Perinatal Mental Health Flashcards
The risk of a mental health issue in and around pregnancy is predicted by what things?
Previous psychiatric disorder
Other vulnerable factors
Family history of bipolar disorder in a 1st degree relative
Name some red flag presentations which would warrant urgent refarral to a specialist perinatal mental health team?
Recent significant change in mental state
New thoughts or acts of violent self harm
New and persistent expressions of incompentency as a mother or estrangement from their baby
Is pregnanct protective of mental health disorders?
What happens to bipolar disorder around pregnancy?
If a patient already has depression before getting pregnant which is mild, what caould you do?
No
High rate of relapse postnatally
Stop their medication and refer for psychological treatment instead
How common are the baby blues?
What is this?
What may be some features?
When does it present?
What is the management?
Occurs in 50% of women
A brief period of emotional instability
Tearfulness, irritability, anxiety, poor sleep
Days 3-10 postnatally
It is self limiting, give support and reassurance
How common in postnatal depression?
Who is it more common in?
This has the same features as normal depression, but what are some that are maybe a bit more specific?
What is a common presentation of this?
When does this usually present?
How long can it last?
10% of women are affected
Teenage mothers
Losing interest in the baby, feeling hopeless/unable to cope
Concerns about the baby
2-6 weeks post-natally
Weeks-months
What are some adverse effects of having postnatal depression?
Effects on bonding and child development
Effects on marriage
Risk of suicide
How is mild-moderate postnatal depression treated?
How is moderate-severe postnatal depression treated?
Self-help and counselling
Psychotherapy and medications, possible admission
How likely is postnatal depression to recur?
What is the lifetime risk of depression?
25%
70%
How common is puerperal psychosis?
What is the risk of a) suicide? b) infanticide?
What are some risk factors for this?
- 1% of women are affected
a) 5% b) 4%
Bipolar disorder (50%), previous puerperal psychosis (50%) and having a 1st degree family history
When does puerperal psychosis tend to present?
What are some early symptoms?
What are some more severe symptoms?
Are these symptoms present all the time?
25% of people with this go on to develop what?
Within 2 weeks of delivery
Sleep disturbance, confusion, irrational ideas
Delusions, hallucinations, mania
They can fluctuate
Bipolar disorder
What is the management of puerperal psychosis?
Needs admission to a specialist mother and baby unit
Anti-depressants
Anti-psychotics
Mood stabilisers
ECT
What are some risks to a child of untreated depression?
Low birth weight
Preterm delivery
Adverse childhood outcomes
Poor engagement/bonding (reduces learning)
When prescribing in pregnancy, you should always use the lowest possible dose of monotherapy. What way of giving medication should be avoided?
What should happen to screening of the baby if the mother is on medications?
Stopping a drug with known teratogenic risk after pregnancy is confirmed may not remove the risk of malformations - i.e. if the patient was on valproate, the damage would be done by when?
Depot
Increased screening for cardiac abnormalities and growth
5 weeks
What is the main risk of taking certain medications in the 1st trimester?
What is the main risk of taking certain medications in the 3rd trimester?
What is the risk of taking certain medications while breastfeeding?
Teratogenicity
Neonatal withdrawal
Passing it into the breastmilk
Are anti-depressants safe to use in the 1st trimester?
Generally yes, except paroxetine as it increases the risk of foetal heart defects
