Maternal mental health Flashcards
What percentage of women suffer from antenatal depression?
10%
What is the 12 month prevalence of PND?
15%
what is the prevalence of schizophrenia?
1% 1:100
what is the incidence of PP psychosis
1:1000
What is the prevalence of borderline personality disorder? and how does this differ/why in the pregnant population?
1%, however more like 2.7% in women over 25 yrs
Which 4 tools are available to screen for antenatal depression?
EPDS
PHQ-9
Whooley Questions
Kessler psychological distress scaleW
Which 4 tools are available to screen for antenatal depression?
EPDS
PHQ-9
Whooley Questions
Kessler psychological distress scaleW
Which 4 tools can be used to screen for postnatal depression?
- EPDS
- K10
- Whooley Questions
- PHQ-9
Which scoring systems can be used for anxiety in the perinatal period?
- Items 3,4 and 5 in EPDS
- GAD 7 item scale
- GHQ - 12, 28 or 30 item scale
- HADS
- State-trait anxiety inventory
List 6 psychosocial risk factors for poor mental health PP
- past history of abuse
- previous pregnancy loss
- unwanted pregnancy
- inability to be with baby in 1st week of life (NICU)
- minimal support
List 5 psychosocial risk factors for poor mental health PP
- past history of abuse
- previous pregnancy loss
- unwanted pregnancy
- inability to be with baby in 1st week of life (NICU)
- minimal support
what are the 8 pharmacotherapy principles in pregnancy
- seek advice from specialist
- choose medication with lowest profile of risk to mother and baby - taking into account previous response to treatment
- use lowest effective dose
- use a single drug if possible
- dose adjustment in pregnancy (pharmacodynamics)
- if anticonvulsant exposure in 1st trimester - tertiary anatomy scan
- plan early PN review for women who cease medication in pregnancy
- arrange observation for infants exposed to psychoactive drugs within first 3 days of life
How would you manage mild to moderate depression in pregnancy and post partum?
- provide structured psychoeducational therapy
- advise benefits of social support groups
- recommend individual CBT or IPT
- no good evidence for complementary therapies - omega-3 no benefit, no harm, St Johns wort - no benefit HARM, Ginko - no research
Is there an association between use of TCAs and SSRIs in 1st trimester and risk of neonatal mortality?
No
Is SSRI associated with fetal malformations in pregnancy (particularly in 1st TM?)
No
WHICH STATEMENT IS MOST CORRECT
A) TCAs are NOT associated with congenital malformations when used in 1st Trimester
B) TCAs do not appear to be associated with congenital malformations when used in 1st Trimester
C) TCAs ARE associated with congenital malformations when used in 1st trimester
B) TCAs do not appear to be associated with congenital malformations when used in 1st trimester
Which statement is MOST correct?
A) There is an association between the use of SSRI any time in pregnancy and SGA
B) There is not an association between the use of SSRI any time in pregnancy and SGA
C) There does not appear to be an association between use of SSRI any time in pregnancy and SGA
C) there does not appear to be an association between use of SSRI any time in pregnancy and SGA
Which statement is MOST correct?
A) There is an increased risk of miscarriage with the use of SSRI and SNRI in the first 20/40 of pregnancy
B) There appears to be no association between the risk of miscarriage and the use of SSRI and SNR in the first 20/40 of pregnancy
C) There is no increased risk of miscarriage with the use of SSRI and SNRI in the first 20/40 of pregnancy
A) there is an increased risk of miscarriage with the use of SSRI and SNRI in the first 20/40 of pregnancy
Which SSRI is associated with an increased risk of miscarriage? A) Fluoxetine B) Paroxetine C) sertraline D) Fluvoxamine
B) paroxetine
which sentence is MOST correct
A) the use of SSRI in late pregnancy is not associated with PTB
B) the use of SSRI in late pregnancy is associated with slight increase in risk of PTB
C) the use of SSRI in late pregnancy is associated with PPROM
B) the use of SSRI in late pregnancy is associated with slight increase risk of PTB
List 3 neonatal outcomes that have a small association with use of SSRI in pregnancy
RDS
persistent pulmonary HTN
convulsions in the newborn
What is the ANRQ?
the AnteNatal risk questionnaire 12 item questionnaire that reviews: - mental health history - emotional and practical support from partner - h/o physical or sexual abuse - stressors/losses in past year - anxiety and perfectionism level Score of 23 or more requires action
What are the 4 criteria for women that need follow up according to the ANRQ?
- Total ANRQ score of 23 or more
- significant MH hx
- h/o abuse
- clinical expertise overrides
What is the EPDS?
10 item questionnaire
designed to be completed antenatally and postnatally
score of 13 or more should be followed up
