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Flashcards in Adolesence Deck (37)
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1

What is adolescence?

  • Adolescence – phase between childhood & adulthood
  • Pubertal development may be start of adolescence

2

When does adolesence usually start in males and females?

3

What is adrenarche and when does it start?

  • Precursor to puberty - stimulation of adrenal glands
  • Females: 6-9 years
  • Males: 7-10 years

4

What happens in adrenarche?

  • Rise in adrenal 19- carbon steroid production, dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS).
  • These are the precursors of sex steroids
  • Manifests clinically as the appearance of axillary and pubic hair, usually about age 8.

5

How is body fat related to periods?

  • Leptin stimulates the release of GnRH from the hypothalamus
  • No body fat = periods stop

6

What is menarche?

  • The 1st period
  • Usually, periods aren't considered to be established until 3 cycles are complete 
  • So although menarche is a single event, it can only be defined in retrospect

7

What is the endocrine axis of adrenarche?

  • Hypothalamus produces CRH
  • Anterior pituitary produces ACTH
  • Adrenal cortex produced Androstenedione and DHEA
  • These feedback on the pituitary and hypothalamus
  • They also initiate the development of:
    • pubic hair
    • armpit hair
    • acne

8

What is the endocrine axis of male puberty?

  • Hypothalamus produces GnRH
  • Anterior pituitary gonadotrophs produce LH&FSH
  • Act on gonads to initiate sperm production
  • Also act on gonads to produce androgens which initiate the development of:
    • Penis
    • Pubic hair
    • Testes

9

What is the endocrine axis of female puberty?

  • Hypothalamus produces GnRH
  • Anterior pituitary gonadotrophs produce LH&FSH
  • Act on gonads to initiate ovarian production and menarche
  • Also acts on gonads to produce estrogen - initiating the development of:
    • breasts 
    • ovaries
    • uterus

10

What are the phases of puberty?

  • Phase 1: Pre puberty
  • Phase 2-4: Puberty
  • Phase 5: Fully developed

11

What are the 3 measured stages of puberty?

  • Axillary hair growth
  • Pubic hair growth
  • Breast/penis growth

12

Why is puberty starting earlier than it used to?

Improvements in diet

13

What are the psychological changes of adolescence?

  • Cognition e.g. morality
  • Identity
  • Increased self-awareness
  • Affect expression and regulation

14

What are the social changes of adolescence?

  • Family - parental surveillance, confiding 
  • Peers
    • Increased importance
    • More complex & hierarchical
    • More sensitive to acceptance & rejection
    • Romantic relationships •
  • Social role – education, occupation, etc

15

How does the brain change during adolescence?

  • Increases in cortical thickness
  • Peaks at aprox 10 years old
  • Then begins synaptic pruning - removing unused synapses

16

What is the developmental mismatch hypothesis?

  • Increase in cognitive control throughout adolescence - increasing integration of affect (understanding your feelings)
  • Dopaminergic activity also increases up to 18 years which is associated with increased sensation seeking
  • This period where sensation seeking is higher than cognitive control is the risk period

17

What is the definition of anorexia nervosa?

  • 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)

Old definition:

  • Body weight at least 15% below expected
  • With endocrine disturbance and wt loss behaviours.

18

What are the predisposing factors of anorexia nervosa?

Pre-morbid weight

Bullying

Genetics

Culture

Media

19

What are the precipitating factors of anorexia nervosa?

Social exclusion 

20

What are the maintaining factors of anorexia nervosa?

Isolation

Social media

Family

Culture

Starvation-induced reward feeling

21

What factors can be used to predict development of anorexia?

  • Earlier pubertal maturation, & higher body fat
  •  Concurrent psychological problem e.g. depression
  •  Poor body image
  •  Specific cognitive phenotypes

22

How does anorexia cause change in neuropsychology?

  • Loose the ability to see the bigger picture - global processing difficulties
  • Association with autism

 

23

How is the assessment for anorexia made?

  • Family interview
  • Individual interview with child/adolescent
  • Physical examination
  • Data on growth
  • Physical examination & investigations

24

What are the other differential diagnoses of anorexia?

Physical:

  • Gastro-intestinal disorder eg. crohns disease
  • Metabolic eg diabetes
  • Pituitary

Psychiatric:

  • Other feeding or eating disorder
  • Depression
  • Psychosis
  • Obsessive compulsive disorder

25

How is conduct disorder defined?

  • Repetitive & persistent (> 6 months) pattern of dis-social, aggressive or defiant behaviour
  •  Frequency & severity beyond age appropriate norms.

26

What are some behaviours associated with conduct disorders?

  • 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

27

What are the types of conduct disorder?

  • Unsocialized CD
  • Socialized CD
  • Oppositional CD
  • Depressive CD
  • Hyperkinetic CD

28

What is the difference between:

Antisocial behaviour

Delinquency/offending

Conduct disorder

  • Antisocial behaviour - defined by society

  • Delinquency/offending - defined by the law

  • Conduct disorder - defined by psychiatry

29

What are the aetological factors for conduct disorders?

  • Environmental factors e.g. inner city, school 
    • This is the main target for therapy
  • Family factors e.g. inadequate parenting
    • This is the 2nd target for therapy
  • Child factors e.g. ADHD, depression
    • this is the last target for therapy

30

What is the prognosis of conduct disorders?

Predictor of:

  • Antisocial PD in adulthood 
  • Alcoholism & drug dependence
  • Unemployment and relationship difficulties

 

  • 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.