Perinatal Psychiatry Flashcards
How many women who have a child will have a mental illness?
1 in 10
What percentage of women will conceive?
80%
How many suicides related to pregnancy occur up to 12 weeks postnatally?
50%
What 3 questions should be asked at a booking appointment related to mental health?
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?
When should the psychiatry team become involved in antenatal care?
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
How soon should psychotherapy referrals be seen?
Within 1 month, maximum 3 months
What are the principles of treatment in antenatal psychotherapy?
Drugs with low risk to both mother and fetus
Lowest dose monotherapy (avoid depot)
Increase screening of fetus- cardio and growth
Encourage breastfeeding whenever possible
What are the possible effects of benzos in pregnancy?
Cleft
Neonatal withdrawal
Do anxiety disorders during pregnancy predict postnatal depression?
Yes
What percentage of women are effected by BAD?
1%
What percentage of women with BAD are at risk of an episode postnatally without treatment?
50%
Is there a risk of suicide in BAD?
Yes
What are the odds that a child will be affected by BAD if the mother has it?
1 in 7
What effects can valproate have on a child when the mother takes this during pregnancy?
NTD Cranofacial defects CV abnormality IUGR Reduced IQ Cleft Genitourinary anomalies
What effects can carbamazepine have on a child when the mother takes this during pregnancy?
Facial dysmorphism
Cardiac anomalies
Fingernail hypoplasia
NTD
What effects can lamotrigine have on a child when the mother takes this during pregnancy?
Cleft
SJS if breast fed
If a women continues mood stabilisers whilst pregnancy, what should she take also?
5mg folic acid
What deficiency and disease can occur with carbamazepine?
Vit K deficiency
Haemorrhagic disease of newborn
Can you breast feed whilst on carbamazepine?
Yes- rare SE
What effects can lithium have on a child when the mother takes this during pregnancy?
Cardiac abnormalities Risk with maternal toxicity Ebstein's anomaly Neonatal hypotonia Hypothyroidism Hypoglycaemia
Is lithium contraindicated in breastfeeding?
Yes
How should lithium be taken in pregnancy?
Stopped gradually, may not remove risks to fetus
Keep levels within lower end therapeutic level
Consider elective postpartum lithium
What is the risk of inheritance of schizophrenia?
10%
What neonatal complications can the atypical antipsychotics cause?
GDM
IUGR
What should babies be observed for when the mother has been on antipsychotics?
Lethargy, sedation and appropriate milestones as drugs are sedating and have long t1/2
Why is clozapine contraindicated during breast feeding?
It’s liability of inducing potential life-threatening events in the infant
Which antipsychotic is associated with an increased risk of inducing extrapyramidal reactions in the breast-fed babies?
Olanzapine
Should anticholinergic drugs be used in pregnancy?
No
What is the incidence of eating disorders in pregnancy?
Bulimia nervosa 1%
Anorexia 0.2%
Tend to improve in pregnancy
What effects can eating disorders cause during pregnancy?
IUGR Prematurity Hypokalaemia Hyponatraemia Metabolic alkalosis Miscarriage Premature delivery
How are eating disorders treated during pregnancy?
Psychological treatment
What rate of depression relapse occurs if medication is stopped during pregnancy?
68%
How should depression be treated during pregnancy?
Psychological for mild/moderate
Pharmacological for moderate/severe
During pregnancy is mild and on Tx, considering referring for psychological Tx
What complication can venlafaxine cause?
Hypertension
What complication can paroxtetine cause?
Cardiac abnormalities
Why should SSRI’s be used with caution after 20wks gestation?
Risk of Pulmonary HT
Do all antidepressants carry risk of withdrawal or toxicity in neonates?
Yes
What antidepressants are found at high levels in breast milk?
Citalopram
Fluoxetine
What SSRI is okay in breastfeeding?
Sertraline
What TCA’s are okay in pregnancy and breastfeeding?
Amitriptyline
Nortriptyline
What is the incidence of postnatal depression?
10%
What are some symptoms of postnatal depression?
Tearfulness Irritable Anxiety Lack of enjoyment Poor sleep Wt loss Concerns re baby
When does PND commence and for how long?
2-6 weeks postnatally
Lasts weeks to months- 1/3 lasts >=1y
How is PND treated?
Mild-moderate: self help, counselling
Mod-severe: psychotherapy and antidepressants, admission
How often does PND reoccur?
25%
What risk of depression does PND have?
70%
What is the incidence of baby blues?
50%
What are the symptoms of baby blues?
Tearful Irritable Anxiety Poor sleep Confusion
When is the onset of baby blues and how long does it last?
Day 3-10
Self limiting
How is baby blues treated?
Support and reassurance
What is included in the DDx of puerperal psychosis?
Episode of bipolar
Unipolar depression
Schizophrenia
Organic brain dysfunction (2’ to physical illness)
When does puerperal psychosis usually present?
Within 2 weeks of delivery
What are the symptoms of puerperal psychosis?
Early: sleep disturbance, confusion, irrational ideas Mania Delusions Hallucinations Confusion
What is the incidence of puerperal psychosis?
0.1%
What is the suicide and infanticide risk of puerperal psychosis?
5% and 4% respectively
What are the RFs for puerperal psychosis?
Bipolar (50%)
Previous puerperal psychosis
1st degree relative with Hx
How should puerperal psychosis be managed?
Emergency
Admission to specialised mother-baby unit
Antidepressants, antipsychotics, mood stabilisers and ECT
What is the 10y recurrence of puerperal psychosis?
80%
What percentage of women with puerperal psychosis go on to develop bipolar?
25%
What aspects of mental illness are associated with substance abuse in pregnancy?
Personality
Depression
Anxiety x 3
What is substance abuse in pregnancy associated with?
Nutritional deficiency HIV, Hep C, Hep B VTE STIs Endocarditis/sepsis Poor venous access Opiate tolerance/withdrawal Drug OD/death Risk of domestic abuse and suicide IUGT, Stillbirth, SIDs, PTD
What are the alcohol intake recommendations during pregnancy?
Abstinence- but no evidence that 2units/week detrimental
What can alcoholism during pregnancy cause?
Risk of miscarriage
FAS- facial deformities, lower IQ, neurodevelopmental delay, epilepsy, hearing, heart and kidney defects
What can alcoholism lead to in pregnant women?
Withdrawal
Risk of Wernicke’s encephalopathy- 20% mortality (B1 deficiency)
Korsakoff Syndrome- permanent
What teratogenic effects can drugs cause during pregnancy?
Microcephaly
Cardiac defects
Genitourinary defects
Limb defects
What gestational issues can drugs cause?
PET
Abruption
Miscarriage
PTL
What neonatal issues can drugs cause?
IUGR
Developmental delay
SIDS
Withdrawal
What can opiates cause in pregnancy?
Maternal deaths 1-2% Neonatal withdrawal IUGR SIDS Stillbirth
What can nicotine cause in pregnancy?
Miscarriage Abruption IUGR Stillbirth SIDS
What antenatal care should be carried out in pregnant 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
