Adolescence - Lecture Materials

Adolescence Sex Average age of 1st sex is 16 30% of boys and 26% of girls have had sex before 16 The earlier the encounter, the higher the regret Over 40% of teenagers think that the majority of under 16’s have had sex 75% of teenage pregnancies are unplanned 46% of under 18 conceptions end in abortion STIs are highest in 16-19 yr women Infant mortality is 60% higher PND is 3x more common Risk factors for teen pregnancies Poverty Poor housing Emotional problems from 7-16 Victims of sexual abuse In local authority care Dislike / poor school attendance / exclusion / poor school performance Alcohol intake à higher unprotected sex & higher regret Ways to reduce teen pregnancy Sex education in and out of school to aim to delay 1st sex, highlight risks of unprotected sex, effective contraception Legal issues of teen consultations Confidentiality – cannot disclose for a competent teen UNLESS risk of significant harm (in that case tell patient some secrets can’t be kept) Consent – under 16 can consent to treatment if sufficient understanding and intelligence Sexually transmitted Infections Gonorrhoea Incubation of a few days Ureththral discharge in males & females In women can à infertility / ectopic pregnancy Can be totally asymptomatic Rx with antibiotics Chlamydia Often no symptoms Can be vaginal bleeding, discharge, abdo pain, fever & cervical inflammation in women Can be watery penile discharge in men Long term complications can be severe in women à PID, ectopic pregnancy & infertility Rx with antibiotics Genital Warts (Human Papillomavirus) Found around the penis, anus & Vagina Some types are assoc with cervical cancer Warts often disappear without treatment BUT can be removed by freezing, burning or laser Syphilis Incubation period from 3days to a few months Non-specific symptoms initially Then painless, highly infectious sores anywhere around body (usually at site of infection) Can cause miscarriage / stillbirth Rx with antibiotics Genital Herpes (Herpes Simplex Virus) Common infection with type 1 or 2 Small blisters in genital area à painful ulcers May à pain on urination HIV infection See separate notes Contraception Can be given under age of 16 if: Young person understands the doctor’s advice Doctor can’t persuade the young person to inform the parents The young person is likely to have sex anyway, with or without the contraception The young person’s physical / mental health is likely to suffer unless they receive it The doctor gives information / advice in the young person’s best interests Eating Disorders Screening questions: Do you think you have an eating problem? Do you worry excessively about your weight? Detection / High risk groups: Young women who are underweight With depressed mood Patients with weight concerns who are not overweight Children with poor growth Menstrual disturbance / infertility GI disturbance Type 1 diabetes with poor control Anorexia Strict dieting +++ Self-induced vomiting + Laxative Misuse + Over Exercising ++ Binges + Ritualistic eating habits ++ Anxiety when eating with others +++ Over evaluation of shape & wt +++ Depressive Sx + Anxiety Sx + Obsessional Sx ++ Impaired concentration +++ Social withdrawal +++ Substance abuse - Anorexia Usually the parents / school / friends who make contact Weight loss, under-eating & overexercise Patient denies there is a problem DEATH occurs in 10% usually due to electrolyte disturbance / arrhythmia / CCF Aim to AVOID rapid weight gain (target 200-400g/d) Bradycardia can be as low as 20bpm with hypotension. Admit if HR <45 AVOID antidepressants if QTc prolonged as can à dysrhythmia Bulimia Often the patient presents with complaint they are unable to control their eating Bulimia +++ ++ ++ + +++ +++ +++ +++ ++ + +++ + + May also have physical / psych symptoms Who to treat / who to refer? Weight / BMI alone are poor indicators. Look at trends / growth Be alert to signs of abuse (as underlying cause) Respect confidentiality Refer IF: BMI < 13.5 Severe depression Medical complications of severe wt loss Refer to child psychiatrist Treatment Family therapy and consider impact on siblings Admit only if absolutely required Feeding against child’s will must be done under mental health act 1983 or Children’s Act 1989 Antidepressants may be of use in bulimia, but not in anorexia May respond to CBT Aim to achieve a weight gain of 0.5kg/week as outpatient Follow up for at least a year to ensure sustained weight Substance Abuse Teens who smoke are: 3 x more likely to drink 8 x more likely to use marijuana 22 x more likely to use cocaine By 16 years old – 1/3 will smoke, 1/3 will have tried & stopped, 1/3 will have never tried smoking Signs of illegal drug use include: Physical – fatigue, repeated health complaints, red/glazed eyes, lasting cough Emotional – personality change, sudden mood change, irritability, irresponsible behaviour, low self-esteem, poor judgement, depression, general lack of interest Family – starting arguments, negative attitudes, breaking rules, withdrawing from family, secretiveness School – decreased interest, negative attitude, drop in grades, many absences, truancy, discipline problems Social Problems – new friends who make poor decisions & are not interested in family / school, problems with the law, changes to less conventional styles in dress & music Acne Skin produces sebum = oily substance to moisturise & stop skin drying out Increasing androgens in puberty à increased sebum & can à blocked pores à inflammation of surrounding skin Severity of acne increases & peaks at 17-19yrs Mostly reduces by mid 20s (occasionally continues to 40’s) Spots due to propionibacterium acnes – a common skin bacterium that feeds on sebum à waste products & fatty acids that irritate the sebaceous glands à inflammation Factors that worsen acne Working in damp environment with oil/ grease/ other chemicals Stress / emotion Squeezing / picking at spots Menstrual cycle Some medicines / chemicals Management Washing face b.d. with mild cleanser Avoiding hairstyles which have hair touching the face & keeping hair clean Not picking at spots (can à scaring) Water based moisturiser – oil/grease based creams block pores Balanced diet If not working à try benzoyl peroxide à topical / systemic antibiotics e.g. oxytetracycline à isotretinoin