5: Perinatal psychiatry Flashcards
What is the leading cause of maternal death in the year following birth?
Suicide re: mental illness
Women who develop post-partum mental health problems often have a history of what?
Mental health problems
so it doesn’t come out of nowhere
What are three red flags for mental illness in a pregnant women?
Recent significant change in mental state
New thoughts of violence / self-harm
New thoughts of estrangement from baby
If a pregnant woman has red flag symptoms for mental illness, where should she be admitted?
Perinatal mental health unit
which is referred to as the ‘Mother and baby unit’
What mental health screening questions should be asked at antenatal clinic?
Do you have any new feelings which are making your disturbed or anxious?
Do you have any thoughts of self-harm or suicide?
Do you feel a sense of distance or estrangement from your baby?
Do you feel you are getting worse in general?
When do pregnant women have their first appointment with their midwife?
12 weeks
At which point you should be screening for mental health
Pregnant women with a history of which disorders should be referred to psychiatry?
Anxiety
Depression
Bipolar
Psychosis
What is the recurrence rate of peurperal psychosis?
50%
Under what circumstances should you refer a pregnant / post-natal woman to psychiatry?
Severe anxiety, depression, bipolar or psychotic symptoms
Pregnancy is (protective / not protective) for pre-existing mental health problems.
not protective
Pregnant women being so elated that their mental disorders disappear is a myth
What are baby blues?
Mild periods of emotional instability during pregnancy
What is the course of baby blues?
Up to 10 days
Self-limiting
What percentage of pregnant women develop peurperal psychosis?
0.1%
What are the symptoms of puerperal psychosis?
Delusions
Hallucinations
Mania
Confusion (separating from standard psychosis)
What is the prevalence of puerperal psychosis?
1 in 1000 pregnant women
or 0.1%
How is puerperal psychosis managed?
Admission to antenatal mental health unit
Antidepressants, antipsychotics, mood stabilisers, ECT
Puerperal psychosis has a (high / low) relapse rate.
high relapse rate
What do many women with undiagnosed postnatal depression worry about?
Effect of diagnosis on possession of child
How do you differentiate baby blues from postnatal depression?
Baby blues lasts up to 2 weeks and is self-limiting
Postnatal depression has a later (2 weeks+) onset and negatively affects relationship with child
Does maternal depression have physical effects on the child?
What are some examples?
Yes
Low birth weight, premature delivery, poor relationship
What are the principles for drug treatment of psychiatric problems in pregnancy?
Avoid high risk drugs (which change with trimester)
Use lowest dose monotherapy
Consider interactions
Encourage breastfeeding (exception: lithium)
Adverse effects re: teratogenic drugs may have occurred before the ___ is discovered.
before pregnancy is discovered
Which psychiatric drugs are notably teratogenic?
Lithium
Sodium valproate
Which sedative drugs should be avoided in pregnancy?
Benzodiazepines
In general, antipsychotics are safe to use during pregnancy.
Which specific drugs should be avoided?
Clozapine - agranulocytosis
Olanzapine - obesity, diabetes
Why should depot injections be avoided in pregnant women?
High concentration of drug can accumulate in foetus
Which drug, used in bipolar disorder and epilepsy, is contraindicated in pregnancy?
Why?
Sodium valproate
Neural tube defects (which often occur before the pregnancy is discovered)
If a woman of childbearing age is on sodium valproate, she should be using ___.
contraception
What lifestyle disorder increases a pregnant woman’s chances of mental health problems?
Substance abuse
Which bloodborne viruses should be tested for in pregnant women?
HIV
Hep B & C
Pregnant women who abuse alcohol are at risk of ___ deficiency.
nutrient deficiency
particularly thiamine (Vitamin B1)
Why are substance users more likely to contract STIs?
“Chaotic lifestyle”
People who inject drugs are at risk of which vascular complication?
Venous thromboembolism
e.g DVT leading to PE, MI, stroke
Can women with a history of opiate abuse be given opiates during labour?
Yes
It’s analgesia
May even require an increased dose due to tolerance
What are the guidelines re: alcohol consumption for pregnant women?
Abstain if possible
Otherwise < 2 units / week
What is a foetal consequence of alcohol abuse during pregnancy?
Foetal alcohol syndrome
look up presentation
What cardiovascular diseases occur secondary to the use of cocaine, amphetamine and ecstasy during pregnancy?
Arrythmias
Stroke
What are the guidelines re: smoking in pregnancy?
Don’t
Linked to miscarriage, placental abruption, IUGR
