Perinatal Psychiatry Flashcards
What are the red flag perinatal presentations?
recent signif change in mental state; new thoughts or acts of violent self harm; persistent expressions of incompetency or estrangment
What is the differencein methods between suicide perinatally and femal suicide in general?
perinatally methods are much more violent
What are the risk factors for mental health issues in pregnnacy?
young/single; domestic issues; lack support; substance abuse; unplanned/unwanted pregnancy; pre-existing metnal health problem
When should a woman be referred to the psych team?
psychosis; severe anxiety; depression; suicidal; self-neglect; self harm; symptoms with signif interference in ADLs; hx of bipolar; SZ or puerperal psychosis; psychotropic medications; mod illness in late pregnancy or early postpartum; mild/mod but FHx; prev inpatietn
What is the general rule with pregnancies effect on mental health?
not protective
What are the risks associated with eating disorder in pregnancy?
IUGR; prematurity; hypokalaemia; hyponatraemia; metabolic alkalosis; miscarriage
How common in baby blues?
50% women
What is the baby blues?
brief period of emotional instability- tearful; irritable; anxiety; poor sleep; confusion
When does baby blues tend to occur?
days 3-10: self-limitng
What is the treatment for the baby blues?
support and reassurance
What is the differential for puerperal psychosis?
episode of bipolar; unipolar depression; SZ; organic brain dysfunction
When does puerperal psychosis usually present?
within 2 weeks of delivery
What are the early symptoms of puerperal psychosis?
sleep disturbance and confusion; irrational ideas
What are the symtpoms of puerperal psychosis?
mania; delusions; hallucinations; confusion— different to otehr psychoses; very changeable
What are the risk factors for developing puerperal psychosis?
bipolar disorder; previous puerperal psychosis; FHx
What is the treatment for puerperal psychosis?
admission to mother-baby unit; antidepressants; antipsychotics; mood stabilisers and ECT
How common is postnatal depression?
10%
What are the symptoms of postnatal depression?
tearfulenss; irritable; anxiety; lack of enjoyment; poor sleep; weight loss; concerns re baby
When does postnatal depression start?
2-6 weeks postnatally
What are the child of untreated depression?
low birth weight; preterm delivery; emotional and conduct problems; ADHD; poor bonding with child- cognitive development affected
What type of preparations should be avoided in pregnancy?
depot
What is the risk to the fetus generally in the 1st trimester with drugs?
teratogenicity
What is the risk to the fetus generally in 3rd trimester with drugs?
neonatal withdrawal
Why is there no need generally to stop a drug that was used during pregnnacy in breast feeding?
exposure in breat milk is uually less than in utero
What antidepressant carries the greatest risk of fetal malformation?
paroxetine- heart defects
What is general teratogenic risk with antidepressants?
no increase in major malformations or spontaneous abortion
What is there an increased risk of with antidepressants in the third trimester?
neonatal withdrawal (milld and self-limiting); neonatal persistent hypertension; low birth weight/prematurity
Which antidepressants in crease the risk of neonatal persistent pulmonary hypertension?
SSRIs and venlafaxine taken after 20 weeks
What SSRIs carry the lowest risk in the 3rd trimester?
sertraline and fluoxetine
What TCAs carry the lowest risk in the 3rd trimester?
imipramine/amitriptyline
Do TCAs or SSRIs carry the higher risks in the 3rd trimester?
SSRIs
What antidepressants should be avoided in breastfeeding?
citalopram and doxepin
What antidepressants are good in breastfeeding?
sertraline; paroxetine; imipramine
Why should BZDs be avoided in the first trimester?
increase risk of fetal malformation eg cleft palate
Why should BZDs be avoided in the 3rd trimester?
increased risk of floppy baby syndrome
What are the symptoms of floppy baby syndrome?
hypothermia; hypotonia; respiratory depression; withdrawal effets
Why should BZDs be avoided in breastfeeding?
risks of neonatal lethargy and weight loss and accumulation of long acting drugs (developing liver metabolism)
Why should clozapine be avoided in pregnancy?
agranulocytosis- no way to easily check fetus blood
What are the risks in pregnancy associated iwth olanzapine?
GDM and weight gain
What is the risk of lithium in the 1st trimester?
increased Ebstein’s abnormality
Even though there is teratogenic risk with lithium what should not be done?
sudden discontinuation
Why should serum lithium levels be monitored very closely in 3rd trimester?
changes in volume of distribution and lithium toxicity can mimic PET
How often should lithium levels be monitored from week 36?
weekly
Can lithium be usedi n breastfeeding?
no-high quantities in breast milk
What are the risks associated with sodium valproate in the first trimester?
neural tube defects; craniofacial defects and intellectual devleopment - increased autism
When does the neural tube close?
day 28
Is valproate safe to use when breastfeeding?
yes- no evidence of adverse effects
What are the risks associated with carbamazepine in pregnancy?
NTDs; GI and cardiac; neonatal anticonvulsant syndrome
why should lamotrigine be avoided in the 1st trimester?
increased risk of oral cleft
What is the risk with lamotrigine in breastfeeding?
risk of SJS in infant
What are the fetal risks with substance abuse?
IUGR; stillbirth; SIDs and preterm labour
What are the symptoms of fetal alcohol syndrome?
facial deformities; lower IQ; neurodevelopmental delay; epilepsy; hearing; heart and kidney defects
