Flashcards in Issues in Adolescent Health Deck (18):
When is the best time to start gonadotropin releasing hormone (GnRH) analogs in gender nonconforming youth?
at Tanner stage 2 (breast budding/testicular enlargement) - then switch to cross gender hormones (patient will not develop sperm or oocytes that are viable for production - cannot have own children)
What are potential side effects of GnRH?
alteration in pubertal growth spurt, decrease in bone density, females - hot flashes/irritability/depression, males - fatigue/decreased strength - need to monitor every 3 months: endogenous sex hormone (estradiol or testosterone) and gonanotropin (LH and FSH) levels, bone age, and bone density
Which aspects of development are not reversible if cross-gender hormone therapy is started after puberty is complete?
MTF: voice pitch, laryngeal prominence, height, growth of facial hair; FTM: size of breasts
Which effects of estrogen therapy are irreversible in MTF?
development of breasts and decreased testicular mass
Which type of estrogen is used in cross-gender hormone therapy?
oral 17 beta-estradiol - blood levels can be monitored and there is less risk for thromboembolic events
Which effects of testosterone therapy are irreversible in FTM?
clitoral enlargement and deepening of voice - receipt of testosterone will not prevent pregnancy
What are predisposing factors for suicide?
increase an individual's risk for suicide - psychiatric disorders, previous suicide attempts, family Hx of mood disorder, Hx of physical/sexual abuse, exposure to violence, biologic factors
What are precipitating factors for suicide?
factors unlikely to contribute to suicide risk in and of themselves - access to means, alcohol/drug use, exposure to suicide, social stress/isolation, emotional/cognitive factors
When is the risk of completed suicide the greatest?
among those with a previous attempt within the first year following the previous attempt - risk remains elevated even a decade after the attempt
Among which groups of youth are the risks for suicide greatest following a parent's suicide?
children and those who have lost a mother to suicide
What biologic factors contribute to suicide risk?
lower levels of 5-hydroxyindoleacetic acid (the major serotonin metabolite) - extent of metabolite reduction is directly related to the lethality of the suicide attempt
What is suicidal contagion?
suicide clusters or outbreaks of suicides in a community - adolescents who imitate the suicide of another peer are usually not close friends of the victim and may have deficits in coping skills and lack models for healthy coping strategies
What is the minority stress model?
the proposal that being a minority is linked to bias, discrimination, and lack of support, which leads to stress, anxiety, and depresion
How do sexual minority youth generally first present to a health care provider?
with depression, anxiety, behavior problems, or school problems
What are the four categories of preventive services for adolescents?
screening, counseling to reduce risk, providing immunizations, giving general health guidance
What is the recommended strategy for providing preventive services to adolescents?
(1) gather information and identify problems, (2) for each identified problem, further assess to determine the level of risk and perform physical assessment, (3) identify and prioritize problems together, (4) develop a management plan for each set of problems
What are the steps to developing a health management plan with adolescents?
(1) negotiate the intervention, (2) promote the teen's confidence that the management plan can work, (3) discuss strategies with the teen to overcome barriers to the management plan, (4) develop a contract or verbal agreement, (5) follow up with the actions identified