Perinatal Flashcards
What are the recommendations to prevent psychiatric deaths?
Psychiatric services should have priority care pathways for pregnant and postpartum women. These will include a lowered threshold for referral and intervention, including admission and a rapid response time for women in late pregnancy and the first 6 weeks following delivery.
Risk assessments of pregnant or postpartum women should be modified to take account of risk associated with previous history, the distinctive clinical picture of perinatal disorders and the violent methods of suicide.
Women with a previous history of serious affective disorder or other psychoses should be referred in pregnancy for psychiatric assessment and management even if they are well.
Who should be referred from screening services?
All women with previous or current: schizophrenia or psychosis bipolar disorder postpartum psychosis severe depression All woman on mood stabilisers. Any women with a family history of bipolar affective disorder or schizoaffective disorder AND a personal history of any psychiatric disorder.
What are the psychiatric disorders in pregnancy?
disorders are slightly increased in the 1st trimester in comparison to the general population
These disorders are usually mild and likely to improve
Milder psychiatric disorders respond to psychosocial interventions
The first onset of serious mental illness is rare in pregnancy
Depression & anxiety in the 3rd trimester may continue in the postpartum as postnatal depression
What are the “pinks”?
Normal phenomena which occur in the first 48 hours postpartum, characterised by excitement and a sense of euphoria. A woman may also present as mildly over talkative and overactive with some insomnia.
Though there is a slight risk of exhaustion, the Pinks will resolve without any intervention.
What are the “blues”?
Common occurrence in the postpartum period, 50-80%
requently present about Day 5 but usually present between Day 3 to 10. The Blues are attributed to hormonal changes in combination with physical and emotional exhaustion
emotional lability, tearfulness, mild anxiety and irritability
The Blues generally last 48 hours and no specific treatment is required.
When does depressive illness occur postpartum?
The peak onset of depressive illnesses is between 2 to 4 weeks postpartum, however there also exists a secondary peak at around 3 months postpartum.
With prompt and appropriate treatment two-thirds of illnesses will resolve within 2 to 3 months. Without treatment, it can take 6 months or longer to recover
If a woman has suffered from a previous severe depressive illness or postnatal depressive illness, then the risk of developing a further illness following this delivery is around 50%.
When does postpartum psychosis present?
Risk os 0.2%
50% present by day 7
75% present by day 16
95% present by day 90
99% of postpartum psychoses are either bipolar or schizoaffective disorder.
Risk of 50% if bipolar or previous postpartum psychosis
What should be included in the birth plan (35 weeks onwards)?
Monitoring her mental health immediately following delivery
A requirement for liaison between all health professionals
Use of prophylactic medication, where appropriate
Consideration of child protection
Emergency contact details
What are the common methods of suicide in postnatal women?
31% hanging 31% jumping from high 10% self-immolation 10% overdose 7% drowning 3% cutting/stabbing 3% CO 3% ingestion of bleach
What are the additional features of postnatal depression?
Anxious about baby’s health Feelings of guilt/inadequacy
Reduced affection to baby
Obsessional phenomena – recurrent, intrusive thoughts about harming the baby Infanticidal thoughts about killing the baby
What is the management for postnatal depression?
Counselling – supportive, mother-and-baby groups, relationship counselling Antidepressants if severe – although caution with breast-feeding
Low dose amitriptyline seems to be safe
Hospital admission if severe PND with suicidal/infanticidal ideation ECT
What is the management for puerperal psychosis?
Assess for risk of suicide or infanticide
Concerning symptoms:
Thoughts of self-harming or harming the baby
Severe depressive delusions, eg believing baby should be dead Command hallucinations to harm themselves/the baby
Hospitalisation is common and may need to be detained under the MHA
Treat with antipsychotics;
Lithium = risk of toxicity in breast milk – 40% concentration of maternal lithium
Antipsychotics = only small amount excreted but still risk to infant, consider bottle-feed Benzodiazepines are a last resort if there is severe behavioural disturbance
Avoid when breast-feeding, causes lethargy in infants Could use ECT if severe or treatment-resistant
What is the prognosis for puerperal psychosis?
Most recover by 3 months – 75% within six weeks 30% chance of recurrence with another childbirth
