Mental Health Flashcards by Daiyan Haider

What is postnatal depression defined by?

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

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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

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

50%

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What symptoms do baby blues present with?

Mood swings
Low mood
Anxiety
Irritability
Tearfulness

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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

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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.

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What is postnatal depression?

Postnatal depression is similar to depression that occurs outside of pregnancy

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What is the classic triad of postnatal depression?

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

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When are typically women affected by postnatal depression

3 months after birth

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

2 weeks

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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

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What are the differential diagnoses for postnatal depression

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

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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.

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What is puerperal psychosis?

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

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What are full psychotic symptoms of puerperal psychosis?

Delusions
Hallucinations
Depression
Mania
Confusion
Thought disorder

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What do women with puerperal psychosis need?

need urgent assessment and input from specialist mental health services.

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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)

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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.

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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