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Psychiatry > Symposium 4 - Child and Adolescent > Flashcards

Symposium 4 - Child and Adolescent Flashcards

1
Q

In CAHMS, what is the criteria for a child to be seen by a psychiatrist?

A
  1. Mental illness in presentation

2. Some kind of functional impairment OR risk

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2
Q

What are potential functional impairments in children associated with mental illness.

A

With school, relationships (family, friends), hobbies

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3
Q

What are potential risks for children and adolescents with mental health problems?

A 
Self harm 
Suicide
Drugs 
Abuse 
Alcohol 
Exploitation 
Grooming 
Running away
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4
Q

What are the three sections of investigating mental health in children and adolescents?

A

Presentation (recently)
Other background (previously)
Mental state examination (right now)

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5
Q

How do you investigate presentation?

A

Presenting complaint + History of presenting complaint

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6
Q

What are the 4 Ps in relation to formulation in psychiatry?

A

Predisposing
Precipitating
Protective
Perpetuating

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7
Q

In CAMHS, what are important factors to consider in the past psychiatric history?

A

Counselling

Therapy

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8
Q

In CAMHS, what are important physical factors to consider when taking a psychiatric history?

A

Seizures (temporal lobe epilepsy)

Head injuries

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9
Q

What sections do you consider in a psychiatric history when taking a history from a child or adolescent?

A 
Past psychiatric 
Past medical 
Meds and allergies
Social and habits 
FH (psychiatric and physical)
Personal 
Developmental
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10
Q

List the sections of the mental state exam for children and adolescents.

A 
Appearance
Behaviour
Speech
Mood 
Thoughts 
Perception 
Cognition 
Risk 
Insight
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11
Q

What tool is used to understand the cognitive profile of children and young people?

A

WHISC test

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12
Q

What are “Hopes for change” ?

A

Ask about goals of child and parents

Ask about expectations

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13
Q

What are assessment principles of psychiatric history taking?

A

Biopsychological approach, multiple perspectives and relationships, communication

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14
Q

List biological factors that may contribute to a young persons mental health.

A

Genetics, neurodevelopment insults, illness

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15
Q

List psychological factors that may contribute to a young persons mental health.

A

Temperement, attachment style, psychological attributes e.g impulsivity, low self esteem, perfectionism

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16
Q

List social factors that may contribute to a young persons mental health.

A

Relationships, hobbies, interests, religious faith, school, neighbourhood, criminality, finances

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17
Q

What type of studies are increasingly being used to identify genetic risk factors for psychiatric disorders?

A

Genone Wide Association Studies

Twin studies

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18
Q

What are developmental influences on psychopathology?

A

Genetics
Family history
Intrauterine and perinatal factors
Environmental factors

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19
Q

List intra-uterine and perinatal factors of development of psychopathology.

A 
Maternal health 
Substance misuse
Toxins 
Drugs
Endocrine environment 
immune environment 
premature birth 
twinning
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20
Q

What are signs of fetal alcohol syndrome/

A

Growth retardation

Neuro-developmental effects: sensorimotor, cognitive development, executive function, language, ADHD, DCD, LD

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21
Q

What is poor white matter connectivity associated with?

A

Cognitive instability
ADHD
Poor concentration
Distractibility

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22
Q

List common psychiatric problems in children.

A

Learning difficulties
Conduct disorders e.g ODD
Combined ADH or ADD or hip-lmp subtypes
Anxiety disorders

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23
Q

List environmental factors that can influence the psychiatry of a child.

A 
Relationships 
Parenting skills 
Marital harmony 
Nutrition 
Poverty 
Abuse/neglect 
Discipline 
Day-care/schooling
Life events 
Physical disability 
Attachment e.g lack of bonding
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24
Q

How does early life stress influence function of the brain?

A

Influences function of limbic circuit including amygdala

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25
Q

How does the brain adapt to a hostile environment?

A

Experience of adversity

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26
Q

List concepts in psychological development.

A 
Reward-based
Executive function 
Delay-aversion 
Sharing emotion and empathy 
Expressed emotion
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27
Q

What is the hypoactive reward response?

A

Application of reward deficiency model

“Addiction”
Increased delay aversion

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28
Q

What is operant conditioning?

A

Dopamine neurons fire when you associate and action with a subsequent reward

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29
Q

Give an example of a test used to look at delay-aversion.

A

Marshmallow test

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30
Q

What is the relationship between delay-aversion and ADHD.

A

Inability to wait and maintain attention in the absence of immediate reward

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31
Q

What is expressed emotion related to?

A

Increased rate of relapse from chronic illness
Schizophrenia, Depression, ADHD
Physical illness (epilepsy, CF, DM, Asthma)

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32
Q

What is the out-of-school matrix?

A

School refusal from fear of leaving home and fear of going to school
vs
Truancy from being unwilling to leave home and to go to school

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33
Q

Not going to school is associated with what mental health disorders?

A

Anxiety, conduct disorder, autism, depression, OCD

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34
Q

List effects of mental health problems on school attendance and learning.

A 
Learning difficulties
Poor attention 
Difficulty controlling emotions 
Lack of energy/motivation
Difficulty joining in 
Sensory problems
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35
Q

Discuss the biological cause of anxiety in childhood.

A

Amygdala activity suppressed by right ventrolateral cortex when labelling emotions

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36
Q

What is separation anxiety?

A

Fear of leaving parents and home

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37
Q

What is social phobia?

A

Fear of joining group

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38
Q

List the 3A’s of anxiety.

A

Anxious thoughts and feelings
Autonomic symptoms
Avoidant behaviour

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39
Q

List factors that can affect school attendance.

A 
learning difficulties 
bullying 
lack of friends
lack of parental attention/concern
maternal depression
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40
Q

Describe the emotional contagion in childhood anxiety.

A

Child fearful –> fearful parent –> fearful doctor

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41
Q

How do you manage anxiety in children?

A

Behavioural e.g learning alternative patterns of behaviour, desensitisation, overcoming fear, managing feelings
Meds - SSRI e.g fluoxetine

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42
Q

What is the differences in CBT for children?

A

Don’t expect children to have cognitive awareness
Parents should be collaborators
Step-wise approach
Goal setting

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43
Q

What medication can you give to children with anxiety?

A

Fluoxetine (SSRI)

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44
Q

What are autistic spectrum disorders?

A

Syndromes of persistent, pervasive and distinctive behavioural abnormalities

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45
Q

What is the etiological factors for autism?

A

M>F (3:1), Highly heritable, comorbid with congenital or genetic disorders e.g rubella

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46
Q

What are distinctive features of ASDs?

A

Reciprocity
Language problems
Obsessions

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47
Q

What are common clinical problems associated with ASD?

A

Learning disability, disturbed sleep and eating habits, hyperactivity, increased anxiety and depression, OCD, school avoidance, aggression, tantrums, self-harm/injury, suicidal behaviour

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48
Q

How do you manage ASD?

A 
Recognition and description
Establish needs
Appreciate the can't and won't
Reduce demands --> reduce stress --> increase coping
Psychopharmacology
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49
Q

What conditions fall under Hard to manage children (H2M)?

A

Oppositional defiant disorder (ODD)

Attention deficit hyperactivity disorder (ADHD)

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50
Q

What are signs of ADHD?

A

Aggression is impulsive
Poor cognition control and ability to sustain a goal
Often remorseful
Resistant to poor behavioural management

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51
Q

Does ADHD or ODD have the strongest genetic component?

A

ADHD

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52
Q

Discuss ODD.

A

Relates to temperament - irritable and headstrong
Behaviour is learned
More likely to result from impaired parenting

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53
Q

What are outcome risks of H2M children?

A

Antisocial behaviour, substance misuse, long-term mental health problems

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54
Q

How are H2M children managed?

A 
Parent training 
Multi-systemic therapy 
Meds - stimulants (Rital/methylphenidate), atomoxetine, guanfacine
School interventions
Treat comorbidity 
Voluntary organisations
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55
Q

What are SEs of methylphenidate used for ADHD?

A

Appetite, weight and sleep disturbances

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56
Q

What is the ABCD of dementia?

A

ADLs
Behavioural and psychiatric symptoms of dementia
Cognitive impairment
Decline

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57
Q

What re cognitive features of dementia?

A

Dysmnesia plus one or more of: dysphasia, dyspraxia, dygnosia, dysexecutive functioning

Functional decline

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58
Q

List neuropsychiatric disturbances linked with dementia.

A 
Psychosis
Depression 
Agitation 
Anxiety 
Altered circadian rhythms
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59
Q

What re two types of dysphasia/

A

Expressive and receptive

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60
Q

What is dyspraxia?

A

Inability to carry out motor tasks

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61
Q

What is ‘sundown’ common in dementia patients?

A

Get more agitated late afternoon

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62
Q

What is the characteristic sign of vascular dementia?

A

Step-wise progression

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63
Q

What is the most common type of dementia?

A

Alzheimer’s

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64
Q

What causes a dementia syndrome?

A

Different pathologies - e.g overlap between different types

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65
Q

List difference between dementia and delirium.

A

Dementia - insidious onset, slow gradual progressive decline, irreversible, disorientated in late illness

Delirium - abrupt onset, acute illness lasting days to weeks, usually reversible, disorientated in early illness

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66
Q

What are differentials for dementia that need to be excluded?

A

Delirium and depression

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67
Q

What basic cognitive tests are carried out for dementia?

A

MMSE

MOCA

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68
Q

78 year old woman referred by GP with 3 year history of gradual and progressive deterioration in memory. Cognitive testing show dyskinesia and dysexecutive dysfunction. Reliant on daughter, no focal neurological signs, no h/o vascular disease or risk factors.

Most likely diagnosis?

A

Alzheimer’s

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69
Q

What imaging would you organise for suspected Alzheimer’s?

A

CT or MRI or SPECT

MEDIAL TEMPORAL ATROPHY ON BOTH LOBES

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70
Q

What is dementia with Lewy bodies?

A

Dementia
Amnesia not prominent
Deficits of attention, frontal executive, visuospatial

Fluctuation
Visual hallucinations
Parkinsonism
Psychotic symptoms

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71
Q

What type of drugs do Lewy body Dementia patients have a sensitive to which complicates treatment?

A

Antipsychotics

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72
Q

What scan is used to determine Lewy body dementia?

A

DATScan

73
Q

50 year old man presents with gradual change in behaviour over last 2 years, stopped taking care of his appearance and e personal hygiene, clear personality change, apathetic, withdrawn. What is the likely diagnosis?

A

Frontotemporal dementia

74
Q

What scan will confirm frontotemporal dementia?

A

Axial MRI - cerebral atrophy in frontal and temporal regions

75
Q

What are drug treatments prescribed for dementia?

A

Acetylcholinesterase inhibitors e.g donepezilm rivastigmine, galantamine

Antipsychotics (risperidone, quetiapine, amisulpride)
antidepressants
Anxiolytics
Hypnotics
Anticonvulsants
76
Q

What drug is prescribed for Alzheimers?

A

Memantine

77
Q

What is the benefit of cholinesterase inhibitors for dementia?

A

Improve cognitive function and non-cognitive symptoms e.g ADL, longer at home

78
Q

What are common mental health problems in old age?

A

Dementia
Depression Anxiety disorders - GAD, panic disorder, agoraphobia, PTSD
Affective disorders - mania, schizophrenia, alcohol problems
Grief, mourning and bereavement

79
Q

What are abnormal symptoms from grief/bereavement?

A 
Persistent beyond 2 months
Guilt
Thoughts of death 
Worthlessness
Psychomotor retardation 
Psychosis
Prolonged and marked functional impairment
80
Q

What is the rate of suicide in elderly?

A

Same as for under 25

M>F

81
Q

What are common triggers for suicide in elderly/

A 
Loneliness
Widowed
Ill health 
Chronic pain 
Recent life events
82
Q

How do you manage schizophrenia in elderly/

A

Neuroleptics
Increased social contact
Compulsory admission

83
Q

What are risk factors for schizophrenia in elderly/

A

Social isolation
Genetic
Sensory loss

84
Q

What questionnaire can be used as a screening tool for eating disorders?

A

SCOFF Questionnaire - 2 or more then likely

Do you make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone in a three month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say Food dominates your life?

85
Q

What are signs of anorexia nervosa?

A

Restriction of intake to reduce weight

Relies on compulsive compensatory behaviours when food cannot be avoided, self induced vomiting, laxative abuse, excessive exercise

86
Q

At what BMI is considered anorexic?

A

15% below ideal body weight/ B,MI 17.5 or less

87
Q

What suggests anorexia nervosa in relation to menstrual cycles?

A

Absence of menstrual cycle or amenorrhoea (greater than 3 cycles)

88
Q

what are signs of anorexia nervosa?

A 
Cold intolerance 
Blue hands and feet 
Constipation 
Bloating 
Delayed puberty 
Primary or secondary amenorrhea
Dry skin 
Fainting 
Hypotension 
Lanugo hair
Scalp hair loss
Early satiety 
Weakness, fatigue
short stature
Osteopenia and osteoporosis
89
Q

What are signs of bulimia nervosa?

A

Episodes of binge eating with a sense of loss of control
Binge eating followed by compensatory behaviour of the purging type

Binges and compensatory behaviour must occur a minimum of two times per week for three months

Dissatisfaction with body shape and weight

90
Q

What are signs and symptoms of bulimia nervosa?

A 
Mouth sores
Pharyngeal trauma
Dental caries
Heartburn/chest pain 
Oesophageal rupture 
Impulsivity 
Muscle cramps 
Weakness
Bloody diarrhoea
Irregular periods
Fainting 
Swollen parotid glands 
Hypotension
91
Q

What is binge eating disorder?

A

Similar to bulimia but absence of purging behaviours

Ongoing and/or repetitive cycles often include - eating quickly, alone, unusually large amounts, embarrassment, shame, guilt and depression afterwards

92
Q

Give examples of avoidance behaviours seen in eating disorders.

A

Not touching food
Developing dislikes, pickiness
Avoiding parties and social occasions, spoiling or messing of food

93
Q

How do patients with eating disorders try to get rid of calories?

A 
Self-induced vomiting 
Chewing and spitting out 
Overexercuse
Overactivity 
Cooling 
Blood letting 
Medication abuse
94
Q

What medications can be abused to try get rid of calories?

A

Excessive caffeine, stimulant consumption - laxatives, ipecac, pain killers

95
Q

What is diabulimia?

A

Patient enjoys carb rich diet but then omits insulin so as to “effectively purge” calories and insulin omission in diabetic patients

May omit to reduce insulin after meals

96
Q

What are psychological consequences of eating disorders?

A

Depression
Anxiety
Obsessionalitu
Loss of concentration on anything but food

97
Q

What are social consequences of eating disorders?

A

Forced to lie and cheat or steal

Withdraw from friendships and lose interest in sexual relationships

98
Q

What are potential physical consequences of eating disorders?

A 
Prolonged QTc --> arrhythmia
Seizures
Infections
Anaemia
Bone loss
Fertility problems
Hypokalaemia
Disruption of growth and development
99
Q

What are causes of eating disorders?

A

Predisposing - genetics, OCD, anxiety, perfectionism, perinatal, life events

Perpetuating - consequences of starvation and of avoidance, delayed gastric emptying, narrowing focus, obsessionality

Precipitating factors - puberty, dieting, increased exercise, stressful life events

100
Q

What psychiatric disorder has the highest mortality rate?

A

Anorexia nervosa

101
Q

What is the average time for recovery from anorexia nervosa?

A

6-7 years

102
Q

How can anorexia nervosa patients be helped?

A 
Re-feeding 
CBT 
Mantra
SSCM 
IPT 
Fluoxetine
Olanzapine (antipsychotic)
Specialist family work
103
Q

What is the only evidence based medication for eating disorders.

A

Olanzapine - feel less anxious, helps sleep, blocks intrusive thoughts

104
Q

What are organic mental disorders?

A

Due to common demonstrable aetiology in cerebral disease, brain injury or other insult leading to cerebral dysfunction

105
Q

What is the difference between primary and secondary organic mental illness?

A

Primary - direct effect on brain

Secondary - systemic disease that affects the brain

106
Q

List psychiatric disorders that have an organic basis?

A

Schizophrenia
BAD
Melancholia

107
Q

What are common features of organic mental illness?

A

Cognitive - memory, intellect, learning

Sensorium - consciousness, attention

Mood - depression, elation, anxiety

Psychotic - hallucinations, delusions

Personality and behaviour disturbance

108
Q

When can organic mental illness occur?

A

Any age - most start in adult or later life

109
Q

List acute/subacute organic mental disorders.

A

Delirium
Organic mood disorder
Organic psychotic disorder

110
Q

List chronic organic mental disorders.

A

Dementia
Amnesic syndrome
Organic personality change

111
Q

List presenting features of delirium.

A 
Impairment of consciousness and attention 
Global disturbance of cognition 
Psychomotor disturbances 
Disturbance in sleep-wake cycle 
Emotional disturbance

Rapid onset, diurnal variation, duration less than 6 months

112
Q

What are physical signs of delirium?

A 
Tachycardia
Hypertension 
Diaphoresis
Dilated pupils
Fever
113
Q

List causes of delirium.

A 
Medications
Drug abuse
Withdrawal symptoms 
Metabolic 
Vitamin deficiencies 
Endocrinopathies
Infections
Neurological causes 
Toxins and industrial exposures
SLE
Cerebral vasculitis
Paraneoplastic syndromes
114
Q

What medications can be given for delirium?

A

Avoid sedation unless required for safety

115
Q

What is the difference between delirium and encephalopathy/

A 
Delirium = psychiatric presentation 
Encephalopathy = description of underlying process
116
Q

Give examples of encephalopathies?

A

Hepatic, Wernicke’s, HIV

117
Q

What are signs of hepatic encephalopathy?

A

General psychomotor retardation
Drowsiness
Fluctuating confusion
Asterixis

118
Q

List examples of organic mental disorders.

A

Delirium
Encephalopathies
Dementia
Amnesic syndrome

119
Q

What is amnesic syndrome?

A

Syndrome of impairment of recent and remote memory

120
Q

What are signs of amnesic syndrome/

A 
Immediate recall preserved
New learning reduced
Anterograde amnesia
Disorientation 
retrograde amnesia
Confabulation 
Perception and other cognitive functions preserved
121
Q

What are the most common causes of amnesic syndrome?

A

Alcohol

Poor nutrition

122
Q

How do you treat amnesic syndrome?

A

Depends on cause

Prevent alcohol amnesic syndrome

123
Q

How do you prevent alcohol amnesic syndrome?

A 
Months - years 
Pabrinex (vitB1)
Oral thaimine
Abstinence form alcohol 
MDT rehab
124
Q

What is the definition of learning disability?

A

Condition of arrested or incomplete development of mind which is characterised by impairment of skills manifested during DEVELOPMENT period

125
Q

What IQ suggests intellectual impairment?

A

Less than 70

126
Q

What is the gold standard scale used to measure intelligence and indicate intellectual impairment/

A

Weschler

127
Q

Discuss the Weschler classification scale used to classify ld.

A

Mild 50-69
Moderate 35-49
Severe 20-34
Profound <20

128
Q

Discuss aetiology of learning difficulties.

A

Genetics - single gene (Fragile x), micro deletion (DiGeorge), chromosomal (Down syndrome)

Infective

Toxic

Trauma

Idiopathic

129
Q

Give examples of infective causes of learning disability.

A

Ante-natal e.g rubella

Post-natal e.g meningitis

130
Q

Give examples of common and/or important physical conditions associated with LD.

A 
Epilepsy 
Sensory impairment 
Obesity 
GI issues 
Resp problems e.g aspiration pneumonia
Cerebral palsy 
Orthopaedic problems e.g osteoporosis
Dermatological or dental
131
Q

What is the commonest aetiology of learning difficulties?

A

Unknown

132
Q

What is the link for psychiatric disorders and learning difficulties?

A

More severe LD has higher prevalence of psychiatric disorders

133
Q

What are psychiatric assessment areas for learning difficulties?

A

Aetiology of LD
Associated biomedical conditions
Severity of LD
Consequences e.g forensic history

134
Q

What are common mental health problems associated with LD?

A

OCD
Autism
Over-activity syndromes
Self-harm

135
Q

What questionnaire can be given to patient if considering depression in general practice?

A

PHQ-9 Depression

136
Q

If recognised depression with persistent sub threshold symptoms or mild to moderate depression, what would you suggest in GP?

A

Advice on sleep hygiene
Active monitoring
Low-level CBT, mindfulness

DON’T rountinely use antidepressants

137
Q

In primary care, what would be the first line medications prescribed for depression?

A

SSRI - e.g fluoxetine, citalopram

138
Q

What are Med-3 forms?

A

Fit for work forms

139
Q

What are main side effects from SSRI?

A

Gastric - dyspepsia, diarrhoea, N&V

140
Q

What is the normal follow-up in primary care for antidepressants?

A

2 weeks after starting, intervals of every 2-4 weeks for 3 months

141
Q

How long do you recommend patients to remain on antidepressants after remission?

A

6 months - up to 2 years

142
Q

What should you do if patient does not respond to antidepressants after 3-4 weeks at therapeutic dose?

A

Increase level of support or switch to another SSRI, then another class e.g TCA, MAOI, can combine or augment, or augment with lithium

143
Q

In primary care, what should you do for severe and complex depression with risk to life, psychotic symptoms or severe self-neglect?

A

Refer to MDT and possible inpatient care

144
Q

What should you do if you suspect bipolar disorder in primary care?

A

Refer/ discuss with secondary care

145
Q

In primary care, what would you offer to a patient with a generalised anxiety disorder?

A

Active monitoring
GAD-7 scoring
SSRI
Psyhchoeducational groups

146
Q

What should you not prescribe for GAD?

A

Benzodiazepines, antipsychotics

147
Q

What do you prescribe for management of panic disorders?

A

Psychological therapy - CBT
Self-help
SSRI - sertraline

148
Q

What should you NOT prescribe for panic disorders?

A

Fluoxetine

Avoid benzodiazepines/sedating antihistamines/antipsychotics

149
Q

How do you treat social anxiety disorder/

A

CBT

Medication - sertraline or escitalopram

150
Q

What is prolonged grief disorder?

A

MARKED DISTRESS AND DISABILITY CAUSED BY THE GRIEF REACTION and PERSISTENCE FOR MORE THAN 6 MONTHS

151
Q

What are treatment options for grief disorder?

A

Counselling

Antidepressants for co-morbid depression

152
Q

What is the criteria for diagnosis of OCD?

A

Obsessions and compulsions must be time consuming >1 hour, or cause significant distress or functional impairment

153
Q

What should you do in primary care who presents with insomnia?

A

Screen for secondary causes e.g anxiety/depression, physical problems, sleep apnoea, excess alcohol/drugs

154
Q

List parasomnias.

A

Restkess legs, sleep walking/talking/terrors/teeth grinding

155
Q

How do you treat insomnias?

A

Sleep hygiene
CBT-I
Melatonin
For >55Y, <13 weeks use

156
Q

What monitoring do you need to do for lithium?

A

TFTs, kidney function - 6 monthly

3 monthly checks

157
Q

What are common side effects of lithium?

A 
Fine tremor
Dry mouth 
altered taste
Increased thrust 
Urinary frequency 
Mild nausea
Weight gain
158
Q

What are signs of lithium toxicity?

A 
Confusion
Ataxia
Coarse tremor
Slurred speech 
Blurred vision 
Seizures
D&amp;V
Muscle weakness
Lethargy
159
Q

List reasons for increased prevalence of mental health disorders in general hospitals?

A

Challenges of physical illness

Treatment of physical illness

160
Q

What mental health problems are less commonly seen in general hospitals?

A

Schizophrenia
BAD
Severe depression

161
Q

What illnesses is depression common in?

A

Chronic illness

Neurological diseases

162
Q

With regards to self-harm, what percentage of patients will repeat within one year?

A

15-20%

163
Q

What is the most common drug taken in overdose?

A

Paracetamol

164
Q

What are functional mental health disorders?

A

Medically unexplained symptoms

165
Q

What mental disorders are classed as functional disorders?

A

Dissociative disorders

Somatoformin disorders

166
Q

What are symptoms of functional disorders?

A

Present in all specialities e.g IBS, fibromyalgia, chronic fatigue syndrome

FND presents more with psychological symptoms

167
Q

What causes rebound mania in association with lithium use?

A

Dose to low

168
Q

Doe lithium have a large or narrow therapeutic index?

A

Narrow

169
Q

When does postpartum psychosis occur?

A

within days to 6 weeks

170
Q

When does postnatal depression occur?

A

Within 6 months

171
Q

Define Agraphia

A

inability to write

172
Q

Define Alexithymia

A

sub clinical emotional blindness

173
Q

Define Cyclothymia

A

relatively mild mood fluctuations

174
Q

Define Dyscalculia

A

difficulty dealing with numbers

175
Q

Define Anhedonia

A

lack of pleasure/interest

176
Q

Define Catatonia

A

immobility, stupor

177
Q

Define Dysarthia

A

difficulty articulating speech

178
Q

Define Dystonia

A

involuntary muscle spasms/contractions

Psychiatry (5 decks)

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