9) Maternal Medicine - Psychiatry Flashcards
What percentage of women will develop mental health problems during or after pregnancy?
10%
Most common mental health problem in pregnancy
Anxiety
Incidence of depression in pregnancy
12%
Incidence of anxiety in pregnancy
13%
Which questionnaires should be used as initial screening tools for anxiety/depression?
GAD-2 and Whooley questions
Incidence of postpartum psychosis
1-2 in 1000
If concern is raised on the depression screening Qs what further assessment tools could be used?
Edinburgh PND Scale
PHQ-9
If concern is raised on the anxiety screening Qs what further assessment tools could be used?
GAD-7
How quickly should women be seen after referral with sudden onset symptoms suggesting of postpartum psychosis?
4 hours
How quickly should a woman be seen after referral to secondary care?
Assess for treatment within 2 weeks and psychological interventions within 1 month.
Treatment of mild–>moderate depression
Facilitated self help
Treatment of moderate–>severe depression
- CBT
- TCA/SNRI/SSRI
- CBT in combination with medication
Treatment of mild anxiety
Facilitated self help
Treatment of anxiety disorder
- Low or high intensity psychological intervention
- High intensity recommended for PTSD and social anxiety
What to measure in women on antipsychotics planning a pregnancy?
Prolactin
What screening test to offer in pregnancy for women on antipsychotics?
GTT
When to use depot antipsychotics?
Only if stable on them and previous non-compliance with oral antipsychotics.
Which drugs should not be used for mental health problems in pregnancy?
Valproate/Carbemazepine
What to do with antipsychotics in pregnancy?
If stable and likely to relapse without it then continue.
When to use lithium?
Only if antipsychotics have not been effective
What to do with lithium in pregnancy?
- Can stop gradually over 4 weeks if well
- If not well or high risk of relapse then can consider gradually switching to an antipsychotic, stopping lithium and restarting in 2nd trimester or continuing with lithium.
Risk of relapse in women with bipolar disorder who stop medication
2 x increased risk
How often to measure lithium plasma levels?
Every 4 weeks and then weekly from 36th week
What to do with lithium in labour?
Stop during labour and check plasma lithium levels 12 hours after last dose
What percentage of women with a mental health problem require inpatient treatment?
4%
When does postpartum psychosis occur?
Frequently occurs early - 50% within first 3 days postpartum.
Risk of postpartum psychosis in a woman with bipolar disorder
> 25%
Risk of postpartum psychosis in a woman with bipolar disorder and a family history of postpartum psychosis
50%
Recurrence risk of postpartum psychosis
50%
Risk of suicide with postpartum psychosis
2%
Incidence of suicide
1 in 100,000
What percentage of women who committed suicide had a diagnosis of a severe affective illness?
60%
What percentage of women who develop postpartum psychosis have no risk factors?
50%
Incidence of chronic serious mental illness (bipolar/schizophrenia)
2 in 1000
Incidence of severe depressive illness
30 in 1000
Incidence of PTSD
30 in 1000
Incidence of adjustment disorders and distress
150-300 in 1000
Incidence of postpartum blues
50-80%
When do postpartum blues occur?
D3-D10, lasting 48 hours
Risk of postnatal depression if you have history of depression
15%
Risk of postnatal depression if you have a history of depression and FHx of postpartum depression
40%
What proportion of women with PND develop depression before or during pregnancy?
1/2
When does PND occur?
Gradual onset during first 2 weeks after birth, with two peak presentations 2-4 and 10-14 weeks postnatal.
Risk of recurrence of PND
2-3 x increased
What percentage of women take antidepressants in pregnancy?
3%
Criteria for referral to specialised perinatal mental health service:
- Current severe psychiatric symptoms
- Hx severe postpartum illness/schizophrenia/bipolar
- Complex psychotropic medications
Referral should be considered for those with moderate symptoms developed late in pregnancy/early postpartum, or mild symptoms and a family history of BP/PP.
