Perinatal Mental Health Flashcards
Learn about the epidemiology of perinatal mental illness Understand the rationale for management of perinatal mental illness, including pharmacokinetic and pharmacodynamic changes in pregnancy and post-partum, the main classes of psychotropic medication employed in periinatal psychiatry, and consdierations of prescribing in pregnancy and lactation Learn about the medium and long-term consequences of untreated maternal mental illness on child development
Name at least 3 pregnancy-related disorders which tend to reoccur later in life
Pre-eclampsia (as hypertension), gestational diabetes, post-partum thyroid disease, postnatal depression, puerperal psychosis
Name at least 3 disorders which can be exacerbated by pregnancy
SLE, eating disorders, OCD, bipolar disorder
Name some sub-clinical syndromes unmasked by pregnancy
Thyroiditis, eating disorders, OCD
Define the ‘baby blues’ and state their prevalence (Henshaw, 2003)
Self-limiting depressive mood changes after delivery, prevalence 50%
State the peri and post-natal prevalence of minor depression
Perinatal: 11%
Postnatal: 13%
State the peri and post-natal prevalence of major depression
Perinatal: 3-5%
Postnatal: 4.7%
What percentage of post-partum women report obsessional thoughts of harm to their baby? (Wisner et al, 1999)
57%
State at least 5 risks of pharmacological intervention during pregnancy
Teratogenecity, obstetric complications, neonatal toxicity & withdrawal, neonatal complications, incompatibility with breastfeeding, neurodevelopmental disorders (autism), child psychopathology
State at least 5 risks of untreated mental illness during pregnancy
Increased risk of hospitalisation, worsening of long-term prognosis, suicide, premature delivery, low birth weight, still birth, early infant death, attachment disorders, slow infant cognitive development
Name 2 psychiatric disorders associated with premature delivery
Depression, schizophrenia
Name 2 psychiatric disorders associated with low birth weight
Anorexia nervosa, schizophrenia
Name a psychiatric disorder associated with still-birth and early infant death
Schizophrenia
Name a psychiatric disorder associated with slow infant cognitive development (Stein et al, 2014)
Depression
When in life is the relative risk of admission to hospital with a psychotic illness highest? (Kendell et al, 1987)
First 30 days after childbirth
What percentage of women who die 6 weeks to a year after pregnancy die from psychiatric causes?
23%
Describe the findings from the South London Child Development Study (SLDCS) on perinatal mental health and child development
Perinatal maternal depression increased the risk of child and adolescent psychopathology
Describe the findings from the Avon Longitudinal Study of Parents and Children (ALSPAC) on perinatal mental health and child development
Antenatal maternal anxiety predicted behavioural and emotional problems in children, with a stronger impact on males
Describe the Barker hypothesis
Developmental programming in utero modifies the risk of disease later in life
What effects does the intrauterine environment have at an organ level?
It alters cellular and metabolic function, leading to altered appetite and lipogenesis
What effects does the intrauterine environment have at a cellular level?
It alters the number, size, and proliferation of cells, changing intracellular organisation
What effects does the intrauterine environment have at an epigenetic level?
It affects DNA methylation and modifies chromatin, leading to modified gene expression and signalling
Name the 4 neuorbiological correlates of perinatal mental health
Adrenaline-cortisol pathways, serotoninergic pathways, dopaminergic pathways, and oxytocin system
Which pathways are involved in depression?
Serotoninergic pathways
Which pathways are involved in anxiety?
Adrenaline-cortisol pathways
Which pathways are involved in psychosis?
Dopaminergic pathways
Which pathways are involved in addiction?
Dopaminergic system
How does the dopaminergic system ensure survival of the species
It counteracts the irritations of caring for children
Name at least 3 classes of psychotropic medication
Antipsychotics/ neuroleptics, selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), mood stabilisers, anxiolytics/ sedatives
State the method of action of antipsychotics and name at least 2
Dopaminergic D2 antagonists - risperidone, olanzapine, quetiapine aripiprazole
State the method of action of SSRIs and name at least 2
Inhibit the reuptake of serotonin (5-hydroxytriptamine) in the synapse, increasing the bioavailable concentration and prolonging neuronal activity - fluoxetine, citalopram, escitalopram, sertraline
State the method of action of SNRIs and name 2
Inhibit the reuptake of both serotonin and noradrenaline from the synapse - venlafaxine, duloxetine
State the method of action of mood stabilisers and name at least 2
Reduce the excitability of neural membranes - lithium, carbamazepine, valproate, lamotrigine
State the method of action of anxiolytics and name at least 2
Act on GABA receptors and promote GABAergic inhibitory neurotransmission - diazepam, lorazepam, temazepam, zopiclone, zolpidem
Describe the ‘theory of the inflamed mind’ for mental illness
Inflammatory proteins act directly on the brain to change thoughts and behaviours
Give a piece of evidence for the theory of the inflamed mind
1) 25% of RA patients are depressed
2) 1/3 of patients with depression have chronic inflammation
