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3A Womens health > Mental Health > Flashcards

Mental Health Flashcards

1
Q

What is postnatal depression defined by?

A

Postnatal depression is characterised by low mood in the postnatal period.

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2
Q

What are the 4 different types of postnatal mental health illness?

A

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

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3
Q

What percentage of women are affected by baby blues in the first week or so after birth?

A

50%

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4
Q

What symptoms do baby blues present with?

A

Mood swings
Low mood
Anxiety
Irritability
Tearfulness

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5
Q

What are baby blues the result of?

A

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

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6
Q

What is the treatment for baby blue’s?

A

Symptoms are usually mild, only last a few days and resolve within two weeks of delivery. No treatment is required.

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7
Q

What is postnatal depression?

A

Postnatal depression is similar to depression that occurs outside of pregnancy

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8
Q

What is the classic triad of postnatal depression?

A

Low mood
Anhedonia (lack of pleasure in activities)
Low energy

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9
Q

When are typically women affected by postnatal depression

A

3 months after birth

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10
Q

How many weeks should symptoms last before postnatal depression is diagnosed?

A

2 weeks

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11
Q

What is the management for postnatal depression?

A

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

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12
Q

What are the differential diagnoses for postnatal depression

A

Baby blues
Postpartum psychosis (puerperal psychosis)
Bipolar disorder
GAD
OCD
PTSD

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13
Q

What is the Edinburgh Postnatal Depression Sale?

A

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.

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14
Q

What is puerperal psychosis?

A

Puerperal psychosis is a rare but severe illness that typically has an onset between two to three weeks after delivery

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15
Q

What are full psychotic symptoms of puerperal psychosis?

A

Delusions
Hallucinations
Depression
Mania
Confusion
Thought disorder

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16
Q

What do women with puerperal psychosis need?

A

need urgent assessment and input from specialist mental health services.

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17
Q

What is the treatment for puerperal psychosis?

A

Directed by specialist services:
Admission to the mother and baby unit
Cognitive behavioural therapy
Medications (antidepressants, antipsychotics or mood stabilisers)
Electroconvulsive therapy (ECT)

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18
Q

What is the mother and Baby unit?

A

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.

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19
Q

Where are women that have existing mental health concerns before or during pregnancy are referred?

A

Perinatal mental health services

20
Q

What do perinatal mental health services do?

A

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.

21
Q

What can SSRI’s cause during pregnancy?

A

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.

22
Q

What is MBRRACE-UK?

A

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

23
Q

What does MMBRACE-UK help with?

A

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

24
Q

What are the effects of perinatal mental health on the baby?

A

Pre-term delivery

Emotional disorders and depressive illness in child

Behavioural difficulties

Low birthweight

25
Q

What is the incidence of mental health disorders during pregnancy and postnatal?

A

Pregnancy
Depression – 12%
Anxiety - 13%

Postnatal
Combination of Anxiety and depression – 15-20%
Psychosis – 1-2/1000
Only half diagnosed
Fewer receive treatment

26
Q

How do we identify perinatal mental illness?

A

Past medical and psychiatric history
Drug history & substance use
Family History
Domestic/ Sexual Abuse
Patient Health Questionnaire-2

27
Q

Depression in pregnant women and what are the red flag signs?

A

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

28
Q

Patient Health Questionnaire-9

A
29
Q

What is the management of depression

A

MDT approach
Behavioural - CBT
Medication
SSRIs
SNRIs
Tricyclic antidepressants

30
Q

SSRIs and pregnancy

A

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

31
Q

What is anxiety characterised by in pregnancy?

A

Anxiety affects 13% of pregnant women
Characterised by:
Chronic excessive worry (not situational)
Hyperarousal
Screening
Generalised Anxiety Disorder -2
Diagnosis
GAD-7

32
Q

GAD 7 questionnaire

A
33
Q

What are some common anxiety disorders

A

GAD
PTSD
OCD
Tocophobia - Morbid dread and fear of childbirth, Primary/secondary

34
Q

What is the management of anxiety disorders?

A

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

35
Q

Psychotic illness and pregnancy

A

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

36
Q

Bipolar affective disorder and pregnancy

A

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

37
Q

Management of BPD in pregnancy

A

Psychological

Pharmacological
- Antipsychotics
- Mood stabilisers
- Benzodiazapines

Relapse prevention
- CBT
- Psychoeducation

38
Q

Antipsychotics and pregnancy

A

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

39
Q

Mood stabilisers and pregnancy

A

Sodium Valproate, Lithium – both contra-indicated in pregnancy

40
Q

Schizophrenia and schizo-affective disorder in pregnancy

A

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

41
Q

Baby blues features

A

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

42
Q

Puerperal psychosis in pregnancy

A

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

43
Q

What are the Signs of puerperal psychosis?

A

Vague- insomnia, tearfulness, agitation

Psychotic – delusions (78% about the baby), hallucinations

Mania

Rapidly changing mental state

44
Q

Mgmt of puerperal psychosis

A

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

44
Q
A

3A Womens health (33 decks)

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