Perinatal Psychiatry Flashcards
leading cause of maternal death in UK?
mental illness
when do most maternal suicides occur after birth?
first 3 months after delivery
red flags for referral to perinatal MH team?
- significant change in mental health or new symptoms
- new thoughts or acts of violent self harm
- new or persistent expressions of incompetence as a mother
- estrangement from baby
what MH screening should be done at booking?
current/past MH problems
previous treatment
FH
what is a mother and baby unit?
a unit dedicated to treating mothers with MH problems eg puerperal psychosis and can stay with their baby
what would prompt a referral to a mother and baby unit?
rapidly changing mental state suicidal ideation significant estrangement from baby pervasive guilt/hopelessness beliefs of inadequacy as a mother evidence of psychosis
how do women with puerperal psychosis tend to attempt suicide?
violently - more violent than female population as a whole
questions to ask a mum about MH?
- 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?
when would you refer someone to psychiatry for their MH?
psychosis
if it’s really severe
Hx of BPD/schizphrenia/PP
previous admissions to MHU
risk factors for MH issues in pregnancy?
young/single domestic issues lack of support substance abuse unplanned pregnancy pre-existing MH problems
when would a MH problem be considered as severe?
suicidal
psychosis
self neglect
harm
presentation of baby blues?
tearful irritable anxiety poor sleep confusion
when do baby blues tend to occur?
day 3-10 after delivery
DDx of puerperal psychosis
episode of bipolar
depression
schizphrenia
when does PP present?
within 2 weeks of delivery
early symptoms of PP?
sleep disturbance
confusion
irrational ideas
risk factors for PP
BPD!!
previous PP
1st degree relative with Hx
Tx of PP?
admission to mum and baby unit antidepressants antipsychotics mood stabilisers ECT
onset of postnatal depression?
2-6 weeks postnatally
how long does postnatal depression last?
6 weeks to months
presentation of postnatal depression?
tearfulness irritable anxiety lack of enjoyment poor sleep weight loss
how is postnatal depression different than baby blues?
occurs much later (baby blues is within the 1st week, PND occurs a few weeks later)
Tx of mild-moderate PND?
self help
counselling
Tx of moderate-severe PND?
psychotherapy
antidepressants
admission
risks to baby of untreated depression?
LBW
pre-term delivery
risk of autism/ADHD in baby
poor engagement with child
how should you make decisions on whether to prescribe in the perinatal period?
their past history
frequency and severity of episodes
response to treatment
what should you aim for when you prescribe in pregnancy?
use drugs with low risk
lowest dose monotherapy
what psychiatric drug is contraindicated in breastfeeding?
lithium
when does the neural tube form? what impact does this have on prescribing
5-6 weeks
usually by the time a woman has found out she’s pregnant the neural tube has a already formed
how should you stop teratogenic drugs in pregnancy?
don’t stop immediately
try and titrate it down
main drug risk to baby in 1T?
tertogenicity
main drug risk to baby in 3T?
neonatal withdrawal
should you stop a drug used in pregnancy for breastfeeding?
no, conc of drug given to baby is lower in breast milk so if they were fine in utero they should be fine now
what antidepressant is worst in 1T?
paroxetine
what SSRI is best in 3T?
sertraline
fluoxetine
what antidepressants have the lowest risk in 3T?
tricyclics eg imipramine/amitryptylline
best antidepessants during breastfeeding?
sertraline
paroxetine
imipramine
what psychiatric drugs are contraindicated in pregnancy and why?
benzodiazepines
cause fetal malformation/floppy baby syndrome
what antipsychotics should be avoided in pregnancy?
clozapine
olanzapine and other weight gain drugs
depot injections
can you take lithium in pregnancy?
yes but its risky so only give if they really need it
what has to be done if a woman of child-bearing age still wants to use valproate?
written consent by woman
evidence she is on adequate contraception
reassess yearly
you’re 3x more likely to have what mental illnesses if you abuse substances?
perosnality disorder
depression
anxiety
what conditions are screened for in mothers with substance abuse?
HIV
hep c
hep b
STIs
what acute illnesses are more common in women who abuse substances?
VTE
sepsis
endocarditis
if you cant get venous access to a woman, where should you go to next?
interosseus
can opiate abusers receive diamorphine in labour?
yes
drinking more than _ units per week puts you at increased risk of affecting the baby
8
patients who abuse oral recreational drugs are at more risk of what pregnancy complications?
placental abruption IUGR preterm labour miscarriage fetal anomalies pre-eclampsia SIDS withdrawal
nicotine should be stopped in pregnancy T or f
T
risks of nicotine use in pregnancy?
miscarriages abruption IUGR stillbirth SIDS
what interventions should you take with a pregnant mother who is substance abusing?
consider methadone programme child protection/social work referral via "unborn baby protocol" smear history breastfeeding if free of substances early IV access
when can a woman not breastfeed if theyre substance abusing?
if alcohol intake is > 8 units
HIV
cocaine
what should you do if you find out theyre at risk of abuse?
keep them in a safe place ie the hospital until you get them involved with social work etc
why do you get heartburn in pregnancy?
progesterone relaxes spincters
Tx of bulimic patients with heartburn?
ranitidine
massive PPH involves what volume of blood?
1500ml ++
