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Y2 RDA (LCRS1) > Adolesence > Flashcards

Adolesence Flashcards

1
Q

What is adolescence?

A
  • Adolescence – phase between childhood & adulthood
  • Pubertal development may be start of adolescence
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2
Q

When does adolesence usually start in males and females?

A
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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
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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.
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5
Q

How is body fat related to periods?

A
  • Leptin stimulates the release of GnRH from the hypothalamus
  • No body fat = periods stop
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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
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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
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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
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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
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10
Q

What are the phases of puberty?

A
  • Phase 1: Pre puberty
  • Phase 2-4: Puberty
  • Phase 5: Fully developed
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11
Q

What are the 3 measured stages of puberty?

A
  • Axillary hair growth
  • Pubic hair growth
  • Breast/penis growth
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12
Q

Why is puberty starting earlier than it used to?

A

Improvements in diet

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13
Q

What are the psychological changes of adolescence?

A
  • Cognition e.g. morality
  • Identity
  • Increased self-awareness
  • Affect expression and regulation
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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
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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
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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
Q

How is conduct disorder defined?

A
  • Repetitive & persistent (> 6 months) pattern of dis-social, aggressive or defiant behaviour
  • Frequency & severity beyond age appropriate norms.
26
Q

What are some behaviours associated with conduct disorders?

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
27
Q

What are the types of conduct disorder?

A
  • Unsocialized CD
  • Socialized CD
  • Oppositional CD
  • Depressive CD
  • Hyperkinetic CD
28
Q

What is the difference between:

Antisocial behaviour

Delinquency/offending

Conduct disorder

A
  • Antisocial behaviour - defined by society
  • Delinquency/offending - defined by the law
  • Conduct disorder - defined by psychiatry
29
Q

What are the aetological factors for conduct disorders?

A
  • 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
Q

What is the prognosis of conduct disorders?

A

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
Q

What are the symptoms of depression?

A
  • 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
Q

What are the features of type 1 pre-pubertal depression?

A
  • 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
Q

What are the features of type 2 pre-pubertal depression?

A
  • Less common
  • Highly familial with multigenerational loading for depression
  • High rates of anxiety and bipolar disorder
  • Recurrences of depression in adolescence and adulthood
34
Q

What is adolescent depressive disorder?

A
  • Irritability instead of sadness/low mood
  • Especially in boys
  • Somatic complaints and social withdrawal are common
  • Psychotic symptoms rare before mid-adolescence
35
Q

What are the treatment options for mild depression?

A
  • Cognitive behavioural therapy [Individual or group]
  • Interpersonal psychotherapy for adolescents
36
Q

What are the treatment options for moderate/severe depression?

A
  • 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
Q

What factors increase the vulnerability to depression?

A
  • Biological changes e.g. genetics, puberty
  • Social changes e.g. peers and family
  • Life events e.g. losses
  • Psychological/cognitive emotional changes

Y2 RDA (LCRS1) (8 decks)

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