Define adolescence
Early 11-14
middle 14-17
late 18+
What are the main physical changes in puberty?
Girls - breast budding, growth of pubic hair, growth spurt, menarche, underarm hair, change in body shape
Boys - growth of scrotum and testes, change in voice, lengthening of penis, growth of pubic hair, growth spurt (later than girls), change in body shape, growth of facial and underarm hair
Define puberty
process of physical changes through which a child’s body matures into an adult body capable of sexual reproduction
what are the main endocrine factors associated with puberty?
Testosterone and oestradiol
Neurokinin B and kisspeptin - switches on GnRH
IGF1 - growth
Leptin
Before puberty, the hypothalamus and pituitary are very sensitive to negative feedback signals from testosteron and oestrogen. During puberty, this decreases
What are the normal ages of puberty?
Girls - 8-17
Boys - 9-18
What are the changes in the inset of puberty since mid-19th centruy?
Age of onset lowering
drop of 4 months every decade
Define menarche and adrenarche
menarche - onset of first menstrual cycle
Adrenarche - prior to onset of puberty, increase in androgen production, age 6-10
What are the main psychological changes in adolescence?
Identity vs confusion
Abstract thinking, personal moral compass
What are the main areas of normal social development in adolescence?
More formal groups of friends formed
Friendships - empathic stage - share common interests, make active attempts to understand each other, share personal info, respond sensitively
What are the main features of anorexia nervosa?
Deliberate weight loss, induced and sustained by a dread of fatness and flabbiness - overvalued idea
Patients impose a low weight threshold on themselves
Body weight is 15% below BMI
Pre-pubertal patients may not go through puberty well
Amenorrhoea
loss of libido
HIGHEST MORTALITY RATE of any psychiatric disorder
What are the range of mood disorders?
Depression
Bipolar affective disorder
Psychotic depression
mixed anxiety and depression
What are the main features of conduct disorder?
persistent failure to control behaviour appropriately within socially defined rules
- defiance against authority
- aggressiveness
- antisocial behaviour
What are the risk factors for anorexia?
psychological - depression, anxiety, low self esteem, perfectionism
social - higher social class, profession, media, culture
biological - genetic, hormones
external - childhood abuse, dieting, life events
In what group of people is anorexia most common in?
most common in adolescent girls and women up to menopause
What are the symptoms of anorexia?
restricted diet
excessive exercise
induced vomiting
use of diuretics or appetite suppressants
What are the treatments available for anorexia?
psychological - family therapy, cognitive behavioural therapy
Physical - hospital admin, nasogastric tube feed
What is depression?
can be single symptom or cluster
symptoms persist for at least 2 weeks
irritability
Increased rate of depression in girls from mid/late adolescence
Is there a familial link for depression?
Yes
What’s is the treatment for mild depression?
Support and stress reduction, non-specific counselling
What is the treatment for moderate depression?
3 step plan
support/ stress reduction
cognitive behavioural therpy
medication
What is the treatment for severe depression?
Combo from start
May last for 6-9 months
What is conduct disorder associated with?
More in males
lower socioeconomic class
large family size
What could be the cause of conduct disorder?
immediate environment - parents, sexual abuse
wider environment - school, others
What is the treatment for conduct disorder?
Child-focused: behaviour modification, problem-solving skills training
Family-focused:
- family counselling
- social work
- parent management training
