Perinatal Mental Health Flashcards
What is perinatal mental health?
- mental health problems that occur during pregnancy and in the 1st year after birth
Perinatal mental health is the mental health problems that occur during pregnancy and in the 1st year after birth. What % of women are affected by perinatal mental health?
1 - 1%
2 - 5-10%
3 - 10-20%
4 - >30%
3 - 10-20% of women during this period
Why is perinatal mental health important?
1 - impacts mother, new baby and rest of family
2 - large financial costs associated with it
3 - NHS is unable to support everyone
4 - mothers dont get support from fathers
1 - impacts mother, new baby and rest of family
- negative impact health and wellbeing of mother
- negative impact on health, wellbeing and development of child
- negative impact on wider family including other children
Perinatal mental health is important for the following reasons:
- negative impact health and wellbeing of mother
- negative impact on health, wellbeing and development of child
- negative impact on wider family including other children
What % of maternal deaths are associated perinatal mental health problems and generally when does this occur?
1 - 1% between 6 weeks and 1 year after childbirth
2 - 5-10% between 6 weeks and 1 year after childbirth
3 - 10-20% between 6 weeks and 1 year after childbirth
4 - 25% between 6 weeks and 1 year after childbirth
4 - 25% of maternal deaths between 6 weeks and 1 year after childbirth
- 1 in 7 of these women died by suicide
Does perinatal mental health services support just perinatally?
- no
- can begin start pre-conception as well in high risk groups (bipolar conditions)
- bipolar patients likely to relapse following birth
The development of new psychiatric illness in the perinatal period has similar rates to the general population. Is it generally the same issues that cause them?
- can be
- generally different stressors
- psychosocial stressors or stopping or changing medication due to the pregnancy
The baby blues affects up to 50% of women, but what is it?
- low mood
- mild depression
- both occur when a woman expects they should feel happy after having a baby
The baby blues is low mood and a mild depression, which occur when a woman expects to be feeling happy after having a baby. What % of women experience the baby blues?
1 - 10%
2 - 20%
3 - 35%
4 - 50%
4 - 50%
The baby blues affects up to 50% of women, which is low mood and mild depression occurring when a woman expects they should feel happy after having a baby. When is it most likely to occur and how long does it generally last for?
1 - immediately following birth, lasting 1 week resolving in 2 weeks
2 - 0-5 days following birth, lasting 5 days resolving in 2 weeks
3 - 10 days following birth, lasting 3-5 days, resolving in 2 weeks
4 - immediately following birth, lasting 4 week resolving in 2 weeks
3 - 10 days following birth, lasting 3-5 days, resolving in 2 weeks
- symptoms peak days 3-5 but resolves within 2 weeks
- no specific interventions are required
Although not definitive, what has been linked with the baby blues?
1 - risk in progesterone
2 - drop in oxytocin
3 - rise in prolactin
4 - drop in progesterone
4 - drop in progesterone
What is post-natal depression?
- women will present with similar symptoms to a depressive episode
Post-natal depression is when a women presents with similar symptoms to a depressive episode. When does this generally develop and how long does it take to peak?
1 - develops <3 months following, peaking at 3-4 weeks post delivery
2 - develops <1 week following, peaking at 3-4 weeks post delivery
3 - develops <3 weeks following, peaking at 3-4 weeks post delivery
4 - develops <6 weeks following, peaking at 3-4 weeks post delivery
1 - develops <3 months following, peaking at 3-4 weeks post delivery
Post-natal depression is when a women presents with similar symptoms to a depressive episode. This generally develops within 3 months of birth and peaks within 3-4 weeks post delivery. If this continues beyond 6 months is this still post natal depression?
- no
Post-natal depression is when a women presents with similar symptoms to a depressive episode. This generally develops within 3 months of birth and peaks within 3-4 weeks post delivery. What is the incidence of postnatal depression?
1 - 12%
2 - 24%
3 - 35%
4 - 50%
1 - 12%
Post-natal depression is when a women presents with similar symptoms to a depressive episode. This generally develops within 3 months of birth and peaks within 3-4 weeks post delivery. It is associated predominantly with psychosocial than biological factors. What are 4 key risk factors that increase the risk of postnatal depression?
- lack of a close confiding relationship
- domestic violence
- low income
- young maternal age
If a woman has previous history of depression, what are they more at risk of during pregnancy?
1 - depression following birth
2 - obstetric complications during delivery
3 - obstetric complications following delivery
2 - obstetric complications during delivery
Although the symptoms of postnatal depression are similar to those of a depressive episode, they can present differently. What are the key clinical signs someone has postnatal depression?
- preoccupation with health of baby
- guilt and inadequacy regarding the health of the baby
- reduced affection for baby and difficulty bonding
- obsessions, particularly thoughts of harming baby
- true thoughts (rather than obsessions) of harming baby (infanticidal thoughts)
Some women with post-natal depression may experience thoughts about harming the baby. Are these true thoughts or are they obsessions?
- true thoughts as mother is thinking like this at the time
- not the same as obsessions
What are 4 methods we can use to manage postnatal depression through psychosocial measures for both prevention and management?
1 - mother and baby groups
2 - support from midwives and health visitors often crucial
3 - relationship counselling
4 - facilitated self-help
We can manage postnatal depression through psychosocial measures for both prevention and management using the methods below:
1 - mother and baby groups
2 - support from midwives and health visitors often crucial
3 - relationship counselling
4 - facilitated self-help
In some patients they may have more severe forms of postnatal depression. What are the treatment options for these mums?
1 - high intensity psychological intervention (e.g. CBT)
2 - antidepressant medication
3 - inpatient care if needed
4 - ideally in mother and baby unit
5 - electroconvulsive therapy if indicated; can provide rapid improvement
We can manage postnatal depression through psychosocial measures for both prevention and management. In some patients they may have more severe forms of postnatal depression. Out of the following, which should be avoided where possible and why?
1 - high intensity psychological intervention (e.g. CBT)
2 - antidepressant medication
3 - inpatient care if needed
4 - ideally in mother and baby unit
5 - electroconvulsive therapy if indicated; can provide rapid improvement
1 - antidepressant medication
- takes too long to have an effect (Electroconvulsive therapy is immediate)
How long can it take women to recover from postnatal depression?
1 - 1-3 days
2 - 1-3 weeks
3 - 3-6 months
4 - >6 months
3 - 3-6 months
If a woman has had postnatal depression previously, what % risk is this woman of having postnatal depression again in the future?
1 - 12%
2 - 24%
3 - 40%
4 - 50%
3 - 40%
What is postpartum psychosis?
- loss of contact with reality following pregnancy
- can include seeing or hearing things that other people cannot see or hear (hallucinations)
- can include believing things that are not actually true (delusions)
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). Is this dangerous?
- yes BIG RED FLAG!
- psychiatric emergency
- rapid onset and deterioration in patient
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. How soon does this generally occur and how common is this?
1 - 1 in 5 women are affected
2 - 1:50 women are affected
3 - 1:500 women are affected
4 - 1:5000 women are affected
3 - 1:500 women are affected
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. It affects 1:500 women. How soon does this generally occur?
1 - immediately postnatally
2 - 50% within 1-3 days and 50% within 3-14 days
3 - 50% within 7 days and 50% within 14 days
2 - 50% within 1-3 days and 50% within 3-14 days
- all are within 2 weeks though
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. What treatment is provided to these women?
- often hospital admission in mother and baby unit
- mental health act 2 (detained for assessment for up to 28 days)
- pharmacological and psychological treatment offered
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. If a woman has had no previous postpartum psychosis, what is her risk of developing postpartum psychosis?
1 - 0.1 - 0.25%
2 - 20%
3 - 5 - 7.5%
4 - 10%
1 - 0.1 - 0.25%
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. If a woman has previously had postpartum psychosis, what is her risk of developing postpartum psychosis?
1 - 0.1 - 0.25%
2 - 20%
3 - 50%
4 - 7.5%
3 - 50%
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. If a woman has has a history of bipolar disorder, what is her risk of developing postpartum psychosis?
1 - 0.1 - 0.25%
2 - 20%
3 - 50%
4 - 7.5%
2 - 20%
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. If a woman has has a history of schizophrenia or depression what is her risk of developing postpartum psychosis?
1 - 2.5%
2 - 20%
3 - 50%
4 - 7.5%
1 - 2.5%
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. What are some of the common clinical features of postpartum psychosis?
- fluctuates dramatically in presentation
- mood symptoms prominent (elation, depression, mixed affective state)
- bizarre delusions
- hallucinations (usually auditory)
- insight variable (awareness of their condition)
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. How long does it generally take to recover from postpartum psychosis?
1- 75% within 6 weeks and 25% within weeks 7-12
2- 15% within 3 weeks and 85% within weeks 12
3 - 90% within 6 weeks and 10% within weeks 7-12
4 - 50% within 6 weeks and 50% within weeks 10-12
1 - 75% within 6 weeks and 25% within weeks 7-12
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. If a woman has previously experienced postpartum psychosis, how likely is it that she will experience it again in future pregnancies?
- 50%
- can be reduced with prophylactic treatment (preventative measures)
Postpartum psychosis is a loss of contact with reality following pregnancy. It can include seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). This is very dangerous and is a BIG RED FLAG with rapid onset and deterioration in patient. What are the 3 most important factors in preventing negative effects of perinatal mental illness on children?
1 - social support
2 - quality of parenting
3 - length and severity of mental illness
Why is discussing a history of mental health important with women who are or are planning on becoming pregnant?
- prevention or reduced risk of further mental health problems
- ensure support is in place if anything happens
What are the 3 most common non-pharmacological management options for women who are or may become pregnant?
- supportive group
- psychological support
- multidisciplinary approach to support (communication)
If a woman is pregnant, which trimester is the one where any mental health drugs should be avoided?
1 - 1st trimester
2 - 2nd trimester
3 - 3rd trimester
1 - 1st trimester
- drugs are teratogen (agent causing abnormality to foetus during pregnancy)
If a woman is either:
- planning on becoming pregnant
- may become pregnant but not planning
Why would we discuss previous mental health issues?
- ensure preventative measures can be implemented
- discuss treatment (drugs are generally last line though)
If a woman is either:
- planning on becoming pregnant
- is pregnant
Why would we discuss previous mental health issues?
- discuss changing medication or stopping altogether
- discuss relapse risk
In terms of prescribing an anti-depressant what is the safest drug, in terms of exposure to placental exposure and therefore having the lowest teratogen affect?
1 - clozapine
2 - lithium
3 - sertraline (SSTI)
4 - haloperidol
3 - sertraline (SSTI)
- other selective serotonin re-uptake inhibitor (SSRI)
In terms of prescribing an anti-psychotics, instead of prescribing sertraline, why would we potentially choose to prescribe an older drug such as haloperidol?
- more information on them
- BUT 2nd generation psychotics may be safe (Olanzapine)
Which mood stabilising drug has the highest teratogenic effect?
1 - clozapine
2 - valproate
3 - sertraline (SSTI)
4 - haloperidol
2 - valproate
- AVOID MOOD STABILISER DRUGS (LITHIUM)
Valproate (and some other mood stabilising drugs) should be avoided during pregnancy, why?
- large teratogenic affect (7-10% risk)
- increased risk of congenital malformations (cognitive deficiencies)
Does psychotic medication have any bearing on breast milk?
- yes
- will be excreted in breast milk
All psychotic medication will be excreted in breast milk. What can we as medics do in situation where the women needs to take psychotic medication whilst breast feeding?
1 - lowest dose possible
2 - drug a novel drug that doesn’t transfer through breast milk
3 - provide a relative infant dose (RID)
4 - don’t breast feed if on medication
3 - provide a relative infant dose (RID)
- dose is adjusted based on babies weight as a proportion of mums weight
= RID = infant weight adjusted as proportion of maternal weight adjusted dose
All psychotic medication will be excreted in breast milk. To minimise the risk to the baby we can provide a relative infant dose (RID), which is a dose that is adjusted based on babies weight as a proportion of mums weight.
- RID = infant weight adjusted as proportion of maternal weight adjusted dose
What is the cut off for drugs that are deemed as safe when considering RID?
1 - 1%
2 - 10%
3 - 30%
4 - 50%
2 - 10%
- i.e. baby weight is 9k and mums weight is 89kgs
- 89/9 = 9.8%
What drugs are generally safest to use if a women is breast feeding, but required anti-pyschotic medication?
- sertraline (selective serotonin re-uptake inhibitors)
- olanzapine (2nd generation anti-pyschotics)
