Perinatal Psychiatry Flashcards
List some red flag presentations in pregnant/post natal women:
Significant change to mental state
New emergence of symptoms
New thoughts/acts of violent self harm
New/persistent expressions of incompetency as a mother or estrangement from baby
List reasons for when admission to the mother and baby unit be considered?
- Rapidly changing mental state
- Suicidal intent
- significant estrangement from infant
- evidence of psychosis
- pervasive guilt / hopelessness / inadequacy
What 5 of women suffer form baby blues?
Up to 50%
Give some characteristics of baby blues:
Brief period of emotional instability Tearful Irritable Anxiety Confusion Poor sleep
What is the timeline of baby blues?
From about Day 3 - day 10 post birth
Give some symptoms of puerperal psychosis:
Sleep disturbance Confusion Irrational ideas Mania Delusions Hallucinations
What is the time of onset in puerperal psychosis?
Usually within 2 weeks of delivery
What % of women suffer from puerperal psychosis
0.1%
What are the two serious outcomes you wish to avoid in puerperal psychosis
Suicide
Infanticide
State 3 risk factors for puerperal psychosis
Bipolar disorder
previous episode
1st degree relative with Hx
__ % of cases with puerperal psychosis will go on to develop ______ _______
25%
Bipolar Disorder
How is puerperal psychosis managed
Emergency admission to mother-baby unit Anti-depressants Anti-psychotics Mood stabilizers ECT
What % of women who suffer from puerperal psychosis will have a re occurrence within 10 years
80%
What is the usual time of onset for postnatal depression?
2-6 weeks postnatal
What % of women suffer from postnatal depression
10%
Women who suffer post natal depression have a __% chance of developing _______ later in life
70%
Depression
Treatment for mild-moderate postnatal depression
elf help
Counselling
Treatment for moderate-severe postnatal depression
Psychotherapy
Antidepressants
Admission may be required
What is the risk of recurrence in post natal depression
25%
Give 4 risks to the child if depression goes untreated during pregnancy:
low birth weight
Pre-term delivery
Adverse childhood outcomes
Poor engagement and bonding
What is the main risk of prescribing anti-depressants/anti-psychotics in the 1st trimester?
Risk of teratogenicity
What is the main risk of prescribing anti-depressants/anti-psychotics in the 3rd trimester?
Risk of neonatal withdrawal
Which anti-depressant is not encouraged during 1st trimester and why?
Paroxetine
Increased risk of fetal heart defects
What antidepressants are considered safest during pregnancy?
Fluoxetine
Sertraline
