Perinatal Psychiatry Flashcards
red flag presentations in perinatal period?
recent significant change in mental state or emergence of new symptoms
new thoughts or acts of violent self harm
new and persistent expressions of incompetency as a mother or estrangement from their baby
admission to a mother and baby unit should always be considered where a women presents with what?
rapidly changing mental state suicidal ideation (particularly of a violent nature) significant estrangement from baby pervasive guilt or hopelessness beliefs of inadequacy as a mother evidence of psychosis
who can admit to a mother and baby unit?
only a psychiatrist
important parts of screening for mental health problems
at booking
- history of mental health problems, treatment and family history
- identify risk factors
risk factors for perinatal mental health problems?
young single domestic issues lack of support substance abuse unplanned pregnancy pre-existing mental health problem
screening questions which should be asked at every appointment?
any feeling down, depressed or hopeless in last month?
bothered by having little interest or pleasure in doing things in last month?
is this something you feel you need help with?
psychiatry team must see any woman with any of which features?
psychosis
severe anxiety, depression, suicidal, self neglect, self harm
symptoms with significant interference with daily functioning
history of bipolar or schizophrenia history of puerperal psychosis
psychotropic medications
if any moderate mental illness in late pregnancy or early post partum
mild-mod illness but 1st degree relative with bipolar or puerperal psychosis
previous in patient admission to mental health unit
how does pregnancy interact with pre-existing mental health problems?
pregnancy is generally not protective against mental illness
bipolar
- high relapse rate post-natally
eating disorders
- may improve during pregnancy but risks during pregnancy
antenatal depression
- 68% relapse if mother stops meds
risks in pregnancy if eating disorder present?
IUGR prematurity hypokalaemia hyponatraemia metabolic alkalosis miscarriae premature delivery
how is depression managed during pregnancy?
if mild and on treatment - can consider stopping treatment and referring for psychological treatment
mild-mod = GP managed
severe = referral to psychiatry
features of normal baby blues?
occurs in 50% brief period of emotional instability tearful irritable anxiety poor sleep confusion usually 3-10 days self limiting managed with support and reassurance
features of puerperal psychosis?
early - sleep disturbance - confusion - irrational ideas later - mania - delusions - hallucinations - confusion
usually present within 2 weeks of delivery
risk factors for puerperal psychosis?
bipolar
previous episode
1st degree relative with history
how is puerperal psychosis managed?
medical emergency
needs admission to specialised mother baby unit same day
managed with antidepressants, anti-psychotics, mood stabilisers and ECT if needed
long term risks of puerperal psychosis?
80% 10 year recurrence
25% go on to develop bipolar disorder
what is post-natal depression?
episode of depression (more severe than baby blues) following child birth
features of post-natal depression?
onset 2-6 weeks, lasts weeks to months tearfulness irritable anxiety lack of enjoyment poor sleep weight loss can present as concerns re baby effects on bonding, child development, miscarriage risk, suicide
how is post-natal depression managed?
screened for routinely
mild-mod = self help, counselling
mod-severe = psychotherapy and antidepressents, admission if needed
