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3 Reproduction and Sexual Health > Perinatal Psychiatry > Flashcards

Perinatal Psychiatry Flashcards

1
Q

leading cause of maternal death in UK?

A

mental illness

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2
Q

when do most maternal suicides occur after birth?

A

first 3 months after delivery

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3
Q

red flags for referral to perinatal MH team?

A
  1. significant change in mental health or new symptoms
  2. new thoughts or acts of violent self harm
  3. new or persistent expressions of incompetence as a mother
  4. estrangement from baby
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4
Q

what MH screening should be done at booking?

A

current/past MH problems
previous treatment
FH

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5
Q

what is a mother and baby unit?

A

a unit dedicated to treating mothers with MH problems eg puerperal psychosis and can stay with their baby

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6
Q

what would prompt a referral to a mother and baby unit?

A 
rapidly changing mental state
suicidal ideation
significant estrangement from baby
pervasive guilt/hopelessness
beliefs of inadequacy as a mother
evidence of psychosis
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7
Q

how do women with puerperal psychosis tend to attempt suicide?

A

violently - more violent than female population as a whole

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8
Q

questions to ask a mum about MH?

A
  • new thoughts and feelings that are new? do they disturb or worry you?
  • thoughts of suicide/harming yourself?
  • feeling incompetent/cant cope or estranged from baby? is this persistent?
  • do you feel it’s getting worse?
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9
Q

when would you refer someone to psychiatry for their MH?

A

psychosis
if it’s really severe
Hx of BPD/schizphrenia/PP
previous admissions to MHU

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10
Q

risk factors for MH issues in pregnancy?

A 
young/single
domestic issues
lack of support
substance abuse
unplanned pregnancy
pre-existing MH problems
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11
Q

when would a MH problem be considered as severe?

A

suicidal
psychosis
self neglect
harm

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12
Q

presentation of baby blues?

A 
tearful
irritable
anxiety
poor sleep
confusion
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13
Q

when do baby blues tend to occur?

A

day 3-10 after delivery

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14
Q

DDx of puerperal psychosis

A

episode of bipolar
depression
schizphrenia

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15
Q

when does PP present?

A

within 2 weeks of delivery

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16
Q

early symptoms of PP?

A

sleep disturbance
confusion
irrational ideas

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17
Q

risk factors for PP

A

BPD!!
previous PP
1st degree relative with Hx

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18
Q

Tx of PP?

A 
admission to mum and baby unit
antidepressants
antipsychotics
mood stabilisers
ECT
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19
Q

onset of postnatal depression?

A

2-6 weeks postnatally

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20
Q

how long does postnatal depression last?

A

6 weeks to months

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21
Q

presentation of postnatal depression?

A 
tearfulness
irritable
anxiety
lack of enjoyment
poor sleep
weight loss
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22
Q

how is postnatal depression different than baby blues?

A

occurs much later (baby blues is within the 1st week, PND occurs a few weeks later)

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23
Q

Tx of mild-moderate PND?

A

self help

counselling

24
Q

Tx of moderate-severe PND?

A

psychotherapy
antidepressants
admission

25
Q

risks to baby of untreated depression?

A

LBW
pre-term delivery
risk of autism/ADHD in baby
poor engagement with child

26
Q

how should you make decisions on whether to prescribe in the perinatal period?

A

their past history
frequency and severity of episodes
response to treatment

27
Q

what should you aim for when you prescribe in pregnancy?

A

use drugs with low risk

lowest dose monotherapy

28
Q

what psychiatric drug is contraindicated in breastfeeding?

A

lithium

29
Q

when does the neural tube form? what impact does this have on prescribing

A

5-6 weeks

usually by the time a woman has found out she’s pregnant the neural tube has a already formed

30
Q

how should you stop teratogenic drugs in pregnancy?

A

don’t stop immediately

try and titrate it down

31
Q

main drug risk to baby in 1T?

A

tertogenicity

32
Q

main drug risk to baby in 3T?

A

neonatal withdrawal

33
Q

should you stop a drug used in pregnancy for breastfeeding?

A

no, conc of drug given to baby is lower in breast milk so if they were fine in utero they should be fine now

34
Q

what antidepressant is worst in 1T?

A

paroxetine

35
Q

what SSRI is best in 3T?

A

sertraline

fluoxetine

36
Q

what antidepressants have the lowest risk in 3T?

A

tricyclics eg imipramine/amitryptylline

37
Q

best antidepessants during breastfeeding?

A

sertraline
paroxetine
imipramine

38
Q

what psychiatric drugs are contraindicated in pregnancy and why?

A

benzodiazepines

cause fetal malformation/floppy baby syndrome

39
Q

what antipsychotics should be avoided in pregnancy?

A

clozapine
olanzapine and other weight gain drugs
depot injections

40
Q

can you take lithium in pregnancy?

A

yes but its risky so only give if they really need it

41
Q

what has to be done if a woman of child-bearing age still wants to use valproate?

A

written consent by woman
evidence she is on adequate contraception
reassess yearly

42
Q

you’re 3x more likely to have what mental illnesses if you abuse substances?

A

perosnality disorder
depression
anxiety

43
Q

what conditions are screened for in mothers with substance abuse?

A

HIV
hep c
hep b
STIs

44
Q

what acute illnesses are more common in women who abuse substances?

A

VTE
sepsis
endocarditis

45
Q

if you cant get venous access to a woman, where should you go to next?

A

interosseus

46
Q

can opiate abusers receive diamorphine in labour?

A

yes

47
Q

drinking more than _ units per week puts you at increased risk of affecting the baby

A

8

48
Q

patients who abuse oral recreational drugs are at more risk of what pregnancy complications?

A 
placental abruption
IUGR
preterm labour
miscarriage
fetal anomalies
pre-eclampsia
SIDS
withdrawal
49
Q

nicotine should be stopped in pregnancy T or f

A

T

50
Q

risks of nicotine use in pregnancy?

A 
miscarriages
abruption
IUGR
stillbirth
SIDS
51
Q

what interventions should you take with a pregnant mother who is substance abusing?

A 
consider methadone programme
child protection/social work referral via "unborn baby protocol"
smear history
breastfeeding if free of substances
early IV access
52
Q

when can a woman not breastfeed if theyre substance abusing?

A

if alcohol intake is > 8 units
HIV
cocaine

53
Q

what should you do if you find out theyre at risk of abuse?

A

keep them in a safe place ie the hospital until you get them involved with social work etc

54
Q

why do you get heartburn in pregnancy?

A

progesterone relaxes spincters

55
Q

Tx of bulimic patients with heartburn?

A

ranitidine

56
Q

massive PPH involves what volume of blood?

A

1500ml ++

3 Reproduction and Sexual Health (51 decks)

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