Perinatal psychiatry Flashcards
When should pregnant women with history of serious affective disorder/psychosis be referred to psychiatry?
all women with this hx should be referred for psychiatric assessment
even if they are well
regular monitoring/support for at least 3/12 post-delivery
Risks/impacts of poor mental health to mother
deliberate self harm/suicide/risky behaviour
self-neglect
vulnerability
relationships
employment
financial
hospital admission
driving
bonding
Risk of poor maternal mental health to infant
maternal self neglect
increased risk of pregnancy loss
affective illness may increase risk of preterm delivery
congenital malformations + perinatal mortality
neglect or harm to infant
influence of poor mental health on child development/attachment
What are adverse childhood experiences?
traumatic events that can have negative, lasting effects on health + wellbeing
Name some adverse childhood experiences
abuse - physical, emotional, sexual
household challenges - domestic violence, substance abuse, mental illness, parental separation/abuse, incarcerated parent
neglect - emotional, physical
Common presentations in perinatal psychiatry
baby blues
antenatal depression
postnatal depression
puerperal psychosis
disorders of mother/infant attachment
postpartum relapse in known bipolar affective disorder
risk of recurrent post-partum psychosis
What PHQ-9 scores would get referral in perinatal psychiatry?
5-9 = mild
10-14 = moderate = GP appt
15-19 = moderate to severe
20-27 = severe = MH input
What GAD-7 scores would get referral in perinatal psychiatry?
11-15 = moderate to severe = GP appt
16-21 = severe = MH input
Risk factors for puerperal psychosis
psychiatric history
family psychiatric history
first child
Symptoms of puerperal psychosis
feeling high, manic or on top of the world
low mood and tearfulness
anxiety or irritability
rapid changes in mood
severe confusion
being restless and agitated
racing thoughts
behaviour that is out of character
hallucinations
delusions
feeling paranoid
loss of inhibitions
Which antidepressants can be used in pregnancy?
SSRI widely used
most evidence for fluoxetine
concern re pulmonary hypertension
paroxetine to be avoided - cardiac abnormalities, low birth weight
What foetal abnormality can lithium cause?
Ebstein’s anomaly
What foetal abnormality can SSRIs cause?
persistent pulmonary hypertension
What congenital abnormalities can valproate cause?
polydactyly
spina bifida
cleft palate
hypospadias
harmful at all stages of foetal development - AVOID
Antipsychotic prescribing in pregnancy
do not routinely prescribe depots/clozapine (definitely don’t initiate)
psychotic relapse probably more dangerous to foetus than antipsychotic
anticholinergics should not be prescribed for EPSEs apart from acute short-term use
