Adolesence Flashcards
What is adolescence?
- Adolescence – phase between childhood & adulthood
- Pubertal development may be start of adolescence
When does adolesence usually start in males and females?
9-12 years
What is adrenarche and when does it start?
- Precursor to puberty - stimulation of adrenal glands
- Females: 6-9 years
- Males: 7-10 years
What happens in adrenarche?
- 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.
How is body fat related to periods?
- Leptin stimulates the release of GnRH from the hypothalamus
- No body fat = periods stop
What is menarche?
- 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
What is the endocrine axis of adrenarche?
- 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
What is the endocrine axis of male puberty?
- 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
What is the endocrine axis of female puberty?
- 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
What are the phases of puberty?
- Phase 1: Pre puberty
- Phase 2-4: Puberty
- Phase 5: Fully developed
What are the 3 measured stages of puberty?
- Axillary hair growth
- Pubic hair growth
- Breast/penis growth
Why is puberty starting earlier than it used to?
Improvements in diet
What are the psychological changes of adolescence?
- Cognition e.g. morality
- Identity
- Increased self-awareness
- Affect expression and regulation
What are the social changes of adolescence?
- Family - parental surveillance, confiding
- Peers
- Increased importance
- More complex & hierarchical
- More sensitive to acceptance & rejection
- Romantic relationships •
- Social role – education, occupation, etc
How does the brain change during adolescence?
- Increases in cortical thickness
- Peaks at aprox 10 years old
- Then begins synaptic pruning - removing unused synapses
What is the developmental mismatch hypothesis?
- 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
What is the definition of anorexia nervosa?
- 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.
What are the predisposing factors of anorexia nervosa?
Pre-morbid weight
Bullying
Genetics
Culture
Media
What are the precipitating factors of anorexia nervosa?
Social exclusion
What are the maintaining factors of anorexia nervosa?
Isolation
Social media
Family
Culture
Starvation-induced reward feeling
What factors can be used to predict development of anorexia?
- Earlier pubertal maturation, & higher body fat
- Concurrent psychological problem e.g. depression
- Poor body image
- Specific cognitive phenotypes
How does anorexia cause change in neuropsychology?
- Loose the ability to see the bigger picture - global processing difficulties
- Association with autism
How is the assessment for anorexia made?
- Family interview
- Individual interview with child/adolescent
- Physical examination
- Data on growth
- Physical examination & investigations
What are the other differential diagnoses of anorexia?
Physical:
- Gastro-intestinal disorder eg. crohns disease
- Metabolic eg diabetes
- Pituitary
Psychiatric:
- Other feeding or eating disorder
- Depression
- Psychosis
- Obsessive compulsive disorder
How is conduct disorder defined?
- Repetitive & persistent (> 6 months) pattern of dis-social, aggressive or defiant behaviour
- Frequency & severity beyond age appropriate norms.
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
What are the types of conduct disorder?
- Unsocialized CD
- Socialized CD
- Oppositional CD
- Depressive CD
- Hyperkinetic CD
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
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
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.
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
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
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
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
What are the treatment options for mild depression?
- Cognitive behavioural therapy [Individual or group]
- Interpersonal psychotherapy for adolescents
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
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
