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Women's health > Maternal mental health > Flashcards

Maternal mental health Flashcards

1
Q

How common are perinatal mental health conditions?

A

Affects 1:10 women
15-20% anxiety depression
3-5% require specialist input through perinatal mental health team

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2
Q

How is perinatal mental health identified?

A

Pre-conception counselling if pre-existing condition - explain how illness will affect pregnancy, medication alterations
Booking appointment
Antenatal period - PHQ2 screening
Acute presentation - MSE

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3
Q

What conditions require pre-conception counselling?

A

Severe depression
Bipolar
Schizophrenia

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4
Q

What happens at the booking appointment and when is it?

A

10 weeks
Full medical history
Drug history and substance abuse
Family history - first degree relatives with schizophrenia/postnatal depression/bipolar
Domestic/sexual abuse
Bloods
BMI

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5
Q

When should someone be referred to perinatal mental health team?

A

Pre-existing psychiatric condition - severe depression, bipolar, schizophrenia
FHx of first degree relative with schizophrenia, postnatal depression, bipolar

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6
Q

What questionnaire is used to diagnose post-natal depression?

A

Edinburgh post-natal depression score

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7
Q

What are the effects of perinatal depression on the baby?

A

Pre-term delivery
Emotional disorders and depressive illness in child
Behavioural difficulties

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8
Q

What are the effects of perinatal anorexia nervosa on the baby?

A

Low birthweight

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9
Q

What are the effects of schizophrenia on the baby?

A

Low birthweight
Preterm delivery
Stillbirth

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10
Q

What are the effects of post-natal depression on the baby?

A

Emotional disorders in child
Increased risk of depression

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11
Q

What effect can maternal mental health have on the foetus?

A

Epigenetic impact
Genetic processes - neurobiological processes

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12
Q

What effect can poor perinatal mental health have on the mother?

A

More women die of psychiatric illness than pre-eclampsia and amniotic fluid embolism
Suicide leading cause of maternal death up to 1 year post-delivery

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13
Q

How common is depression in the perinatal period?

A

Affect 12%

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14
Q

What are the S&S of perinatal depression?

A

Difficulty bonding with child
Suicidal ideation
Self-neglect
Anhedonia
Tiredness
Difficulty concentration

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15
Q

How is perinatal depression diagnosed?

A

PHQ9

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16
Q

What is the risk of recurrence of perinatal depression?

A

1:2 to 1:3 risk of postnatal depression

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17
Q

Why should perinatal depression be treated?

A

Reduces risk of postnatal depression which affects bonding with baby

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18
Q

What is the management of perinatal depression?

A

SSRIs - safe in pregnancy
SNRIs - can take during pregnancy but limited data
TCAs- risk in overdose

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19
Q

What is important to ensure in babies born to mothers on SSRIs?

A

Risk of persistent pulmonary hypertension if used > 20 weeks - must deliver in hospital and baby monitored for 24 hours
Risk of neonatal adaptation syndrome - tapering dose if appropriate - crying, jittery

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20
Q

What is important to take into account with SSRI treatment and breast feeding?

A

Readily transfer into milk but in low doses
Sertraline lowest dose so mothers often on this
Fluoxetine highest levels

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21
Q

How common is anxiety in pregnant women?

A

13%

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22
Q

What are the symptoms of anxiety?

A

Chronic excessive worry (not situational)
Hyperarousal

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23
Q

What is the screening tool for anxiety?

A

GAD-2

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24
Q

What is the diagnosis of anxiety?

A

GAD-7

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25
Q

What are the common anxiety disorders in pregnancy?

A

Generalised anxiety disorders
PTSD - flashbacks (can be a result of previous pregnancy, due to previous sexual abuse and routine examinations during pregnancy/labour)
OCD
Tocophobia

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26
Q

What is tocophobia?

A

Morbid dread and fear of childbirth

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27
Q

What are the two different types of tocophobia?

A

Primary - never delivered before
Secondary

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28
Q

What are the symptoms of tocophobia?

A

Request an elective CS
Identify underlying cause

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29
Q

What is the management of mild/moderate anxiety during pregnancy?

A

GAD- active/psychoeducation, self help
OCD - CBT, exposure therapy, self help
PTSD - trauma focussed CBT, EMDR

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30
Q

What is the management of severe anxiety during pregnancy?

A

GAD - CBT/applied relaxation/medication/combined therapy
Panic disorders - CBT/anti-depressants/self help
OCD - antidepressants/combined therapies/ECT
PTSD - drug treatment

31
Q

What medications can be used in anxiety in pregnancy?

A

Anti-depressants (SSRIs)
Benzodiazepines - for short term management

32
Q

What are the dangers of benzodiazepines during pregnancy?

A

Associated with cleft palate, neonatal withdrawal syndrome, floppy baby syndrome

33
Q

How do you deal with the risks of benzodiazepines during pregnancy?

A

Lowest dose possible for shortest time possible
Avoid in third trimester

34
Q

What are the risks of psychotic illness in pregnancy?

A

Increased risk of puerperal psychosis

35
Q

How are mothers with psychotic illnesses managed?

A

Perinatal mental health team
Preconception
Birth planning meeting (32/40)
Intrapartum and postnatal care
Elective mother and baby unit admission - not always required - to prevent deterioration of mother
MDT management

36
Q

How common is bipolar?

A

1% of population
Mean age of onset 17 to 22

37
Q

What is bipolar?

A

Characterised by episodes of low mood and mania

38
Q

What are the risks of bipolar in pregnancy?

A

25-50% risk of puerperal psychosis - emergency

39
Q

What are the psychological managements of bipolar?

A

Relapse prevention
CBT
Psychoeducation

40
Q

What are the pharmacological managements for bipolar?

A

Antipsychotics
Mood stabilisers
Benzodiazepines

41
Q

Can antipsychotics be used in pregnancy?

A

Yes

42
Q

Can antipsychotics be used in pregnancy?

A

Yes - not teratogenic

42
Q

Can antipsychotics be used in pregnancy?

A

Yes - not teratogenic but possible link with cardiac malformation (1-1.5%)

43
Q

What about antipsychotics should be avoided during pregnancy and why?

A

Depots - changed pharmacokinetics in pregnancy

44
Q

Which antipsychotics should be avoided during pregnancy/perinatal period and why?

A

Olanzapine - increased risk of weight gain and gestational diabetes
Risperidone - raised prolactin so difficulty conceiving

45
Q

Which mood stabiliser should not be used in women of child bearing age?

A

Sodium valproate

46
Q

What are the risks of lithium to the foetus?

A

Ebstein anomaly

47
Q

What is Ebstein anomaly?

A

ASD
Abnormal tricuspid valve
Enlarged RA
Right ventricular outflow tract obstruction

48
Q

Can lithium be given during pregnancy and if so, when should it be avoided and how?

A

Yes
Avoid in first trimester and when breastfeeding
Switch to antipsychotic if possible
Lithium assays weekly - can easily get out of therapeutic range during pregnancy

49
Q

What are the red flag mood symptoms during pregnancy?

A

Suicidal ideation
Feelings of incompetence as a parent
Estrangement from child
Hallucinations

50
Q

How common is schizophrenia?

A

1% population

51
Q

What are the positive symptoms of schizophrenia?

A

Hallucinations
Delusions
Thought disorders

52
Q

What are the negative symptoms of schizophrenia?

A

Lack of empathy/drive
Catatonia

53
Q

What are the risks of schizophrenia in pregnancy?

A

Risk of relapse post-delivery and puerperal psychosis (emergency)

54
Q

What is the psychological management of schizophrenia?

A

Relapse prevention
CBT
Psychoeducation

55
Q

What is the pharmacological management of schizophrenia?

A

Antipsychotics
Mood stabilisers
Antidepressants (for schizo-affective)
Benzodiazepines

56
Q

What are the two main overarching reasons that women may experience post-natal mood changes?

A

Biological and psychological

57
Q

What biological causes can cause post-natal mood changes?

A

Genetics - 50% risk if first degree relative had post-natal depression
Hormone changes

58
Q

What psychosocial changes can cause post-natal mood changes?

A

Stressors
Support
Relationships
Finances
Housing

59
Q

Which is the most important question on the Edinburgh postnatal depression score?

A

No 10 - thoughts of self harm
Even if score low on everything else needs acting on

60
Q

How common are baby blues?

A

50-85% women affected

61
Q

When is baby blues most common?

A

Days 3 to 10
Peak symptoms day 5

62
Q

What are the symptoms of baby blues?

A

Crying
Irritability
Anxiety

63
Q

What is the management of baby blues?

A

Self-limiting so reassurance and support
Physiological

64
Q

How common is puerperal psychosis?

A

1-2 in 1000 women

65
Q

When is the onset of puerperal psychosis?

A

Early post natal
50% by day 7
75% by day 16
95% by day 90
Often out of hospital so rely on reports from families

66
Q

What are the risk factors for puerperal psychosis?

A

Bipolar
Previous postnatal psychosis > 50% risk
FHx postnatal psychosis/bipolar
Schizophrenia

67
Q

What are the signs of puerperal psychosis?

A

Vague - insomnia, tearfulness, agitation
Delusions (most about baby), hallucinations
Mania
Rapidly changing mental state

68
Q

What is the management of puerperal psychosis?

A

Exclude physical illness eg stroke/space occupying lesion
Psychiatric emergency - refer to crisis team
May need diazepam
Admission to mother and baby unit/psychiatric ward under mental health act

69
Q

What is the risks of puerperal psychosis?

A

2% suicide risk
Infanticide risk - one to one care

70
Q

What is the treatment for puerperal psychosis?

A

Antipsychotics
Antidepressants
Mood stabilisers
ECT
Psychotherapy/relapse prevention
Contraception

71
Q

What is the prognosis of puerperal psychosis?

A

50% risk recurrence
65% may develop bipolar

72
Q

Name 3 forms of loss of a child

A

Intrauterine death/stillbirth
Miscarriage
Non-viable pregnancy so termination
Neonatal death
Removed child by social services
Ectopic pregnancies

73
Q

What can partners mental health be like after birth?

A

Mirrors mothers experiences
Offer support so mother has full support

Women's health (9 decks)

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