Perinatal mental health Flashcards
what is the leading cause of death in women in the first postnatal year
suicide
what to consider in a risk assessment
Risk to self (suicide or DSH) Risk to others Risk from others (Domestic Violence) Drugs, Alcohol & Smoking Compliance/ engagement Physical Disabilities/ Cognitive impairments
what are baby blues
mood swings, tearfulness, irritable, low and anxious, over-react to things at times. usually stops when baby is 10 days old
features of post natal depression
depressive symptoms >2w
features of post natal anxiety
anxiety symptoms >2w
features of post partum psychosis
severe mental illness, normally occurs within 1 month after birth, symptoms fluctuate hour-hour and day-day
confounding factors for post partum psychosis
PMH: bipolar affective disorder, schizoaffective disorder, schizophrenia or PPP
Fhx
traumatic birth or pregnancy
what are the 3 Whooley screening questions
During the past month have you often been bothered by feeling down, depressed or hopeless?
During the past month have you often been bothered by having little pleasure or interest in doing things?
If yes to either question, is this something you feel you need or want help with?
symptoms to look for in post natal depression
Look for low mood, inability to enjoy/take
pleasure, guilt, hopelessness, suicidal thoughts, anxiety may be first symptom, Women may express negative/ ambivalent feelings towards infant and have doubts or concerns about ability to care for infant/ children
As severity increases level of function decreases
Suicidal and infanticidal thoughts may emerge
Emotions
unhappy, tearful, anhedonia, feeling restless, irritable, loss of self-confidence, feeling useless, worthless, hopeless and thoughts of suicide.
Thoughts
negative thinking, finding it hard to make even simple decisions and difficulty in concentrating.
Physical
losing appetite and weight, insomnia, fatigue, constipation, loss of libido
Behavior
difficulty in starting or completing things – even everyday chores, crying and avoiding contact with other people.
RFs for antenatal depression
Past history of depression Marital discord/ dissatisfaction Inadequate social support Recent adverse life events Lower socio-economic status Unwanted pregnancy < 16years old Describes self as nervy, a worrier, angry, shy/self-conscious Perfectionist Family History Major health problems Baby of non-desired sex For one third of women who get depressed in pregnancy, this is first episode of major depression
define psychosis
losing touch with reality
clinical features of psychosis
Delusions & Hallucinations
Mania - grandiose delusions, on an important mission or have special powers and abilities.
Depression – guilty delusions, that you are worse than anybody else, done something wrong, or don’t exist or body rotting.
treatment for PND/ anxiety
Education on diagnosis- Acceptance Psychosocial stressors Psychological talking therapies Medication HTT/ Admission (Informal)
High Risk, not consenting to treatment/ lacks capacity- MHA
Admission (Section 2 or 3)
MBU/ General Adult ward/ PICU
ECT
psychological therapy in PND/ anxiety treatment
Short term evidence based therapies such as CBT or CAT
Longer term mother-infant psychotherapy
Family therapy
Group Therapy
pre-conception/ pregnancy advice
Healthy Lifestyle Advice
400mcg Folic Acid 3/12 before conception and 3/12 after
5mg Folic Acid (Medication that has teratogenic potential)
GP/Perinatal MH Service/ CMHT
Continue on Medication? Risk vs benefits
Do not stop medication suddenly
Problems conceiving check prolactin levels (?antipsychotic medication)
risks of not taking medicine
Mother neglecting her health
Not attending appointments, missing out on antenatal care
Alcohol and drug use
If relapse may require a higher dose of medication or several medications and admission. More risky for baby than if remained on standard dose of medication
Unwell - difficult to care for baby and bond
Some research studies have found pre eclampsia more likely and low birth weight, premature, SIDS if their mother has untreated depression.
Untreated mental illness can also affect a baby’s development later on.
medication for PND
1st line – Sertraline, Escitalopram (SSRI) & Mirtazapine (NASSAs)
Combination Antipsychotics (Olanzapine or Quetiapine)
Lamotrigine
Other antidepressants or mood stabilisers (risks vs benefits)
side effects of SSRIs
First 2 weeks- nausea and more anxiety. Indigestion, which settles with food. They may interfere with sexual function. Rarely been reports of aggression.
However, most people get a small number of mild side-effects (if any).
The side-effects usually wear off over a couple of weeks as your body gets used to the medication.
More serious (but rare) – urinary retention, memory loss, confusion.
Sife effects of SNRIs
Similar to the SSRIs, although Venlafaxine can also increase blood pressure
side effects of NASSAs
Similar to SSRIs. But can cause drowsiness, and cause weight gain, but they cause less sexual problems.
side effects of tricyclics
These commonly cause a dry mouth, a slight tremor, fast heartbeat, constipation, sleepiness, and weight gain.
In older people, they may cause confusion, slowness in starting and stopping when passing water, hypotension- syncope and falls. Avoid if heart trouble.
Interfere with sexual function
Tricyclic antidepressants are dangerous in overdos
how long do mothers need to take antidepressants for?
at least 6 months after they start feeling better
Consider what the triggers are and ways to minimise them.
If had two or more attacks of depression then treatment should be continued for at least two years.
risks of antidepressants during pregnancy- sertraline and escitalopram
No clear link with an increased risk of major malformations, miscarriage, stillbirth or baby being premature
7-9 months risk of high blood pressure
Birth “persistent pulmonary hypertension in the newborn” (or PPHN). The risk is very low: about 3/1000 compared to about 1/1000 if they did not. This can be treated.
Discontinuation symptoms - irritable, crying, shivering, or problems eating and sleeping. Usually mild, and go away in a few days without treatment. They can be helped if take medication whilst breastfeeding
risks of antidepressants during breast feeding- sertraline and escitalopram
Breastfeeding a little more difficult to get started
They get into breast milk in very small amounts but not usually enough to affect the baby, unless the baby is premature.
The best ways to reduce the risks are:
Take once daily
Take straight after a main feed in the morning
Use expressed milk or formula feeds when levels of medicine in your body are likely to be highest
