Perinatal psychiatry 1 Flashcards
What is the leading cause of maternal deaths occuring within a year after the end of pregnancy?
Specifically - Maternal suicide
Broadly speaking mental health illness is the leading cause of maternal death
1 in 4 women who died between 6 weeks and 1 year after pregnancy died of mental health related causes
1 in 7 were by suicide.
Appreciate this pic of post-natal causes of maternal death with the 23% standing for mental illness
What are the key risk factors for predicting mental illness during pregnancy/postnatally ?
Previous psychiatry disorder, other vulnerable factors, family history of bipolar disorder
What are the red flags requiring urgent referral to a specialist perinatal mental health team?
- Recent significant change in mental 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 during antenatal care should there be a routine enquiry about a current or past history of mental health problems?
At the booking visit and then monitored throughout pregnancy assessing for red flag signs
When does changes in mental health require consideration of admission to the 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
What are the questions you want to cover when assessing a mothers mental health?
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? Are these feelings persistent?
Do you feel you are getting worse?
Define what is meant by the term estranged ?
No longer close or affectionate to someone; alienated.
When should a mother be referred to see the psychiatry team ?
- 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 medications
- If developed moderate mental illness in late pregnancy or early postpartum
- Mild- moderate illness but 1st degree relative with bipolar or puerperal psychosis
- Previous in-patient admissions to mental health unit
Appreciate the interaction of pre-exisiting mental health problems and pregnancy
Bipolar disorder:
- High rate of relapse postnatally (50% if untreated)
Eating disorders:
- may be some improvement in pregnancy
- risks of IUGR, prematurity, hypokalaemia, hyponatraemia, metabolic alkalosis, miscarriage, premature delivery
Antenatal Depression:
- 68% relapse if stop meds in pregnancy
- but if mild and on treatment, consider stopping and referring for psychological treatment
- Self help strategies – CBT, Computerised CBT and self guided help of benefit
- Mild-moderate: GP managed
- Severe (suicidal, psychosis, self neglect, harm): referral to psychiatry
What are the baby blues and how is it managed ?
Brief period, lasting from days 3-10, of emotional instability -Tearful, irritable, anxiety and poor sleep confusion
Management = Support and reassurance
What is puerperal psychosis ?
Post-natal psychosis
What are the early smyptoms of post-natal psychosis ?
- Sleep disturbance
- Confusion
- Irrational ideas
- Mania
- Delusions
- Hallucinations
- Confusion
What are the main risk factors for someone developing puerperal psychosis?
- Bipolar disorder
- Previous puerperal psychosis
- 1st degree relative with history of puerperal psychosis
What is the main 2 risks of puerperal psychosis to the mother and child ?
5% risk of maternal suicide and 4% risk of infanticide (killing of infant)
What is the treatment of puerperal psychosis ?
It is an emergency and requires immediate admission to the mother baby unit
If a pregnant woman develops mania or psychosis and is not taking psychotropic medication,
1st line = antipsychotic drug. along with CBT and family intervention to all families of people with psychosis or schizophrenia who live with or are in close contact with the service user
2nd line = increase dose or change antipsychotic drug
3rd line = lithium if no response and still severe mania
4th line = ECT if no response
Note psychotic patinet may also be depressed so may need anti-depressants
When are women usually affected by post-natal depression ?
Onset 2-6 weeks postnatally, lasts weeks to months some more than a year
What are the risks/effects on life associated with post-natal depression ?
Effects on bonding, child development, marriage, risk suicid, 70% lifetime risk of developing depression
Remind yourslef of the classification of severity of depression
What is the treatment of post-natal depression ?
For mild-moderate depression - self help e.g. computerised CBT, exercise and counselling
For Moderate-severe - Structured psychological treatment specifically for depression (CBT or IPT). and anti-depressants
What are the risks to the child of untreated depression?
- Low birth weight
- Pre-term delivery
- Adverse childhood outcomes e.g. emotional & conduct problems, ADHD
- Poor engagement / bonding with child - Reduced infant learning & cognitive development
What care should be offered to a women with an eating disorder in pregnancy or postnatally?
offer a psychological intervention and monitor weight (go with the psychological intervention in psych block)
