Perinatal Psychiatry Flashcards
1
Q
What do perinatal MH services offer?
A
- Preconception medication advice
- Support women with severe mental illness who are pregnant or postnatal
- Diagnose and support those with perinatal illness
- Support bonding and parenting in those with mental illness
- Liase with other services
2
Q
What do maternal MH team do?
A
- Psychologist based
- Support re birth trauma, pregnancy loss, fear of childbirth
3
Q
Perinatal MH service - who is part
A
- Psychiatrist
- Perinatal nurses - monitor MH, medication, see in home
- OT - support re routine/functioning, anxiety management
- Psychologist - talking therapy for birth trauma or EMDR
- Recovery workers/peer workers - listening
- Nursery nurses - support with parenting, bonding, trained in childcare (worked in nurseries), VIG - video them with child and challenge bond beliefs
- Work closely with safeguarding and MINT clinic
4
Q
What is MINT clinic?
A
- UHL clinic at obs and gynae
- For people with additional risks in pregnancy eg mental health problems
5
Q
What is mother and baby unit?
A
- For people 37 weeks pregnant and above or within 9 months of birth
- Help builds bond with baby, parenting confidence and routine alongside recovery
- Full perinatal MDT present
- Overnight support if needed - can look after them overnight if needed
- Local ones are Nottingham and Derby
6
Q
Social care MBU
A
- Assessment due to safeguarding risk
- Not related to psychiatry
- Assess if ok to look after child
7
Q
History taking for perinatal psychiatry
A
- Mindful re sleep, energy, libido and eating
- Sleep - ask if are you able to sleep when baby is sleeping, waking up before them etc?
- Obstetric history - previous loss, terminations, IVF, trauma, planned, bond, term baby
- Feeding/plans - breastfeeding
- SH - support, relationships, domestic violence, safeguarding, finances
- Substance abuse - risk to baby?
- FH - any perinatal MH problems? puerperal psychosis, depression - admission to hospital
- Safeguard
8
Q
What to consider re medications in perinatal period?
A
- Teratogenicity
- Breastfeeding
- Sedation
- MH of mother is recommended priority - information often incomplete and evidence limited as not tested on women - but there is data from other women who have taken it
9
Q
Main priority of medication in perinatal period
A
- Mental health of mother is priority
- Stopping medication is not a no risk option - counsel risks vs benefits to support woman to make decision
- Monotherapy/lowest effective dose is preferred
10
Q
Risk of untreated mental illness perinatally
A
- Indicate higher risk of postnatal mental illness
- Increased risk substance use
- Risk pre-term birth or smaller baby
- Self neglect - poor nutrition, disengagement with MH services
- Paternal depression increased risk if maternal depression
- Affect babyes cognitive, emotional and behavioural development
- Increase risk of MH problems in child/baby
11
Q
Information for medication re pregnancy
A
- BUMPS
- Teratogenecity advice service
- UK drugs in lactation advice service UKDILAS
- BNF
- Perinatal team
12
Q
Risky medications in pregnancy
A
- Lithium - Ebsteins anomaly (cardiac malformation) - if breastfeed, baby needs levels done too
- Sodium valproate - DO NOT give it really - massive risks for men and women, neural tube defects, spina bifida, learning development problems. Need LARC. Also PCOS link - affect future fertility
- Carbamazepine not recommended - lamotrigine better
- Benzodiazepines - risk of defects in 1st trimester, risk neonatal withdrawal in 3rd trimester - floppy baby syndrome (promethazine instead)
13
Q
Safer psychiatric medication in pregnancy
A
- SSRI - overall low risk (SGA and PPH), sertraline preferred as crosses placenta less. Paroxetine is least preferred as cardiac malformation, deliver in hospital due to risk withdrawal
- Antipsychotics - beware re prolactin (affects fertility), GDM in SGA, possible neonatal withdrawal so deliver in hospital
14
Q
Post natal depression - features
A
- Within first year generally considered PND (<6 weeks on WHO but ignore this)
- Persistent low mood
- Anhedonia
- Guilt
- Poor concentration
- Withdrawing from others
- Poor sleep and lack energy
- Intrusive/frightening thoughts - harming baby/self, suicidal thoughts
- Lack bond with baby
15
Q
Management of post-natal depression
A
- SSRI
- Nursery nurse input
- Talking therapy
- Self help techniques
16
Q
Risk factors for postnatal depression
A
- BUT can be anyone
- PMH depression or anxiety inc during pregnancy
- FH
- Lack social support
- Poor partner relationship
- Preterm birth, need for NICU
- Unplanned
- Unemployed
- Parental stress antenatally
- Longer time to conceive
- Depression in fathers
- Substance misuse - current or history
17
Q
RF puerperal psychosis
A
- FH PP, bipolar/schizoaffective disorder
- BUT can be out of the blue
18
Q
Onset puerperal psychosis
A
- Sudden - within days-weeks of birth
19
Q
What can contribute to puerperal psychosis
A
Poor sleep can contribute
20
Q
Symptoms of puerperal psychosis
A
- Significant mood changes (mania, depression or changebale)
- Confused
- Delusions - paranoid, grandiose, can be problematic when about baby
- Hallucinations
- Agitated/restless
- Racing thoughts
- Poor sleep
21
Q
Management puerperal psychosis
A
- EMERGENCY
- Can be safeguard risk
- Mother and baby unit often under MHA - other parent has to agree to baby going
- Perinatal MDT
- Antipsychotics/mood stabilisers
- Discuss breastfeeding - can be done on most meds
22
Q
Birth trauma/PTSD
A
- Flashbacks, nightmares or intense upsetting memories of birth
- Anxiety, anger, depression or guilt in relation of birth
- Avoid triggers
- Don’t want to think about it or obsess over it
23
Q
Causes of birth trauma/PTSD
A
- Felt out of control/dismissed/uninformed at some point of birth
- Fears of risk to life to self/baby
- Difficult delivery
- History of abuse/trauma - intimate examinations
24
Q
Consequences of birth trauma/PTSD
A
- Distress
- Avoiding baby
- Overprotection
- Decisions about future deliveries/children
- Poor sleep
- Low libido
25
Q
Treatment for birth trauma/PTSD
A
- Debrief eg Birth Reflections - can invite dad/birth partner (often helpful for them too) go through sequence of events and make it make more sense
- Self care/relaxation techniques
- MMH team
- Psychotherapy
- EMDR
- Antidepressants esp if PND
26
Q
What is tokophobia?
A
- Pathological phobia of birth (and therefore pregnancy)
- Primary - never experienced birth - FH of difficult births, professional experiences, sexual abuse or anxiety
- Seconday - after traumatic birth
27
Q
Consequences of tokophobia
A
- Can affect obstetric decisions (termination?, elective CS)
- Bonding with pregnancy/baby
- Mental wellbeing during pregnancy
28
Q
Management of tokophobia
A
- MMH
- CBT
- Antidepressants
- Consider hypnobirthing - being relaxed during labour is the best way to go through it and that they are in control. Problem is it isn’t always this way.
- Some may still consider elective CS
29
Q
Perinatal OCD and intrusive thoughts - what are intrusive thoughts
A
- Intrusive thoughts can be part of depression, anxiety, OCD or normal human experience
- Can cause significant guilt but often do not indicate intent
- Consider impact
- Pop into head randomly
30
Q
What are obsessions and compulsions of OCD?
A
- Unwanted/unwelcome/uncomfortable intrusive thoughts
- Compulsions - repeated actions to reduce distress of obsessions
31
Q
Treatment perinatal OCD
A
- Psychoeducation
- Talking therapies - CBT, exposure response prevention
- Medication eg SSRI
- Self care
