Adolescence and puberty Flashcards

Question

Describe the changes in cortical thickness during puberty

Answer 1

Increases from 5-9 Then decreases during adolescence as a result of pruning Different regions attain peak cortical thickness at different times

Answer 2

Developmental mismatch hypothesis: dopaminergic activity (sensation seeking) increases rapidly between ages 10 and 18, while the regulatory controls develop slower, leading to a period of risk taking behaviours (sex, delinquency, violence and self harm) when this dopaminergic activity is greater than the regulatory control (leading to poor risk assessment) Dopaminergic activity decreases after 18

Answer 3

Social media: harms mediated by Cyberbullying Reduction in sleep Reduction in physical activity Not total time spent necessarily

Answer 4

Mental Health: Diagnosable: 1/10 children 5-16 have diagnosable condition Establishment: 1/2 all MH problems established by age 14, 3/4 by age 24

Answer 5

Piaget’s stages: § Birth à 2 Sensorimotor stage. § 2 à 7 Preoperational stage – symbolic thinking. § 7 à 11 Concrete operational stage – reason logically. § 11 à 15 Formal operational stage – abstract, idealistic and logical reasoning.

Answer 6

o 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. · Sequence of this is fixed and people may never reach the highest levels.

Answer 7

o Self-concept – Harter’s 8-dimension model of self-concept: § Scholastic, job, athletic, physical appearance, social acceptance, close friends, romantic appeal and conduct of self – Some Jobs Are Pretty Shit, Can’t Really Complain. · Self-concepts have clinical implications – 20-30% adolescents have low self-esteem which can lead to depression, anxiety, poor academia, social isolation, etc. However, people with good self-esteem can also be disposed to this!

Answer 8

o Identity formation – Erikson’s 8-life-span stages: § Don’t need to know the stages but one stage is in age’s 10-20 which is “Identity vs. confusion”. o Identity formation – Marcia: § Identity diffusion (no crisis, no commitment) à identity foreclosure (no crisis, commitment) à moratorium (crisis, actively searching for identity) à identity achievement (crisis over). · Only moratorium necessary for identity development. · Identity is associated with higher – achievement, moral reasoning, social skills, et

Answer 9

o Ethnic identity – cultural minorities: § Integration – retain base culture, develop and maintain with mainstream culture as well. ++ § Assimilation – lose base culture, develop and maintain into mainstream culture. -+ § Separation – retain base culture, no development into mainstream culture. +- § Marginalisation – lose base culture, no development into mainstream culture.

Answer 10

o Social domains – adolescents and parents may have different views about who has the final say depending upon the social “domains” – friendships, clothes, etc. – mid-adolescence is most intense negotiations.

Answer 11

o Family: § Conflict with parents – most adolescents have good relationships, high confiding in mothers. § Family connectedness is associated with – reduced risk behaviours and increased self-esteem. o Peer development: § Primary school (7-11) – goal to be accepted by peers, prefer same gender and gain loyalty. § 11-13 – expect genuineness, intimacy, common interests, emergence of cliques. § 13-16 – friendship goals, cross-gender relationships and develop larger groups. § 16-18 – emotional support expected and increase dyadic romantic ties. o Influence: § Peers influence – interpersonal style, fashion/entertainment. § Parents influence – academic choice, career choice and future aspirations.

Answer 12

o Gender differences: § Boys – less intimate, disclosing and friendships embedded in larger circles. § Girls – close and confiding relationships but are more brittle.

Answer 13

o School – 5 or more A*- C at GCSE factors: | § Higher social class, girls > boys, ethnicity (Chinese > Indian > white) – combined effect = ~10

Answer 14

More likely to compare themselves to others and this is even more so in those who have mental health disorders less likely to occur in boys (even those with mental health disorders).

Answer 15

Adolescence

Answer 16

Hyperactivity and other less common ones

Answer 17

Non communicable diseases (NCD) dominate Global Burden of Disease Mental disorders

Answer 18

A. Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health. • B. Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain. • C. Disturbance in experience of weight/shape, undue influence of wt/shape on self-evaluation, or persistent lack of recognition of seriousness of low body weight • D. Amenorrhoea NOT in DSM-5! • Subtype: Restricting vs. Binge-eating/Purge Important to remove amenorrhea- doesn't take into account boys, girls or post-menopausal women No weight criteria - should be when it causes impairment for that patient differ from avoidance restrictive food disorder as in anorexia- fear of gaining weight and negative affect on body image- important to understand why negative affect is on body image.

Answer 19

Individual ,familial or systemic factors which can be: Predisposing, precipitating, perpetuating or protective Predisposing factors: genetics (70% heritable) Precipitating factors: weight related bullying, societal factors, depression, peers Perpetuating factors: isolation, feeling of control, response of others Protective factors: Can have psychological, biological or social factors instead

Answer 20

Genetic correlations between anorexia nervosa and variable phenotypes personality, psychiatric, educational ,weight and BMI related, insulin and glucose related, lipoprotein and cholesterol.

Answer 21

Genetic factors and other prenatal factors (such as influence of hormones) Both of these influence our traits and cognitive style (obsessionailty, perfectionism ,deficits in social cognition, inflexibility) These can influence diet, potentially leading to weight loss, this can lead to starvation induced changes, leading to increased anxiety, depression and obsessionality, driving the cycle Note puberty via brain development, hormones, stressful life events and cultural values influence this cycle two outcomes- recovery or chronic illness as a result of starvation- induced changes

Answer 22

For boys: the changes of puberty e.g. increased height, and musculature are welcomed, and are associated with increased status and athletic prowess. a lot feel fat, few diet and a lot want to gain weight 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. A lot feel fat, a lot diet and very few want to lose weight

Answer 23

Cultural variation: 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. Asian similar to whites, similar trend with boys

Answer 24

Dislikes weight, severe dieting unhealthy behaviour e.g. vomiting, laxatives etc 10% AN + BN +1-2%

Answer 25

* Adolescent eating problems (symptoms) associated with: • Earlier pubertal maturation, & higher body fat (also extremely low BMI) * Concurrent psychological problem e.g. depression • Poor body image • Specific cognitive phenotypes

Answer 26

• Association anorexia nervosa and ASD • Weak central coherence in ED’s • Global processing difficulties [review] • Poorer global processing =>Weak central coherence • Impaired set shifting Executive function defects When asked to draw a complex diagram- will focu on one part perfectly- inability to see bigger picture- weak central coherence.

Answer 27

…..most young people who have parental/carer support with AN should be offered AN focussed family therapy (FT-AN or FBT) in conjoint, separated or multifamily format as first line treatment on an outpatient or if too sick, day patient basis, following a brief (<3 week admission) for medical stabilisation if needed Treatment: focus on the perpetuating (maintaining) factors, as these are most likely to be modifiable

Answer 28

• About 40% respond to first line interventions alone • Up to 80% recover overall within 5 years • Around 30% develop binge eating at some point during recovery • Around 20% run a more chronic course • Mortality e.g. at 20 years: 5-10% of which 1 in 5 is suicide • Duration of illness predicts recovery therefore adolescent onset better prognosis because earlier help seeking • Early treatment response is the only robust predictor of outcome but more extreme social difficulties are a factor

Answer 29

Treatment Family intervention For abnormal eating attitudes and depression: cognitive behavioural therapy. Small % need admission for weight restoration Causes Genetic predisposition, perfectionist temperament, specific subcultures, childhood abuse and adversities; perhaps higher social class.

Answer 30

Dimension: Continuum, increased symptoms lead to increased impairment Category: Disorder present or not

Answer 31

• Low mood/sadness • Loss of enjoyment (anhedonia) • Loss of energy

Answer 32

• Changes to: • Appetite / Weight-( / ) • Sleep- ( / ) • Concentration • Thoughts: Pessimism, Guilt • Self esteem/confidence • Libido • Psychomotor agitation/retardation • Self harm / Suicide

Answer 33

``` Symptoms pervasive (present all the time) • Impairing • Present for at least 2 weeks • Symptoms and impairment distinguish mild, moderate & severe ```

Answer 34

• Depressive episode (~ 50% recur) • Recurrent depression • Dysthymia (low mood, which may ameliorate)• Bipolar depression • Psychotic depression • Atypical depression • Seasonal affective disorder (SAD) • ?Inflammatory subtype

Answer 35

• Increased risk of self-harm • Association with anxiety disorders; eating disorders [females]; conduct problems; substance misuse • Familial aggregation (genetic and learning)

Answer 36

• 1st: • 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 Essentially, a bad-upbringing

Answer 37

• Less common • highly familial with multigenerational loading for depression • High rates of anxiety and bipolar disorder and • Recurrences of depression in adolescence and adulthood# § Irritability instead of sadness (especially in boys), social withdrawal. § Outcome with high recurrence and impairment in later adult relationships.

Answer 38

o (1) Persistent sadness or low mood and/or; o (2) Loss of interest or pleasure – anhedonia. o (3) Fatigue/low-energy – anergia. § At least 1 of the above, most of the time for at least 2 weeks and some associated symptoms: · (4) Disturbed sleep, (5) poor concentration, (6) low self-confidence, (7) changes in appetite and weight, (8) suicidal thoughts/acts, (9) agitation, (10) guilt or self-blame – these changes may be positive or negative (i.e. weight gain or loss). § Total 10 symptoms then classify level of depression - <4 (not), 4 (mild depression), 5-6 (moderate), 7> (severe).

Answer 39

§ Symptom clusters – the 10 symptoms but clustered: o Affective – sadness, loss of enjoyment, irritability. o Cognitive – self-blame, hopelessness, guilt. o Biological – disturbed sleep, reduced appetite.

Answer 40

§ Developmental consideration – as you develop, these happen which may predispose to depression: o Endocrine – especially in females and may increase risk of low mood. o Relationships with family – get closer with family as you develop à more conflict. o Peers – increased involvement with peers as you develop à more rejection and conflict. o Responsibilities and hassle.

Answer 41

• Irritability instead of sadness/low mood Especially in boys • Somatic complaints and social withdrawal are common • Psychotic symptoms rare before mid-adolescence

Answer 42

Short term • High rates of persistence and recurrence (20% in 1 yr) Lewinson et al, 1994 • Long term • Significant continuity adolescence  adulthood • Adolescent Depressive Disorder •  40-70% recurrence in adulthood •  2-7x increased risk as an adult • Impairment relationships/education in adulthood

Answer 43

Biological changes -genetics -Puberty -Brain growth Social changes -Peer -Family -Social world Life events losses All influence Psychological/cognitive emotional changes -More advanced & efficient -More intense/fluctuant mood -Self concept, autonomy Which influences vulnerability to depression

Answer 44

•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 • Combined treatment  highest rate of symptomatic remission in 37% combined vs 20% fluoxetine alone

Answer 45

``` Prognosis Major depression: Duration 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) ```

Answer 46

2-5% of adolescents

Answer 47

Psychiatry- conducting disorder delinquency/offending- law anti-social behaviour- society

Answer 48

Repetitive & persistent (> 6 months) pattern of dis-social, aggressive or defiant behaviour • Frequency & severity beyond age appropriate norms. • No sharp dividing line! Persistent failure to control behaviour appropriately within socially defined rules.

Answer 49

Oppositional behaviour, defiance Tantrums Excessive levels of fighting or bullying, assault Running away from home Truancy Cruelty to animals Stealing Destructiveness to property Fire-setting

Answer 50

``` CD confined to the family context Unsocialized CD Socialized CD Oppositional CD Depressive CD Hyperkinetic CD ```

Answer 51

• Conduct Disorder is commonest psychiatric disorder of childhood. • National Survey of Child Mental Health (2017) • About one in twenty (4.6%) 5 to 19 year olds had a behavioural disorder, with rates higher in boys (5.8%) than girls (3.4%) • Increases with age • More common in urban than rural communities • Anti-social behaviour • Adolescent-limited • Life course persistent

Answer 52

1. Genetic – weak 2. Child – difficult temperament (ADHD) Family – poor parenting, discord, lack warmth, inconsistent discipline, coercive interaction, aggression 3. Wider environment poor schools neighbourhoods (gang culture in cities)

Answer 53

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 & alcohol, petty offending frequent.

Answer 54

``` 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 lower socio-economic status ```

Answer 55

Should be targeted at major modifiable risk factors and should begin at an early age • Managing underlying hyperactivity • Parenting programmes • Cognitive problem-solving skills training • Interventions at school • Multi-systemic therapy

Answer 56

• 40% of 7 and 8 year olds with CD became recidivist delinquents as teenagers. • Over 90% of recidivist juvenile delinquents had conduct disorder as children. • Predictor of • Antisocial PD in adulthood (~50%) • Alcoholism & drug dependence • Unemployment and relationship difficulties • Intergenerational transmission • HENCE IMPORTANCE OF PREVENTION!

Answer 57

Poorer outcome with more problems in child, and family Risk of antisocial personality disorder in males Range of emotional and personality disorders in females

Adolescence and puberty Flashcards

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