Reproduction 6 - Adolescence Flashcards
Why does growth occur?
- Due to gonadal steroids (androgens) working in conjunction with other hormones
- Particularly somatotrophin from the adenohypophysis
What are the two theories for the onset of puberty?
- Maturation of the CNS affecting GnRH neurones (increased pulsatile release)
- Altered set point to gonadal steroid negative feedback
Why is there a trend towards earlier puberty?
- Improved health care
- Improved socioeconomic factors (nutrition)
How has age and weight at menarche changed?
- Decreased over the last 150 years
- Levelled off over the last 3-4 decades
- Body weight has remained approximately 47kg
Describe the role of kisspeptin in puberty
- Kisspeptin stimulates GnRH and GnRHR
- Increased leptin can stimulate kisspeptin and therefore stimulate more GnRH
- Therefore, childhood obesity leads to early puberty
What are the psychological impacts of puberty?
- In boys, changes in puberty are welcomed and associated with increased status and athletic prowess
- In girls, increased adiposity associated with ambivalent feelings due to negative attitudes towards plumpness
- English girls are more negative about body shape and weight, and these attitudes increase as weight increases
- Increased self awareness, identity, cognition, affect expression and regulation
What are the 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.
List the cardinal features of anorexia nervosa
- Body weight maintained 15% below expected weight, or BMI < 17.5. (weight is low for that persons development and physical health)
- Weight loss is self-induced
- Psychopathology – dread of fatness, and preoccupation with this. (weight/shape concerns)
- Endocrine disturbance: amenorrhoea, or delayed growth and puberty in younger sufferers.
- Restrictive/ binge purge subtype
Describe epidemiology of anorexia nervosa
- Approx 0.5-1% adolescent females.
- Approx 10% cases or less male.
List causes of anorexia nervosa
- Formulation approach used
- Genetic predisposition (biopsychosocial)
- Perfectionist temperament
- Specific subcultures
- Childhood abuse and adversities
- Perhaps higher social class.
- Weak central coherence (ability to see the big picture)
What is treatment of anorexia nervosa?
- Family intervention
- For abnormal eating attitudes and depression: cognitive behavioural therapy.
- Small % need admission for weight restoration
What are the outcomes for anorexia nervosa patients?
- Community sample: 50% recover after 5 years
- Clinic samples: after 1 year 37% recover; 25% weight gain but not menstruating; 37% underweight, symptoms.
- Highest mortality of mental health disorders (5-10% death at 20 years)
Describe depression
- May refer to a single symptom, a symptom cluster or a disorder. (Depression is a continuum)
- 10% of 10 year olds and 40% of 14 year olds self report symptoms
List symptom clusters of depression
- Affective – sadness, loss of enjoyment (anhedonia), irritability
- Cognitive – self-blame, hopelessness, guilt
- Biological – disturbed sleep, reduced appetite
- May reach threshold for disorder (symptoms and impairment must be present at least 2 weeks)
What are the developmental considerations of 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
What is the prevalence of depressive disorder?
2-5% of adolescents
List causes of depressive disorder
- Familial aggregation; genetic factors known
- Effects of family interaction e.g. criticism
- Life events, adversities
What is the prognosis of depresssive disorder
- 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)
What are the interventions used in depressive disorder?
- Cognitive behavioural therapy
- Interpersonal psychotherapy
- Family intervention for associated family problems
- Antidepressants – selective serotonin reuptake inhibitors e.g. fluoxetine for moderate – severe depression.
What is conduct disorder?
Persistent (over 6 months) failure to control behaviour appropriately within socially defined rules.
List clinical features of conduct disorder in children
- Looses temper and argues
- Defies adult requests or rules
- Bullies, fights or intimidates,
- Stealing, breaking into cars or houses, destroys property
- Running away, truanting
List developmental considerations in conduct disorder
- Changes in family relationships – less direct surveillance, physical closeness, joint activities
- Peers – increased involvement with peers; may amplify antisocial behavior
- Experimentation and risk taking – rule violation, drugs and alcohol, petty offending frequent.
Describe epidemiology of conduct disorder
- 4% at ages 5-10 years; 6% at ages 10-15 years; overall 5% at ages 5-15 years.
- Higher in deprived inner-city areas
- Boys: girls 3:1
- Age of onset may vary
- Associated with larger family size and lower socio-economic status
List causes of conductive disorder
- Genetic – weak
- Child – difficult temperament
- Family – poor parenting, discord, lack warmth, inconsistent discipline, coercive interaction, aggression
- Wider environment (poor schools, neighbourhoods)
What is the outcome in conductive disorder?
- Poorer outcome with more problems in child, and family
- Risk of antisocial personality disorder in males
- Range of emotional and personality disorders in females
List interventions used in conductive disorder
- For child – problem solving skills.
- Parent training
- Family intervention
- Address problems across contexts e.g. in school
- Manage underlying hyperactivity
What is adolescence?
- Phase between childhood and adulthood (child under 18)
- New adolescence 10-25
What changes during adolescence?
- Emotional change, cognitive change (higher awareness of the world)
- Self awareness (reflective functioning)
- Self identity
- Changing family rules, less confiding in parents
- Puberty/ endocrine changes and physical growth
- Peer activities/ confiding, sexual relationships, peer group influences values and behaviour (acceptance and rejection)
What is adrenarche?
- Development of axillary and pubic hair under drive of the adrenal glands, precursor of puberty (DHEA and DHEAS)
- Females 6-9 years and males 7-10 years
- Role is uncertain
What is puberty?
- Development of sexual characteristics, mediated by the gonads.
- Girls develop earlier than boys
What are the stages of puberty?
Females
- Breast budding
- Growth of pubic hair
- Growth spurt
- First period
- Growth of underarm hair
- Change in body shape
- Adult breast size
Boys
- Growth of scrotum and testes
- Change in voice
- Lengthening of penis
- Growth of pubic hair
- Growth spurt
- Change in body shape
- Growth of facial and underarm hair
Describe brain development in puberty
- Pruning - decrease in grey matter with increase in white matter (until age 20)
- Increase in cortical thickness and then decrease again
- Changes in the grey, white and opiodinergic increase vulnerability to risk taking (miscalculations of risk)
Describe formation of mental health problems in young people
- 1/10 children age 5-16 have a diagnosable condition
- 1/2 of all mental health problems are established by age 14
- 3/4 of all mental health problems are established by age 24
Which disorders develop in adolescence?
- Emotional disorders
- Behavioural, hyperactivity and less common disorders are more evenly spread between childhood/adolescence
List types of depression
- Mild
- Moderate
- Severe
OR
- Depressive episode (~ 50% recur)
- Recurrent depression
- Dysthymia
- Bipolar depression
- Psychotic depression
- Atypical depression
- Seasonal affective disorder (SAD)
- ?Inflammatory subtype
List associated problems with depression
- Increased risk of self harm
- Association with anxiety, eating disorders, substance misuse
- Familial aggregation
List the two types of pre-pubertal depression
Type 1
- 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
Type 2
- Less common
- Highly familial with multigenerational loading for
depression
- High rates of anxiety and bipolar disorder and
- Recurrences of depression in adolescence and adulthood
What is treatment of depression?
Mild depression
- Cognitive behavioural therapy [Individual or group]
- Interpersonal psychotherapy for adolescents
- Brief Psychosocial Intervention
Moderate-Severe Depression
- Antidepressants e.g. SSRI’s: fluoxetine
- Could be SSRI + CBT
List types of conduct disorders
- Unsocialized CD
- Socialized CD
- Oppositional CD
- Depressive CD
- Hyperkinetic CD
Compare the age of puberty in males and females
- Peak for girls is 11-13.5
- Peak for boys is 13-15
- Girls start puberty around age 8, while boys start around age 10.5
List developmental stages of adolescence
- Early 11-14
- Middle 14-17
- Late 18-21
What is adolescent depressive disorder?
- Irritability instead of sadness
- Social withdrawal
- High recurrence and impairment in later adult relationships
- 3-8% prevalence
Describe cognitive development in adolescence
Piaget’s stages:
- Birth to 2 years Sensorimotor stage.
- 2-7 years Preoperational stage – symbolic thinking.
- 7-11 years Concrete operational stage – reason logically.
- 11-15 years Formal operational stage – abstract, idealistic and logical reasoning.
Kohlberg’s theory of moral development:
- Level 1 & 2 Pre-conventional – desire to avoid punishment.
- Level 3 & 4 Conventional – to illicit validation from others.
- Level 5 & 6 Post-conventional – internal moral code and independent of others.
