Peri-natal Psychiatry Flashcards
What do perinatal mental health services cover?
- preconception and medication advice
- support women with severe mental health illness, who are pregnant or postnatal
- diagnose and support those with perinatal illness
- support bonding, parenting
- MMH: birth trauma, tokophobia, pregnancy loss
- liaise with other services
Who is included in the perinatal mental health team?
psychiatrists
perinatal nurses
OT
psychologists
recovery workers and peer workers
nursery nurses
*safeguarding
What is the purpose of the mother and baby unit?
Full perinatal MDT
help build bond with baby
parenting confidence
routine alongside recovery from mental illness
*overnight support if needed
What are some important things to consider when taking a history in these circumstances?
*judge answers to sleep, energy, libido and eating under context with baby
- obstetric Hx: previous loss/termination, IVF/infertility, complications, birth trauma, planned pregnancy, bond, term or SCBU baby
- feeding plan: medication guidance
- social: support, wellbeing, safeguarding, finances
- substance abuse: risk to baby, MH
- FHx: puerperal psychosis, PND, depression
What is important to consider when thinking of medications in the perinatal period?
teratogenicity, breastfeeding, term baby, sedation
*mothers MH priority
*stopping medication when no risk
*least amount of medications and doses preferred
What are the risks of untreated mental illness?
higher risk of postnatal illness
increased substance misuse risk
self and child neglect
preterm baby risk
self neglect and baby neglect
affect babies development
What are some medications to be aware of to avoid?
sodium valproate: avoid in child bearing age women, neural tube defects, PCOS in women
carbamazepine similar
benzodiazepines: neonatal withdrawals etc
antipsychotics: beware prolactin as affects fertility, neonate withdrawal
Differentiate between the baby blues and post natal depression
baby blues are within 0-2 weeks where mother in anxious, tearful and irritable whereas PND is within first year where the low mood is persistent, with other signs of depression
What are the signs and symptoms of postnatal depression?
persistent low mood
anhedonia
guilt
poor concentration
withdrawing from others
poor sleep
lacking energy
*intrusive thoughts about harming baby or self, suicidal
lack of bond with baby
How would you treat PND?
SSRI
nursery nurse input
talking therapies - CBT
self help techniques
What are some risk factors for post natal depression?
past history of MHI or PND
FHx of depression
lack of social support
poor partner relationship
preterm birth
parents upbringing perceptions
unplanned
antenatal stress
substance misuse
What is puerperal psychosis?
- severe mental illness: starts suddenly in the days, or weeks, after having a baby.
- Symptoms change rapidly: high mood (mania), depression, confusion, hallucinations and delusions
*safeguarding risk and psych emergency!!
What are some risk factors to develop puerperal psychosis?
previous episode or FHx of PP, BPD, schizoaffective or out of the blue
poor sleep may contribute
How would you treat puerperal psychosis?
mother and baby unit
mental health act
perinatal MDT
antipsychotics/ mood stabilisers
discuss breastfeeding
What is the impact of birth trauma and PTSD?
- flashbacks leading to anxiety, anger, depression, guilt and avoidance of triggers –> may avoid baby, overprotective, low libido
- causes: difficult delivery, feeling out of control, fears of risk to life or baby, Hx of abuse
