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
Do anti-depressants cause neonatal withdrawal if used in the 3rd trimester?
There is an increased risk of what condition in the baby if the mother is taking an SSRI or venlafaxine after 20 weeks?
Which SSRIs are the lowest risk?
What medications are lower risk than SSRIs?
Yes, but it is generally mild and self-limiting
Persistent pulmonary hypertension
Fluoxetine and sertraline
Tricyclics
Are anti-depressants safe to use in breastfeeding?
Yes generally, though citalopram should be avoided
Benzodiazepines should be avoided if possible through all of pregnancy. What is the reason for this in:
a) 1st trimester?
b) 3rd trimester?
c) breastfeeding?
a) foetal malformation e.g. cleft palate
b) floppy baby syndrome (hypothermia, hypotonia, respiratory depression)
c) lethargy and weight loss
Why is lithium use not advised in the 1st trimester of pregnancy?
Can it be continued if necessary?
What should you avoid doing?
Increased risk of foetal abnormality, potentially including Ebstein’s anomaly (a rare congenital heart defect affecting the tricuspid valve)
Yes
Stopping it suddenly
How should lithium use in pregnancy be monitored?
Lithium toxicity in pregnancy can mimic what?
When should lithium always be avoided?
Monitor lithium levels closely: monthly, then weekly from week 36 and then within 24 hours of delivery
Pre-eclampsia
In breastfeeding
Why can being on an anti-psychotic reduce chances of conception?
There is more evidence for the safety of which type of anti-psychotic in pregnancy?
Anti-psychotics are secreted in breast milk and are considered safe to use, but what should you monitor the baby for?
Increases prolactin levels
Typicals
Sedation/lethargy
Which anti-psychotic should always be avoided in pregnancy and why?
Why should olanzapine be avoided if possible?
Which method of giving anti-psychotics should be avoided?
In pregnancy, you should avoid treated EPSEs with what?
Clozapine - risk of agranulocytosis in mother and baby
Increases the risk of gestational diabetes and causes weight gain
Depot injections
Anti-cholinergics
What are the risks of using sodium valproate in early pregnancy?
Can it be used in breastfeeding?
Increased risk of neural tube defects, craniofacial defects and adverse effects on the child’s intellectual development
Yes
What are the risks of carbamazepine in pregnancy?
Neural tube defects
Facial dysmorphism
Fingernail hypoplasia
Why should lamotrigine be avoided in the first trimester of pregnancy?
If this is used in breastfeeding, there is a risk of what in the infant?
Oral cleft risk
Stevens-Johnsons syndrome
What are some risks of substance misuse in pregnancy?
IUGR
Sudden infant death syndrome
Stillbirth
Preterm labour
