Mental Health Flashcards
What is postnatal depression defined by?
Postnatal depression is characterised by low mood in the postnatal period.
What are the 4 different types of postnatal mental health illness?
Baby blues is seen in the majority of women in the first week or so after birth
Postnatal depression is seen in about one in ten women, with a peak around three months after birth
Puerperal psychosis is seen in about one in a thousand women, starting a few weeks after birth
What percentage of women are affected by baby blues in the first week or so after birth?
50%
What symptoms do baby blues present with?
Mood swings
Low mood
Anxiety
Irritability
Tearfulness
What are baby blues the result of?
Significant hormonal changes
Recovery from birth
Fatigue and sleep deprivation
The responsibility of caring for the neonate
Establishing feeding
All the other changes and events around this time
What is the treatment for baby blue’s?
Symptoms are usually mild, only last a few days and resolve within two weeks of delivery. No treatment is required.
What is postnatal depression?
Postnatal depression is similar to depression that occurs outside of pregnancy
What is the classic triad of postnatal depression?
Low mood
Anhedonia (lack of pleasure in activities)
Low energy
When are typically women affected by postnatal depression
3 months after birth
How many weeks should symptoms last before postnatal depression is diagnosed?
2 weeks
What is the management for postnatal depression?
Mild cases may be managed with additional support, self-help and follow up with their GP
Moderate cases may be managed with antidepressant medications (e.g. SSRIs) and cognitive behavioural therapy
Severe cases may need input from specialist psychiatry services, and rarely inpatient care on the mother and baby unit
What are the differential diagnoses for postnatal depression
Baby blues
Postpartum psychosis (puerperal psychosis)
Bipolar disorder
GAD
OCD
PTSD
What is the Edinburgh Postnatal Depression Sale?
The Edinburgh postnatal depression scale can be used to assess how the mother has felt over the past week, as a screening tool for postnatal depression
There are ten questions, with a total score out of 30 points. A score of 10 or more suggests postnatal depression.
What is puerperal psychosis?
Puerperal psychosis is a rare but severe illness that typically has an onset between two to three weeks after delivery
What are full psychotic symptoms of puerperal psychosis?
Delusions
Hallucinations
Depression
Mania
Confusion
Thought disorder
What do women with puerperal psychosis need?
need urgent assessment and input from specialist mental health services.
What is the treatment for puerperal psychosis?
Directed by specialist services:
Admission to the mother and baby unit
Cognitive behavioural therapy
Medications (antidepressants, antipsychotics or mood stabilisers)
Electroconvulsive therapy (ECT)
What is the mother and Baby unit?
The mother and baby unit is a specialist unit for pregnant women and women that have given birth in the past 12 months. They are designed so that the mother and baby can remain together and continue to bond. Mothers are supported to continue caring for their baby while they get specialist treatment.
Where are women that have existing mental health concerns before or during pregnancy are referred?
Perinatal mental health services
What do perinatal mental health services do?
advice and specialist input. This includes decisions and ongoing management of psychiatric medications, such as SSRIs, antipsychotics and lithium. A plan is put in place for after delivery to ensure they are followed up closely with help from midwives, health visitors, GPs, family and friends, so that treatment and additional support can be put in place early if required.
What can SSRI’s cause during pregnancy?
neonatal abstinence syndrome (also known as neonatal adaptation syndrome). It presents in the first few days after birth with symptoms such as irritability and poor feeding. Neonates are monitored for this after delivery. Supportive management is usually all that is required.
What is MBRRACE-UK?
A national programme investigating maternal deaths in the UK and Ireland
Report includes data on women who died during their pregnancy or up to 1 year after
Latest report includes 2018-2020, published 10th November 2022
What does MMBRACE-UK help with?
Psychiatric disorders and cardiovascular disorders are now responsible for the same number of maternal deaths in the UK
Together they account for 30% of maternal deaths
Deaths from mental health-related disorders (suicide or substance misuse) account for nearly 40% of deaths occurring within a year of pregnancy
Maternal suicide is the leading cause of direct deaths in this postnatal period
What are the effects of perinatal mental health on the baby?
Pre-term delivery
Emotional disorders and depressive illness in child
Behavioural difficulties
Low birthweight
What is the incidence of mental health disorders during pregnancy and postnatal?
Pregnancy
Depression – 12%
Anxiety - 13%
Postnatal
Combination of Anxiety and depression – 15-20%
Psychosis – 1-2/1000
Only half diagnosed
Fewer receive treatment
How do we identify perinatal mental illness?
Past medical and psychiatric history
Drug history & substance use
Family History
Domestic/ Sexual Abuse
Patient Health Questionnaire-2
Depression in pregnant women and what are the red flag signs?
Affects 12% of pregnant women
Red Flag Signs
Suicidal ideation
Feelings of incompetence as a parent
Estrangement from child
Hallucinations
Diagnosis:
Patient Health Questionnaire-9
Risk of recurrence of postnatal depression 1:2 to 1:3
Patient Health Questionnaire-9
What is the management of depression
MDT approach
Behavioural - CBT
Medication
SSRIs
SNRIs
Tricyclic antidepressants
SSRIs and pregnancy
Not associated with fetal malformation
Conflicting data regarding risk of cardiac malformation
Risk of persistent pulmonary hypertension if used > 20 weeks
Risk of neonatal adaptation syndrome -Tapering dose if appropriate
Secretion in breast milk - In low doses
Sertraline low levels
Fluoxetine high levels
What is anxiety characterised by in pregnancy?
Anxiety affects 13% of pregnant women
Characterised by:
Chronic excessive worry (not situational)
Hyperarousal
Screening
Generalised Anxiety Disorder -2
Diagnosis
GAD-7
GAD 7 questionnaire
What are some common anxiety disorders
GAD
PTSD
OCD
Tocophobia - Morbid dread and fear of childbirth, Primary/secondary
What is the management of anxiety disorders?
MDT
Behavioural
Medication - Anti-depressants
Benzodiazepines
Associated with cleft palate, neonatal withdrawal syndrome & floppy baby syndrome
Short term management of symptoms
Lowest dose possible for shortest time possible
Avoid in third trimester
Psychotic illness and pregnancy
Increased risk of puerperal psychosis
Require perinatal mental health team management
Preconception
Birth planning meeting (32/40)
Intrapartum and postnatal care
Elective Mother and Baby Unit admission
MDT approach
Bipolar affective disorder and pregnancy
Affects 1% of population
Mean age of onset 17 to 22
Characterised by episodes of low mood and mania
25-50% risk of puerperal psychosis
Management of BPD in pregnancy
Psychological
Pharmacological
- Antipsychotics
- Mood stabilisers
- Benzodiazapines
Relapse prevention
- CBT
- Psychoeducation
Antipsychotics and pregnancy
Not teratogenic
Avoid depots
Possible link with cardiac malformation 1 to 1.5%
Olanzapine increased risk of weight gain and gestational diabetes
Risperidone raised prolactin levels
Mood stabilisers and pregnancy
Sodium Valproate, Lithium – both contra-indicated in pregnancy
Schizophrenia and schizo-affective disorder in pregnancy
Psychosis and schizophrenia affects 1% of population
Symptoms - Positive symptoms: hallucinations, delusions, thought disorders
- Negative symptoms: lack of empathy/ drive, catatonia
Schizo-affective disorder linked with mood disorders
Risks: Relapse & Puerperal psychosis
Baby blues features
Affect 50- 85%
Days 3-10, peak day 5
Self-limiting
Presentation – crying, irritability, anxiety
Management – Reassurance, Support
Causes
Biological – Genetics, Hormones
Psychosocial – stressors, support, relationships, finances, housing
t mood changes
Puerperal psychosis in pregnancy
Affects 1-2: 1000 women
Onset early in postnatal period
50% by day 7, 75% by day 16, 95% by day 90
Risks factors
Bipolar affective disorder
Previous postnatal psychosis (>50% risk)
FH of postnatal psychosis/ bipolar affective disorder
Schizophrenia
What are the Signs of puerperal psychosis?
Vague- insomnia, tearfulness, agitation
Psychotic – delusions (78% about the baby), hallucinations
Mania
Rapidly changing mental state
Mgmt of puerperal psychosis
Psychiatric emergency
2% risk of suicide
Mental health liaison team/ Crisis team
One to one care
Admission to mother and baby unit
Pharmacological
ECT
Psychotherapy/ relapse prevention
Contraception
Prognosis
50% risk recurrence
Up to may 65% develop Bipolar disease
