Perinatal Psychiatry Flashcards
maternal suicide is the leading cause of direct maternal deaths for how long after delivery?
1 year
what symptoms reported by a pregnant women would indicate urgent referral is needed to the perinatal mental health team?
significant change in mental state or new symptoms
- new thoughts / acts of self harm
- new / persistent expression of incompetency as mother or estrangement from child
what recommendations does “saving mothers lives” campaign make with regards to communication in perinatal psychiatry?
at booking, enquire about current / past mental health problems
if women visit their GP during pregnancy, they should communicate about past psych history in antenatal referral
antenatal services, GPs and psychiatry should communicate well with each other
when should admission to a mother and baby unit be considered?
rapidly changing mental state suicidal ideation significant estrangement from infant pervasive guilt / hopelessness beliefs of inadequacy as mother evidence of psychosis
how should mental health disorders be screened for at booking diagnosis?
check Hx of mental health problems
previous treatment
family history
risk factors
- young / single
- domestic issues
- lack of support
- substance abuse
- unplanned pregnancy
- pre existing mental health problem
what questions about mental health problems should be screened for at every antenatal appointment?
during last month have you been feeling down, depressed or hopeless?
during 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?
what mental health symptoms of conditions during or after pregnancy should be referred to a psychiatrist?
psychosis
sever anxiety, depression, suicidal, self neglect or harm
symptoms impairing daily function
history of bipolar / schizophrenia / puerperal psychosis
psychotropic medications
developed moderate mental illness in late pregnancy or early postpartum
pregnancy can cause previous mental health problems to get better - true or false?
false
pregnancy is not protective
some may improve slightly (eg ED) but risk of relapse high
what are the risks of a mother suffering from an eating disorder during pregnancy?
IUGR prematurity hypokalaemia hyponatraemia metabolic alkalosis miscarriage
if a patient experiences mild to moderate depression and wishes to come off her medication during pregnancy, what options can be offered?
stop medication and refer for psychological treatment during this time
promote self help strategies - CBT
how long does baby blues normally last?
day 3-10 postnatal
self limiting
what symptoms are commonly experienced in baby blues?
tearful irritable anxiety poor sleep confusion
how is baby blues treated?
support and reassurance
when does puerperal psychosis normally present?
usually within 2 weeks of delivery
what symptoms are often seen in puerperal psychosis?
early symptoms = sleep disturbance, confusion, irrational ideas
late symptoms = mania, delusions, hallucinations, confusion
why is puerperal psychosis a big risk to both mother and baby?
increased risk of suicide (5%) and infanticide (4%)
how is puerperal psychosis managed?
refer for admission to specialised mother-baby unit
antidepressants, antipsychotics, mood stabilisers and ECT can be used
what does one episode of puerperal psychosis increase the long term risk of?
80% = 10 year recurrence
25% = develop bipolar disorder
what symptoms are common to post-natal depression?
tearfulness irritable anxiety lack of enjoyment poor sleep weight loss
when does post-natal depression normally start and how long does this last for?
onset 2-6 weeks postnatally
lasts weeks to months
post-natal depression can affect more than just mother - what else?
bonding with child
child development
marriage
suicide risk
how is post-natal depression treated?
mild-moderate = self help / counselling
moderate-severe = psychotherapy and antidepressants (or admission if required)
what long term consequences result from post-natal depression?
25% recurrence
70% lifetime risk of depression
untreated depression in the other poses what risks to the child?
low birth weight
pre-term delivery
adverse childhood outcomes
poor engagement / bonding with child
