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REPRO > Perinatal psychiatry > Flashcards

Perinatal psychiatry Flashcards

1
Q

How common is suicide among moms who just delivered?

A

1 in 7 are suicides; among moms who died between 6 weeks and 1 year after pregnancy

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2
Q

What was noted from those who suicided within 7 weeks of delivery?

A
  • 2/3 had hx of mental health problems
    (only half of that had that hx identified)
    —–only 1/2 of those who had the identified hx had a management plan in place
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3
Q

When should a lady be referred to a specialist perinatal mental health team?

A
  • recent SIGNIFICANT change in mental state
  • new thoughts of acts of violence/self harm
  • persistent and new expressions of incompetency as a mom or estrangement from bby
  • evidence of psychosis
  • pervasive hopelessness
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4
Q

How to ensure mental health is well addressed in a patient?

A
  • routine enquiry at booking about CURRENT/ PAST hx of mental health problems (cover all mental issues)
  • GPs should communicate about PAST psychiatric hx in antenatal referral to pt
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5
Q

What is criticial for good quality care for women with mental ill heath?

A
  • good communication between GPs, Antenatal services and psychiatry
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6
Q

What should be addressed in the booking appointment?

A
  • hx of mental health problems, previous rx, family hx

- risk factors to be identified

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7
Q

What risk factors should be identified in a pt at a booking appointment?

A
  • young/single
  • domestic issues
  • lack of support
  • substance abuse
  • unplanned/unwanted pregnancy
  • pre-existing mental health problem
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8
Q

It is important to screen the pt at EVERY appointment. What qs should be asked?

A
  • past month, have you been bothered by feeling down, depressed or hopeless?
  • in the past month, have you been bothered by having little interest or pleasure in doing things?
  • something you feel you need help with ?
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9
Q

What is the risk of prolapse with bipolar d.o?

A
  • high rate of relapse Post-natally (50% if untreated)
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10
Q

What are danger a pt with past hx of eating d.o?

A
  • –d.o improvement in pregnancy

- —risks of IUGR, hypokalemia, hyponatremia, metabolic alkalosis, miscarriage, premature delivery

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11
Q

Risk of stopping anti-depressants in pregnancy?

A
  • 68% of relapse > antenatal depression
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12
Q

How to manage antenatal depression?

A
  • consider stopping rx if mild, refer to psychological rx
  • self-help strategies: CBT, computerized CBT
  • Mild-moderate: GP managed
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13
Q

What is recommended for Severe antenatal depression?

What mental d.os should be considered?

A
  • referral to psychiatry

—–d.os include suicide, psychosis, self-neglect, harm

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14
Q

How would a lady experiencing baby blues present as? And for how long?

A
    • period of emotional instability
      (tearful, irritable, anxiety and poor sleep)
      —–day 3-10(self-limiting)
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15
Q

What is the prevalence of baby blues?

A
  • seen in 50% of women
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16
Q

What is puerperal psychosis?

A
  • initially: sleep disturbance, confusion, irrational ideas, mania, delusions, hallucinations
  • only 0.1% affected
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17
Q

When does puerperal psychosis usually occur?

A
  • within 2wks of delivery
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18
Q

What are the risk factors of puerperal psychosis?

A
  • 50% have bipolar d.o
  • previous puerperal psychosis
  • 1st degree relative with hx
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19
Q

List 3 ddx for puerperal psychosis.

A
  • bipolar d.o
  • unipolar depression
  • schizorphrenia
  • —-organic brain dysfunction
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20
Q

How is puerperal psychosis managed?

A
  • EMERGENCY
  • MUST admit to mother-baby unit

—–antidepressants/ antipsychotics/ mood stabilizers/ ECT

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21
Q

Which condition may recur in 80% of the women?

A
  • puerperal psychosis
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22
Q

How long does post-natal depression last and when may it start?

A
  • 10% of women
  • 1/3 lasts a year or more
  • —-starts 2-6 weeks post-natally
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23
Q

How does post-natal depression affect the lady’s relationship to bby and partner?

A
  • affects bonding with the baby, child development
  • marriage is affected
  • suicide risk is present
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24
Q

Moderate and severe post-natal depression would require ______for management

A
  • psychotherapy and anti-depressants

- admission may be needed

25
Q

What 3 things should be considered when managing perinatal d.os?

A
  1. risks of UNTREATED illness
  2. principles of prescribing in perinatal period
  3. benefits and harms of diff. rx
26
Q

What risks arise with untreated perinatal depression?

A
  • Low birth wgt
  • Pre-term delivery
  • Adverse childhood outcomes (ADHD, emotional and conduct probs)
  • Poor engagement/ bonding with child (reduces kid’s cognitive develop.)
27
Q

What issue should be cautioned in the 1st trimester?

A
  • Risk of Teratogenicity
28
Q

What issue is a.w 3rd trimester?

A
  • risk of Neonatal withdrawal
29
Q

WHat risk does breastfeeding while on medication, hold?

A
  • risk of medication passin into milk

—-NOTE: exposure in breast milk is usually LESS than in utero
don’t stop a drug you used during pregn.

30
Q

What anti-depressant is recommended in 1st trimester?

A
  • Paroxetine

incr. fetal heart defects!

31
Q

What is antidepress. is used in 3rd trimester?

A

Sertraline/fluoxetine

TCA: imipramine/ amtriptyline

32
Q

What effect does SSRi use in 3rd trimester have on the baby?

A
  • risk of neonatal withdrawal
  • ^ risk of low birth wgt
  • ^ risk of neonatal persistent pulmonary hypertension (if SSRI taken after 20wks)
33
Q

Best antidepress. to be used when breast feeding:

A

Sertraline/ paroxetine/ imipramine

—-fluoxetine is uncertain

34
Q

Why should benzodiazepines be avoided in 1st and 3rd trimester?

A

1st: incre. risked of fetal malformation
3rd: to avoid risk of FLOPPY baby $ (hypotonia/hypothermia/ depression)

35
Q

Are benzodiazepines avoid in breastfeeding?

A
  • regular use is NOT recommended!

> risk of lethargy, wgt loss, drug accumulation

36
Q

What gr. of anti-psychotics are said to be safer?

A

TYPICAL (Haloperidol/fluphenazine)

  • -atypical: Clozapine (risk of agranulocytosis)
  • olanzapine (^ risk of GDM and wgt gain)
37
Q

How to avoid extra-pyramidal SE in pregnany?

A
  • avoid depot antipsychotics

- avoid anticholinergics

38
Q

Can lithium be given to a pregnant lady?

A

YES
1st trimester: despite risk of fetal abnormality (60/1000) and ebstein abnormality (10/20000)
—–can be continued if indicated

3rd trimester: monitor serum lithium closely monthly, then weekly from week 36

39
Q

What condition may lithium toxicity mimic?

A
  • PET
40
Q

Can lithium be taken with breastfeeding?

A

NO -high quantities is seen in breast milk

—-should only be re-introduced if not breastfeeding

41
Q

Does sodium valproate hold any risk for the fetus?

A
  • they have increased risk of NTD
  • craniofacial defects+child’s intellectual development
  • INCR. risk of Autism
42
Q

Does a particular dose hold less NTD risk?

A
  • <1000mg
43
Q

What risk does carbamazepine have on the fetus?

A
  • NTD 20-50/10000

- facial dysmorphism

44
Q

RIsk of lamotigrine?

A
  • risk of oral cleft (9/1000) —-AVOID IN 1st TRIMESTER or withdraw
45
Q

Risk of lamotigrine on bby when breast feeding?

A

-Stevens-Johnson Syndrome

46
Q

Risks of alcoholism?

A
  • miscarriage
  • fetal alcohol $: Facial deformities, lower IQ, epilepsy, hearing, heart and kidney defects
  • neonatal withdrawal
  • wernicke;s encephalopathy (20% die)
  • korsakoff syndrome
47
Q

Affect of cocaine, amphetamine and ecstasy on fetus.

A

death via stroke and arrhythmias

  • teratogenic/ pre-eclampsia/abruption
  • IUGR
  • pre-term labour
  • miscarriage
  • SIDS, withdrawal, develop. delay
48
Q

What do opiates cause?

A
  • 1-2% maternal deaths
  • neonatal withdrawal
  • IUGR
  • SIDS
  • stillbirth
49
Q

What does nicotine cause?

A
  • miscarriages
  • abruption
  • IUGR
  • stillbirths
  • SIDS
50
Q

How to manage substance abuse in pregnant women?

A
  1. consider methadone programme
  2. child protection and social work referral
  3. SMEAR hx
  4. no breastfeeding if on cocaine, has HIV, alcohol intake >8)
  5. early IV access
  6. postnatal contraception plan
51
Q

12wks pregnant Patient X admits to drinking bottle of vodka per day. Who will you refer this patient to?

A
  • alcohol misuse service and social work
52
Q

What antenatal care should be provided?

A
  • obstetric led care
  • routine booking and 20 week scans with growth scans (IUGR risk)
  • Nutritionist
  • Appointments with midwife
  • Nutritional status
  • renal and liver fxns
53
Q

What plans if alcohol abuse continues?

A
  • anticipate withdrawal

- begin withdrawal protocol

54
Q

Management of hyperemesis in a bulimic pt?

A
  • hydration status
  • U&Es
  • Anti-emetics
  • Steroids
  • —assess mental health
55
Q

Advise for bulimic pregnant girl?

A

they feel better by 16 weeks

—eating d.o stabilizes in preg.

56
Q

Post natal plan of a bulimic pt?

A
  • encourage breastfeeding

- high risk of postnatal depression

57
Q

35 y.o on paroxetine for her depression, is trying to concieve—-still occasionally feels low and poor conc….what should the GP do?

A
  • do not suddenly stop

- continue if paroxetine is the best option

58
Q

How tell baby blues from post-natal depression?

A

PND >6wks

59
Q

Antenatal care plan for a IVDU?

A
  • RED pathway; screen for HEP, HIV, syphilis

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