Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction and Sexual Health > Perinatal Psychiatry > Flashcards

Perinatal Psychiatry Flashcards

1
Q

What is the leading cause of maternal death in the UK?

A

Mental illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Half of all maternal suicides occur up to ___ weeks post-natal

A

12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The rate of maternal death by suicide remains unchanged since 2003 and maternal suicides is now the leading cause of direct maternal deaths occurring within a year after the end of pregnancy

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Suicide is the leading cause of maternal death occurring within a year of the end of pregnancy

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2/3rd of women who kill themselves following birth have already suffered a mental health condition at some stage in their life

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Women who report what are given an urgent referral to a specialist perinatal mental health team?

A
  • Recent significant change in mental state or emergence of new symptoms
  • New thoughts or acts of violent self-harm.
  • New and persistent expressions of incompetency as a mother or estrangement from their baby.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A woman with significant change in mental state or emergency of new symptoms …

A

Urgent referral to a specialist perinatal mental health team

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A woman with new thoughts or acts of violent self-harm

A

Urgent referral to a specialist perinatal mental health team

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A woman with a new and persistent feeling of incompetency as a mother or estrangement from baby

A

Urgent referral to a specialist perinatal mental health team

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should always be discussed at booking?

A

Current or past history of mental health problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When should admission to a mother and baby unit always be considered?

A

If a woman presents with any of the following …

  • Rapidly changing mental state.
  • Suicidal ideation (particularly of a violent nature).
  • Significant estrangement from the infant.
  • Pervasive guilt or hopelessness.
  • Beliefs of inadequacy as a mother.
  • Evidence of psychosis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Good questions to ask include …

A

Do you have new feelings and thoughts which you have never had before, which make you disturbed or anxious?

Are you experiencing thoughts of suicide or harming yourself in violent ways?

Are you feeling incompetent, as though you can’t cope, or estranged from your baby? Are these feelings persistent?

Do you feel you are getting worse?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

With regard to screening for mental health issues, what should be done/addressed at the booking appointment?

A
  • History of mental health problems, previous treatment and family history.
  • Identification of risk factors.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors for mental health issues in relation to pregnancy?

A
  • Young/single.
  • Domestic issues.
  • Lack support.
  • Substance abuse.
  • Unplanned/unwanted pregnancy.
  • Pre-existing mental health problem.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

** What screening questions should be used at every appointment? **

A
  • During the last month have you been bothered by feeling down, depressed or hopeless?
  • During the last month have you been bothered by having little interest or pleasure in doing things?
  • Is this something you feel you need or want help with?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In what situations should the psychiatric team see a woman?

A
  • Psychosis
  • Severe anxiety, depression, suicidal, self-neglect, self-harm
  • Symptoms with significant interference with daily functioning
  • History of bipolar or schizophrenia
  • History of puerperal psychosis
  • Psychotropic medications
  • If developed moderate mental illness in late pregnancy or early postpartum
  • Mild- moderate illness but 1st degree relative with bipolar or puerperal psychosis
  • Previous in-patient admissions to mental health unit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pregnancy is/is not protective against maternal mental health conditions

A

IS NOT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does pregnancy tend to affect bipolar disorder?

A

It is associated with a high rate of relapse postnatally (50% if untreated).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How might eating disorders be affected by pregnancy?

A

They may be improved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What risks are associated with pregnancy in someone with an eating disorder?

A
  • IUGR.
  • Prematurity.
  • Hypokalaemia.
  • Hyponatraemia.
  • Metabolic alkalosis.
  • Miscarriage.
  • Premature delivery.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What % of women with antenatal depression will relapse if they stop meds in pregnancy?

A

68%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What self-help strategies may be used in the treatment of antenatal depression?

A

CBT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If a woman with antenatal depression has a mild relapse, what can be done?

A

If mild and on treatment, consider stopping and referring for psychological treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If antenatal depression is mild-moderate, who might it be managed by?

A

GP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What would qualify as severe antenatal depression

A
  • Suicidal
  • Psychosis
  • Self-neglect
  • Harm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What should be done if a woman presents with severe antenatal depression?

A

Refer to psychiatry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What % of women experience baby blues?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are baby blues?

A

A brief period of emotional instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

List the symptoms of baby blues.

A
  • Tearful
  • Irritable
  • Anxiety
  • Poor sleep
  • Confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When does baby blues usually occur?

A

Day 3-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Baby blues are usually self-limiting

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How are baby blues managed?

A

Support + reassurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When does Puerperal Psychosis usually present?

A

2 weeks after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

List some early symptoms of Puerperal Psychosis?

A

Sleep disturbance and confusion, irrational ideas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Except from sleep disturbance and confusion, list some other symptoms of puerperal psychosis?

A
  • Mania
  • Delusions
  • Hallucinations
  • Confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the main symptoms pf puerperal psychosis?

A
  • Sleep disturbance
  • Confusion
  • Irrational ideas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What % of women get puerperal psychosis?

A

0.1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What % of women with puerperal psychosis commit suicide?

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What % of women with puerperal psychosis kill their child?

A

4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the risk factors for puerperal psychosis?

A
  • Bipolar disorder (50%)
  • Previous puerperal psychosis
  • 1st degree relative with history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Puerperal psychosis is treated as an __________

A

EMERGENCY !!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How is puerperal psychosis managed?

A
  • Needs admission to a specialised mother-baby unit.

* Antidepressants, antipsychotics, mood stabilisers and ECT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the 10 year recurrence rate of puerperal psychosis?

A

80%

44
Q

What do 25% of women with puerperal psychosis go on to develop?

A

Bipolar disorder

45
Q

What % of women get postnatal depression?

A

10%

46
Q

Of all postnatal depression cases, how many last >1 year?

A

1/3

47
Q

What are the signs and symptoms of postnatal depression?

A
  • Tearfulness
  • Irritable
  • Anxiety
  • Lack of enjoyment
  • Poor sleep
  • Weight loss
48
Q

When does postnatal depression usually onset?

A

2-6 post birth

49
Q

Postnatal depression is screened for routinely

A

T

50
Q

What can postnatal depression have impacts on?

A
  • Bonding
  • Child development
  • Marriage
  • Suicide risk
51
Q

How is mild-moderate postnatal depression managed?

A

With self-help and counselling

52
Q

How is moderate-severe postnatal depression managed?

A

With psychotherapy and antidepressants

Admission might be needed

53
Q

In women who have had postnatal depression, what % will have a recurrence?

A

25%

54
Q

What is the lifetime risk of depression in women who have had postnatal depression?

A

70%

55
Q

What are some of the risks to a baby, in a mum with untreated depression?

A
  • Low birth weight
  • Preterm delivery
  • Adverse childhood outcomes
  • Poor engagement/bonding with the child.
56
Q

LBW and preterm delivery are associated with the ___________ of depression

A

Severity

57
Q

In a pregnant lady with depression, what should there be increased screening of?

A
  • Foetal cardio

* Foetal growth

58
Q

What is the main prescribing risk in the 1st trimester?

A

Risk of teratogenicity

59
Q

What is the main prescribing risk in the 3rd trimester?

A

Risk of neonatal withdrawal

60
Q

The passage of drug from mother to baby is less via breastmilk than in utero

A

T

61
Q

What antidepressant is associated with increased risk of ofetal heart defects in the 1st trimester?

A

Paroxetine

62
Q

In the 3rd trimester, what is there a risk of with SSRIs taken after 20weeks (+ venlafaxine)?

A

Increased risk of neonatal persistent pulmonary hypertension

63
Q

In the 3rd trimester, what do antidepressants also increase the risk of?

A

Low birth weight/prematurity

64
Q

What is the SSRI with lowest risk?

A

SERTALINE / fluoxetine

65
Q

What drugs are lower risk than SSRI’s?

A

TCA’s e.g. imipramine/amitriptyline

66
Q

All (SSRIs + TCAs) are in breast milk to some extent, although there have been no reports of adverse effects on neonatal development

A

T

67
Q

It is ok for a woman on SSRI or TCA to breastfeed?

A

T

68
Q

What are thought to be the ‘better’ antidepressants to use when breastfeeding?

A
  • SERTRALINE
  • Paroxetine
  • Imipramine
69
Q

What drug are we uncertain about the safety of in breastfeeding mothers?

A

Fluoxetine

70
Q

What antidepressants should NOT be used in breastfeeding?

A

Citalopram/doxepin

71
Q

Don’t use BZD’s ….

A
  • 1st trimester - foetal malformations e.g. cleft palate.

* 3rd trimester - floppy baby syndrome.

72
Q

What is floppy baby syndrome?

A
  • Hypothermia
  • Hypotonia
  • Respiratory depression
  • Withdrawal effects
73
Q

BZD’s should not be used 1st or 3rd trimester

A

T

74
Q

Should you avoid BZD’s in breastfeeding?

A

Yes - risk of lethargy and weight loss

75
Q

What ‘side effect’ of antipsychotic used may reduce chances of conception?

A

Raised prolactin levels

76
Q

What hormone does antipsychotics increase?

A

Prolactin

77
Q

Where are antipsychotics excreted?

A

ALL are excreted in breast milk

78
Q

Which antipsychotic should be avoided at all time points? Why?

A

Clozapine – due to risk of agranulocytosis

79
Q

What is the risk with clozapine?

A

Agranulocytosis

80
Q

What does olanzapine increase the risk of?

A

Gestational diabetes and weight gain

81
Q

What type of antipsychotics (in terms of mode of delivery) should be avoided? Why?

A

DEPOT antipsychotics – due to prolonged effects e.g. EPSE in neonates.

82
Q

Why should anticholinergics be avoided?

A

Due to risk of EPSE in pregnancy. (extrapyramidal side effects)

83
Q

In the 1st trimester, what are the risks associated with lithium?

A
  • Increased risk of foetal abnormality.

* Increased risk of Ebstein’s abnormality.

84
Q

What is Ebstein’s abnormality?

A

A congenital heart defect in which the septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle of the heart

85
Q

What should you not do with lithium?

A

Suddenly stop it

86
Q

Can lithium be given in pregnancy?

A

Yes - if needed

87
Q

In the 3rd trimester, what needs to be monitored in someone on lithium?

A

Serum lithium levels

Due to changes in vol of distribution.

Monthly, then weekly from week 36, then within 24 hours of childbirth.

88
Q

Is lithium safe when breastfeeding?

A

No – avoid due to high quantities in breast milk

89
Q

In the 1st trimester, what does sodium valproate increase the risk of?

A

Neural tube defects

90
Q

When does the neural tube close?

A

Day 28

91
Q

Sodium valproate should not be prescribed to women of childbearing age unless all other options fail

A

T

92
Q

What does sodium valproate have long term effects on?

A

Neurological development – increased risk of autism

93
Q

Sodium valproate increases the risk of ________

A

Autism

94
Q

Sodium valproate – definitely NOT in early pregnancy, but ok in breastfeeding

A

T

95
Q

Can sodium valproate be used when breastfeeding?

A

Yes – low risk, with no evidence of adverse effects in breast feeding

96
Q

If a woman on sodium valproate says she wants to get pregnant, what should be done?

A
  • Stop if possible before planned pregnancy.

* Use folate supplements

97
Q

What physical features might Carbamazepine result in?

A
  • Facial dysmorphism.

* Fingernail hypoplasia

98
Q

When should lamotrigine be avoided?

A

1st trimester

99
Q

What is the risk associated with the use of lamotrigine in the 1st trimester?

A

Oral cleft

100
Q

If a woman on lamotrigine is breastfeeding, what is there an increased risk of?

A

Stevens Johnson syndrome

101
Q

Who causes death in mothers on coke, ket or eccies?

A

Stroke and arrhythmias

102
Q

Wernicke’s is a ____ deficiency

A

B1

103
Q

Wernicke’s is temporary. What is it called when it becomes permanent?

A

Korsakoff

104
Q

Although the RCOG suggests abstinence, there is no evidence that how many units of alcohol per week is detrimental?

A

2 units

105
Q

What are the risks/potential negative side effects of alcoholism in a pregnant mother?

A
  • Miscarriage
  • Foetal alcohol syndrome
  • Withdrawal.
  • Risk of Wernicke’s encephalopathy – 20% die (B1 deficiency).
  • Korsakoff Syndrome – permanent.
106
Q

List some signs of foetal alcohol syndrome.

A
  • Facial deformities
  • Lower IQ
  • Neurodevelopmental delay
  • Epilepsy
  • Hearing
  • Heart and kidney defects

Reproduction and Sexual Health (51 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions