Perinatal Psychiatry Flashcards
What is the leading cause of direct maternal death in the year after childbirth?
Suicide
What are the red flag mental health presentations for recent mothers?
Significant change in mental state
Thoughts/acts of violent self harm
Feelings of estrangement from their baby
When may a woman be admitted to the mother and baby unit?
Rapidly changing mental state Suicidal ideation Estrangement from infant Guilt or hopelessness Beliefs of inadequacy Evidence of psychosis
Pregnancy is thought to be protective of mental health problems. True/false?
False - not protective
When do baby blues occur?
Days 3-10 postpartum
What occurs in baby blues?
Brief period of emotional instability where woman is tearful/irritable/anxious
How is baby blues treated?
Support and reassurance
Puerperal psychosis is a psychiatric emergency. True/false?
True
Give some features of puerperal psychosis
Sleep disturbance Confusion Mania Delusions Hallucinations
What are the main risk factors for puerperal psychosis?
Bipolar disorder
Previous puerperal psychosis
1st degree relative with history
What are the main risks of puerperal psychosis?
Suicide
Infanticide
How is puerperal psychosis managed?
Admission to mother-baby unit
Antidepressants; antipsychotics; mood stabilisers; ECT
When is the onset of postnatal depression?
2-6 weeks postnatally
Give some common clinical features of postnatal depression
Tearful Irritable Anxiety Poor sleep Weight loss
Most antidepressants should be avoided during pregnancy and breastfeeding. True/false?
False - most are pretty safe
Which antidepressant increases risk of fetal heart defects?
Paroxetine
Which SSRIs are women advised to take during pregnancy?
Sertraline
Fluoxetine
Benzodiazepines should be generally avoided during pregnancy and breastfeeding. True/false?
True
Give some risks of BZDs in the 1st and 3rd trimester
1st trimester - increased risk of fetal malformation
3rd trimester - increased risk of floppy baby syndrome
Most antipsychotics should be avoided in pregnancy due to risk of fetal malformation. True/false?
False - most are pretty safe
Which antipsychotics should be avoided in pregnancy? Why?
Clozapine - risk of agranulocytosis
Olanzapine - risk of gestational diabetes
Can lithium be continued during pregnancy?
Yes - but caution is advised
Lithium must be avoided during breastfeeding. True/false?
True
Why should sodium valproate be avoided in all women of childbearing age?
Increased risk of neural tube defects and craniofacial defects
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
What are the main risks of carbamazepine and lamotrigine in pregnancy?
Carbamazepine - neural tube defects
Lamotrigine - oral cleft
Can women who abuse opiates be prescribed diamorphine in labour?
Yes - probably will need a higher dose
Give some risks of alcoholism in pregnancy
Miscarriage
Fetal alcohol syndrome
Wernicke-Korsakoff syndrome
Give some risks of cocaine/amphetamine use in pregnancy
Death (stroke/arrhythmia)
Teratogenicity
Pre-eclampsia
IUGR
Give some risks of opiates in pregnancy
IUGR
SIDS
Stillbirth
Give some risks of nicotine in pregnancy
Miscarriage
Abruption
IUGR
SIDS
