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Adolescence and puberty Flashcards

1
Q

What is growth due to

What is adolescence

A

Gonadal steroids (in particular androgens)

+ other hormones such as GH (somatotrophin) from anterior pit.

Adolescence: Adolescence refers to the period of development that occurs between ages 12-18 years.

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2
Q

How does the onset of puberty occur

A

Theories

  1. Maturation of the CNS affecting GnRH neurones (increased pulsatile release)
  2. Altered set point to gonadal steroid negative feedback
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3
Q

What might trigger maturation of CNS

A

Unclear….

BUT THERE IS EARLIER PUBERTY NOW:

Improved health care

Improved socio-economic factors (photoperiod and nutrition)

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4
Q

Outline Altered set point to gonadal steroid negative feedback

A

Initially:

  • Low gonadal steroids
  • But high sensitivity to these in negative feedback on pituitary/hypothalamus
  • So low gonadotrophins

THEN, the sensitivity of the hypothalamus/pituitary to the gonadal secretions reduces, so

  • Unchanged gonadal steroids results in
  • Increased gonadotrophins (because the same amount of gonadal hormone has a lower negative feedback action because of the reduced sensitivity of the hypothalamus and pituitary)
  • Gonadal hormones therefore increase (because of the increased GnRH and gonadotrophins)

The feedback further decreases until there are adult levels, whihc involve much higher hormone leves

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5
Q

What is menarche

A

the first occurrence of menstruation.

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6
Q

What has happened to age at menarche

A

Evidence that age at menarche has decreased over the last 150 years. Over the last 3-4 decades it seems to have levelled off – or it could even be increasing again.

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7
Q

How has body weight at menarche changed?

A

body weight at menarche has remained relatively constant at approximately 47kg.

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8
Q

What is adrenarche and what is it due to

A

Role: It’s like the precurosr to puberty

Rise in adrenal 19- carbon steroid production,
dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS)

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9
Q

When is adrenarche in males and females

A
  • Females: 6-9 years

* Males: 7-10 years

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10
Q

T/F adrenarche marks the beginning of puberty

A

F… it’s the precursor to it.

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11
Q

What does adrenarche manifest as

A

• Manifests clinically as the appearance of axillary and pubic hair,
usually about age 8

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12
Q

Outline endocrinology of adrenarche

A

HPA axis

CNS and Hypothalamus stimulated leading to CRH

CRH leads to adenohypophysis ACTH release.

ACTH causes DHEA and DHEAS release from the zona reticularis

Leads to axillary, groin hair and acne

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13
Q

Outline endocrinology of puberty

A

HPG (not HPA like adrenarche)

CNS and hypothalamus releasing GnRH, pituitary releases LH/FSH. Menarche/sperm production and release of androgen and estrogen

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14
Q

What do oestrogen and androgen cause development of

A

ANDROGEN:

  • penis, pubic hair and testes
  • Also pubic, armpit hair and acne

ESTROGEN:
-breasts, ovaries, uterus

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15
Q

Why can extremely skinny women have periods stopping

A

Because leptin stimulates release of GnRH from the hypothalamus VIA increased kisspeptin release (which stimulates the GnRH neurones)

So if low leptin due to low body fat, then periods stop

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16
Q

Is menarche a single event

A

It is defined as such,

however periods take 3 cycles to be classed as fully established, so not clear cut

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17
Q

When do girls and boys have their growth spurts

Is this reflective of the rest of their development

A

Girls around age 12/13

Boys arund 15

Yes- girls are around 2 years ahead developmentally!

The boy growth spurt is also larger than the girls

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18
Q

What is the tanner scale

A

Scale to assess how advanced puberty is.

Based on:
i. Penile development
ii Breast development
iii. Growth of pubic hair

Each of these is rated 1-5 for development. 1 is pre-pubertyal and 5 is fully developed

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19
Q

What has the earlier age of puberty been down to

What is the normal age of puberty commencing for boys and girls

A

Improvement of diet

However obesity and overweight can lead to early onset of puberty

The average age for girls to begin puberty is 11, while for boys the average age is 12

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20
Q

Psychological changes in puberty

A

Cognition e.g. morality

Identity

Increased self-awareness

Affect expression and regulation (i.e. can you speak about how you feel, and then turn off those feelings)

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21
Q

T/F the psychological and biological development are not interlinked

A

F they are highly interrelated

Some hormones are required for proper cognition (oxytocin)

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22
Q

T/F menarche is early in the developmental process

A

F it’s quite late (the child is quite developed at this point)

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23
Q

Social changes in puberty

A

• Family - parental surveillance, confiding

Peers
• Increased importance
• More complex & hierarchical
• More sensitive to acceptance & rejection
• Romantic relationships

Social role- education, occupation etc.

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24
Q

What changes in terms of importance of reationships in puberty

A

Changes from importance of parents to peers.

This is why some autism traits are only realised in puberty, when it is important to develop relationships with those outside of family when peers become primary relationships

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25
Why is onset of mental health conditions often in pubery
Again because of this change in primary relationship from parents to support And social support strognly associated with metnal health And more sensitive to acceptance and rejection (because of infreased self awareness)
26
What are the wider cultural influences on puberty
• School • Work • Culture (“teen” subculture; migration/culture) • Social influences eg unemployment, poverty/affluence, housing, neighbourhood effects
27
What happens with brain during development
Grey matter volume = decreases from 6 yrs to adolescence & there is a linear increase in white matter at about 20 years
28
Outline developmental mismatch
Adolescence is a time of risk taking Yes because of increased Regulatory/ Cognitive control Integration of affect But Sensation seeking activity sharpy increases up to 17 years old and then decreases again The area between these two lines is the risk taking activity
29
Examples of risk in adolescence
``` Sex Delinquency Violence Self-harm Disease control ```
30
When do mental health problems start
3/4 by the age of 24 1/2 by the age of 14
31
Outline differences between comparing yourself to others between boys and girls with mental health conditions
Boys with mental health conditions no more likely to compare themselves to others than boys without condiitons Girls with metnal health conditions almost 2X more likely to compare themsleves to others than girls without metnal health conditions
32
Which is the relaionship between mental health sidorders and age
Most increase in frequency from 2-19 Emotional disorders, behaioural disorders and any disorders increases Hyperractiity and 'less common disorders' (e.g. autism) more common at younger age
33
Cardinal features of anorexia nervosa
Body weight maintained 15% below expected wight, or BMI < 17.5. Weight loss is self-induced Psychopathology – dread of fatness, and preoccupation with this. Endocrine disturbance: amenorrhoea, or delayed growth and puberty in younger sufferers.
34
Good way to think about these diseases
INDIVIDUAL, FAMILY, SOCIETY And then predisposing, precipitating, perpetuating and protective
35
Predisposing factors for eating disorder
Genetics, culture, media, family history, pre-morbid weight, high stress, self image, role model
36
Precipitating factors for eating disorder
Social exclusion
37
Maintaining factors of eating disorder
Isolation, feeling of control, social media
38
What are adolescent eating disorders associated with
* Earlier pubertal maturation, & higher body fat * Concurrent psychological problem e.g. depression * Poor body image * Specific cognitive phenotypes
39
What executive functional deficits are occurring in anorexia nervosa
Anorexia Nervosa associated with autism spectrum disorder There is weak central coherence in EDs (global processing issues) Impaired set shifting i.e. can't see the bigger pircutre
40
What do psychological implications of puberty vary according to
gender and cultural background.
41
Outline the difference in psychologiclal implications of puberty for different gender
For boys: the changes of puberty e.g. increased height, and musculature are welcomed, and are associated with increased status and athletic prowess. For girls: the changes of puberty e.g. increased adiposity are may be associated with ambivalent feelings, in view of the negative attitudes to plumpness, and ambivalent feelings about onset menarche.
42
Outline the differences in the psychologicla implications of puberty depending on culturral background
white English girls are more negative about body shape and weight than African Caribbean girls. Negative attitudes increase as weight and body mass index increase.
43
Implications of body weight dissatisfcation
1. Urge to reduce weight 2. Dieting/weight control measures 3. This may induce dysphoria and repeated attempts to control weight 4. Risk of ED increased
44
What proportion of anorexia nervosa cases are male
Approx 10% cases or less male.
45
Causes of anorexia nervosa
Genetic predisposition, perfectionist temperament, specific subcultures, childhood abuse and adversities; perhaps higher social class.
46
Outcome for anorexia nervosa
Community: 50% recover after 5 years Clinic: after 1 year 37% recover; 25% weight gain but not menstruating; 37% underweight, symptoms.
47
Treatment for anorexia nervosa
Family intervention For abnormal eating attitudes and depression: cognitive behavioural therapy. Small % need admission for weight restoration
48
Depression in adolescence symptoms
Affective – sadness, loss of enjoyment, irritability Cognitive – self-blame, hopelessness, guilt Biological – disturbed sleep, reduced appetite May reach threshold for disorder
49
Developmental considerations in depression
Endocrine change Changes in family relationships Peers Responsibilities and hassles
50
How can endocrine change affect depression
especially female may increase risk low mood
51
How can change in family dynamics in puberty affect depression
physical closeness, joint activities, family conflict
52
How can peers in puberty affect depression How can change in family dynamics in puberty affect depression
increased involvement with peers; peer rejection and conflict
53
How can Responsibilities and hassles in adolescence affect depression
life events, exams, etc
54
What affects more anorexia or depression
Depression is 0.5-2% | anorexia 0.1%
55
Causes of depression
Familial aggregation; genetic factors known Effects of family interaction e.g. criticism Life events, adversities
56
Prognosis of depression
Prepubertal onset – better prognosis Primary care: 2-3 months duration In specialist CAMHS: 6-9 months Small number in adolescence – bipolar (mania, hypomania)
57
Treatmnet for depression
Cognitive behavioural therapy Interpersonal psychotherapy Family intervention for associated family problems Antidepressants – selective serotonin reuptake inhibitors e.g. fluoxetine for moderate – severe depression.
58
Define conduct disorder
Persistent failure to control behaviour appropriately within socially defined rules.
59
Clinical features of conduct disorder in the child
looses temper and argues defies adult requests or rules bullies, fights or intimidates, stealing, breaking into cars or houses, destroys property running away, truanting
60
Developmental considerations for conduct disorder- family relationships
less direct surveillance, physical closeness, joint activities
61
Developmental considerations for conduct disorder- peers
increased involvement with peers; may amplify antisocial behavior
62
Developmental considerations for conduct disorder-experimentation and risk taking
rule violation, drugs & alcohol, petty offending frequent.
63
Prevalence of conduct disorder
4% at ages 5-10 years; 6% at ages 10-15 years; overall 5% at ages 5-15 years.
64
Where and among whom is conduct disorder more prevalnet
Higher in deprived inner-city areas Boys: girls 3:1 Variable age of onset
65
What is conduct disorder assocated wth
Larger family size | lower socio-economic status
66
Causes of conduct disorder
Genetic Child Wider environment
67
Causes of conduct disorder- genetic
Weak
68
Causes of conduct disorder- child
Family – poor parenting, discord, lack warmth,inconsistent discipline, coercive interaction, aggression
69
Causes of conduct disorder- wider environment
poor schools | neighbourhoods
70
Outcome or conduct 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
71
Interventions for conduct disorder
For child – problem solving skills. Parent training Family intervention Address problems across contexts e.g. in school

Rob's RDA (10 decks)

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