Lecture - Psych Med - Maternal Mental Health

Question 1

Perinatal Period (refers to whole of pregnancy and immediately after birth):

1. There are obviously physiological changes. What sort of psychological changes happen though?
2. Are these changes likely to cause mental disorders?

Answer 1

1. There are changes in relationships, working life, sleep, lactation, and parenting.
2. These changes themselves aren’t likely to cause mental disorder but they are factors you need to assess and they have treatment implications

Question 2

Pregnancy:

1. Pregnant women may suffer from an existing mental disorder and when they are pregnant, what happens?
2. Those with pre-existing conditions are at risk since?
3. What percentage of those women who cease anti-depressants and bipolar medications relapse?
4. Women with alcohol or drug abuse issues increases risk to baby including…..
5. What seems to be more prevalent in pregnancy?

Answer 2

1. They are likely to relapse or develop a new disorder
2. Since they cease their medication
3. 2/3
4. Premature birth, small for dates baby, withdrawal symptoms and foetal alcohol syndrome.
5. Family violence

Question 3

Pregnancy loss and infertility:

What are types of loss and thus can lead to depression?

Answer 3

Miscarriage, stillbirth and infertility are all types of loss and these losses are increase risk of relapse of depression (or lead to it?). You need adequate social support and if you have a past psychiatric history then that warrants attention

Question 4

What are the symptoms of depression and are they the same in pregnancy?

Answer 4

Yes, same in pregnancy and they are C-GASP-DIE

C: Concentration
G: Guilt 
A: Appetite 
S: Sleep problem 
P: Psychomotor agitation/retardation 
D: Death - sociality 
I: Interest - Anhedonia 
E: Energy

Question 5

What is the spectrum of postpartum mood changes?

Answer 5

There is the non-pathological postpartum blues which are expected - you’re tearful or sad within the first couple of days

Then you have postpartum depression which blues can herald. It happens within 4 weeks.

——Management for depression is similar no matter where you have it in life so even here, same treatment except breastfeeding here——-

Then the psychiatric emergency is when you have postpartum psychosis - need to be hospitalised for that

Question 6

Postpartum depression:

1. What percentage of women experience this?
2. Which groups is it elevated in?
3. What are predictors of PPD? 4. What scale is used for screening?
4. What three things to of for management of PPD?

Answer 6

1. 10 to 15%
2. Adolescents, substance abuse ppl, socially isolated and unsupported ppl, those who have history of depression and those with relationship issues and life stressors
3. Lack of support, history of depression, childhood abuse, low SES, psychiatric history,
4. Edinburgh Postnatal Depression Scale is widely used
5. Psychological therapy, medication and support groups

Question 7

Postpartum psychosis:

1. How rare is it?
2. Why is it a medical emergency?
3. What sort of onset does it have?
4. What are its characteristics?
5. What can it be a first episode of? Or it can be restricted to postpartum context
6. What do you use to treat?

Answer 7

1. Only 1-2 births per 1000
2. Emergency bc associated with suicide and infanticide
3. It has abrupt onset but it’s mostly in first month
4. First episode of bipolar disorder or schizophrenia
5. Responds well to lithium or ECT - normal talking therapy doesn’t work.

Generaly psychotic peole hv lost touch w/ relaisty and they’ll get messages from any strange siutation like TV. They’ll hear voices in head that will tell them to harm baby.

Question 8

What are the short and log term risks of perinatal mental illness?

Answer 8

1. Suicide
2. The child is vulnerable
3. Poor mother-child attachment
4. There is child neglect

Question 9

What are the clinical considerations in breastfeeding women?

Answer 9

The treatment of breastfeeding mothers requires careful risk/benefit assessment

You might weight the risk of treatment against risk of untreated illness to mother and infant. Anti-depressants are excreted into human breast milk but like, maternal depression has adverse effects of infants

Other factors to consider are the severity of illness, psychiatric history, history of response and safety data in lactation

Question 10

What is Munchausen Syndrome by Poxy?

• is it common?
• what does the do-er seem like?
• what is the child’s pattern?

Answer 10

• It is a psychological disorder marked by ATTENTION SEEKING BEHAVIOUR by a caregiver through those in their care - usually the mother.
• It’s rather rare
• they appear to be friendly and cooperative with health care team and seem concerned for their child
• child improves in hospital but worsens at home so like, diagnose when children having odd symptoms that don’t ring true and happen over and over.

Question 11

What is the virtual reality training for stress inoculation?

Answer 11

They have these virtual games and the therapist gives them stressors and then talks them through and that helps the patient. It like makes clients accustomed to stressful and emotional situations. It also enhances their coping skills and resilience.

Question 12

What about childbirth preparation?

Answer 12

You can but wont work for longer-term since maybe prep wont be enough if you’re predisposed to the disorder

Question 13

Does pain in childbirth matter

Answer 13

Pain possibly increases post-natal depression and people seem to think pain makes them stronger

Lower pain increases birth satisfaction

Question 14

What increases and what decreases pain in childbirth?

Answer 14

Increase: anxiety, expectation being bad, labour duration, anger, menstrual pain, -ve feelings towards pregnancy, mode of delivery

Decrease: midwife support, age (old = less pain), parity (more kids = less pain), self-confidence and preparation