Perinatal psychiatry Flashcards
Who is the pre-conceptual appointment mainly aimed at?
For women at high perinatal risk e.g. previous postnatal psychosis, severe Bipolar Affective Disorder, complex medication regimen
What are the purposes of a pre-conceptual appointment?
Outline risks to allow a more informed decision as to whether to try to get pregnant or not
Allow a plan e.g. to reduce / change medication PRIOR to pregnancy
- E.g. risk of postnatal psychosis in a future pregnancy if it occurred in earlier one = 50%
- E.g. reduce and stop Lithium in a planned way prior to pregnancy
What trimester of pregnancy is there the highest risk of teratogenicity?
1st trimester
Harm may already have been done prior to presentation e.g. neural tube closes at day 28; cardiac anatomy is formed by 7-8 weeks
Why is it important to assess the mothers mental health?
Maternal mental health problems (e.g. depression, anxiety) have adverse effects on the developing foetus so need to balance this against teratogenicity risk
For the booking appointment on the mothers mental health, what is important to check for?
History of mental health problems, previous treatment, Family History
Identify risk factors: Young, single, domestic issues, lack support, substance abuse, unplanned/unwanted pregnancy, pre existing mental health problem
During mental health screening appointment, what questions on depression are commonly used?
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?
What are 3 issues to consider in the treatment of perinatal disorders?
- Risks of untreated illness
- To mother and to infant - General principles of prescribing in perinatal period
- Benefits and harms of specific treatments
What risks present to the child in untreated maternal depression?
Low birth weight
- Associated with severity of depression
Pre-term delivery
- Associated with severity of depression
Adverse childhood outcomes
- e.g. emotional & conduct problems, ADHD
Poor engagement / bonding with child
- Reduced infant learning & cognitive development
What group of antidepressants are first line for maternal depression?
SSRI’s
What SSRI has the least placental exposure?
Sertraline - reduced placental drug transfer to foetus
What SSRI is thought to be the safest?
Fluoxetine - thought to be the “safest” as it has been used longest there is lots of data for it
What SSRI is thought to be less safe than the other SSRI’s?
Paroxetine - potential increased risk of congenital cardiac malformations
Risks of taking SSRI’s in pregnancy?
Persistent hypertension of the newborn
Lower birth weight
Increased early birth (by a matter of days)
Post partum haemorrhage
What other antidepressants can be used in pregnancy?
Tricyclics antidepressants (i.e. imipramine and amitriptyline)
- do not appear to cause major problems
- may be some mild & self-limiting neonatal withdrawal
Venlafaxine (SNRI)
- less evidence
- cardiac defects and cleft palate, neonatal withdrawal
Mirtazapine (tetracylic antidepressants)
- limited evidence
Antidepressant recommendations during pregnancy?
Woman with high risk of relapse should be maintained on medication during and after pregnancy
Moderate to severe depression should be treated with antidepressants
Several antidepressants have lots of evidence related to safety profiles
Make use of priority access to psychological therapies during perinatal period
1st generation (typical) antipsychotic examples?
Haloperidol, chlorpromazine
2nd generation (atypical) antipsychotic examples?
Olanzapine, quetiapine
What a risk of antipsychotic use in pregnancy (especially with 2nd gen)?
Risk of gestational diabetes
Antipsychotics are medications that prove high risk of teratogenicity. true/false?
False
Appear to be safe and not evidence of major teratogenicity
How can antipsychotics reduce fertility?
Raised prolactin levels
With antipsychotic use, hyperprolactinemia can lead to reduced oestrogen levels in women and gonadal dysfunction.
Can lead to amenorrhea, menstrual irregularities, and infertility.