Perinatal psychiatry Flashcards
When do you do urgent referrals to a specialist mental health team?
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
When should the admission to a mother and baby unit be considered?
When a mom has any of the following: (admit the baby and mom)
- rapidly changing mental state
- suicidal ideation (particularly of a violent nature)
- significant estrangement from the infant
- pervasive guilt or hopelessness
- beliefs of inadequacy as a mother
- evidence of psychosis
Important Qs to ask moms
Do you have new feelings and thoughts which you have never had before, which make you disturbed or anxious?
Are you experiencing thoughts of suicide or harming yourself in violent ways?
Are you feeling incompetent, as though you can’t cope, or estranged from your baby? Are these feelings persistent?
Do you feel you are getting worse?
Risk factors for mental health issues in pregnant women
<18, single , domestic issues, substance abuse, unplanned pregnancy, pre-existing mental heatlh problems
What is done during a booking appointment?
Screening for mental health disorder: History of mental health problems, previous treatment, family history and identify the previous rik factors
What screening Qs are asked at every appointment?
During the last month have you been bothered by feeling down, depressed or hopeless?
During the last month have you been bothered by having little interest or pleasure in doing things
Is this something you feel you need or want help with?
When do you refer moms to a psychiatry team?
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 developed moderate mental illness in late pregnancy or early postpartum
Mild- moderate illness but 1st degree relative with bipolar or puerperal psychosis
Previous in-patient admissions to mental health unit
Is pregnancy protective from mental health disorders?
No
What happens to ppl with eating disorders in pregnancy?
Mostly some improvement
What happens if you stop depression meds during pregnancy?
68% relapse if they stop meds! -Do not STOP abruptly!
Mild/ moderate - GP
How is mild-moderate depression treated?
treated by the gp
mild and on treatment, consider stopping and referring for psychological treatment
How is severe depression treated during pregnancy?
refer to psychiatry
What are the initial symtpoms of psychosis?
Sleep disturbance and confusion
What is baby blues?
50% women
Brief period of emotional instability
Tearful, irritable, anxiety and poor sleep confusion
How long does it take for baby blues to go away?
Day 3-10, self-limiting
What happens if a midwife sees a sleep deprived and confused patient, how does she differentiate btw someone with baby blues and psychosis?
Daily monitoring
How many women develop post-natal depression?
1/10
Differential diagnosis for puerperal psychosis?
episode of bipolar, unipolar depression, schizophrenia, organic brain dysfunction (secondary to physical illness)
Usually presents within 2 weeks of delivery
Early symptoms are sleep disturbance and confusion, irrational ideas
Mania, delusions, hallucinations, confusion
How to manage pueperal psychosis?
Is an emergency
Needs admission to specialised mother-baby unit
Antidepressants, antipsychotics, mood stabilizers and ECT
80% 10 year recurrence
25% go onto develop bipolar disorder
What are the features of postnatal depression?
10% women, 1/3 lasts a year or more
Tearfulness, irritable, anxiety, lack of enjoyment and poor sleep, weight loss, can present as concerns re baby
Onset 2-6 weeks postnatally, lasts weeks to months
How to manage mild-moderate postnatal depression?
Self-help, counseling
How to manage moderate-severe postnatal depression?
Psychotherapy and antidepressants
Drugs usually used in post-natal depression?
Sertraline