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Reproduction & Sexual Health > Perinatal Psychiatry > Flashcards

Perinatal Psychiatry Flashcards

1
Q

What percentage of women who suffer a perinatal psychiatric condition have pre-exisiting mental health problems?

A

2/3

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2
Q

What are the red flags in the perinatal period?

A

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

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3
Q

What symptoms would warrant admission in a perinatal patient?

A 
Rapidly changing mental state 
Suicidal ideation 
Significant estrangement from the infant 
Pervasive guilt/hopelessness
Beliefs of inadequacy 
Evidence of psychosis
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4
Q

What questions can help to determine the mental state of a new mum?

A

Do you have feelings/thoughts which you have never had before?
Are you experiencing thoughts of suicide or harming yourself?
Are you feeling incompetent as thought you can’t cope or estranged from your baby?
Do you feel you are getting worse?

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5
Q

State the screening questions for pregnant women’s mental health

A

Have you been feeling down, depressed, hopeless?
Have you had little interest in doing things?
Is this something you feel you want/need help with?

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6
Q

What is the rate of relapse of bipolar during/after pregnancy?

A

50%

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7
Q

What are the risks of an eating disorder?

A

IUGR, prematurity, hypokalaemia, metabolic alkalosis, miscarriage, premature delivery

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8
Q

What are baby blues and how many women experience them?

A

50% women - brief period of emotional instability
Tearful, irritable, anxiety, poor sleep and confusion
Day 3-10 self limiting
Support and reassure

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9
Q

When and how will puerperal psychosis present?

A

Two weeks post delivery
Early symptoms - sleep disturbance, confusion, irrational ideas
Progression - mania, delusions, hallucinations, confusion

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10
Q

What are the risk factors for puerperal psychosis?

A

Bipolar
Previous episode (50%)
1st degree relative with bipolar

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11
Q

How is puerperal psychosis managed?

A

Same day psychiatric assessment - emergency

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12
Q

When and how does post natal depression present?

A

10% women, onset 2-6 weeks

Tearful, irritable, anxiety, lack of enjoyment, poor sleep, weight loss, concerns re. baby

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13
Q

How is post natal depression managed?

A

Mild-moderate - self help

Moderate - severe - psychiatry

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14
Q

What are the risks to the baby if mental health is left untreated?

A

Low birth weight
Pre-term delivery
Adverse childhood outcomes
Poor engagement

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15
Q

What medication is used first line for depression?

A

SSRIs - best evidence and not thought to be teratogenic

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16
Q

Which SSRIs should/should not be used?

A

Sertraline and fluoxetine (best) should be used

Paroxetine should not be used due to risk of malformation

17
Q

What can tricyclics cause?

A

Self limiting neonatal withdrawal

18
Q

Which antipsychotics can be used and which have the best evidence?

A

1st gen - chlorpromazine and haloperidol

2nd gen - olanzapine and quetiapine (best evidence)

19
Q

What are the risks of anti-psychotics?

A 
Gestational diabetes (particularly 2nd gen)
Reduced fertility due to raised prolactin
20
Q

State the risk associated with bipolar disease?

A

Induction/C-section
Pre-term
Small babies

21
Q

What mood stabilisers must not be used?

A

Valproate

Carbamazepine

22
Q

Which mood stabiliser seems fairly safe?

A

Lamotrigine

23
Q

What can Lithium cause?

A

Ebstein’s anomaly

24
Q

What is the relapse rate in patients with bipolar who come off lithium?

A

70% - consider reducing dose, changing in third trimester or just coming off for 1st trimester

25
Q

When can lithium definitely not be used?

A

Breastfeeding

26
Q

State the side effect of benzodiazepines?

A

3rd Trimester ‘floppy baby’

27
Q

What drugs are safe to use in anxiety?

A

SSRIs

28
Q

Name the effects of alcohol misuse in pregnancy

A

Foetal Alcohol Syndrome
Withdrawal
Wernicke’s encephalopathy (20% mortality)
Korsakoff

29
Q

Describe foetal alcohol syndrome

A

Facial deformities, lower QI, neurodevelopment delay, epilepsy, heart and kidney defects

30
Q

What are the risks of cocaine/ectasy/amphetamine?

A

Death via stroke and arrhythmias

Teratogenic, pre-eclampsia, abruption, IUGR, preterm, miscarriage, SIDS, developmental delay

31
Q

Describe the effect of opiate consumption during pregnancy

A

Maternal death, neonatal withdrawal, IUGR, SIDS, stillbirth,

32
Q

What can nicotine do if taken during pregnancy?

A

Miscarriage, abruption, IUGR, stillbirth, SIDS

33
Q

State three breastfeeding contraindications

A

Alcohol >8
HIV
Cocaine

34
Q

How are women with substance abuse generally managed?

A

Consider methadone, social work referral, smear history, labour plan, early IV access, contraception

Reproduction & Sexual Health (36 decks)

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