Perinatal Mental Health

Question 1

What determines the success of a child’s attachment to its mother?

Answer 1

The quality of caregiver responses to the infant’s attachment behaviours repeated over time.

Question 2

What influences attachment?

Answer 2

• Quality of mother-infant relationship (maternal sensitivity)
• Mother’s attachment experience
• Parental reflective functioning or mentalising capacity (capacity to understand her own and other’s behaviours in terms of mental state)
• Mind mindedness (mother’s ability to attribute attention to infant’s signals)
• Infant temperament
• Contextual (parental age, MH Dxs, SES)

Question 3

Who is monitored by the perinatal mental health team?

Answer 3

Pregnancy - 12m post partum
-Pre existing MH problems who become pregnant
-MH problems develop antenatally or postnatally
and their children and family

Question 4

What are the additional risk factors during the pregnancy of women with schizophrenia?

Answer 4

• Effects of psychotic illness
• Effects of psychotropic medication
• Poor nutritition
• Substance abuse (nicotine, EtOH, illicit drugs)
• Poverty
• Homelessness
• Poor social support
• Victims of violence

Question 5

how does schizophrenia impact on pregnancy?

Answer 5

• Present late, avoid care
• IUGR due to poor self care
• Inc preterm, antepartum haemorrhage and placental abruption
• More difficulty managing labour, higher rates caesarian section

Question 6

What is the impact of schizophrenia on neonatal outcomes?

Answer 6

Inc rates of:

• CV and congenital abnormality
• Stillbirth and neonatal death
• Failure to thrive
• impact on attachment and parenting abilities

Question 7

How does pregnancy impact the mental health of women with a psychotic condition?

Answer 7

Increased risk of relapse and risk of incorporation of pregnancy / baby into delusional system

Question 8

What are the effects of parental mental illness of parent-infant interaction?

Answer 8

• Lack of emotional warmth and intimacy
• Attentional deficits
• impaired maternal competence

Question 9

What are the principles of improving maternal and perinatal mental health of women and schiozphrenia and BPAD?

Answer 9

• Consideration of reproductive choices in routine care
• Early detection and monitoring of pregnancy
• Team approach in pregnancy and post partum

Question 10

How does depression relate to pregnancy?

Answer 10

• Depressive symptoms common during pregnancy, peak T3 and fall following delivery.
• Post partum blues: time limited mood disturbance in post partum period (up to 80%)
• Post natal depression

Question 11

How does depression impact on the pregnancy?

Answer 11

• Lack of care about pregnancy
• Poor health behaviours (i.e. smoking, EtOH)
• RFx suicide, foeticide
• Increased rate spontaneous abortion
• Inc risk gestational HTN, pre eclampsia

Question 12

What are the altered developmental outcomes to children exposed to maternal anxiety / depression?

Answer 12

–  Developmental delay
–  Lowered IQ in adolescence
–  Impaired language development
–  increased rate of emo,onal and behavioural problems –  increased rate of ADHD
–  Associa,on with criminality

Question 13

How does mothers with high levels of depression interact differently with their infants?

Answer 13

• Show less behavioural synchrony with their infant
• Less responsive to their infant’s cues
• Less affirming of their infant’s behaviour

Question 14

During which time of pregnancy is exposure associated with structural abnormalities?

Answer 14

3-12 is period of maximum vulnerability

Question 15

What are the pregnancy complications of antipsychotics?

Answer 15

• Increased rates of gestational diabetes

- More likely to require C section

Question 16

What are the neonatal outcomes of anti psychotic use in pregnancy?

Answer 16

• Inc rates pre term birth and lower birth weight (FGAs)
• Neonatal hypoglycemia related to hyperinsulinism
• Inc birth weight SGAs esp OLZ and clozapine
• Lower APGAR, resp difficulty
• Extrapyramidal SEs (FGAs)

Question 17

How teratogenic are antipsychotics?

Answer 17

On balance little evidence they are teratogenic

Question 18

What are the neonatal outcomes of mood stabilisers (anti epileptics)?

Answer 18

–  Reduced head circumference-CBZ (VPA)
–  Lower birth weight-CBZ (VPA)
–  Neonatal hypoglycaemia (VPA) 
-Neonatal hepatotoxicity LTG, CBZ, 
-Coagulation defects (Vit K) CBZ
–  Sedation withdrawal, toxicity

Question 19

What are the pregnancy complications of lithium?

Answer 19

Lithium toxicity

Question 20

What are the neonatal outcomes of lithium?

Answer 20

• Occassional goite, hypothyroidism

- Nephrogenic diabetes

Question 21

What are the structural abnormalities of lithium?

Answer 21

• Ebstein’s anomaly (displacement of tricuspid valve into RV)
  1: 20000 to 1:1000

Question 22

How do antidepressants influence reproductive loss?

Answer 22

• apparent increase in spontaneous abortion

- no suggestion of increased risk of FDIU or SB

Question 23

How do antidepressants affect neonatal outcomes?

Answer 23

-Increase in preterm births (

Question 24

What are the principles of psychotropics in pregnancy?

Answer 24

• Careful risk-benefit assessment
• Use psychological interventions when possible and appropriate
• Avoid 1st trimester exposure when possible
• Use the lowest effective dose for shortest appropriate/ sufficient time
• Avoid polypharmacy if at all possible
• Remember that serious mental illness has independent
adverse effects on pregnancy/infant

Question 25

Which psychotropics should be avoided during breastfeeding?

Answer 25

• Clozapine not recommended

- Lithium should be avoided

Question 26

Principles for psychotropics in pregnancy?

Answer 26

• If possible use drugs with short half-life
• time feeds when maternal serum levels are lowest i.e. just before next dose.
• May also express milk when serum levels highest and discard milk
• Monitor feeding activity, sleep and conscious level of breasted infants mother on APAs