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Reproductive and Sexual Health > Perinatal Psychiatry > Flashcards

Perinatal Psychiatry Flashcards

1
Q

Red flags for perinatal mental health problems: (3)

A

feelings of inadequacy/estrangement from baby
new feelings/thoughts of violent harm to self
new and rapid change to mental state

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2
Q

What signs would indicate admission to the mother-baby unit? (5)

A 
Rapid change to mental state
suicidal ideation
significant estrangement from child
psychosis
hopelessnes/guilt (pervasive)
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3
Q

Is pregnancy protective against mental health issues?

A

No

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4
Q

What can complications of eating disorders in pregnancy be?

A

can lead to foetal growth restriction, preterm labour, electrolyte imbalance, metabolic alkalosis, miscarriage

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5
Q

What are baby blues?

A

this occurs in 50% of women between days 3-10 postpartum. They will be tearful, irritable, find it difficult to sleep and anxious

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6
Q

How do you treat baby blues?

A

This is self-limiting and should be supported and reassured

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7
Q

What is peurperal psychosis? Symptoms?

A

This is the presence of psychotic symptoms between weeks 0-2 postpartum.
Symptoms may include: sleep disturbance, irritability, confusion, irrational ideas (later = mania, hallucinations, delusions and loss of insight)

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8
Q

What is the rate of pueperal psychosis?

A

0.1% of women

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9
Q

What is the rate of suicide and infanticide in pueperal psychosis?

A

5% and 4% respectively

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10
Q

How should puerperal psychosis be managed?

A

Urgent admission to the mother baby unit (EMERGENCY)

give antidepressants, antipsychotics, mood stabilisers and ECT

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11
Q

What is the 10 year rate of recurrence in puerperal psychosis?

A

80%

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12
Q

What is the rate of conversion into long term bipolar in puerperal psychosis?

A

25%

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13
Q

What are some risk factors for puerperal psychosis?

A

bipolar disease, previous history in past pregnancy and FHx (1st degree relative)

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14
Q

What is post-natal depression?

A

This is a period of low mood, anxiety, sleep disturbance, weight loss, loss of pleasure etc around 2-6 weeks postpartum

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15
Q

How long does postnatal depression last for?

A

Can last week-months but can also become lifelong

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16
Q

How often does postnatal depression occur?

A

10% of women

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17
Q

What are the effects of postnatal depression?

A

poor bonding with child, effects child development, marriage strain

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18
Q

How is postnatal depression treated?

A 
mild-moderate = self-help, counselling, CBT
moderate-severe = GP ADs, consider admission if at risk of suicide
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19
Q

What is an example of an anti-depressant used in pregnancy?

A

sertraline - SSRI

SSRIs pose risk of persistent pulmonary hypotension in the neonate

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20
Q

What antidepressant should always been avoided in the 1st trimester of pregnancy?

A

Paroxetine (due to risk of heart defect)

21
Q

What Antidepressant should be avoided in breast feeding and which are ok?

A

AVOID citalopram

use sertraline or imipramine instead

22
Q

Are benzodiazipines ok for use in pregnancy? Why/why not?

A

No - risk of floppy baby syndrome

23
Q

What is floppy baby syndrome?

A

This is caused by benzo use during pregnancy (3rd trimester especially). Characterised by hypothermia, reduced tone, resp depression and withdrawal effects

24
Q

Can benzodiazipines be used in breast feeding?

A

No - risk of lethargy/weight loss

25
Q

Which antipsychotic is associated with agranulocytosis?

A

Clozapine

26
Q

What is olanzipine use in pregnancy associated with?

A

Gestational diabetes and weight gain

27
Q

Can depot injections of antipsychotics be used in pregnancy?

A

No - risk of EPSE in the neonate

28
Q

Are antipsychotics safe in breast feeding?

A

No definite evidence to suggest not safe but monitor for lethargy and sedation - YES are safe

29
Q

Can lithium be used during pregnancy?

A

Yes if indicated - avoid sudden stopping

30
Q

What needs to be checked with lithium?

A

Lithium levels in the blood need to be monitored monthly until 36 weeks. After 36 weeks needs to be monitored weekly then 24hrs before delivery.

31
Q

Why is lithium so closely managed in pregnancy?

A

as lithium toxicity can mimic the symptoms of PET.

Volume changes during pregnancy can expose risk of toxicity.

32
Q

Is lithium safe in breast feeding?

A

No

33
Q

Is sodium valproate safe in pregnancy?

A

No - increases risk of NT defects significantly so should avoid prescribing in any female of child bearing age or provide appropriate counselling and contraception.

34
Q

What should be done if planning to become pregnant but on sodium valproate?

A

Wean off and ensure toxicity is low BEFORE becoming pregnant

Give folic acid supplements

35
Q

Is sodium valproate safe for use in pregnancy?

A

Yes

36
Q

What is associated with lamotrigine?

A

risk of SJS (and oral cleft)

37
Q

what is associated with carbamazepine?

A

increased risk of NT defect

38
Q

What are the stats re women with alcohol and illicit drug dependency?

A

Alcohol = 4.7%

Illicit drug = 2.2%

39
Q

What are the guidelines re alcohol use in pregnancy?

A

Abstinence - although 2 units shows no significant change to foetal health

40
Q

What are the effects of alcoholism on the neonate?

A

Can cause foetal alcohol syndrome - neurodevelopmental delay, epilepsy, lower IQ, facial deformity, hearing, cardiac and kidney defects
Also risk of withdrawal

41
Q

Can wernicke’s and korsakoff’s affect the neonate?

A

Yes - 20% with wernicke’s will die (B1 deficiency) and Korsakoff’s will have permanent effects

42
Q

What are the effects of cocaine, ecstasy and amphetamine misuse?

A

can cause maternal death
teratogenic (limb defect, GU, microephaly and cardiac)
Developmental delay, IUGR, pre-term birth, SIDS, withdrawal

43
Q

What are the effects of cocaine, ecstasy and amphetamine misuse on the pregnancy?

A 
Abruption
PET
Pre-term labour
Miscarriage
IUGR
44
Q

What are the effects of opiod misuse in pregnancy?

A

maternal death, withdrawal, IUGR, stillbirth, SIDS

45
Q

What are the effects of nicotine misuse in pregnancy?

A

miscarriage, IUGR, abruption, SIDS, still birth

46
Q

If someone is a heroin user and pregnant then what should you consider and why?

A

Referral to the methadone program as it is safer to use heroin in a controlled environment - reduces the risk of infection, HIV, overdose, and allows for maternal monitoring

47
Q

If there are worrying substance abuses in pregnancy then who should you contact?

A

Child protection and social services

48
Q

When should breast feeding (in substance abuse) be discouraged?

A

> 8units of alcohol/day
HIV positive
Cocaine

49
Q

What should always be put into place with post-natal but Hx of substance abuse?

A

CONTRACEPTIVE PLAN

Reproductive and Sexual Health (27 decks)

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