Perinatal Psychiatry Flashcards
Red flags for perinatal mental health problems: (3)
feelings of inadequacy/estrangement from baby
new feelings/thoughts of violent harm to self
new and rapid change to mental state
What signs would indicate admission to the mother-baby unit? (5)
Rapid change to mental state suicidal ideation significant estrangement from child psychosis hopelessnes/guilt (pervasive)
Is pregnancy protective against mental health issues?
No
What can complications of eating disorders in pregnancy be?
can lead to foetal growth restriction, preterm labour, electrolyte imbalance, metabolic alkalosis, miscarriage
What are baby blues?
this occurs in 50% of women between days 3-10 postpartum. They will be tearful, irritable, find it difficult to sleep and anxious
How do you treat baby blues?
This is self-limiting and should be supported and reassured
What is peurperal psychosis? Symptoms?
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)
What is the rate of pueperal psychosis?
0.1% of women
What is the rate of suicide and infanticide in pueperal psychosis?
5% and 4% respectively
How should puerperal psychosis be managed?
Urgent admission to the mother baby unit (EMERGENCY)
give antidepressants, antipsychotics, mood stabilisers and ECT
What is the 10 year rate of recurrence in puerperal psychosis?
80%
What is the rate of conversion into long term bipolar in puerperal psychosis?
25%
What are some risk factors for puerperal psychosis?
bipolar disease, previous history in past pregnancy and FHx (1st degree relative)
What is post-natal depression?
This is a period of low mood, anxiety, sleep disturbance, weight loss, loss of pleasure etc around 2-6 weeks postpartum
How long does postnatal depression last for?
Can last week-months but can also become lifelong
How often does postnatal depression occur?
10% of women
What are the effects of postnatal depression?
poor bonding with child, effects child development, marriage strain
How is postnatal depression treated?
mild-moderate = self-help, counselling, CBT moderate-severe = GP ADs, consider admission if at risk of suicide
What is an example of an anti-depressant used in pregnancy?
sertraline - SSRI
SSRIs pose risk of persistent pulmonary hypotension in the neonate
What antidepressant should always been avoided in the 1st trimester of pregnancy?
Paroxetine (due to risk of heart defect)
What Antidepressant should be avoided in breast feeding and which are ok?
AVOID citalopram
use sertraline or imipramine instead
Are benzodiazipines ok for use in pregnancy? Why/why not?
No - risk of floppy baby syndrome
What is floppy baby syndrome?
This is caused by benzo use during pregnancy (3rd trimester especially). Characterised by hypothermia, reduced tone, resp depression and withdrawal effects
Can benzodiazipines be used in breast feeding?
No - risk of lethargy/weight loss
Which antipsychotic is associated with agranulocytosis?
Clozapine
What is olanzipine use in pregnancy associated with?
Gestational diabetes and weight gain
Can depot injections of antipsychotics be used in pregnancy?
No - risk of EPSE in the neonate
Are antipsychotics safe in breast feeding?
No definite evidence to suggest not safe but monitor for lethargy and sedation - YES are safe
Can lithium be used during pregnancy?
Yes if indicated - avoid sudden stopping
What needs to be checked with lithium?
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.
Why is lithium so closely managed in pregnancy?
as lithium toxicity can mimic the symptoms of PET.
Volume changes during pregnancy can expose risk of toxicity.
Is lithium safe in breast feeding?
No
Is sodium valproate safe in pregnancy?
No - increases risk of NT defects significantly so should avoid prescribing in any female of child bearing age or provide appropriate counselling and contraception.
What should be done if planning to become pregnant but on sodium valproate?
Wean off and ensure toxicity is low BEFORE becoming pregnant
Give folic acid supplements
Is sodium valproate safe for use in pregnancy?
Yes
What is associated with lamotrigine?
risk of SJS (and oral cleft)
what is associated with carbamazepine?
increased risk of NT defect
What are the stats re women with alcohol and illicit drug dependency?
Alcohol = 4.7%
Illicit drug = 2.2%
What are the guidelines re alcohol use in pregnancy?
Abstinence - although 2 units shows no significant change to foetal health
What are the effects of alcoholism on the neonate?
Can cause foetal alcohol syndrome - neurodevelopmental delay, epilepsy, lower IQ, facial deformity, hearing, cardiac and kidney defects
Also risk of withdrawal
Can wernicke’s and korsakoff’s affect the neonate?
Yes - 20% with wernicke’s will die (B1 deficiency) and Korsakoff’s will have permanent effects
What are the effects of cocaine, ecstasy and amphetamine misuse?
can cause maternal death
teratogenic (limb defect, GU, microephaly and cardiac)
Developmental delay, IUGR, pre-term birth, SIDS, withdrawal
What are the effects of cocaine, ecstasy and amphetamine misuse on the pregnancy?
Abruption PET Pre-term labour Miscarriage IUGR
What are the effects of opiod misuse in pregnancy?
maternal death, withdrawal, IUGR, stillbirth, SIDS
What are the effects of nicotine misuse in pregnancy?
miscarriage, IUGR, abruption, SIDS, still birth
If someone is a heroin user and pregnant then what should you consider and why?
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
If there are worrying substance abuses in pregnancy then who should you contact?
Child protection and social services
When should breast feeding (in substance abuse) be discouraged?
> 8units of alcohol/day
HIV positive
Cocaine
What should always be put into place with post-natal but Hx of substance abuse?
CONTRACEPTIVE PLAN
