Perinatal Psychiatry Flashcards
How many suicides occur up to 12 weeks postnatally?
Half
What 3 questions are very important for screening for mental health issues?
- During the last month have you been bothered by feeling down, depressed or hopeless?
- During the last month have you ever been bothered by having little interest or pleasure in doing things?
- Is there something you feel you need or want help with?
What are the 7 things that can indicate mental health issues?
Appearance and behaviour Speech Mood Thoughts Perceptions Cognition Insight
What tests can be done for screening someones mental health?
Lithium levels Toxicology FBC WBC U&E's LFT's Glucose CRP CT of head
What is important to do when a psychiatric patient becomes pregnant?
Make a plan with the patient regarding delivery, their medications and monitoring/support etc.
What are the 4 principles of treating a pregnant psychiatric patient?
Drugs with low risk to mother and fetus
Lowest dose monotherapy (avoid depot)
Increase screening of fetus-cardio and growth
Encourage breastfeeding whenever possible
What should be avoided in pregnant women and why?
Benzodiazepines
Can cause cleft palates and neonatal withdrawl
What is the risk of the baby developing bipolar disorder if the mother has it?
1 in 7
What are fetal abnormalities caused by valproate (anticonvulsant-mood stabiliser) for bipolar disorder?
Craniofacial defects CV abnormality IUGR Reduced IQ Cleft Genitourinary anomalies NTD
What are side effects of the anticonvulsant, Carbamazepine?
Facial dysmorphism Cardiac anomalies Fingernail hypoplasia NTD (Neural tube defect) Vit K deficiency Haemorrhagic disease
What side effects of Lamotrigine can occur?
Cleft
Steven Johnson syndrome if baby is breast fed
What cardiac issues can be caused by Lithium?
Maternal toxicity
Ebstein’s anomaly
What other abnormalities can be caused by lithium?
Hypotonia
Hypothyroidism
Hypoglycaemia
Can lithium just be stopped or does it need to be stopped gradually?
Gradually
What is the risk of the child developing schizophrenia if the mother has it?
10%
If the mother is on antipsychotics during the pregnancy, what should the baby be monitored for and why?
Lethargy
Sedation
Milestones
Due to antipsychotics being sedative and having long half-lives
Name 3 atypical antipsychotics
Clozapine
Risperidone
Olanzapine
What are the risks of atypicals in pregnancy?
gestational diabetes
IUGR
Name 2 typical antipsychotics
Haloperidol
Chlorprmazine
Appear safe
What drug shouldn’t be used during breastfeeding?
Clozapine
What can olanzapine cause in the baby while baby is being breastfed?
Extrapyramidal reactions
Can anticholinergics be used in pregnancy? (Used for extrapyramidal side effects)
No
What problems regarding pregnancy can be caused by eating disorders?
IUGR Prematurity Hypokalaemia Hyponatraemia Metabolic alkalosis Miscarriage Premature delivery
When should SSRI’s be used with caution and why?
After 20 weeks
Due to pulmonary hypertension
What 2 SSRI’s have higher levels present in breast milk?
Citalopram
Fluoxetine
What 2 TCA’s are safe in pregnancy and OK in breastfeeding?
Amitriptilline
Nortryptilline
What percentage of women suffer from postnatal depression?
10% - 1/3 for a year or more
What are the features of postnatal depression?
Tearfulness Irritable Anxiety Lack of enjoyment Poor sleep Weight loss
When does postnatal depression usually occur?
2-6 weeks postnatally
What can postnatal depression have an effect on?
Bonding
Child development
Marriage
Risk of suicide
What is baby blues?
Brief period of emotional instability
What % of women get baby blues?
50
What are features of baby blues?
Tearful
Irritable
Anxiety
Poor sleep confusion
How do you manage baby blues?
Support and reasurrance
How do you treat mild-moderate postnatal depression?
Self help and counselling
How do you treat severe postnatal depression?
Psychotherapy
Antidepressants
Possible admission
What are differentials of Puerperal psychosis?
Episode of bipolar
Unipolar depression
Schizophrenia
Organic brain dysfunction (secondary to physical illness)
When does Puerperal psychosis usually present?
Within 2 weeks of delivery
What are early symptoms of Puerperal psychosis?
Sleep disturbances
Confusion
Irrational ideas
What are other symptoms of Puerperal psychosis?
Mania
Delusions
Hallucinations
Confusion
What % of women get Puerperal psychosis?
0.1
What are the risks of suicide and infanticide in women with Puerperal psychosis?
5% suicide
4% infanticide
What are risk factors for Puerperal psychosis?
Bipolar (50%)
1st degree relative
How do you manage Puerperal psychosis?
It’s an emergency!
Admit to specialised mother-baby unit
Antidepressants, antipsychotics, mood stabilisers and ECT
What % of women have a 10 year recurrence and what % go onto develop bipolar?
10 year recurrence = 80%
Bipolar = 25%
What fetal problems are assoc. with substance abuse in pregnancy?
IUGR
Stillbirth
SIDs
PTD
How many women of child bearing age have dependence on alcohol and illicit drugs?
Alcohol = 4.7%
Illicit drugs = 2.2%
What problems regarding pregnancy can alcohol cause?
Miscarriage Facial deformities Lower IQ neurodevelopmental delay Epilepsy Hearing Heart and kidney defects Withdrawl
What causes Wernicke’s encephalopathy?
B1 deficiency
How long does Karsakoff syndrome last?
Permanent
How can Cocaine, amphetamine and ecstasy cause death?
Stroke
Arrhythmias
What fetal abnormalities can Cocaine, amphetamine and ecstasy cause?
Teratogenic (microcephaly) Cardiac Genitourianary Limb defects PET Abruption IUGR PTL Miscarriage Developmental delay SIDS Withdrawal
What antenatal care should be considered regarding substance abuse?
Consider methadone programme
Child protection and social work referral
Smear Hx
Breastfeeding - not if alcohol, HIV or cocaine
Early IV access
Postnatal contraception