Perinatal psychiatry Flashcards
What are some of the risk factors for mental health issues during/after pregnancy?
Young Single Domestic issues Lack of support Substance abuse Unplanned/unwanted pregnancy Pre existing mental illness Family history of bipolar
What are the screening questions used during each antenatal/postnatal visit to screen for mental health issues?
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?
What factors would indicate that a pregnant women should see the psychiatry team?
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
What mental illness can be a predictor for postnatal depression?
Anxiety
What anxiolytic drug should be avoided in pregnancy and why?
Benzodiazepines
Can cause cleft palate and neonatal withdrawl
What risks to the fetus are associated with taking sodium valproate in pregnancy?
Neural tube defect
Craniofacial defects
Cardiovascular abnormalities
What are the risks to the fetus associated with taking carbemazepine in pregnancy?
Facial dysmorphism
Cardiac anomalies
Fingernail hypoplasia
Neural tube defect
What is the risk to the baby if breast fed by a mother taking lamotrigine?
Steven-Johnson syndrome
What is Ebstein’s anomaly?
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
What psychiatric drug can cause Ebstein’s anomaly?
Lithium
What complications in a baby can lithium cause?
Neonatal hypotonia
Hypothyroidism
Hypoglycaemia
How should a pregnant women taking lithium be managed?
Reduce dose gradually
Switch to SSRIs
Is lithium contraindicated in breastfeeding?
Yes
Are antipsychotics safe in pregnancy?
Yes
What are some of the pregnancy complications that atypical antipsychotics increase the risk of?
Gestational diabetes
IUGR
What should babies be monitored for in pregnant mothers taking antipsychotics?
Lethargy
Sedation
Appropriate developmental milestones
What are the risks associated with an eating disorder in pregnancy?
IUGR Prematurity Hypokalaemia Hyponatraemia Metabolic alkalosis Miscarriage Premature delivery
Which antidepressant may cause cardiac abnormalities?
Paroxetine
Which antidepressant may cause hypertension?
Venlafaxine
Which SSRI is safe in breastfeeding?
Sertraline
Which TCAs are safe in breastfeeding?
Amitryptilline
Nortriptilline
What are the symptoms and signs of postnatal depression?
Tearfulness Irritable Anxiety Lack of enjoyment and poor sleep Weight loss Can present as concerns re baby
When is the typical onset of postnatal depression?
2-6 weeks postnatally
What effects does postnatal depression have on the mother?
Affects bonding with baby and child development
Affect marriage
Risk of suicide
What is the recurrence rate of postnatal depression?
25%
What is the lifetime depression risk following postnatal depression?
70%
What are the baby blues?
A self-limiting brief period of emotional instability
Tearful, irritable, anxious, poor sleep and confusion
How are the baby blues treated?
Self limiting: lasts 3-10 days
How does puerperal psychosis present?
Early symptoms are sleep disturbance and confusion, irrational ideas
Mania, delusions, hallucinations, confusion
What are the risk factors for puerperal psychosis?
Bipolar disorder
1st degree relative with history of puerperal psychosis
What are the risks associated with puerperal psychosis?
5% risk of suicide
4% risk of infanticide
What is the treatment for puerperal psychosis?
Antidepressants
Antipsychotics
Mood stabilizers
ECT
What is the recurrence rate of puerperal psychosis?
80% in ten years
What is the risk of developing bipolar following puerperal psychosis?
25%
What are the features of fetal alcohol syndrome?
Facial deformities Lower IQ Neurodevelopmental delay Epilepsy Hearing defects Heart and kidney defects
What is Korsakoff syndrome?
A chronic memory disorder caused by a severe deficiency of thiamine
What are the risks to the baby of a pregnant alcoholic mother?
Fetal alcohol syndrome
Wernicke’s encephalopathy
Korsakoff syndrome
Withdrawl
What is the cause of death in babies whose mothers abuse cocaine, ecstasy or amphetamine?
Strokes or arrhytmias
What complications in pregnancy do opiates cause?
Maternal deaths (1-2%) Neonatal withdrawal IUGR SIDS Stillbirth
What complications in pregnancy does nicotine cause?
Miscarriages Abruption IUGR Stillbirths SIDS
What extra antenatal care is undertaken in women with substance abuse?
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
