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Reproduction and sexual health > Perinatal psychiatry > Flashcards

Perinatal psychiatry Flashcards

1
Q

what is the leading cause of maternal death 1 year after delivery

A

Mental health conditions

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2
Q

What are the red flag presentations of maternal mental health

A

recent significant change in mental state
emergence of new symptoms
new thoughts/acts of violent self harm
new/persistent thoughts of inadequacy as a mother or estrangement from their baby

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3
Q

What are the indications for admission to the mother & baby unit

A 
rapidly changing mental state 
suicidal ideation 
significant estrangement from baby 
pervasive hopelessness/guilt 
feelings of inadequacy as mother 
psychosis
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4
Q

What risk factors for maternal mental health are looked for at the booking appointment

A 
young age 
single 
lack of support 
domestic issues 
substance abuse 
unplanned/unwanted pregnancy 
pre existing mental health condition
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5
Q

When should you refer a woman to psychiatry

A

psychosis
severe anxiety/depression/suicidal/self harm/ self neglect
History of BPAD or Schizophrenia
History of puerperal psychosis
symptoms significantly interfere with daily functioning
psychotropic medications
develop mod. illness in late pregnancy/early post partum
mild-mod disease but 1st degree relative has BPAD or puerperal psychosis
previous admission to mental health unit

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6
Q

Bipolar affective disorder has a low rate of relapse post natally if untreated, true or false

A

FALSE - high relapse rate

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7
Q

Pregnancy is generally protective of mental health conditions, true or false

A

FALSE

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8
Q

What are risks of eating disorders in pregnancy

A 
IUGR 
prematurity 
hypokalaemia 
hyponatraemia 
metabolic alkalosis 
miscarriage
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9
Q

What are the baby blues

A

very common in women post natally

period of emotional instability

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10
Q

What are the symptoms of baby blues

A

tearful
irritable
anxiety
confusion from poor sleep

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11
Q

What is the onset of baby blues and its management

A

days 3-10
self limiting
support and reassurance

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12
Q

Puerperal pyschosis is an emergency, true or false

A

TRUE - needs same day admission to mother & baby unit

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13
Q

When does puerperal psychosis present

A

within 2 weeks of delivery

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14
Q

What are the symptoms of puerperal psychosis

A 
confusion 
sleep disturbance 
irrational ideas 
mania 
delusions 
hallucinations
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15
Q

What are risk factors for developing puerperal psychosis

A

BPAD
previous puerperal psychosis
1st degree relative with puerperal psychosis

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16
Q

What are differential diagnoses for puerperal psychosis

A

BPAD
unipolar depression
schizophrenia
organic brain dysfunction - sepsis, infection

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17
Q

What is the onset and duration of post natal depression

A

2-6 weeks post natally

lasts weeks to months

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18
Q

what are symptoms of post natal depression

A 
tearfulness 
poor sleep 
irritability 
anxiety 
lack of enjoyment 
weight loss
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19
Q

What are risks to the child in untreated maternal depression

A

low birth weight
pre term delivery
adverse childhood outcomes
poor bonding with child

20
Q

General principles of prescribing in pregnancy

A

Lowest dose monotherapy with dose adjustments Increase foetal screening
Different drugs can have different effects at different times of the pregnancy
Abruptly stopping drugs is risky

21
Q

What are risks of drugs in
1st trimester
3rd trimester
Breast feeding

A

1st trimester - teratogenicity
3rd trimester - neonatal withdrawal
Breastfeeding - excretion of drug into breast milk

22
Q

Antidepressants are generally safe to use in pregnancy, true or false

A

TRUE

23
Q

what is the 1st line group of anti depressants used

A

SSRIs - sertraline and fluoxetine

24
Q

Which SSRI is avoided in pregnancy

A

Paroxetine

25
Q

Tricyclics are generally safe to use, true or false

A

TRUE

26
Q

Venlafaxine and mirtazapine are regarded as safe to use, true or false

A

FALSE, not enough evidence base

27
Q

Which antipsychotics are generally used in pregnancy

A

Olanzapine and quetiapine

28
Q

What are risks of atypical antipsychotics in pregnancy

A

weight gain and GDM

29
Q

Which antipsychotic should be avoided

A

clozapine - agranulocytosis

30
Q

What are the teratogenic effects of lithium

A

cardiac defects - Ebsteins anomaly

31
Q

What are the teratogenic effects of Na valproate

A

NTD
craniofacial defects
impaired intellectual development

32
Q

Carbamazepine should be avoided in pregnancy, why

A

risk of NTD, facial dysmorphism, fingernail hypoplasia

33
Q

Lamotrigine is the less bad anticonvulsant, true or false

A

TRUE - but still avoid if possible

34
Q

What drug class is 1st line for anxiety in pregnancy

A

Antidepressants - SSRIs

35
Q

Benzodiazepines can be used in pregnancy, true or false

A

FALSE - try to avoid

36
Q

What are the risks of benzodiazepines

A

cleft palate

floppy baby syndrome with use in 3rd trimester

37
Q

Which drug should not be used at all in breast feeding

A

Lithium

38
Q

What is associated with substance abuse in pregnancy

A 
other mental health conditions 
HIV, Hep B+C
STIs 
VTE 
nutritional deficiency 
endocarditis / sepsis 
poor venous access 
opioid tolerance / withdrawal 
drug overdose 
domestic abuse / suicide 
IUGR, SID, still birth, prematurity
39
Q

What are the guidelines for alcohol consumption during pregnancy

A

no alcohol should be consumed

40
Q

what can alcohol cause in pregnancy

A

Miscarriage
foetal alcohol syndrome
withdrawal
Wernicke-Korsakoff’s

41
Q

What are the harmful effects of cocaine, ectasy and amphetamines

A

death via stroke or arrhythmia
teratogenic: microcephaly, cardiac, genitourinary, limb defects
pre eclampsia
placental abruption
IUGR, SID, miscarriage, prematurity, withdrawal, neurodevelopmental delay

42
Q

Harmful effects of opiates

A 
maternal death 
neonatal withdrawal 
IUGR 
SID 
stillbirth
43
Q

Harmful effects of nicotine

A 
miscarriage 
abruption 
IUGR 
stillbirth 
SID
44
Q

What is the management of pregnant women and substance abuse

A 
consider methadone programme 
SOCIAL WORK 
child protection 
cervical smear history 
breastfeeding
labour plan 
early IV access 
postnatal contraception - LARC
45
Q

Contraindications to breast feeding

A

> 8 units alcohol a week
HIV+
cocaine misuse
lithium therapy

Reproduction and sexual health (46 decks)

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