Adolesence Flashcards
1
Q
What is adolescence?
A
- Adolescence – phase between childhood & adulthood
- Pubertal development may be start of adolescence
2
Q
When does adolesence usually start in males and females?
A
3
Q
What is adrenarche and when does it start?
A
- Precursor to puberty - stimulation of adrenal glands
- Females: 6-9 years
- Males: 7-10 years
4
Q
What happens in adrenarche?
A
- Rise in adrenal 19- carbon steroid production, dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS).
- These are the precursors of sex steroids
- Manifests clinically as the appearance of axillary and pubic hair, usually about age 8.
5
Q
How is body fat related to periods?
A
- Leptin stimulates the release of GnRH from the hypothalamus
- No body fat = periods stop
6
Q
What is menarche?
A
- The 1st period
- Usually, periods aren’t considered to be established until 3 cycles are complete
- So although menarche is a single event, it can only be defined in retrospect
7
Q
What is the endocrine axis of adrenarche?
A
- Hypothalamus produces CRH
- Anterior pituitary produces ACTH
- Adrenal cortex produced Androstenedione and DHEA
- These feedback on the pituitary and hypothalamus
- They also initiate the development of:
- pubic hair
- armpit hair
- acne
8
Q
What is the endocrine axis of male puberty?
A
- Hypothalamus produces GnRH
- Anterior pituitary gonadotrophs produce LH&FSH
- Act on gonads to initiate sperm production
- Also act on gonads to produce androgens which initiate the development of:
- Penis
- Pubic hair
- Testes
9
Q
What is the endocrine axis of female puberty?
A
- Hypothalamus produces GnRH
- Anterior pituitary gonadotrophs produce LH&FSH
- Act on gonads to initiate ovarian production and menarche
- Also acts on gonads to produce estrogen - initiating the development of:
- breasts
- ovaries
- uterus
10
Q
What are the phases of puberty?
A
- Phase 1: Pre puberty
- Phase 2-4: Puberty
- Phase 5: Fully developed
11
Q
What are the 3 measured stages of puberty?
A
- Axillary hair growth
- Pubic hair growth
- Breast/penis growth
12
Q
Why is puberty starting earlier than it used to?
A
Improvements in diet
13
Q
What are the psychological changes of adolescence?
A
- Cognition e.g. morality
- Identity
- Increased self-awareness
- Affect expression and regulation
14
Q
What are the social changes of adolescence?
A
- Family - parental surveillance, confiding
- Peers
- Increased importance
- More complex & hierarchical
- More sensitive to acceptance & rejection
- Romantic relationships •
- Social role – education, occupation, etc
15
Q
How does the brain change during adolescence?
A
- Increases in cortical thickness
- Peaks at aprox 10 years old
- Then begins synaptic pruning - removing unused synapses
16
Q
What is the developmental mismatch hypothesis?
A
- Increase in cognitive control throughout adolescence - increasing integration of affect (understanding your feelings)
- Dopaminergic activity also increases up to 18 years which is associated with increased sensation seeking
- This period where sensation seeking is higher than cognitive control is the risk period
17
Q
What is the definition of 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)
Old definition:
- Body weight at least 15% below expected
- With endocrine disturbance and wt loss behaviours.
18
Q
What are the predisposing factors of anorexia nervosa?
A
Pre-morbid weight
Bullying
Genetics
Culture
Media
19
Q
What are the precipitating factors of anorexia nervosa?
A
Social exclusion
20
Q
What are the maintaining factors of anorexia nervosa?
A
Isolation
Social media
Family
Culture
Starvation-induced reward feeling
21
Q
What factors can be used to predict development of anorexia?
A
- Earlier pubertal maturation, & higher body fat
- Concurrent psychological problem e.g. depression
- Poor body image
- Specific cognitive phenotypes
22
Q
How does anorexia cause change in neuropsychology?
A
- Loose the ability to see the bigger picture - global processing difficulties
- Association with autism
23
Q
How is the assessment for anorexia made?
A
- Family interview
- Individual interview with child/adolescent
- Physical examination
- Data on growth
- Physical examination & investigations
24
Q
What are the other differential diagnoses of anorexia?
A
Physical:
- Gastro-intestinal disorder eg. crohns disease
- Metabolic eg diabetes
- Pituitary
Psychiatric:
- Other feeding or eating disorder
- Depression
- Psychosis
- Obsessive compulsive disorder
25
How is conduct disorder defined?
* Repetitive & persistent (\> 6 months) pattern of dis-social, aggressive or defiant behaviour
* Frequency & severity beyond age appropriate norms.
26
What are some behaviours associated with conduct disorders?
* 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
27
What are the types of conduct disorder?
* Unsocialized CD
* Socialized CD
* Oppositional CD
* Depressive CD
* Hyperkinetic CD
28
What is the difference between:
Antisocial behaviour
Delinquency/offending
Conduct disorder
* Antisocial behaviour - defined by society
* Delinquency/offending - defined by the law
* Conduct disorder - defined by psychiatry
29
What are the aetological factors for conduct disorders?
* Environmental factors e.g. inner city, school
* This is the main target for therapy
* Family factors e.g. inadequate parenting
* This is the 2nd target for therapy
* Child factors e.g. ADHD, depression
* this is the last target for therapy
30
What is the prognosis of conduct disorders?
Predictor of:
* Antisocial PD in adulthood
* Alcoholism & drug dependence
* Unemployment and relationship difficulties
* 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.
31
What are the symptoms of depression?
* Low mood/sadness
* Loss of enjoyment (anhedonia)
* Loss of energy
Further changes to:
* Appetite / Weight
* Sleep
* Concentration
* Thoughts: Pessimism, Guilt
* Self esteem/confidence
* Libido
* Psychomotor agitation/retardation
* Self harm / Suicide
32
What are the features of type 1 pre-pubertal depression?
* 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
33
What are the features of type 2 pre-pubertal depression?
* Less common
* Highly familial with multigenerational loading for depression
* High rates of anxiety and bipolar disorder
* Recurrences of depression in adolescence and adulthood
34
What is adolescent depressive disorder?
* Irritability instead of sadness/low mood
* Especially in boys
* Somatic complaints and social withdrawal are common
* Psychotic symptoms rare before mid-adolescence
35
What are the treatment options for mild depression?
* Cognitive behavioural therapy [Individual or group]
* Interpersonal psychotherapy for adolescents
36
What are the treatment options for moderate/severe depression?
* Antidepressants e.g. SSRI’s: fluoxetine
* Could be SSRI + CBT (cognitive behavioural therapy)
* Combined treatment -\> highest rate of symptomatic remission in 37% combined vs 20% fluoxetine alone
37
What factors increase the vulnerability to depression?
* Biological changes e.g. genetics, puberty
* Social changes e.g. peers and family
* Life events e.g. losses
* Psychological/cognitive emotional changes
