Perinatal Psychiatry Flashcards
Baby Blues
Common transient psychological state occurring after childbirth
Characterized by following features:
Episodic tearfulness, Labile Mood, Poor Concentration, Sleep Disturbance, Irritability, Feelings of Depression and anxiety, Feeling separate from baby
Usually begins 3-5 days following childbirth, self-limiting within 10 days of delivery
Post Natal Depression: Risk Factors
Risk Factors: Previous history of mental illness baby blues family hx of PND antenatal anxiety and depression lack of social support low self esteem major life events 16 years or younger Describes self as nervy, a worrier, shy Marital dissatisfaction Major health problems Baby of non-desired sex Poor relationships Level of education, rented housing, adverse social conditions
Post Natal Depression: Symptoms
Usually develops 4-6 weeks after childbirth, symptoms must be present for at least 2 weeks
Core features of depression
Irritability
Poor appetite and sleep
Feelings of guilt, helplessness, worthlessness
Thoughts of deliberate self harm, suicide and harm towards baby
Post Natal Depression: Diagnosis
Full history and MSE. Edinburgh 10-point post-natal depression scale
Post Natal Depression: Management
Psychological therapies: Short term CBT Longer term mother-infant psychotherapy Family therapy Group therapy
Pharmacological:
Consider effects in breastfeeding
What is post natal psychosis ?
Severe mental illness with sudden onset in the first few weeks following childbirth, manifesting as a rapidly evolving psychosis
Symptoms of post natal psychosis
Risk is highest in women with previous history of mental illness and family/personal history of post partum psychosis
Typically presents early after childbirth in first 2 weeks:
Severe confusion, agitation, irritability
Feelings of paranoia or suspicion
Rapid mood fluctuation
Racing thoughts
Delusional ideas and hallucinations
Post Natal Psychosis Management
Psychiatric emergency
Women should be managed in specialist perinatal psychiatry services and admission is usually required at a mother and baby unit
Care Pathway for Perinatal Psychiatric Emergency
Same pathway as any other psychiatric emergency-carries high suicide risk and high risk of harm to the baby
CPMHT–> Too small
Liaison psychiatry services, HTT and acute care coordination centre are key players
Antenatal Depression
Women who have has previous depressive episodes remain at risk of relapse in pregnancy
Depression can lead to women being more likely to miss antenatal appointments and eat less healthily, smoke more and consume more alcohol. Raised cortisol in depression can lead to preterm labour and low birth weight
Mild illness-Psychological treatment
Moderate to severe-Medication
Prescribing in Pregnancy
Medication should be prescribed at the lowest dose, avoided in 1st semester, prescribed independently of other medications and only after risk vs. benefit assessment
SSRIs
Causes small birthweight, preterm labour, cardiac and lung malformation
Paroxetine is associated with cardiac malformation and cannot be used in 1st trimester
Valproate in Pregnancy
Can cause spina bifida, neural tube defects, limb and heart defects, low IQ
Prescribe prophylactic folic acid, give Vit K to mother and baby due to thrombocytopenia risk
Carbamazepine in Pregnancy
Spina bifida, developmental delay, craniofacial abnormalities, growth retardation
Lithium in Pregnancy
Ebstein’s anomaly (major cardiac malformation)
Serum levels should be check every 4 weeks, then weekly from 36th week and less than 24 hours after childbirth
