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Adolescence Flashcards

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1
Q

What is adolescence?

A

The stage of life between childhood and adulthood, when pubertal development begins (10-20yrs/10-25yrs)

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2
Q

List some cognitive/emotional changes which occur with adolescence

A 
Emotional changes (mood swings)
Reasoning becomes more abstract (e.g. thinking about morality)
Greater self awareness
Greater awareness of the world 
Development of identity
Expression and regulation are affected
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3
Q

What is the precursor of puberty?

A

Adrenarche

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4
Q

What is adrenarche?

A

The development of axillary and pubic hair, oily skin, body odour and acne (essentially pre-puberty)

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5
Q

When does adrenarche happen in females and males?

A

Females: 6-9years
Males: 7-10years

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6
Q

A rise in which hormones causes adrenarche?

A

Adrenal 19-carbon steroid
DHEA (dehydroepiandrosterone)
DHEAS (dehydroepiandrosterone sulphate)

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7
Q

Summarise the role of the HPA on puberty

A

Hypothalamus produces GnRH
GnRH acts on pituitary
LH and FSH are produced
These act on the gonads.

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8
Q

What is the consequence of LH and FSH acting on the gonads in males and females?

A 
MALES:
Development of:
Penis
Pubic hair
Testes
Sperm production

FEMALES:
Development of:
Breasts
Ovaries 
Uterus 
Egg production 
Menarche
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9
Q

What is the average age for a girl and a boy to hit puberty?

A

Girl - 12 years

Boy - 15 years

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10
Q

Describe the Tanner’s 5 stages of puberty in girls

A 
Breast budding (8-13)
Growth of pubic hair (8-14) 
Growth spurt (9.5-14.5)
First period (10-16)
Growth of underarm hair (10.5-16.5)
Change in body shape (11-4.5)
Breasts become adult sized (12.5-16.5)

Note: you can be pre-pubertal at aged 13 or fully pubertal at aged 13 - the normal range varies

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11
Q

Describe the pubertal changes as boys grow

A 
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
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12
Q

What are the psychological changes linked to puberty?

A

Cognition e.g. morality
Identity (incl. gender identity)
Increased self-awareness
Affect expression and regulation (emotional regulation)

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13
Q

What are the familial social changes that occur with puberty?

A

Family - parental surveillance, confiding

Role of the parent changes during puberty

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14
Q

What are the social changes that occur with puberty amongst peers?

A

Peers become more important
More complex and hierarchical relationships form
Young people become more sensitive to acceptance and rejection
Romantic relationships

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15
Q

What social roles do post-pubertal teenagers start thinking about?

A

Education

Occupation

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16
Q

What other things can influence or affect teenagers?

A 
School
Work/unemployment 
Cultures e.g. social media, teen subculture, migration
Housing/neighbourhood 
Poverty/affluence
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17
Q

What is the official name for the hypothesis where ‘growing teenagers’ actually behave in self-destructive ways?

A

Developmental mismatch hypothesis

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18
Q

What is the developmental mismatch hypothesis?

A

As grey matter changes to white matter, mismatch between cognitive control and integration of affect means that risk perception is poor, leading to risk behaviours.

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19
Q

List some high risk behaviours

A 
Unprotected sex 
Delinquency (minor crime)
Violence
Self-harm
Lack of hygiene
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20
Q

What is the ICD-10 criteria for anorexia nervosa?

A

Body weight at least 15% below expected weight (but no number given)

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21
Q

What is anorexia nervosa?

A

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)

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22
Q

What is associated with anorexia nervosa?

A

Endocrine disturbance

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23
Q

What are the four ‘p’s in psychiatric conditions?

A

Predisposing
Precipitation
Perpetuating
Protective

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24
Q

What factors should we consider when thinking about why a condition has come on?

A

Systematic
Familial
Individual

or biological, psychological and social

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25
Give some examples of predisposing factors
``` Poor self image Bullying/teasing in childhood Culture/western society Childhood neglect Parents/role models with ED Obese parents Family pressure High-stress environment High achieving Genetics Obesity ```
26
List some precipitating factors
``` Bullying End of relationships/relationship changes Weight gain in puberty/sudden weight gain Adverse life events e.g. bereavement Change in diet Separation from parents Friends losing weight Social media comments Friends with MH disorders Comments from family members ```
27
Give some examples of perpetuating factors
``` Isolation Social media Feeling of control Bullying Lack of support Positive reinforcement Family/social circles Sporting success Admiration from friends Body dysmorphia ```
28
What are the traits or cognitive style of someone with AN?
Obessionality Perfectionism Deficits in social cognition Inflexibility
29
Describe the cycle of AN
Diet Weight loss (pt could recover at this stage) Starvation-induced changes (could become chronic illness) Increased anxiety, depression, obsessionality (back to diet)
30
What happens at puberty which could precipitate AN?
Development of the brain Hormonal changes Stressful life events Receptiveness to cultural values
31
Give some predictors of developing eating disorders
``` Earlier pubertal maturation Higher body fat Concurrent psychological problem Poor self image Specific cognitive phenotypes ```
32
What psychological changes are associated with AN and what else is this associated with?
Executive function deficits (also associated with ASD): Weak central coherence i.e. global processing difficulties Impaired set shifting
33
How would you assess someone with AN?
Family interview Individual interview with child/adolescent Physical examination Gather data on growth Further physical examination and investigations
34
What are the physical differential diagnoses for AN?
GI disorders e.g. Crohn's Metabolic disorders e.g. diabetes Pituitary problems
35
What are the psychiatric differential diagnoses for AN?
Other eating disorders Depression Psychosis OCD
36
What is conduct disorder?
Repetitive and persistent pattern of breaking the law/being anti-social for over 6 months - the frequency and severity is beyond age appropriate norms.
37
Give examples of behaviours in conduct disorder
``` Oppositional behaviour, defiance Tantrums Excessive levels of fighting or bullying, assault Running away from home Truancy (skipping school) Cruelty to animals Stealing Destructiveness to property Fire-setting ```
38
List the types of CD
``` CD confined to family context Unsocialised CD Socialised CD Oppositional CD Depressive CD Hyperkinetic CD ```
39
Compare the epidemiology of CD vs anti-social behaviour
Conduct disorder - commonest psychiatric disorder of childhood Increases with age Anti-social disorder - adolescent limited Persistent throughout life
40
In which communities is CD more common?
Urban > rural
41
List some environmental, familial and child factors which could contribute to CD
Enviro - inner city Family - inadequate parenting Child - ADHD
42
List interventions for CD
``` Multi-system therapy: Home: -Manage underlying hyperactivity -Parenting programme School/life: -Cognitive problem-solving skills training -School interventions ``` Note: intervention should be targeted at major modifiable risk factors and should begin at an early age
43
What is CD a predictor of?
``` Antisocial disorder in adulthood Alcoholism Drug dependence Unemployment Relationship difficulties ```
44
What is depression?
Low mood, loss of enjoyment and loss of energy lasting for more than 2 weeks
45
List some other changes seen in depression
``` Appetite / weight gain or loss Sleep disturbance Loss of concentration Pessimistic, guilt ridden thoughts Low self esteem Low confidence Psychomotor agitation Loss of libido Self harm Suicide ```
46
Describe the presentation and course of the first type of pre-pubertal depression
Presentation is with comorbid behavioural problems, resembles children with CD
47
What is the first type of pre-pubertal depression associated with?
Parental criminality Parental substance abuse Family discord
48
What is the second type of pre-pubertal depression associated with?
High rates of anxiety High rates of bipolar Recurrence of depression in adolescence and adulthood
49
What is the aetiology of the second type of pre-pubertal depression?
Highly familial
50
What is the prognosis of the first type of PP-depression?
No increased risk of occurrence in adult life
51
What is adolescent depressive disorder and which group of people is this more common in?
Irritability instead of low mood Somatic symptoms (in gut) Social withdrawal Seen especially in boys
52
When do psychotic symptoms occur, if at all, in adolescent depressive disorder?
After mid-adolescence (rare before this)
53
What are the short term and long term outcomes of adolescent depressive disorder?
Short term - persistence and recurrence Long term - continuity into adolescence (40-70%) and adulthood (2-7x) Impaired relationships Impaired education
54
List some biological changes which increase vulnerability to depression
Genetics Puberty Brain growth
55
List some social changes which increase vulnerability to depression
Peers Family Social world Relationships
56
What psychological or cognitive changes increase vulnerability to depression?
More intense, fluctuant moods | Developing idea of self and autonomy
57
What is the treatment for mild depression?
CBT (individual or group) | Interpersonal psychotherapy
58
What is the treatment for moderate/severe depression?
Antidepressants CBT Note: combined treatment shows highest rate of symptomatic remission
59
List the most significant cause of earlier puberty
Improved nutrition
60
What are the two subtypes of anorexia nervosa?
Restricting type | Binge eating/purge type
61
Which subtype of conduct disorder has the worst prognosis?
Unsocialised CD

RDA (13 decks)

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