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Psychiatry > Perinatal psychiatry > Flashcards

Perinatal psychiatry Flashcards

1
Q

Timecourse of ‘baby blues’

A

Onset 2-4d after birth, lasts a few days

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2
Q

Management of baby blues

A

Self-limiting, needs only reassurance

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3
Q

Possible aetiology of baby blues

A

Fall in sex steroids post-partum

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4
Q

Prevalence of baby/maternity blues

A

50-75% of mothers

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5
Q

Prevalence of post-partum depression

A

Mild-moderate: 10-15%

Severe: 3%

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6
Q

Time of onset of postpartum depression

A

within 6mo (peak at 3-4 weeks, most within 12w)

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7
Q

Prognosis/duration of postpartum depression

A

90% <4weeks

4% >1yr

Suicide risk lower than general population

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8
Q

Management of postpartum depression

A

Screening: Edinburgh postnatal depression scale + thoughts of self-harm, harm to baby

Conservative: Education + support networks

Psychological: CBT

Pharmacological: Antidepressants (caution if breastfeeding!)

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9
Q

Risk factors for postpartum depression

A

PPH: Hx of depression/anxiety (more recent = higher risk), post-partum psychosis, severe baby blues

FHx: Family Hx of depression, poor relationship with mother

Personal: Unwanted/ambivalent pregnancy, poor social support, domestic violence, single mother, very young/very old

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10
Q

Prevalence of postpartum psychosis

A

1.5/1000 live births

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11
Q

Time of onset of postpartum psychosis

A

1-2w postpartum

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12
Q

Risk factors for postpartum psychosis

A

Personal/FHx of postpartum psychosis

Bipolar disorder/major psychiatric condition (30-40% of cases are with BPD)

Primiparity

Poor social support

Single parenthood

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13
Q

Clinical features of postpartum psychosis

A

Prominent affective symptoms

Develop acutely (over hours)

Perplexity, disorientation (delirium-like) c.f. other psychoses

Lability of symptoms

Thoughts of suicide/infanticide, paranoia about baby’s safety

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14
Q

Management of postpartum psychosis

A

Treatment with antipsychotic

Admission (to mother-baby unit if possible)

Mood stabiliser (esp carbamezapine)

Low threshold for ECT

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15
Q

Prognosis for postpartum psychosis

A

25% risk of relapse in subsequent deliveries

50% lifetime risk of relapse

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16
Q

Effect of pregnancy on neuroses

A

Phobias: Tokophobia + needle phobia may have issues

OCD: Symptoms worsen during pregnancy, esp ‘contamination’ fears

17
Q

Risk factors for maternal suicide

A

Late midwife booking

Domestic abuse

Emotional instability, chaoti lifestyle

Loss of custody of baby

18
Q

Risks to child with antenatal depression

A

Premature delivery

IUGR

Emotional problems, depression, disorganised attachment

LD

19
Q

Risks to child with postnatal depression

A

Emotional dysregulation

Insecure attachment

ADHD sx

adolescent depression

Slower cognitive + developmental milestones

20
Q

Risks to child with schizophrenia

A

Prematurity

Infant mortality

LD

21
Q

Antidepressant prescribing in pregnancy

A

Stick with what works if possible to minimise exposure

SSRIs and TCAs considered safe, sertraline first-line choice

Possible teratogenicity of fluoxetine/paroxetine (persistent pulmonary hypertension)

22
Q

Antipsychotic prescribing in pregnancy

A

May cause EPSEs in baby if taken near-term

Unclear risk of adverse outcomes due to confounding by indication

Obstetric complications more likely

Olanzapine largest evidence base for safety

23
Q

Mood stabilisers in pregnancy

A

Valproate: 10% teratogenicity, contraindication

Lamotrigine: Unlikely teratogenic, possible oral cleft

Lithium: 1/1000 risk of Ebstein’s anomaly, hypothyroidism/arrhythmias in neonate. Only use as 2nd line, antipsychotics preferred.

Li needs weekly monitoring due to changes in circulating volume (esp in 3rd trimester)

24
Q

Anxiolytics in pregnancy

A

Benzos possibly teratogenicity (oral cleft, gut atresia, floppy baby)

Promethiazine used for insomnia (extrapolated from use of other antihistamines)

25
Q

Treatment of comorbid opiate abuse in pregnancy

A

Withdrawal –> risk of spontaneous abortion/neonatal death

Use substitute prescribing (opiates not teratogenic, but safety/lifestyle concerns)

26
Q

Treatment of alcohol dependece in pregnancy

A

Window of opportunity

Medically supervised detox (high seizure risk) + encourage abstinence

27
Q

Antidepressants for use with breastfeeding

A

Sertraline, TCAs (esp amitryptilline)

Avoid MAOIs

28
Q

Mood stabilisers for use in breastfeeding

A

Avoid lithium

Carbamazepine, lamotrigine likely safe

29
Q

Antipsychotics for use in breastfeeding

A

Olanzapine, quetiapine (sedating to baby!)

Avoid clozapine

30
Q

Risks for antenatal depression

A

6-8% prevalence

Hx of depression/anxiety

Unplanned pregnancy

Domestic abuse

Lack of social support

Multiple life stressors

Psychiatry (20 decks)

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