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Psychiatry > Perinatal psychiatry > Flashcards

Perinatal psychiatry Flashcards

1
Q

What are some of the risk factors for mental health issues during/after pregnancy?

A 
Young
Single
Domestic issues
Lack of support
Substance abuse
Unplanned/unwanted pregnancy
Pre existing mental illness
Family history of bipolar
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2
Q

What are the screening questions used during each antenatal/postnatal visit to screen for mental health issues?

A

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?

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3
Q

What factors would indicate that a pregnant women should see the psychiatry team?

A

Psychosis
Severe anxiety, depression, suicidal, self-neglect, self harm
Symptoms with significant interference with daily functioning
History of bipolar or schizophrenia
History of puerperal psychosis
Psycotropic meds
If developed moderate mental illness in late preg or early postpartum
Mild-mod illness but 1st degree relative with bipolar or puerperal psychosis
Previous in-patient admissions to mental health unit

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4
Q

What mental illness can be a predictor for postnatal depression?

A

Anxiety

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5
Q

What anxiolytic drug should be avoided in pregnancy and why?

A

Benzodiazepines

Can cause cleft palate and neonatal withdrawl

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6
Q

What risks to the fetus are associated with taking sodium valproate in pregnancy?

A

Neural tube defect
Craniofacial defects
Cardiovascular abnormalities

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7
Q

What are the risks to the fetus associated with taking carbemazepine in pregnancy?

A

Facial dysmorphism
Cardiac anomalies
Fingernail hypoplasia
Neural tube defect

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8
Q

What is the risk to the baby if breast fed by a mother taking lamotrigine?

A

Steven-Johnson syndrome

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9
Q

What is Ebstein’s anomaly?

A

Ebstein’s anomaly is a congenital heart defect in which the septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle of the heart

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10
Q

What psychiatric drug can cause Ebstein’s anomaly?

A

Lithium

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11
Q

What complications in a baby can lithium cause?

A

Neonatal hypotonia
Hypothyroidism
Hypoglycaemia

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12
Q

How should a pregnant women taking lithium be managed?

A

Reduce dose gradually

Switch to SSRIs

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13
Q

Is lithium contraindicated in breastfeeding?

A

Yes

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14
Q

Are antipsychotics safe in pregnancy?

A

Yes

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15
Q

What are some of the pregnancy complications that atypical antipsychotics increase the risk of?

A

Gestational diabetes

IUGR

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16
Q

What should babies be monitored for in pregnant mothers taking antipsychotics?

A

Lethargy
Sedation
Appropriate developmental milestones

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17
Q

What are the risks associated with an eating disorder in pregnancy?

A 
IUGR
Prematurity
Hypokalaemia
Hyponatraemia
Metabolic alkalosis
Miscarriage
Premature delivery
18
Q

Which antidepressant may cause cardiac abnormalities?

A

Paroxetine

19
Q

Which antidepressant may cause hypertension?

A

Venlafaxine

20
Q

Which SSRI is safe in breastfeeding?

A

Sertraline

21
Q

Which TCAs are safe in breastfeeding?

A

Amitryptilline

Nortriptilline

22
Q

What are the symptoms and signs of postnatal depression?

A 
Tearfulness
Irritable
Anxiety
Lack of enjoyment and poor sleep
Weight loss
Can present as concerns re baby
23
Q

When is the typical onset of postnatal depression?

A

2-6 weeks postnatally

24
Q

What effects does postnatal depression have on the mother?

A

Affects bonding with baby and child development
Affect marriage
Risk of suicide

25
Q

What is the recurrence rate of postnatal depression?

A

25%

26
Q

What is the lifetime depression risk following postnatal depression?

A

70%

27
Q

What are the baby blues?

A

A self-limiting brief period of emotional instability

Tearful, irritable, anxious, poor sleep and confusion

28
Q

How are the baby blues treated?

A

Self limiting: lasts 3-10 days

29
Q

How does puerperal psychosis present?

A

Early symptoms are sleep disturbance and confusion, irrational ideas
Mania, delusions, hallucinations, confusion

30
Q

What are the risk factors for puerperal psychosis?

A

Bipolar disorder

1st degree relative with history of puerperal psychosis

31
Q

What are the risks associated with puerperal psychosis?

A

5% risk of suicide

4% risk of infanticide

32
Q

What is the treatment for puerperal psychosis?

A

Antidepressants
Antipsychotics
Mood stabilizers
ECT

33
Q

What is the recurrence rate of puerperal psychosis?

A

80% in ten years

34
Q

What is the risk of developing bipolar following puerperal psychosis?

A

25%

35
Q

What are the features of fetal alcohol syndrome?

A 
Facial deformities
Lower IQ
Neurodevelopmental delay
Epilepsy
Hearing defects
Heart and kidney defects
36
Q

What is Korsakoff syndrome?

A

A chronic memory disorder caused by a severe deficiency of thiamine

37
Q

What are the risks to the baby of a pregnant alcoholic mother?

A

Fetal alcohol syndrome
Wernicke’s encephalopathy
Korsakoff syndrome
Withdrawl

38
Q

What is the cause of death in babies whose mothers abuse cocaine, ecstasy or amphetamine?

A

Strokes or arrhytmias

39
Q

What complications in pregnancy do opiates cause?

A 
Maternal deaths (1-2%)
Neonatal withdrawal
IUGR 
SIDS
Stillbirth
40
Q

What complications in pregnancy does nicotine cause?

A 
Miscarriages
Abruption
IUGR
Stillbirths
SIDS
41
Q

What extra antenatal care is undertaken in women with substance abuse?

A

Consider methadone programme
Child protection and social work referral
Smear Hx
Breastfeeding (not if alcohol>8 , HIV, cocaine)
Labour plan re analgesia and labour ward delivery
Early IV access
Postnatal contraception plan

Psychiatry (10 decks)

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