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Child Psych Flashcards

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1
Q

What is autism spectrum disorder (ASD)?

A

Characterized by impairments in social communication/interaction & restrictive, repetitive behaviors/interests

Combines 4 previously separate disorders (autistic, Asperger’s, childhood disintegrative, pervasive development disorder)

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2
Q

Diagnosis of ASD

A

Severity depends on degree of impairment:

  • Mild
  • Moderate
  • Severe (severe RBRs)

DEFICITS IN SOCIAL COMMUNICATION & INTERACTION:
Impaired social/emotional reciprocity:
- Can’t hold a conversation (unidirectional)
- Not share (interests, emotions)
- Not check on other person interest
- Lack empathy / understanding
- Screener: understand others emotions?
Deficits in nonverbal communication:
- Eye contact, facial expressions, gestures, body
Relationship / interpersonal challenges:
- Lack of interest in peers
- Not adjust behavior to situation
- Not sharing imaginative play

RESTRICTED, REPETITIVE BEHAVIORS, INTERESTS, & ACTIVITIES (RBRs): Stereotyped repetitive mannerisms (self-stimulating things):
- Motor (hand flapping, circling)
- Speech (No inflection at the right point, breathes at wrong times, emphasis on the wrong part of the syllable, etc.)
Inflexible rituals / routines (rigid thought patterns, sameness):
- Screener questions: trouble w/ transitions (plan to go to dinner, but then decide not to –> outburst)
Intense / peculiar interest:
- Fixated w/ abnormal intensity / focus
Hyper/hypo-reactivity to sensory input:
- Increased (or decreased) - textures, light, sound, pain

If there are no RBRs, it is SOCIAL (PRAGMATIC) COMMUNICATION DISORDER:
- Social use of verbal & nonverbal communication

Not better accounted for by ID or global developmental delay
- When ID & ASD co-occur, social communication is below expectation based on developmental level

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3
Q

Red flags for ASD

A

Rapid deterioration of social &/or language skills during first 2 years of life

If skills are lost after age 2 or more expansive losses occur (e.g. self-care, motor skills), an extensive medical workup needs to be initiated

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4
Q

Epidemiology of ASD

A

Recent increase in prevalence: 1% of population
- Could be related to expansion of diagnostic classification and/or increased awareness/recognition

Males to females ratio is 4:1

Symptoms typically recognized between 12-24 months old, but varies based on severity

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5
Q

Etiology of ASD

A

Multifactorial:

  • Prenatal neurological insults:
    • Infections
    • Drugs
  • Advanced paternal age
  • Low birth weight
  • 15% of cases are associated w/ known genetic mutation:
    • Fragile X syndrome (most common known single gene cause of ASD)
    • Down’s syndrome
    • Rett syndrome
    • Tuberous sclerosis
  • High comorbidity w/ ID
  • Association w/ epilepsy

Known not to cause:

  • Maternal temperament & mental illness
  • Immunizations
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6
Q

Prognosis of ASD

A

It is a chronic condition

  • Prognosis is variable, but 2 most important predictors of adult outcome:
    • Level of intellectual functioning
    • Language impairment
  • Only minority of patients able to live & work independently in adulthood

No cure, but various treatments are used to help manage symptoms & improve basic social, communicative, & cognitive skills

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7
Q

Treatment of ASD

A

Early intervention

Remedial education

Behavioral therapy
- Applied Behavioral Analysis

Psychoeducation

Meds:

  • Used to reduce disruptive behavior / irritability / aggression associated w/ ASD:
    • Low-dose atypical antipsychotic:
      • Risperidone (Risperdal)
      • Aripiprazole (Abilify)
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8
Q

What is intellectual disability (ID)?

A

Formerly mental retardation (this is illegal)

  • De-emphasizing IQ scores
  • Destigmatize

Characterized by severely impaired cognitive & adaptive/social functioning

  • Severity level is based on adaptive functioning, indicating degree of support required
  • Single IQ score does not adequately capture this & is no longer used solely to determine ID severity
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9
Q

Diagnosis of ID

A 
FUNCTIONAL DEFICITS
Intellectual:
- Reasoning
- Problem solving
- Planning
- Abstract thinking
- Judgment 
- Learning (academic & experience) 
- Confirmed by clinical assessment & standardized intelligence testing (scores at least 2 SDs below the population mean)
Adaptive:
- Communication 
- Social participation 
- Independent living
- Require ongoing support in multiple environments

Deficits affect 3 domains:

  • Conceptual
  • Social
  • Practical (being able to live alone)

Onset in developmental period

Severity levels (based on need for support):

  • Mild
  • Moderate
  • Severe
  • Profound
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10
Q

Epidemiology of ID

A

Overall: 1% of population

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11
Q

Etiology of ID

A

GENETIC:
Down Syndrome (trisomy 21) (most common chromosomal disorder, #1 identifiable cause)
- Epicanthic folds, flat nasal bridge, palmar crease
Fragile X syndrome (FMR-1 gene mutation) (#1 inheritable cause, #2 identifiable cause)
- Macrocephaly, joint hyperlaxity, macroorchidism in post-pubertal males
- Males > females
Others:
- Phenylketonuria
- Familial mental retardation
- Prader-Willi
- Williams
- Angelman
- Tuberous sclerosis

PRENATAL:
TORCH infections
- Toxoplasmosis
- Other (syphilis, HIV/AIDS, alcohol/illicit drugs)
- Fetal alcohol syndrome (FAS) = leading preventable cause of birth defects & ID
- 3 features:
- Growth retardation
- CNS involvement (structural, neurologic, functional)
- Facial dysmorphology (smooth philtrum, short palpebral fissures, thin vermillion border)
- May cause range of developmental disabilities, including ID
- Rubella
- CMV
- HSV

PERINATAL:

  • Birth trauma
  • Anoxia
  • Premature
  • Meningitis
  • Hyperbilirubinemia

POSTNATAL:

  • Hypothyroidism
  • Malnutrition
  • Toxin exposure
  • Trauma
  • Psychosocial causes

Idiopathic / unknown = 50%

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12
Q

What is global developmental delay?

A

Failure to meet expected developmental milestones in several areas of intellectual functioning

Diagnosis reserved for patients <5 years old when severity level can’t be reliably assessed via standardized testing
Patients will need to be reevaluated to clarify the diagnosis at a later time

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13
Q

What are specific learning disorders?

A

Characterized by delayed cognitive development in a particular academic domain (with normal IQ - it is difficult to say someone has a learning disorder if he/she is not expected to be at a higher level)

  • Challenges w/ reading, writing, & arithmetic often co-occur
  • Frequently occurs w/ ADHD which can worsen the prognosis
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14
Q

Diagnosis of specific learning disorders

A

Significantly impaired academic skills which are below expected for chronological age
- Interfere w/ schooling, occupation, or activities of daily living (ADLs)

Begins during school-age, but may become more impairing as demands increase

Affected areas:

  • Reading (dyslexia)
    • Learning difficulty with accurate/fluent word recognition, poor decoding, & poor spelling
  • Writing
  • Arithmetic (dyscalculia)

Not better accounted for by ID, visual/auditory deficits, language barriers, or subpar education

Always rule out sensory deficits before diagnosing a specific learning disorder

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15
Q

Epidemiology of specific learning disorders

A

Prevalence in school-age children: 5-15%

Males > females

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16
Q

Etiology of specific learning disorders

A

ENVIRONMENTAL:
Increased risk w/ prematurity, very low birth weight, prenatal nicotine use

GENETIC:
Increased risk in first-degree relatives of affected individuals

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17
Q

Comorbidity of specific learning disorders

A

Commonly co-occurs w/ other neurodevelopmental disorders (e.g. ADHD, communication disorders, developmental coordination disorders, ASD)

Comorbid w/ other mental disorders (e.g. anxiety, depressive, & bipolar disorders)

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18
Q

Treatment of specific learning disorders

A

Work w/ school

  • Develop Individualized Education Plan (IEP) vs. 504 plan
    • IEP:
      • Have to make sure there are adjustments/accommodations for that particular person so that he/she is able to show that he/she can do that specific thing (give calculator, allow longer time, etc.)
    • 504 Plan:
      • Only requires “equal access”
      • It is a structural thing (ramp access, large doors, allowed to go to school, etc.)

Accommodations:

  • Regular classroom
  • Special education

Behavioral techniques may be used to improve learning skills

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19
Q

What are communication disorders?

A

Encompass impaired speech, language, or social communication that are below those expected for chronological age

Begin in the early developmental period

Lead to academic or adaptive issues

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20
Q

What are the types of communication disorders?

A

LANGUAGE DISORDER
Difficulty acquiring & using language due to expressive and/or receptive impairment:
- Reduced vocabulary
- Limited sentence structure
- Impairments in discourse
Increased risk in families of affected individuals

SPEECH SOUND DISORDER (phonological disorder)
Difficulty producing articulate, intelligible speech

CHILDHOOD-ONSET FLUENCY DISORDER (stuttering)
Dysfluency & speech motor production issues
Increased risk of stuttering in first-degree relatives of affected individuals

SOCIAL (pragmatic) COMMUNICATION DISORDER
Challenges w/ social use of verbal & nonverbal communication
If restricted/repetitive behaviors, activities, or interests are present –> diagnose ASD
Increased risk w/ family history of communication disorders, ASD, or specific learning disorder

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21
Q

Treatment of specific learning disorders

A

Speech & language therapy

Family counseling

Tailor education to meet individual’s needs

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22
Q

What is ADHD?

A

Characterized by persistent inattention, hyperactivity, & impulsivity inconsistent w/ patient’s developmental stage

3 subcategories:

  • Predominantly inattentive type
  • Predominantly hyperactive/impulsive type
  • Combined type
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23
Q

Diagnosis of ADHD

A

2 symptom domains: inattentiveness & hyperactivity/impulsivity

INATTENTION (at least 6):

  • Fails to give close attention to details or makes careless mistakes
  • Doesn’t seem to listen when spoken to directly
  • Does not follow through on instructions & can’t finish tasks
  • Difficulty organizing tasks
  • Avoids, dislikes, or reluctant to engage in tasks requiring sustained mental effort
  • Distractible
  • Loses things needed for tasks
  • Forgetful in daily activities

HYPERACTIVITY/ IMPULSIVITY (at least 6):

  • Fidgets w/ hands or feet or squirms in chair
  • Runs/climbs in inappropriate situations
  • Out of seat constantly in situations where remaining seated is expected
  • Difficulty playing quietly
  • “On the go” or “driven by a motor”
  • Talks excessively
  • Difficulty awaiting turn
  • Interrupts or intrudes upon others
  • Blurts out answers before questions have been completed

Symptom onset before age 12, but can be diagnosed retrospectively in adulthood

  • 6+ symptoms for more than 6 months present in AT LEAST 2 settings:
    • Get collateral info from teachers at school
    • Rating scale: Conner’s, Vanderbilt, etc.
      • Sources: parents, teacher, student
      • Compare progress before & after treatment & before/after changes in meds & dosages
    • Symptoms interfere w/ or reduce quality of social/academic/occupational functioning
    • Symptoms not due to another mental disorder
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24
Q

Differential diagnosis of ADHD

A

MEDICAL DISORDERS:

  • Vision / hearing impairments
  • Seizure disorders
  • Lead poisoning
  • Iron deficiency anemia
  • Thyroid disorders
  • Sleep disorder

MEDICATIONS:

  • Prescribed medications (e.g. albuterol, steroids)
  • Drugs of abuse (e.g. cocaine)

EMOTIONAL / BEHAVIORAL DISORDERS:

  • Depression / mood disorders
  • Anxiety disorders

ENVIRONMENTAL DISORDERS:

  • Child abuse / neglect
  • Inadequate parenting
  • Inappropriate educational setting
  • Stressful home environment
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25
Epidemiology of ADHD
Prevalence: - 5% of children - 2.5% of adults Males to females is 2:1 - Females present more often w/ inattentive symptoms
26
Etiology of ADHD
Etiology of ADHD is multifactorial: GENETIC FACTORS: - Increased rate in first-degree relatives of affected individuals ENVIRONMENTAL FACTORS: - Low birth weight - Smoking during pregnancy - Childhood abuse/neglect - Neurotoxin/alcohol exposure
27
Course/prognosis of ADHD
Stable through adolescence Many continue to have symptoms as adults (inattentive > hyperactive) High incidence of comorbid ODD, CD, & specific learning disorder
28
Treatment of ADHD
Multimodal treatment of ADHD: - Meds are most effective treatment for decreasing core symptoms, but should be used in conjunction w/ educational & behavioral interactions MEDS: - 1st line: stimulants (response rate 94% if both are tried) - Methylphenidates (Ritalin, Concerta, Focalin) - Amphetamines (Adderall, Vyvanse, Dexedrine) - Nonstimulants - 2nd line: atomoxetine (SSRI) - Alpha agonists (Guanfacine, Clonidine) - Other meds - Bupropion + TCA THERAPY: - Behavioral therapy (modification techniques & social skills training) - Educational interventions (i.e. classroom modifications) - Parent psychoeducation
29
What are disruptive, impulse-control, & conduct disorders?
These disorders involve problematic interactions / inflicting harm on others - While disruptive behaviors may appear within scope of normal development, they become pathologic when frequency, pervasiveness, & severity impair functioning of individual or of others
30
What is oppositional defiant disorder (ODD)?
Maladaptive pattern of irritability/anger, defiance, or vindictiveness which causes dysfunction or distress in patient or those affected - These interpersonal issues involve at least 1 non-sibling If child has no difficulties getting along w/ peers, but will not comply w/ rules from parents/teachers, consider ODD
31
What is conduct disorder (CD)?
Includes most serious disruptive behaviors, which violate rights of other humans & animals - Inflict cruelty & harm through physical & sexual violence - May lack remorse for committing crimes or lack empathy for victims
32
Diagnosis of ODD
Need 4+ symptoms in past 6 months (with at least 1 individual who is not a sibling): - Anger/irritable mood - Loses temper - Touchy/easily annoyed - Often angry / resentful - Argumentative / defiant behavior: - Breaks rules - Argues w/ authority figures - Deliberately annoys other - Blames others - Vindictiveness - Spiteful at least 2 times in past 6 months - Disturbance associated w/ distress in individual or others or it impacts negatively on functioning - Behaviors do not occur exclusively during another mental disorder
33
Diagnosis of CD
Pattern of recurrently violating basic rights of others or societal norms w/ 3+ symptoms in over the past year w/ at least 1 in the last 6 months: - Aggression to people & animals - Bullies/threatens/intimidates others - Initiates physical fights - Uses weapon - Physically cruel to people/animals - Stolen items while confronting victim - Forced someone into sexual activity - Destruction of property - Engaged in fire setting - Destroyed property by other means - Deceitfulness or theft - Broken into home/car/building - Lied to obtain goods/favors - Stolen items without confronting victim - Serious violations of rules - Stays out late at night before 13 years - Runs away from home overnight at least twice - Often truant from school before 13 years
34
Epidemiology of ODD
Prevalence: approx. 3% Onset usually during preschool years - boys before adolescence Increased incidence of comorbid substance use & ADHD Although ODD often precedes CD, most do not develop CD
35
Epidemiology of CD
Lifetime prevalence: 9% More common in males - Males: higher risk of fighting, stealing, fire-setting, & vandalism - Females: higher risk of lying, running away, prostitution, & substance abuse High incidence of comorbid ADHD & ODD - Associated w/ antisocial personality disorder
36
Treatment of ODD & CD
Behavioral modification, conflict management training, & improving problem-solving skills Parent management training (PMT) can help w/ setting limits & enforcing consistent rules - Family therapy is the key Meds (often used to treat comorbid conditions - ADHD)
37
What is a tic disorder?
Defined as sudden, rapid, repetitive, stereotyped movements or vocalizations - Although experienced as involuntary, patients can learn to temporarily suppress tics - Prior to tic, patients may feel premonitory urge (somatic sensation) w/ subsequent tension release after tic - Anxiety, excitement, & fatigue can be aggravating factors for tics This is the only psychiatric disorder that can be diagnosed without the requirement of it affecting life
38
What are the different types of tic disorders?
Simple tic disorders: - Motor - Vocal Complex tic disorders
39
Diagnosis of tic disorders
PERSISTENT (chronic) MOTOR OR VOCAL TIC DISORDER Single or multiple motor or vocal tics, but not both PROVISIONAL TIC DISORDER Single or multiple motor and/or vocal tics <1 year TOURETTE SYNDROME Most severe of tic disorders Characterized by multiple motor tics & at least 1 vocal tic lasting for at least 1 year - Vocal tics may appear many years after the motor tics, may wax & wane in frequency - Coprolalia: utterance of obscene, taboo words as an abrupt, sharp bark, or grunt - Echolalia: repeating others' words Most common motor tics involve face & head (eye blinking, throat clearing) Onset prior to age 18 year Not caused by a substance (e.g. cocaine) or another medical condition (e.g. Huntington's disease)
40
Epidemiology of tic disorders
Transient tic behaviors: common in children Tourette's disorder: 3/1000 school-age children Prevalence boys > girls
41
Onset of tic disorders
Usually slow If fast, think of PANDAS / PANS
42
Course/prognosis of tic disorders
Onset typically occurs between 4-6 years - Peak severity between ages 10-12 years Tics wax & wane & change in type Symptoms tend to decrease in adolescence & significantly diminish in adulthood High comorbidity w/ OCD & ADHD
43
Treatment of tic disorders
Psychoeducation Behavioral interventions (habit reversal therapy) Meds (only used if tics become impairing) - Alpha-agonists - Guanfacine (first-choice) - Clonidine (more sedating) - In severe cases: - Second generation (atypical) antipsychotics - Risperidone - First generation (typical) antipsychotics - Pimozide
44
What are elimination disorders?
Characterized by developmentally inappropriate elimination of urine / feces Though typically involuntary, this may be intentional Course may be primary (never established continence) or secondary (continence achieved for period & then lost) Can cause significant distress / impair social / other areas of functioning
45
Diagnosis of elimination disorders
ENURESIS Recurrent urination into clothes / bed-wetting Occurs 2x/week for 3+ consecutive months or results in clinical distress or marked impairment 5+ years old developmentally Can occur during sleep (nocturnal), waking hours (diurnal), or both Not due to substance (e.g. diuretic) or another medical condition (e.g. UTI, neurogenic bladder, diabetes) ENCOPRESIS Recurrent defecation into inappropriate places (e.g. clothes, floor) Occurs 1+/month for 3+ months 4+ years old developmentally Not due to substance (e.g. laxatives), or another medical condition (e.g. hypothyroidism, anal fissure, spinal bifida)
46
Epidemiology of elimination disorders
Prevalence of enuresis decreases w/ age: - 5-15% of 5 year old - 3-5% of 10 year old - 1% of >15 years Nocturnal enuresis more common in boys Diurnal enuresis more common in girls Prevalence of encopresis: 1% of 5 year old children, boys > girls
47
Etiology of elimination disorders
Genetic predisposition for nocturnal enuresis: - About 4x increase risk if maternal - About 10 x increase if paternal Psychosocial stressors may contribute to secondary causes Encopresis: often related to constipation / impaction w/ overflow incontinence
48
Treatment of elimination disorders
Take into account the high spontaneous remission rates (5-15% per year) Psychoeducation is key Only treat symptoms if they are distressing & impairing PMT for managing intentional elimination Enuresis: - Limit fluid intake & caffeine at night - Behavioral program w/ monitoring & reward system - Meds (used if above methods are ineffective or for diurnal enuresis): - Desmopressin (DDAVP) (first-line) (antidiuretic hormone analogue) - Imipramine (TCA) Encopresis without constipation: - Comprehensive behavioral program ("bowel training") for appropriate elimination Encopresis due to constipation: - Initial bowel cleaning followed by stool softeners, high-fiber diet, & toileting routine in conjunction w/ behavioral program
49
What is child abuse?
Encompasses physical, sexual, emotional, and neglect Toxic stress may result when children endure prolonged, severe trauma & adversity without buffer of supportive caregivers Can disrupt child's development & lead to spectrum of pathologic sequelae About 1 million cases of child maltreatment in US - Up to 2500 deaths/year caused by abuse in US
50
What are the different types of child abuse?
Physical abuse Sexual abuse Psychological abuse Neglect
51
What is physical abuse?
Any act that results in nonaccidental injury & may be result of severe corporal punishment committed by individual w/ responsibility for the child Physical exam & x-rays demonstrate multiple, concerning injuries not consistent w/ child's developmental age Most common perpetrator is first-degree caregiver (e.g. parent, guardian, mother's boyfriend)
52
Red flags for physical abuse
Delayed medical care for injury Inconsistent explanation of injury Multiple injuries in various stages of healing Spiral bone fractures Bruising patterns consistent w/ hand/belt Cigarette burns Head injuries
53
What is sexual abuse?
Any sexual act involving child intended to provide sexual gratification to individual who has responsibility for child Sexual abuse is most invasive form of abuse & results in detrimental lifetime effects on victim Approx. 25% of girls & 9% of boys exposed to sexual abuse Victim of sexual abuse is typically female - Perpetrator is usually male & known to victim Children are most at risk during preadolescence If child ever reports sexual abuse, it should be taken seriously as it is rarely unfounded
54
Red flags for sexual abuse
STDs Recurrent UTIs Prepubertal vaginal bleeding Pregnancy Trauma/bruising/inflammation of genitals/anus Developmentally inappropriate sexual knowledge / behaviors should raise suspicion
55
What is psychological abuse
Nonaccidental verbal / symbolic acts that result in psychological damage
56
What is neglect?
Failure to provide child w/ adequate food, shelter, supervision, medical care, education, and/or affection Victims of neglect may exhibit poor hygiene, malnutrition, stunted growth, developmental delay, & failure to thrive Severe deprivation can result in death (infants) Neglect accounts for majority of cases
57
Treatment & sequelae of physical abuse
Treatment: early intervention Sequelae: - Increased risk of developing PTSD, anxiety, depression, dissociative disorders, self-destructive behaviors, & substance use disorders - Alcohol is most common drug of abuse by adolescents, followed by cannabis - Increased risk of continuing abuse cycle w/ their own children
58
Causes of attachment disorders
Extreme insufficient care - Primary caregiver - Neglect - Emotional needs not met - Changes in caregivers
59
What are the types of attachment disorders?
REACTIVE ATTACHMENT DISORDER Not interested in caregiver (aggressive / irritable) DISINHIBITED SOCIAL ENGAGEMENT DISORDER Overly friendly to everyone
60
What are different mood disorders seen in children?
Depression Disruptive mood dysregulation disorder - Bipolar is hardly seen in children
61
Presentation of depression in children
Irritability is common
62
Treatment of depression in children
``` MEDS: SSRIs - Fluoxetine (Prozac) - 8 year old - Escitalopram (Lexapro) - 12 year old TCAs ```
63
Presentation of bipolar disorder in children
More frequent mood episodes of shorter duration are more common Bipolar disorder is harder to stabilize & has more chronic course w/ frequent relapses VERY hard for child to meet bipolar criteria
64
What is disruptive mood dysreuglation disorder (DMDD)?
Temper outbursts 3 or more times a week (verbal / physical) Between outbursts: persistent irritability / anger DSM-V new diagnosis: - Constantly irritable mood w/ severe temper outbursts are more likely to develop MDD or GAD later in life, but not Bipolar disorder - Prevent over diagnosis of Bipolar disorder in children who don't actually meet full criteria of BPAD
65
Treatment of bipolar disorder in children
``` MEDS: Mood stabilizers: - Lithium (FDA approved) - Therapeutic levels: 0.6-1.2 - Valproic acid - Therapeutic levels: 60-120 (100x greater than lithium) - Order blood levels early in the morning (want to see the levels during the trough) - Lamotrigine - Trileptal ``` Second generation antipsychotics (all FDA approved) - Aripiprazole (Abilify) - Risperidone (Risperdal) - Quetiapine (Seroquel) - Olanzapine (Zyprexa) - Asenapine (Saphris) Combo approach may be required (mood stabilizer + antipsychotic)
66
What are the types of anxiety related disorders?
GAD Panic PTSD Social anxiety disorder
67
How do anxiety related disorders present in children?
Usually presents w/ irritability
68
Treatment of anxiety related disorders in children
THERAPY: Mainstay of treatment ``` MEDS: SSRIs - Used most commonly - Not as helpful in PTSD in kids - Fluoxetine (Prozac) - Sertraline (Zoloft) - Fluvoxamine (Luvox) - Duloxetine (Cymbalta) ``` TCAs or MAOIs - Less commonly prescribed due to safety issues - Risk of overdose & serious side effects - Except for clomipramine (Anafranil) - TCA which is FDA approved in OD & often used if treatment failure w/ SSRI Benzodiazepines - Not commonly used due to concerns for abuse potential & impairments in cognitive functioning / memory which could affect learning - Diazepam (Valium)
69
How do psychotic disorders present in children?
Common causes of psychotic symptoms include anxiety & meds / drugs Schizophrenia is rare Mania of Bipolar disorder often presents suddenly & hallucinations
70
Treatment of psychotic disorders in children
Atypical antipsychotics - Used most commonly Typical antipsychotics - Less commonly prescribed due to concern for movement disorders / EPS

Psych Shelf (8 decks)

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