Mental Health Conditions Flashcards
Risk of Post-partum psychosis
- No mental illness
- No Fhx mental illness
1/1000
Risk of PPP
- No Pmhx mental Hx
- Mother or sister had PPP
3/100
Risk PPP
- Hx Bipolar/schizoaffective disorder
- No Family Hx
- 1st pregnancy
1/4
Risk PPP
- Hx Bipolar/schizoaffective disorder
- Mother/Sister had PPP
1/2
Risk PPP
- Hx Bipolar/schizoaffective disorder
- 2nd pregnancy, no PPP in 1st pregnancy
1/10
Risk PPP
- Hx Bipolar/schizoaffective disorder
- Hx PPP in previous pregnancy
1/2
PPP occurs in what % of women with no risk factors?
50%
When is PPP most likely to present
Within 2 weeks
50% onset Day 1-3
Symptoms of PPP
A wide variety of psychotic phenomena such as delusions and hallucinations, the content of which is often related to the new child.
Affective (mood) symptoms, both elation and depression.
Disturbance of consciousness marked by an apparent confusion, bewilderment or perplexity.
Differential PPP
Primary cerebral or systemic disease (such as eclampsia or infection) should be excluded
Exogenous toxic substances or hormones
Other psych: PP blues, PN depression (would not have hallucination/delusions)
Management PPP
Admit to hospital, psychiatric emergency (ideally mother and baby unit)
Pharmacological treatment
What questions can be asked to screen for depression?
Whooley depression screen
1) During the past month, have you often been bothered by feeling down, depressed or hopeless?
2) During the past month, have you often been bothered by having little interest or pleasure in doing things?
What questions can be asked to screen for anxiety?
Generalized Anxiety Disorder scale (GAD-2):
1) During the past month, have you been feeling nervous, anxious or on edge?
2) During the past month have you not been able to stop or control worrying?
Scoring system for Whole and GAD-2?
- Not at all: 0
- Several days: 1
- More than half the days: 2
- Nearly every day: 3
If women scores highly >3 on whooley questionnaire?
1) Using the Edinburgh Postnatal Depression Scale (EPDS) or the Patient Health Questionnaire (PHQ-9) as part of a full assessment OR
2) Referring the woman to her GP or, if a severe mental health problem is suspected, to a mental health professional.
If woman scores highly > 3 on GAD-2
1) Using the GAD-7 scale for further assessment or
2) Referring the woman to her GP or, if a severe mental health problem is suspected, to a mental health professional.
How to assess for severe mental illness at booking appointment?
1) Any past or present severe mental illness
2) Past or present treatment by a specialist mental health service, including inpatient care
3) Any severe perinatal mental illness in a first-degree relative (mother, sister or daughter).
Consider referral to perinatal mental health team
When to refer to perinatal mental health
current severe psychiatric symptom
a history of serious postpartum illness or bipolar disorder or schizophrenia
on complex psychotropic medications schemes.
When are women most likely to comment suicide?
Post natal 6-9 months
For women at risk of PPP, but stable, how long should they be followed up PP?
3 months
How common is postpartum blues?
When most likely to present?
50-80%
3-5 days
Will be tearful/tired
How common is perinatal depression?
When can it present>
25%
Anytime in pregnancy up to 1 year PP
Depression
Name Core and minor symptoms of depression according to DSM IV
At least 1
- Depression mood
- Deminished interest/pleasure
4+ minor
- Changes in weight, appetite
- Insomnia/hypersomnia
- Psychomotor agitation or retardation
- Fatigue or less of energy
- Feeling worthless/guilty
- Impaired conc or indecisiveness
- Thoughts of death
Non-pharmacological treatments for mental health conditions
- CBT – low intensity – computerised, high intestity individual or group CBT
- Debriefing
- Non directive counselling
- Interperonal psychotherapy
- Psychodynamic psychotherapy
- Support & education
Who should anti-depressants be given to?
Moderate/severe depression
Side effects of SSRIs to babies
Baby’s can have withdrawal symptoms
30% exposed babies
Usually settles 1-2 days
Or if BF – when stop mediation or stop BF
Symptoms: Resp distress, tremor, jitteriness, increased REM sleep
Extremely small increase risk neonatal pulmonary HTN, SSRI > 20 weeks
Risks of TCAs
Risk of overdose to the mother
Which antidepressants have lowest dose in infant?
Citalopram
Fluoxetine
Which antidepressants have highest dose in infant?
Venlafaxine
Effect of lithium on foetus
Cardiac abnormality, Epstein abnormality 1/100
If continuing lithium in pregnancy, when to check levels
Every 4 weeks until 36 weeks then weekly
How to manage lithium in labour
Stop in labour
Check levels 6-8 hours PP
Retart 12 hours PP, then measure levels 12, 24 hrs after, 2 weekly 4 weeks then weekly 4 weeks
How is lithium excreted?
Renally, need good renal function
Can you breast feed whilst taking lithium
No
SSRI ans SNTI increase what risk in labour?
Increases risk of bleeding
Sodium valproate risk congenital malformation, neurodevelopment disorder
Congenital: 10%
Neuro: 30-40%
What other anti-epileptics have adverse outocomes for neurodevelopment?
Phenobarbital
Phenytoinm
Which antivplepitv dose should be monitoee in pregnancy?
Lamotrigine, levels fall in pregnancy
Levels lamotrigine levetiracetam also decrease
