adolescence

Question 1

define adolescence

Answer 1

phase between childhood and adulthood (expanding from 10-25 y/o)

Question 2

what may be start of adolescence

Answer 2

pubertal development

Question 3

4 key constructs that change significantly during adolescence

Answer 3

cognitive/emotional changes (hormonally driven, identitiy and self-awareness), peers (increase importance), family (challenge rules), biology (puberty, growth)

Question 4

puberty, marriage and childbirth: 1950 vs now

Answer 4

now earlier puberty, later marriage and childbirth

Question 5

what is adrenarche

Answer 5

before puberty and associated with appearance of axillary and pubic hair around 8 y/o

Question 6

what drives adrenarche

Answer 6

adrenal glands to produce DHEA and DHEAS (not gonadal)

Question 7

when does adrenarche happen

Answer 7

in females 6-9 y/o, in males 7-10 y/o

Question 8

adrenal production pathway (adrenarche)

Answer 8

hypothalamus -> CRH -> pituitary -> ATCH -> adrenal cortex -> DHEA (development of pubic hair, armpit hair and acne in females, along with androgens)

Question 9

gonadal production pathway (puberty)

Answer 9

hypothalamus -> GnRH -> pituitary -> LH/FSH -> gonads -> sperm/ovary production, androgen production (development of pubic hair, penis and testes in males) and oestrogen production (development of breasts, ovaries and uterus in females)

Question 10

pattern of growth in puberty for boys and girls

Answer 10

girls do it 2 years earlier (12 vs 14), but wide variation; for girls, growth spurt is early pubertal event, but for boys it is a late pubertal event

Question 11

why has age of puberty reduced over past centuries

Answer 11

improved nutrition

Question 12

4 psychological changes in adolescence

Answer 12

cognition (morality), identity, increased self-awareness, affect expression and regulation

Question 13

3 social changes in adolescence (deficits core to mental health)

Answer 13

family (parental surveillance, confiding), peers (increased importance, heirarchy, romantic), social role (education, occupation etc.)

Question 14

4 wider social influences in adolescence

Answer 14

school, work, culture, social influences (e.g. unemployment, poverty, housing etc.)

Question 15

describe what happens to cortex in brain development

Answer 15

thickens, then thins again

Question 16

what does crossover from grey matter to white matter (pruning) account for and why

Answer 16

fail to calculate risks as mismatch between dopminergic pathways for reward and regulatory congnitive control

Question 17

examples of risks in pruning

Answer 17

sex, delinquency, violence, self-harm, disease control

Question 18

link of brain development with mental health

Answer 18

most in adolescence; 1/10 between 5-16 have diagnosable condition; 1/2 of all mental health problems established by 14; 3/4 all mental health problems established by 24

Question 19

when do emotional orders emerge vs behavioural, hyperactivity and less common disorders

Answer 19

later on (between 17-19 y/o), vs younger

Question 20

DSM-5 criteria for anorexia nervosa (no absolute normal low weight, but only mental health condition with weight; highest mortality of psychiatric disorders)

Answer 20

restriction of energy intake relative to requirements so significantly low body weight in context; intense fear of gaining weight/becoming fat; disturbance in experience of weight/shape, undue influence of weight/shape on self-evaluation, or persistent lack of recognition of seriousness of low body weight (not amenorrhoea as affects all)

Question 21

2 subtypes of anorexia nervosa

Answer 21

restricting, binge-eating/purge

Question 22

formulation framework for mental health conditions

Answer 22

predisposing, precipitating, perpetuating, protective; focuses on individual, family and systemic, or biological, psychological and social

Question 23

what increases likelihood of suffering from anorexia nervosa

Answer 23

complex combination of psychiatric and somatic (genetic and hormonal) risk factors

Question 24

what are adolescent eating problems associated with

Answer 24

earlier pubertal maturation and higher body fat, concurrent psychological problem e.g. depression, poor body image, specific cognitive phenotypes

Question 25

why are anorexia nervosa and autistic spectrum disorder associated

Answer 25

when starved, become more narrow-minded (don't see bigger picture), so difficult to separate effects of starvation from predisposing phenotype

Question 26

2 main drivers for eating disorders and obesity

Answer 26

dieting and body image satisfaction

Question 27

treatment for young people with eating disorders if they have parental/carer support

Answer 27

focussed family therapy in conjoint, separated or multifamily format (as outpatient; if too sick, as day patient following brief admission for medical stabilisation)

Question 28

prognostic factor for anorexia nervosa

Answer 28

duration of illness (earlier the better)

Question 29

concepts of depression: dimension

Answer 29

more symptoms you have, more impaired you're likely to be (continuum)

Question 30

concepts of depression: category

Answer 30

either depressed or not

Question 31

3 core symptoms of depression

Answer 31

low mood/sadness, loss of enjoyment (anhedonia), loss of energy

Question 32

what can depression manifest as

Answer 32

changes to appetite, sleep, concentration, pessimistic thoughts, self-esteem, libido, psychomotor agitation, self harm

Question 33

diagnostic threshold for depression

Answer 33

symptoms pervasive (behave differently but feel same in different contexts), impairing and for >2 weeks

Question 34

subcategories of depression based on severity

Answer 34

mild, moderate, severe

Question 35

subcategories of depression based on course

Answer 35

depressive episodes, recurrent depression, dysthymia, bipolar, pyschotic, atypical, seasonal affective disorder, inflammatory

Question 36

what is depression associated with

Answer 36

increased risk of self-harm; association with anxiety disorders, eating disorders, substance misuse etc.; familial aggregation

Question 37

2 main types of pre-pubertal depression

Answer 37

brought on by low mood with co-morbid behavioural problems (associated with family circumstances and other types of anti-social behaviour, with no recurrence in adulthood), and pure depressive (highly familial with recurrence in adulthood)

Question 38

what can adolescent depressive disorder look like

Answer 38

irritability instead of sadness, somatic complaints and social withdrawal (psychotic symptoms rate before mid-adolescence)

Question 39

adolescent depressive disorder: short term outcome

Answer 39

high rates of persistence and recurrence

Question 40

adolescent depressive disorder: long term outcomes

Answer 40

significant continuity adolescence into adulthood, with impaired relationships and education

Question 41

what influences vulnerability to depression

Answer 41

biological changes, social changes, life events (e.g. losses), psychological and cognitive emotional changes

Question 42

3 treatments for mild depression

Answer 42

cognitive behavioural therapy, interpersonal psychotherapy for adolescents, brief psychosocial intervention

Question 43

2 treatments for moderate-severe depression

Answer 43

antidepressants e.g. SSRIs, cognitive behavoural therapy and antidepressant

Question 44

what is anti-social behaviour defined by

Answer 44

society

Question 45

what is delinquency/offending defined by

Answer 45

law

Question 46

what is conduct disorder defined by

Answer 46

psychiatry

Question 47

what is conduct disorder (commonest psychiatric disorder of childhood that increases with age and is more common in urban areas)

Answer 47

repetitive and persistent (>6 months) pattern of behaviour, with frequency and severity beyond age appropriate norms; usually adolescent-limited

Question 48

examples of conduct disorder behaviours

Answer 48

oppositional behaviour, tantrums, excessive fighting, running away from home, truancy, cruelty to animals, stealing, destroying, arson

Question 49

types of conduct disorder

Answer 49

socialised (with peer group), unsocialised (alone - worse prognosis feature)

Question 50

3 factors affecting conduct disorder

Answer 50

child factors e.g. ADHD, family factors e.g. inadequate parenting, environmental factors e.g. inner city

Question 51

describe intervention of conduct disorder

Answer 51

target at major modifiable risk factors, early, manage underlying hyperactivity, parenting programmes, cognitive problem-solving skills training, interventions at school, multi-systemic therapy

Question 52

what is conduct disorder a predictor of (importance of prevention)

Answer 52

antisocial personality disorder in adulthood, alcoholism and drug dependence, unemployment and relationship difficulties