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Reproduction > Perinatal Psychiatry > Flashcards

Perinatal Psychiatry Flashcards

1
Q

What are the red flag perinatal presentations?

A

recent signif change in mental state; new thoughts or acts of violent self harm; persistent expressions of incompetency or estrangment

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2
Q

What is the differencein methods between suicide perinatally and femal suicide in general?

A

perinatally methods are much more violent

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3
Q

What are the risk factors for mental health issues in pregnnacy?

A

young/single; domestic issues; lack support; substance abuse; unplanned/unwanted pregnancy; pre-existing metnal health problem

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4
Q

When should a woman be referred to the psych team?

A

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

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5
Q

What is the general rule with pregnancies effect on mental health?

A

not protective

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6
Q

What are the risks associated with eating disorder in pregnancy?

A

IUGR; prematurity; hypokalaemia; hyponatraemia; metabolic alkalosis; miscarriage

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7
Q

How common in baby blues?

A

50% women

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8
Q

What is the baby blues?

A

brief period of emotional instability- tearful; irritable; anxiety; poor sleep; confusion

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9
Q

When does baby blues tend to occur?

A

days 3-10: self-limitng

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10
Q

What is the treatment for the baby blues?

A

support and reassurance

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11
Q

What is the differential for puerperal psychosis?

A

episode of bipolar; unipolar depression; SZ; organic brain dysfunction

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12
Q

When does puerperal psychosis usually present?

A

within 2 weeks of delivery

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13
Q

What are the early symptoms of puerperal psychosis?

A

sleep disturbance and confusion; irrational ideas

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14
Q

What are the symtpoms of puerperal psychosis?

A

mania; delusions; hallucinations; confusion— different to otehr psychoses; very changeable

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15
Q

What are the risk factors for developing puerperal psychosis?

A

bipolar disorder; previous puerperal psychosis; FHx

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16
Q

What is the treatment for puerperal psychosis?

A

admission to mother-baby unit; antidepressants; antipsychotics; mood stabilisers and ECT

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17
Q

How common is postnatal depression?

A

10%

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18
Q

What are the symptoms of postnatal depression?

A

tearfulenss; irritable; anxiety; lack of enjoyment; poor sleep; weight loss; concerns re baby

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19
Q

When does postnatal depression start?

A

2-6 weeks postnatally

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20
Q

What are the child of untreated depression?

A

low birth weight; preterm delivery; emotional and conduct problems; ADHD; poor bonding with child- cognitive development affected

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21
Q

What type of preparations should be avoided in pregnancy?

A

depot

22
Q

What is the risk to the fetus generally in the 1st trimester with drugs?

A

teratogenicity

23
Q

What is the risk to the fetus generally in 3rd trimester with drugs?

A

neonatal withdrawal

24
Q

Why is there no need generally to stop a drug that was used during pregnnacy in breast feeding?

A

exposure in breat milk is uually less than in utero

25
Q

What antidepressant carries the greatest risk of fetal malformation?

A

paroxetine- heart defects

26
Q

What is general teratogenic risk with antidepressants?

A

no increase in major malformations or spontaneous abortion

27
Q

What is there an increased risk of with antidepressants in the third trimester?

A

neonatal withdrawal (milld and self-limiting); neonatal persistent hypertension; low birth weight/prematurity

28
Q

Which antidepressants in crease the risk of neonatal persistent pulmonary hypertension?

A

SSRIs and venlafaxine taken after 20 weeks

29
Q

What SSRIs carry the lowest risk in the 3rd trimester?

A

sertraline and fluoxetine

30
Q

What TCAs carry the lowest risk in the 3rd trimester?

A

imipramine/amitriptyline

31
Q

Do TCAs or SSRIs carry the higher risks in the 3rd trimester?

A

SSRIs

32
Q

What antidepressants should be avoided in breastfeeding?

A

citalopram and doxepin

33
Q

What antidepressants are good in breastfeeding?

A

sertraline; paroxetine; imipramine

34
Q

Why should BZDs be avoided in the first trimester?

A

increase risk of fetal malformation eg cleft palate

35
Q

Why should BZDs be avoided in the 3rd trimester?

A

increased risk of floppy baby syndrome

36
Q

What are the symptoms of floppy baby syndrome?

A

hypothermia; hypotonia; respiratory depression; withdrawal effets

37
Q

Why should BZDs be avoided in breastfeeding?

A

risks of neonatal lethargy and weight loss and accumulation of long acting drugs (developing liver metabolism)

38
Q

Why should clozapine be avoided in pregnancy?

A

agranulocytosis- no way to easily check fetus blood

39
Q

What are the risks in pregnancy associated iwth olanzapine?

A

GDM and weight gain

40
Q

What is the risk of lithium in the 1st trimester?

A

increased Ebstein’s abnormality

41
Q

Even though there is teratogenic risk with lithium what should not be done?

A

sudden discontinuation

42
Q

Why should serum lithium levels be monitored very closely in 3rd trimester?

A

changes in volume of distribution and lithium toxicity can mimic PET

43
Q

How often should lithium levels be monitored from week 36?

A

weekly

44
Q

Can lithium be usedi n breastfeeding?

A

no-high quantities in breast milk

45
Q

What are the risks associated with sodium valproate in the first trimester?

A

neural tube defects; craniofacial defects and intellectual devleopment - increased autism

46
Q

When does the neural tube close?

A

day 28

47
Q

Is valproate safe to use when breastfeeding?

A

yes- no evidence of adverse effects

48
Q

What are the risks associated with carbamazepine in pregnancy?

A

NTDs; GI and cardiac; neonatal anticonvulsant syndrome

49
Q

why should lamotrigine be avoided in the 1st trimester?

A

increased risk of oral cleft

50
Q

What is the risk with lamotrigine in breastfeeding?

A

risk of SJS in infant

51
Q

What are the fetal risks with substance abuse?

A

IUGR; stillbirth; SIDs and preterm labour

52
Q

What are the symptoms of fetal alcohol syndrome?

A

facial deformities; lower IQ; neurodevelopmental delay; epilepsy; hearing; heart and kidney defects

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