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Y2 LCRS 1 - Pharm, Endo, Reproduction > RDA; Lecture 4, 5 and 6 - Adolescent psychological development, Depression, Anorexia and Conduct Disorder; Ageing > Flashcards

RDA; Lecture 4, 5 and 6 - Adolescent psychological development, Depression, Anorexia and Conduct Disorder; Ageing Flashcards

1
Q

RDA

What are the developmental stages of adolescence?

A

Early = 11-14; middle = 14-17; late = 18-21

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2
Q

RDA

What are the gender differences of development in adolescents?

A

Girls grow taller earlier than boys

Girls start puberty earlier than boys

Girls are physically mature in general 2 years earlier

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3
Q

RDA

What are the pubertal changes in different sexes during adolescence?

A

x

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4
Q

RDA

What are the clinical implications of the different ages of maturation between the sexes?

A

Early maturing girls and late maturing boys are at higher risk of: Depression Substance abuse Disruptive behaviour/Delinquency Eating Disorder Bullying

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5
Q

RDA

What are the changes in the brain that occur during puberty?

A
  • Grey matter volumes decrease from 6 years-adolescence
  • Linear increase in white matter - 20 years
  • Developmental curves peak at ~12years: frontal and parietal lobes ~16 years: temporal lobes
  • NB: Brain develops from back to the front, with higher thinking developing at around 13 as prefrontal cortex is mainly involved.
  • Synapses are selected , with the ones important for development kept and the ones that aren’t necessary are removed = called pruning
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6
Q

RDA

What cellular processes occur in brain development during puberty?

A

Synaptogenesis followed by pruning (synapse elimination) Axonal myelination [speeds up nerve conduction] Fine tune prefrontal cortex and other cortical regions Cortical function becomes fine-tuned with development. Brain regions associated with more basic functions such as sensory and motor processes mature first, followed by association areas involved in top-down control of behaviour

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7
Q

RDA

What are Piaget’s 4 stages of cognitive development?

A

Symbolic thinking = imagine a bottle is a plane and play with it like a plane

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8
Q

RDA

What is Kohlberg’s theory of moral development?

A

Moral reasoning (basis for ethical behaviour), has 6 developmental stages, each > adequate at responding to moral dilemmas than its predecessor.

Sequence is fixed

Many people never obtain highest level [some adults continue to think in immature terms]

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9
Q

RDA

When do you acquire postconventional moral reasoning in adolescence (Kohlberg’s stages)?

A

x

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10
Q

RDA

What is self concept?

A

Intellectual development = more complex self-concept Pubertal & social changes = self concept Adolescence struggle to understand self Different ways conceptualising self –concept Most common described dimensions of self-concept

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11
Q

RDA

What are the 8 dimensions of self-concept (Harter)?

A

Scholastic competence Job competence Athletic competence Physical appearance Social acceptance Close friendships Romantic appeal Conduct

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12
Q

RDA

What are the clinical implications of emotional development (self concept)?

A

x

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13
Q

RDA

When is identity formed and what are Erikson’s 8 life-span stages?

A

Search for identity important at this stage

Coincides with physical growth

Need for important life decisions

Resolution may be through “crisis”

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14
Q

RDA

What is Marcia’s view on identity formation?

A
  • ID status develops over time;
  • only moratorium is necessary for ID development;
  • extent of crisis is debated/unnecessary.
  • ID associated with highest:
    • Achievement
    • Moral reasoning
    • Career maturity
    • Social skills
    • Lower anxiety
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15
Q

RDA

How is ethnic identity in cultural minorities carried out?

A

x

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16
Q

RDA

What are the clinical implications of ethnic identities?

A

Varied parental expectations (duties etc.) Gender differences May generate conflict

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17
Q

RDA

How do family relationships affect development?

A

Development of autonomy and continuation close relationships Social domains - adolescents and parents may have different views about who has final say depending on “Domain”: friendships, clothes, career etc. Mid-adolescence: most intense negotiations

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18
Q

RDA

What kind of conflicts occur with parents during social development?

A

Most adolescents report good relationships parents Get on well with mother 86% father 80% High confiding to mothers Disagreements around dress, music choice, leisure activities, time of coming home, tidying bedrooms.

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19
Q

RDA

How does family connectedness manifest and what are the benefits?

A

x

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20
Q

RDA

How do peers affect development in primary school 7-11y?

A

Friends shared activities Main goal: acceptance by same gender group Stable preference for same gender friends Loyalty built on earlier interactions

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21
Q

RDA

How do peers affect development from 11-18y?

A
  • Variations in friendships (popularity <=> rejection)
  • Rejected children less satisfying friendships
  • Gender differences:
    • Girls: close relationships, more confiding, more brittle
    • Boys: less intimate, less disclosing, friendships more embedded in larger circle
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22
Q

RDA

What is the difference between parental and peer influence?

A

x

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23
Q

RDA

What are the opportunities and risks of online generation?

A

x

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24
Q

RDA

How does the school and classroom affect development?

A

A study showed that there are higher chances to achieve 5+ GCSE’s A*-C, girls achieve better than boys, can be ethnic variations

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25
Q

RDA

What is anorexia nervosa (ICD10 criteria)?

A

ICD10 criteria = Body wt at least 15% below expected (<17.5 BMI) Avoidance of “fattening” foods (may also be self-induced vomiting, purgative abuse, alternating periods of starvation, drugs eg appetite suppressants, laxatives) Psychopathology-morbid dread of fatness, aims for wt lower than premorbid or healthy Endocrine disturbance (amenorrhea in women and men lose sexual interest) May also be other wt loss behaviours.

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26
Q

RDA

What is anorexia nervosa (DSM5 criteria)?

A

x

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27
Q

RDA

What is bulimia nervosa (ICD10)?

A

Persistent preoccupation with eating, and an irresistible craving for food, succumbs to episodes of eating large amounts of food in short periods of time binges Wt losing behaviours: Purging: by vomiting, taking a laxative, diuretic, or stimulant, &amp;/or excessive exercise Psychopathology- morbid dread of fatness, aims for wt lower than premorbid or healthy

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28
Q

RDA

What is bulimia nervosa (Dsm 5)?

A

x

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29
Q

RDA

What pubertal development occurs in boys?

A

x

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30
Q

RDA

What pubertal development occurs in girls?

A

x

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31
Q

RDA

What are the influences of fashion and media on girl development?

A

Influence of media/fashion Hard to prove direction of causality Models/mannequins getting slimmer last 50 years Slimmer body shapes attractive

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32
Q

RDA

How can you predict eating problems in girls?

A

Earlier pubertal maturation and higher body fat; concurrent psychological problem. Dieting (severe level) can lead to 16x more probability to have eating difficulties

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33
Q

RDA

What is the epidemiology of anorexia nervosa?

A

x

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34
Q

RDA

What is the trend in puberty in girls?

A

Puberty starting earlier

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35
Q

RDA

What is the aetiology of anorexia nervosa - what are the causes?

A

MULTIFACTORIAL!!!! Traumatic event; genetic predisposition, perfectionist temperament, specific subcultures, childhood abuse and adversities, perhaps higher social class

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36
Q

RDA

What are the corresponding neuropsychological mechanisms of anorexia nervosa?

A

Association anorexia nervosa and ASD

Weak central coherence in ED’s Global processing difficulties [review]

Poorer global processing -> Weak central coherence (limited ability to understand context or to “see the big picture”)

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37
Q

RDA

How does anorexia nervosa present?

A

x

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38
Q

RDA

How do you assess for anorexia nervosa?

A

Family interview, individual interview with child/adolescnet, physical exam and investigations and data on growth

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39
Q

RDA

What are the probable differential diagnoses for anorexia nervosa?

A

*Physical Gastro-intestinal disorder e.g.. Crohns disease Metabolic e.g. diabetes Pituitary *Psychiatric Bulimia nervosa Depression Psychosis Obsessive compulsive disorder (OCD)

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40
Q

RDA

What treatment options exist for anorexia nervosa?

A

Admission for weight restoration in a minority of cases - Family therapy - Nutritional counselling - Cognitive behaviour therapy (CBT) - Treatment of persistent depression etc.

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41
Q

RDA

What are the 3 stages of family therapy for anorexia nervosa?

A

TREATMENT OF CHOICE 1) Initial focus of adolescents need to eat Parents/carers to take charge/supervise 2) Adolescent gradually assumes more control of eating Graded improvement in social function 3) Address other developmental/ relationship/life cycle issues

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42
Q

RDA

How does cognitive behavioural therapy work in anorexia nervosa?

A

x

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43
Q

RDA

What is the prognosis of anorexia nervosa?

A

Mortality at 20y follow up is 15-20%

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44
Q

RDA

What developmental features characterise adolescence?

A

Cognitive/emotional changes, family, peers and biology

45
Q

RDA

What defines anti-social behaviour, delinquency/offending and conduct disorder?

A

x

46
Q

RDA

What is a conduct disorder?

A

x

47
Q

RDA

What are the behaviours of conduct disorders?

A

x

48
Q

RDA

What are the types of conduct disorder?

A

x

49
Q

RDA

What is cyberbullying and how does that affect adolescent aggression?

A

x

50
Q

RDA

What is the epidemiology of conduct disorder?

A

x

51
Q

RDA

What is the ecological framework for aetiology of conduct disorder?

A

x

52
Q

RDA

What are the factors and causes of conduct disorder?

A

x

53
Q

RDA

How does the familial relationship affect conduct disorder?

A

x

54
Q

RDA

How does the social and neighbourhood relationship affect conduct disorder?

A

x

55
Q

RDA

What is the impact of conduct disorder?

A

x

56
Q

RDA

What interventions can be used in conduct disorder?

A
  • Best treatment: **prevention**
  • Cognitive problem solving skills:
  • Adolescents with CD may have distorted attributions of aggressive intentions in other people.
  • Techniques to develop more accurate perceptions.
  • Teaching of problem-solving skills including range of options and their consequences.
57
Q

RDA

What are the key aspects of parenting programmes?

A

i) Play and good times together ii) Praise and recognition for good behaviour iii) Clearly expressed expectations iv) Consistent &amp; calm consequences for misbehaviour v) planning ahead to avoid trouble

58
Q

RDA

What are other interventions for conduct disorder?

A

x

59
Q

RDA

What is the prognosis of conduct disorder?

A

x

60
Q

RDA

What are the symptoms of depression disorder?

A

Increase of symptoms -> increase of impairment.

Degree of depression determined by:

  • not depressed (< 4 symptoms)
  • mild depression (4 symptoms)
  • moderate depression (5 to 6 symptoms)
  • severe depression (7 or > symptoms, with or without psychotic symptoms).

Symptoms are pervasive, impairing and present for at least 2wks -> affective (sadness, loss of enjoyment, irritability), biological (disturbed sleep, reduced appetite), cognitive (self blame, hopelessness, guilt)

61
Q

RDA

What are the associated problems with depression?

A

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

62
Q

RDA

How does childhood depression present clinically?

A

Persistent and pervasive; Relatively unresponsive to pleasurable activities, interactions and attention from other people Functional impairment is an important distinguishing factor from the normal mood fluctuations of childhood

63
Q

RDA

What are the 2 main types of pre-pubertal depression?

A

x

64
Q

RDA

What is the difference between normal adolescent angst vs psychiatric disorders?

A

‘Normal adolescent angst’: Mastering the tasks of development physical, cognitive, social, emotional, moral Psychiatric disorder: Symptoms -> Serious suffering/impairment personal, family, peers, education/work

65
Q

RDA

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

66
Q

RDA

What is the epidemiology of depression?

A

FHx of major affective disorders usually depression exist

67
Q

RDA

What is the amine hypothesis of depression?

A

Suggests that depression results from hypo-activity of monoamine NT reward systems

68
Q

RDA

What are the developmental changes that occur during puberty which can lead to depression?

A

Endocrine changes, changes in family relationships, peers, responsibility and hassles

69
Q

RDA

What are the cognitive and emotional changes that occur during puberty which can lead to depression?

A

x

70
Q

RDA

What are the social and relationship changes that occur during puberty which can lead to depression?

A

x

71
Q

RDA

What are the developmental changes and vulnerability to depression?

A

x

72
Q

RDA

What are the treatments for depression?

A

x

73
Q

RDA

How is cognitive behavioural therapy used in depression?

A

x

74
Q

RDA

What is interpersonal psychotherapy in treatment of depression?

A

Conceptualises depression as occurring within an interpersonal matrix and targets resolution of interpersonal stress that seem to be associated with it.

Starts by taking an interpersonal inventory of important relationships.

75
Q

RDA

What medication can be given for depression?

A

No difference between TCA (Tricyclic AD) and placebo Several studies have demonstrated efficacy with selective serotonin reuptake inhibitors (SSRI) Esp. using fluoxetine This may be reflective of an overall developmental difference in so far as adolescents and younger adults may respond better to serotonergic agents

76
Q

RDA

What is a key feature of depression in adolescence?

A

Higher levels of irritability

77
Q

RDA

What is ageing?

A

Process of growing older -> biological, psychological/cognitive and social

78
Q

RDA

What is life expectancy?

A

Statistical measure of how long a person can expect to live -> increasing, with popn getting older overall, led by falling fertility rates and people living longer overall

79
Q

RDA

Why do people age?

A

Programmed ageing - genetic, Hayflick limit (cells appear to be able to count, reaching a certain number of divisions and then stopping - thought to be enough to allow organism to reach maturity and reproduce, reducing risk of Cancer); damage/error theories ->Free radical-oxidative stess due to reactive oxygen species exceeding antioxidant capacity - mitochondria remain source of radicals, but also come from macrophages, peroxisomes, cytochrome P450, supported by people with chronic inflammation/infections clinically age more rapidly; DNA damage -> frequent damage to DNA whilst it is being transcribed, which DNA polymerase can’t always repair, leading to damage accumulation and contributing to eventual cell death

80
Q

RDA

What are the challenges society faces as a result of an ageing popn?

A

Outdated and ageist beliefs/assumptions

Working life/retirement balance

Medical system designed for single acute diseases

Extending healthy old age not just life expectancy Inadequate or absent services

Lack of accessibility for people with disabilities

81
Q

RDA

What decides if we are healthy in old age or not?

A
  • Small proportion due to genetic inheritance, most due to ongoing interactions between broader characteristics of individuals and environment (home, enighbourhood and community). sex and ethnicity, occupation, educational attainment, wealth, contributing to social position and ability to access resources
82
Q

RDA

What are the benefits that the ageing popn give?

A

Older people make +ve contributions to society, so health and social care expenditures for them are an investment not a cost

83
Q

RDA

What is social care in England like?

A

Councils are reducing/freezing the amount they pay care agencies and homes, despite ageing popn

84
Q

RDA

What is frailty?

A
  • Loss of biological reserve across multiple organ systems, leading to vulnerability to physiological decompensation and functional decline after a stressor event.
  • When we have a ‘stressor’ event its fine, we bounce back.
  • When old frail people have a ‘stressor’ event end up with less functional, in hospital and can’t bounce back fast enough.
  • Much longer to get back up to a good level, which may not even be the same level that they were previously at
  • Loss of biological reserve
  • Cumulative damage
  • STRESSOR EVENT
  • Falls and delirium
  • Functional decline
85
Q

RDA

What is the cycle of frailty?

A

x

86
Q

RDA

What is frailty associated with?

A

Increased risk of falls, worsening disability, care home admission, death

87
Q

RDA

How can we treat frailty?

A

Exercise, nutrition and drugs (possibly) -> prevention better than cure

88
Q

RDA

What are the 5 giants of Geriatrics?

A

Instability Immobility Incontinence Intellectual impairment Iatrogenic harm

89
Q

RDA

What is the problem with non-specific presentations in frailty?

A

Older people are less likely to have common, “textbook” symptoms of disease ACS - Less likely to have chest pain PE - Less likely to have pleuritic chest pain Less likely to have haemoptysis More likely to have other symptoms ACS - More likely to have shortness of breath PE - More likely to have syncope

90
Q

RDA

What is multimorbidity?

A

2 or more chronic conditions.

Conditions impact on one another

Treatment for one condition may impact on another

Negative impacts:

  • Worse QoL, more likely to be depressed
  • Increased functional impairment
  • Burden of treatment
  • Polypharmacy
91
Q

RDA

Why is polypharmacy affecting the ageing popn?

A

Comorbidities Guidelines/QOF/NICE

Undetected non adherence

Infrequent review

Poor communication.

Up to 405 of prescriptions are inappropriate, associated with bad outcomes -> falls, increased length of stay, delirium and mortality

92
Q

RDA

What iatrogenic harm can occur to older frail popn?

A

Adverse reactions to medications -Nosocomial conditions: Infections Pressure sores Constipation Deconditioning Delirium Malnutrition Incontinence -Falls Pyschological/cognitive damage 2-36% of inpatients, with half probably avoidable

93
Q

RDA

How do adverse drug reactions affect older popn?

A

Up to 17% of hospital admissions due to drug reactions -> more meds taken = greater risk. Drugs most likely to cause hospital admission: NSAID 30% Opioid 6% Warfarin 10% Digoxin 3% Antidepressant 7%

94
Q

RDA

What is the comprehensive geriatric assessment?

A

CGA in the community1 Reduce admissions to institutional care Reduce falls Most benefit in mild or moderate frailty CGA for frail inpatients2 Reduces inpatient mortality Reduces functional and cognitive decline Reduces admission to institutional care. Multidisciplinary assessment -> medical, functional, social, psychological/psychiatric; problem list, plan

95
Q

RDA

What is the aim of rehab?

A

To restore/improve funcitonaity, multidisciplinary, rehab alongside acute illness (prevent deconditioning), rehabilitation

96
Q

RDA

What are the changes in the ageing brain?

A

White matter reduction; grey matter reduction -> mainly in size and number of connections between neurones not in neuron number.

CSF increases as well, with larger size in ventricles and gaps between major gyr widen

97
Q

RDA

What are the normal cognitive changes in older people?

A

Reduciton in inductive reasoning from 45y, reduction in mental flexibility, ability to generate novel soln to problems and response inhibition from 70y

98
Q

RDA

What is dementia?

A

Decline in all cognitive functions, not just memory

Impairment of function

Progressive

Degenerative

Irreversible, chronic

West London diagnosis rate is 76%

99
Q

RDA

What are the types and causes of dementia?

A

x

100
Q

RDA

What is the difference between demetia and delirium?

A

x

101
Q

RDA

What cognitive assessments are carried out for dementia?

A

AMT, MOCA, MMSE, CAM and 4AT

102
Q

RDA

What is the abbreviated mental test and what are the problems with it?

A

Very orientation focused

Orientation can be well preserved in some forms of dementia

Assumes cultural knowledge/interest (WW2, PM)

Assumes numeracy

Monarch or PM could give different results

No time limit on 20-1

Person recognition can be difficult in hospital

103
Q

RDA

What are the problems with cognitive assessments?

A

Most assumes some basic cultural knowledge Most assume numeracy and literacy Depression can masquerade as dementia Ceiling effects in highly educated/intelligent Interpret them in context

104
Q

RDA

What is the role of Kisspeptin in puberty?

A

Initiates secretion of GnRH at puberty, which triggers release of LH/FSH; encoded by KISS1 gene; it’s a G-protein coupled receptor ligand for GPR54

105
Q

RDA

What are the causes of depression?

A

Familial aggregation, effects of family interaction and life events/adversities

106
Q

RDA

Summarise depression in adolescents - symptoms, epidemiology, prognosis, causes and interventions

A
107
Q

RDA

Summarise conduct disorder - clinical features, epidemiology, developmental considerations, causes, outcome and interventions

A

x

108
Q

RDA

Summarise anorexia nervosa - cardnal features, epidemiology, causes, outcome and treatment

A

x

109
Q

RDA

What is delirium?

A

Delirium is an acute episode of confusion, usually with clear precipitant such as infection/medication changes; usually resolves but can leave residual problems

Y2 LCRS 1 - Pharm, Endo, Reproduction (19 decks)

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