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Repro > Perinatal Psychiatry > Flashcards

Perinatal Psychiatry Flashcards

1
Q

How many suicides occur up to 12 weeks postnatally?

A

Half

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2
Q

What 3 questions are very important for screening for mental health issues?

A
  1. During the last month have you been bothered by feeling down, depressed or hopeless?
  2. During the last month have you ever been bothered by having little interest or pleasure in doing things?
  3. Is there something you feel you need or want help with?
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3
Q

What are the 7 things that can indicate mental health issues?

A 
Appearance and behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight
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4
Q

What tests can be done for screening someones mental health?

A 
Lithium levels
Toxicology
FBC
WBC
U&E's
LFT's
Glucose
CRP
CT of head
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5
Q

What is important to do when a psychiatric patient becomes pregnant?

A

Make a plan with the patient regarding delivery, their medications and monitoring/support etc.

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6
Q

What are the 4 principles of treating a pregnant psychiatric patient?

A

Drugs with low risk to mother and fetus
Lowest dose monotherapy (avoid depot)
Increase screening of fetus-cardio and growth
Encourage breastfeeding whenever possible

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7
Q

What should be avoided in pregnant women and why?

A

Benzodiazepines

Can cause cleft palates and neonatal withdrawl

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8
Q

What is the risk of the baby developing bipolar disorder if the mother has it?

A

1 in 7

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9
Q

What are fetal abnormalities caused by valproate (anticonvulsant-mood stabiliser) for bipolar disorder?

A 
Craniofacial defects
CV abnormality
IUGR
Reduced IQ
Cleft
Genitourinary anomalies
NTD
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10
Q

What are side effects of the anticonvulsant, Carbamazepine?

A 
Facial dysmorphism
Cardiac anomalies
Fingernail hypoplasia
NTD (Neural tube defect)
Vit K deficiency
Haemorrhagic disease
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11
Q

What side effects of Lamotrigine can occur?

A

Cleft

Steven Johnson syndrome if baby is breast fed

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12
Q

What cardiac issues can be caused by Lithium?

A

Maternal toxicity

Ebstein’s anomaly

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13
Q

What other abnormalities can be caused by lithium?

A

Hypotonia
Hypothyroidism
Hypoglycaemia

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14
Q

Can lithium just be stopped or does it need to be stopped gradually?

A

Gradually

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15
Q

What is the risk of the child developing schizophrenia if the mother has it?

A

10%

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16
Q

If the mother is on antipsychotics during the pregnancy, what should the baby be monitored for and why?

A

Lethargy
Sedation
Milestones
Due to antipsychotics being sedative and having long half-lives

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17
Q

Name 3 atypical antipsychotics

A

Clozapine
Risperidone
Olanzapine

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18
Q

What are the risks of atypicals in pregnancy?

A

gestational diabetes

IUGR

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19
Q

Name 2 typical antipsychotics

A

Haloperidol
Chlorprmazine
Appear safe

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20
Q

What drug shouldn’t be used during breastfeeding?

A

Clozapine

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21
Q

What can olanzapine cause in the baby while baby is being breastfed?

A

Extrapyramidal reactions

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22
Q

Can anticholinergics be used in pregnancy? (Used for extrapyramidal side effects)

A

No

23
Q

What problems regarding pregnancy can be caused by eating disorders?

A 
IUGR
Prematurity
Hypokalaemia
Hyponatraemia
Metabolic alkalosis
Miscarriage 
Premature delivery
24
Q

When should SSRI’s be used with caution and why?

A

After 20 weeks

Due to pulmonary hypertension

25
Q

What 2 SSRI’s have higher levels present in breast milk?

A

Citalopram

Fluoxetine

26
Q

What 2 TCA’s are safe in pregnancy and OK in breastfeeding?

A

Amitriptilline

Nortryptilline

27
Q

What percentage of women suffer from postnatal depression?

A

10% - 1/3 for a year or more

28
Q

What are the features of postnatal depression?

A 
Tearfulness
Irritable
Anxiety
Lack of enjoyment
Poor sleep
Weight loss
29
Q

When does postnatal depression usually occur?

A

2-6 weeks postnatally

30
Q

What can postnatal depression have an effect on?

A

Bonding
Child development
Marriage
Risk of suicide

31
Q

What is baby blues?

A

Brief period of emotional instability

32
Q

What % of women get baby blues?

A

50

33
Q

What are features of baby blues?

A

Tearful
Irritable
Anxiety
Poor sleep confusion

34
Q

How do you manage baby blues?

A

Support and reasurrance

35
Q

How do you treat mild-moderate postnatal depression?

A

Self help and counselling

36
Q

How do you treat severe postnatal depression?

A

Psychotherapy
Antidepressants
Possible admission

37
Q

What are differentials of Puerperal psychosis?

A

Episode of bipolar
Unipolar depression
Schizophrenia
Organic brain dysfunction (secondary to physical illness)

38
Q

When does Puerperal psychosis usually present?

A

Within 2 weeks of delivery

39
Q

What are early symptoms of Puerperal psychosis?

A

Sleep disturbances
Confusion
Irrational ideas

40
Q

What are other symptoms of Puerperal psychosis?

A

Mania
Delusions
Hallucinations
Confusion

41
Q

What % of women get Puerperal psychosis?

A

0.1

42
Q

What are the risks of suicide and infanticide in women with Puerperal psychosis?

A

5% suicide

4% infanticide

43
Q

What are risk factors for Puerperal psychosis?

A

Bipolar (50%)

1st degree relative

44
Q

How do you manage Puerperal psychosis?

A

It’s an emergency!
Admit to specialised mother-baby unit
Antidepressants, antipsychotics, mood stabilisers and ECT

45
Q

What % of women have a 10 year recurrence and what % go onto develop bipolar?

A

10 year recurrence = 80%

Bipolar = 25%

46
Q

What fetal problems are assoc. with substance abuse in pregnancy?

A

IUGR
Stillbirth
SIDs
PTD

47
Q

How many women of child bearing age have dependence on alcohol and illicit drugs?

A

Alcohol = 4.7%

Illicit drugs = 2.2%

48
Q

What problems regarding pregnancy can alcohol cause?

A 
Miscarriage
Facial deformities
Lower IQ
neurodevelopmental delay
Epilepsy
Hearing
Heart and kidney defects
Withdrawl
49
Q

What causes Wernicke’s encephalopathy?

A

B1 deficiency

50
Q

How long does Karsakoff syndrome last?

A

Permanent

51
Q

How can Cocaine, amphetamine and ecstasy cause death?

A

Stroke

Arrhythmias

52
Q

What fetal abnormalities can Cocaine, amphetamine and ecstasy cause?

A 
Teratogenic (microcephaly) 
Cardiac
Genitourianary 
Limb defects
PET
Abruption
IUGR
PTL
Miscarriage
Developmental delay
SIDS
Withdrawal
53
Q

What antenatal care should be considered regarding substance abuse?

A

Consider methadone programme
Child protection and social work referral
Smear Hx
Breastfeeding - not if alcohol, HIV or cocaine
Early IV access
Postnatal contraception

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