perinatal psych Flashcards
red flag presentations requiring referral to a specialist perinatal mental health team
recent significant change in mental health state or emergence of new symptoms
new thoughts or acts of violent self harm
new and persistent expressions of incompetency as a mother or estrangement from their baby
when to admit to a mother and baby unit
rapidly changing mental state
suicidal ideation (particularly of a violent nature)
significant estrangement from the infant
pervasive guilt or hopelessness
beliefs of inadequacy as a mother
evidence of psychosis
good questions to ask when assessing mental health state relating to post natal period
do you have new feelings and thoughts which you have never had before, which make you disturbed or anxious?
are you experiencing thoughts of suicide or harming yourself in violent ways?
are you feeling incompetent, as though you can’t cope, or estranged from your baby?
do you feel you are getting worse?
risk factors for mental health issues
young/single domestic issues lack of support substance abuse unplanned/unwnated pregnancy pre-existing mental health problem
screening questions to be used in every appointment
during the last month have you been bothered by feeling down, depressed or hopeless?
during the last month have you been bothered by having little interest or pleasure in doing things?
is this something you feel you need or want help with?
when to refer to psychiatry
psychosis
severe anxiety, depression, suicidal, self-neglect, self harm
symptoms with significant interference with daily functioning
history of bipolar or schizophrenia
history of puerperal psychosis
psychotropic medication
if developed moderate illness in late pregnancy or early post partum
mild-moderate illness but with 1st degree relative with bipolar or puerperal psychosis
previous inpatient admissions to mental health unit
effects of pregnancy on bipolar
high rate of relapse postnatally
effects of pregnancy on eating disorders
may be some improvement
risks of IUGR, prematurity, hypokalaemia, hyponatraemia, metabolic alkalosis, miscarriage, premature delivery
effects of pregnancy on antenatal depression
often relapse if stop meds in pregnancy
management of antenatal depression during pregnancy
mild - self help strategies
mild-moderate - GP managed
severe - referral to psych
differential diagnosis of puerperal psychosis
episode of bipolar
unipolar depression
schizophrenia
organic brain dysfunction
when does puerperal psychosis present
within 2 weeks of delivery
early symptoms of puerperal psychosis
sleep disturbance
confusion
irrational ideas
late symptoms of puerperal psychosis
mania
delusions
hallucinations
confusion
risk factors for puerperal psychosis
bipolar disorder
previous puerperal psychosis
1st degree relative with history
management of puerperal psychosis
admission to specialised mother-baby unit
antidepressants, antipsychotics, mood stabilisers, ECT
typical symptoms of postnatal depression
tearfullness irritable anxiety lack of enjoyment and poor sleep weight loss can present as concerns re baby
usual onset of post natal depression
2-6 weeks
lasts weeks to months
how to differentiate baby blues from postnatal depression
baby blues - week 1
depression weeks 2-6
management of postnatal depression
mild-moderate - self help, counselling
moderate-severe - psychotherapy and antidepressants, admission?
risks to child of untreated depression
low birth weight
preterm delivery
adverse childhood outcomes
poor engagement/bonding with child
risks of medication during 1st trimester
teratogenicity
risks of medication in 3rd trimester
neonatal withdrawal
risks of medication in breast feeding
medication passing into breast milk
exposure is less in breast milk than in utero, so if a drug was fine antenatally it should be fine postnatally
