Perinatal Psychiatry Flashcards

1
Q

What is the leading cause of direct maternal death in the year after childbirth?

A

Suicide

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2
Q

What are the red flag mental health presentations for recent mothers?

A

Significant change in mental state
Thoughts/acts of violent self harm
Feelings of estrangement from their baby

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3
Q

When may a woman be admitted to the mother and baby unit?

A
Rapidly changing mental state
Suicidal ideation 
Estrangement from infant
Guilt or hopelessness
Beliefs of inadequacy 
Evidence of psychosis
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4
Q

Pregnancy is thought to be protective of mental health problems. True/false?

A

False - not protective

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5
Q

When do baby blues occur?

A

Days 3-10 postpartum

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6
Q

What occurs in baby blues?

A

Brief period of emotional instability where woman is tearful/irritable/anxious

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7
Q

How is baby blues treated?

A

Support and reassurance

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8
Q

Puerperal psychosis is a psychiatric emergency. True/false?

A

True

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9
Q

Give some features of puerperal psychosis

A
Sleep disturbance
Confusion
Mania
Delusions
Hallucinations
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10
Q

What are the main risk factors for puerperal psychosis?

A

Bipolar disorder
Previous puerperal psychosis
1st degree relative with history

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11
Q

What are the main risks of puerperal psychosis?

A

Suicide

Infanticide

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12
Q

How is puerperal psychosis managed?

A

Admission to mother-baby unit

Antidepressants; antipsychotics; mood stabilisers; ECT

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13
Q

When is the onset of postnatal depression?

A

2-6 weeks postnatally

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14
Q

Give some common clinical features of postnatal depression

A
Tearful
Irritable
Anxiety
Poor sleep
Weight loss
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15
Q

Most antidepressants should be avoided during pregnancy and breastfeeding. True/false?

A

False - most are pretty safe

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16
Q

Which antidepressant increases risk of fetal heart defects?

A

Paroxetine

17
Q

Which SSRIs are women advised to take during pregnancy?

A

Sertraline

Fluoxetine

18
Q

Benzodiazepines should be generally avoided during pregnancy and breastfeeding. True/false?

19
Q

Give some risks of BZDs in the 1st and 3rd trimester

A

1st trimester - increased risk of fetal malformation

3rd trimester - increased risk of floppy baby syndrome

20
Q

Most antipsychotics should be avoided in pregnancy due to risk of fetal malformation. True/false?

A

False - most are pretty safe

21
Q

Which antipsychotics should be avoided in pregnancy? Why?

A

Clozapine - risk of agranulocytosis

Olanzapine - risk of gestational diabetes

22
Q

Can lithium be continued during pregnancy?

A

Yes - but caution is advised

23
Q

Lithium must be avoided during breastfeeding. True/false?

24
Q

Why should sodium valproate be avoided in all women of childbearing age?

A

Increased risk of neural tube defects and craniofacial defects

25
Why should all women of childbearing age on valproate be using contraception?
As the neural tube defect will commonly occur before the woman realises she is pregnant
26
What are the main risks of carbamazepine and lamotrigine in pregnancy?
Carbamazepine - neural tube defects | Lamotrigine - oral cleft
27
Can women who abuse opiates be prescribed diamorphine in labour?
Yes - probably will need a higher dose
28
Give some risks of alcoholism in pregnancy
Miscarriage Fetal alcohol syndrome Wernicke-Korsakoff syndrome
29
Give some risks of cocaine/amphetamine use in pregnancy
Death (stroke/arrhythmia) Teratogenicity Pre-eclampsia IUGR
30
Give some risks of opiates in pregnancy
IUGR SIDS Stillbirth
31
Give some risks of nicotine in pregnancy
Miscarriage Abruption IUGR SIDS