • Poor body image
  • Specific cognitive phenotypes
24
Q

Neuropsychology of Anorexia Nervosa Executive Function deficits

A
  • Association anorexia nervosa and ASD
  • Weak central coherence in ED’s
  • Global processing difficulties [review]
  • Poorer global processing =>Weak central coherence (2 tests for central coherence shown; you don’t really see the bigger picture)
  • ## difficult to distinguish the effects of starvation and predisposing chatacteristc traits before
25
Q

Treatment for eating disorders

A

…..most young people who have parental/carer support with AN should be offered AN focussed family therapy (FT-AN or FBT) in conjoint, separated or multifamily format as

  • first line treatment on an outpatient or
  • if too sick, day patient basis, following a brief (<3 week admission) for medical stabilisation if needed
  • from NICE guidelines
26
Q

Prognosis of eating disorders

A
  • About 40% respond to first line interventions alone
  • Up to 80% recover overall within 5 years
  • Around 30% develop binge eating at some point during recovery (different prognosis)
  • Around 20% run a more chronic course
  • Mortality e.g. at 20 years: 5-10% of which 1 in 5 is suicide (this is higher than e.g. diabetes)
  • Duration of illness predicts recovery therefore adolescent onset better prognosis because earlier help seeking
  • Early treatment response is the only robust predictor of outcome but more extreme social difficulties are a factor
27
Q

Depression in adolescence

A
  • the more symptoms the more impairment
28
Q

Symptoms in depression

A

Core:
• Low mood/sadness
• Loss of enjoyment (anhedonia)
• Loss of energy

  • Changes to:
  • Appetite / Weight-up /down )
  • Sleep-(up/down)
  • Concentration
  • Thoughts: Pessimism, Guilt
  • Self esteem/confidence
  • Libido
  • Psychomotor agitation/retardation
  • Self harm / Suicide
29
Q

Depression - clinical threshold

A
  • Symptoms pervasive (e.g. all the time and not only in a specific environment)
  • Impairing
  • Present for at least 2 weeks
  • Symptoms and impairment -> distinguish mild, moderate & severe
30
Q

Types of depression

A
  • Depressive episode (~ 50% recur) -> single episode
  • Recurrent depression (with times where it gets better)
  • Dysthymia (persistent mild depression)
  • Bipolar depression
  • Psychotic depression
  • Atypical depression
  • Seasonal affective disorder (SAD)
  • ?Inflammatory subtype
31
Q

Depression associated problems

A

• Increased risk of self-harm
• Association with anxiety disorders; eating disorders [females];
conduct problems; substance misuse
• Familial aggregation (genetic and learning)

32
Q

Pre-pubertal Depression

A

2 main types:

1st:
• More common presentation is with co-morbid behavioural problems, parental criminality, parental substance abuse and family discord
• Course of this resembles that of children with conduct disorder
• No increased risk of recurrence in adult life

2nd
• Less common
• highly familial with multigenerational loading for depression
• High rates of anxiety and bipolar disorder and
• Recurrences of depression in adolescence and adulthood

33
Q

Adolescent Depressive Disorder

A
  • Irritability instead of sadness/low mood Especially in boys
  • Somatisation: somatic complaints and social withdrawal are common
  • Psychotic symptoms rare before mid-adolescence
34
Q

Adolescent Depressive Disorder - outcome

A
  • Short term
  • High rates of persistence and recurrence (20% in 1 yr)
  • Long term
  • Significant continuity adolescenceadulthood
  • Adolescent Depressive Disorder
  • 40-70% recurrence in adulthood
  • 2-7x increased risk as an adult

• Impairment relationships/education in adulthood

35
Q

Dev. changes and vulnerability to depression

A

Biological changes: genetics, puberty, brain growth

Social changes: peer, mails, social world

Life events: losses

-> these lead to vulnerability to depression (either directly or through psychological/cognitive emotional changes (more advanced and efficient; more intense/fluctuant mood; self concept, autonomy.)

36
Q

Treatments for depression

A

Mild depression
• Cognitive behavioural therapy [Individual or group] • Interpersonal psychotherapy for adolescents
• Brief Psychosocial Intervention

Moderate-Severe Depression
• Antidepressants e.g. SSRI’s: fluoxetine • Could be SSRI + CBT

• Combined treatment -> highest rate of symptomatic remission in 37% combined vs 20% fluoxetine alone

37
Q

Conduct Disorder

A

(CD) - ICD-10

  • Repetitive & persistent (> 6 months) pattern of dis-social, aggressive or defiant behaviour
  • Frequency & severity beyond age appropriate norms.
  • No sharp dividing line!
38
Q

Conduct Disorder: behaviours

A 
Oppositional behaviour, defiance
Tantrums
Excessive levels of fighting or bullying, assault Running away from home
Truancy
Cruelty to animals
Stealing
Destructiveness to property
Fire-setting
39
Q

Conduct Disorders: types

A
  • CD confined to the family context
  • Unsocialized CD (worst prognosis)
  • Socialized CD
  • Oppositional CD
  • Depressive CD
  • Hyperkinetic CD
40
Q

What is the commonest psychiatric disorder in childhood?

A
  • Conduct Disorder is commonest psychiatric disorder of childhood.
  • National Survey of Child Mental Health (2017)
  • About one in twenty (4.6%) 5 to 19 year olds had a behavioural disorder, with rates higher in boys (5.8%) than girls (3.4%)
  • Increases with age
  • More common in urban than rural communities

Anti-social behaviour
• Adolescent-limited
• Life course persistent

41
Q

Intervention in Conduct Disorder

A
  • Should be targeted at major modifiable risk factors and should begin at an early age
  • Managing underlying hyperactivity
  • Parenting programmes
  • Cognitive problem-solving skills training
  • Interventions at school
  • Multi-systemic therapy
42
Q

Prognosis of CD

A
  • 40% of 7 and 8 year olds with CD became recidivist delinquents as teenagers.
  • Over 90% of recidivist juvenile delinquents had conduct disorder as children.
  • Predictor of
  • Antisocial PD in adulthood (~50%)
  • Alcoholism & drug dependence
  • Unemployment and relationship difficulties
  • Intergenerational transmission
  • HENCE IMPORTANCE OF PREVENTION!
43
Q

Summary

A
  • Psychosocial factors mediate the relationship between pubertal development and onset of emotional, behavioural, eating & weight controlling behaviours.
  • Biological, temperamental and neuropsychological factors are implicated in vulnerability
  • Treatment improves the outcome (v natural history)
44
Q

What is happening with the incidence of ADHD and Autism?

A

it is increasing

45
Q

Developmental mismatch hypothesis

A

Grey, white & dopaminergic pathway changes increase vulnerability to risk taking

Don’t necessarily take more risks but are less likely to think about the consequences

46
Q

What is the link of adolescence and mental health?

A
  • 1/10 children ages 5-16 have a diagnosable condition
  • 50% of all the mental health problems are established by the age of 14
  • 75% of all mental health problems are established by the age of 24
47
Q

Why is mental health important?

A
  • big impact in global burden of disease

- non-communicable disease

48
Q

Formulation Framework

A

Factors:

  • Predisposing
  • Precipitating (e.g. bullying, relationship problems, puberty, adverse life event, bereavement)
  • Perpetuating (e.g. isolation, feeling of control, social media, family, positive reactions to ED)
  • Protective

Individual, Biological, Psychological, Systemic

49
Q

Etiology of anorexia nervosa

A
  • genetic factors and other prenatal factors such as hormones determine traits and cognitive style
  • this includes: OPID (obsessionally, perfectionism, Inflexifility, deficits in social cognition) -> this occurs during childhood/ adolescence
  • these lead to diet and this starts a vicious cycle:

diet -> weight loss -> starvation induced changes -> increased anxiety, depression and obsessionally -> weight loss…..

  • starvation induced changes can lead to chronic illness
  • recovery can occur (after weight loss)
  • in adolescence there are other things that take place: Brain development, hormones, stressful life events, cultural values.
50
Q

Prediciton of eating problems

A

Adolescent eating problems (symptoms) associated with:
• Earlier pubertal maturation, & higher body fat
• Concurrent psychological problem e.g. depression
• Poor body image
• Specific cognitive phenotypes

51
Q

Neuropsychology of anorexia nervosa

A
  • weak global coherence in anorexia nervosa and other eating disorders
  • e.g. cannot find a number in the test with many 9s and you have to find the 8
  • lack of global coherence when recreating a complex set of shapes, they see the smaller shapes but not the global picture.
52
Q

Prognosis in anorexia nervosa

A
  • About 40% respond to first line interventions alone
  • Up to 80% recover overall within 5 years
  • Around 30% develop binge eating at some point during recovery
  • Around 20% run a more chronic course
  • Mortality e.g. at 20 years: 5-10% of which 1 in 5 is suicide
  • Duration of illness predicts recovery therefore adolescent onset better prognosis because earlier help seeking
  • Early treatment response is the only robust predictor of outcome but more extreme social difficulties are a factor
53
Q

Treatment of anorexia nervosa

A

…..most young people who have parental/carer support with AN should be offered AN focussed family therapy (FT-AN or FBT) in conjoint, separated or multifamily format as first line treatment on an outpatient or if too sick, day patient basis, following a brief (<3 week admission) for medical stabilisation if needed

Year 2 - LCRS - RDA (11 decks)

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