Puberty and Adolescence - Medlearn Flashcards
What causes growth?
gonadal steroids. (particularly androgens) and GH working together.
What causes the onset of puberty?
2 Theories:
- Maturation of the CNS affecting GnRH neurones (increased pulsatile release)
- Altered set point to gonadal steroid negative feedback What might trigger the maturation of the CNS?
What might trigger the maturation of the CNS? (onset of puberty)
It is unclear
- however, because there is a secular trend to earlier puberty, this suggests environmental factors
a) improved health care
b) improved socio-economic factors (photoperiod? nutrition?)
Age at menarche
- decreased over the last 150 years
- has now levelled off or might be increasing
- body weight at menarche is constant (47kg)
Hormonal influences in menarche
- leptin has a positive effect on kisspeptin neurones
- kisspeptin neurones affect GnRH pulsatility
Psychological influences of pubertal development
- The changes of puberty have significant psychological implications which vary according to gender and cultural background.
- For boys: the changes of puberty e.g. increased height, and musculature are welcomed, and are associated with increased status and athletic prowess.
- For girls: the changes of puberty e.g. increased adiposity are may be associated with ambivalent feelings, in view of the negative attitudes to plumpness, and ambivalent feelings about onset menarche.
- Cultural variation: white English girls are more negative about body shape and weight than African Caribbean girls. Negative attitudes increase as weight and BMI increase.
Implications of Body Shape Dissatisfaction
- Body shape dissatisfaction in creases the urge to reduce weight
- This may be brought about by dieting or other weight controlling methods
- Reduced weight may induce dysphoria (unhappiness) and repeated attempts to control weight
- It also significantly increases the risk of an eating disorder including anorexia nervosa
Cardinal features of anorexia nervosa
- Body weight maintained 15% below expected wight, or BMI < 17.5.
- Weight loss is self-induced
- Psychopathology – dread of fatness, and preoccupation with this.
- Endocrine disturbance: amenorrhoea, or delayed growth and puberty in younger sufferers.
Epidemiology of anorexia nervosa and causes
- Approx 0.5-1% adolescent females. Approx 10% cases or less male.
- Genetic predisposition, perfectionist temperament, specific subcultures, childhood abuse and adversities; perhaps higher social class.
Treatment of anorexia nervosa and outcomes
- Family intervention
- For abnormal eating attitudes and depression: CBT
- Small % need admission for weight restoration
Outcome
- Community sample: 50% recover after 5 years
- Clinic samples: after 1 year 37% recover; 25% weight gain but not menstruating; 37% underweight, symptoms.
Depression - symptom clusters
Affective – sadness, loss of enjoyment, irritability
Cognitive – self-blame, hopelessness, guilt
Biological – disturbed sleep, reduced appetite
May reach threshold for disorder
=> depression can refer to a single symptom, a symptom cluster or a disorder.
Developmental considerations with depression
Endocrine change – especially female may increase risk low mood
Changes in family relationships –physical closeness, joint activities, family conflict
Peers – increased involvement with peers; peer rejection and conflict
Responsibilities and hassles: life events, exams, etc
Epidemiology of depressive disorder
2-5% adolescents
Symptom
- Isle of Wight study:
- 10% of 10 year olds – parents report
- 40% of 14 years olds – self report
Causes of depression
- Familial aggregation; genetic factors known
- Effects of family interaction e.g. criticism
- Life events, adversities
Prognosis of depression
- Major depression: Duration
- In specialist CAMHS settings: 6-9 months
- Primary care: 2-3 months
- High risk recurrence
- Prepubertal onset – better prognosis
- Small number in adolescence – bipolar (mania, hypomania)
