Perinatal psychiatry Flashcards
1
Q
causes of death amongst women who died between 6 weeks and 1 year after the end of pregnancy
A
- 1 in 3 deaths secondary to mental illness
2
Q
untreated mental illness and pregnancy
A
- possible small impact on neonatal and obstretic outcomes
- increased risk of emotional problems, self reported problems, and depression in offspring
- limitations and hard to separate medication impact and ante and post natal depression
3
Q
Tocophobia
A
- intense dread of childbirth - can lead to women avoiding pregnancy, seeking a termination, late booking, requesting C section
- in women who have not had a baby 13% report sufficient fear to postpone or avoid pregnancy. fears are more common and severe in women without children
- secondary - labour history, trauma
- important to identify early and understand precipitants
4
Q
trauma symptoms and pregnancy
A
- adjustement disorder and distress (150-300/1000)
- PTSD is estimated to occur in up to 3% of maternities and 6% of women following emergency cesarean section
*past trauma is a major risk factor for birth related psychological trauma
5
Q
perinatal depression
A
- post partum depression classically occur at 1-3 months post partum
- 10-15% of women suffer from mild to moderate perinatal depression
- biological role oxytocin, estrogen, CRH, HPA axis, thyroid dysfunction
- previous depression consider rates of up to 50%
6
Q
symptoms of perinatal depression
A
- core
- reduced energy
- low mood
- anhedonia - cognitive
- Guilt
- worthlessness
- hopelessness
- concentration
- memory - Biological
- sleep
- appetite
- libido - suicidal ideation
7
Q
edinburg postnatal depression scale (EPDS)
A
- screening tool - not diagnostic
- can be self reported
- but Q10 should always
- score of 0-30 = cut off of 13 (above 13 need to access)
8
Q
Post partum psychosis
A
- 2/1000 women
- onset usually in the 1st week (can occur in the first 2 months after childbirth)
- most will require inpatient treatment
- acute onset, severe psychotic symptoms of delusions and hallucinations
- florid affective (mood) symptoms, perplexity, confusion and associated behavioural change (florid means elaborate)
- ** perplexity and confusion may be the dominant symptoms
- essential to rule out any potential underlying medical/physical cause
- a number of maternal deaths have been linked to this misattribution (confusion and perplexity)
- this is an emergency urgent opinion should be sought if it is suspected
9
Q
risk factors for postpartum psychosis
A
- BPAD (type 1)
- prior psychosis
- family history of psychosis
- first baby (OR >3) !!
- older age
- single
- delivery complications (OR 2.5) !!
10
Q
treatment considerations - postnatal psychosis
A
- evaluate risks to mother and baby
- location of treatment
- contact with the baby
- use of the mental health act
- concerns around Social welfare and TULSA
- familiy minimizing symptoms
- risks of sedation with treatment
11
Q
Baby blues
A
- 50-85% of women experience mood lability, irritability and tearfullness following delivery
- occurs in the first 10 days
- last 48 hours
- resolves without treatment
- question the diagnosis? post partum psychosis if atypical or severe
12
Q
Prescribing during pregnancy for psychiatric conditions - cheat sheet
A
- depression - sertraline
- psychosis - quetiapine
- mood stabilizer - lamotrigine
- breastfeeing: generally fine but NOT with clozapine, highly challenging with lithium (recommend not to breastfeed whilst taking lithium unless underadvice from a perinatal psychiatrist - baby needs regular blood tests to monitor his or her lithium level, thyroid and kidney function)
**sodium valproate very bad in pregnancy
13
Q
antidepresant risk in pregnancy
A
- neonatal abstinence syndrome - mild self limiting especially at doses <50% of max
- Persistent pulmonary hypertension of the newborn
- cardiac defects
- Post partum hemorrhage (effect on platelet aggregation)
*effect sizes small and methodology generally low quality
14
Q
cardiac defects in newborn and SSRIs
A
- SSRIs do not all behave the same
- venlafaxine and paroxetine appear to be an issue
- escitalopram appears to be safe
15
Q
SSRI and pregnancy
A
- we rarely change medication
- sertraline has become the drug of choice with its low RID (relative infant dose)
- metabolism is increased in 20% of individuals later in pregnancy
- venlafaxine, paroxetine and drug combinations have often been arrived at after multiple relapses but confer higher risk for complications
- consider if SSRI is actually indicated
