Perinatal psychiatry Flashcards
what is the leading cause of maternal death 1 year after delivery
Mental health conditions
What are the red flag presentations of maternal mental health
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
What are the indications for admission to the mother & baby unit
rapidly changing mental state suicidal ideation significant estrangement from baby pervasive hopelessness/guilt feelings of inadequacy as mother psychosis
What risk factors for maternal mental health are looked for at the booking appointment
young age single lack of support domestic issues substance abuse unplanned/unwanted pregnancy pre existing mental health condition
When should you refer a woman to psychiatry
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
Bipolar affective disorder has a low rate of relapse post natally if untreated, true or false
FALSE - high relapse rate
Pregnancy is generally protective of mental health conditions, true or false
FALSE
What are risks of eating disorders in pregnancy
IUGR prematurity hypokalaemia hyponatraemia metabolic alkalosis miscarriage
What are the baby blues
very common in women post natally
period of emotional instability
What are the symptoms of baby blues
tearful
irritable
anxiety
confusion from poor sleep
What is the onset of baby blues and its management
days 3-10
self limiting
support and reassurance
Puerperal pyschosis is an emergency, true or false
TRUE - needs same day admission to mother & baby unit
When does puerperal psychosis present
within 2 weeks of delivery
What are the symptoms of puerperal psychosis
confusion sleep disturbance irrational ideas mania delusions hallucinations
What are risk factors for developing puerperal psychosis
BPAD
previous puerperal psychosis
1st degree relative with puerperal psychosis
What are differential diagnoses for puerperal psychosis
BPAD
unipolar depression
schizophrenia
organic brain dysfunction - sepsis, infection
What is the onset and duration of post natal depression
2-6 weeks post natally
lasts weeks to months
what are symptoms of post natal depression
tearfulness poor sleep irritability anxiety lack of enjoyment weight loss
What are risks to the child in untreated maternal depression
low birth weight
pre term delivery
adverse childhood outcomes
poor bonding with child
General principles of prescribing in pregnancy
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
What are risks of drugs in
1st trimester
3rd trimester
Breast feeding
1st trimester - teratogenicity
3rd trimester - neonatal withdrawal
Breastfeeding - excretion of drug into breast milk
Antidepressants are generally safe to use in pregnancy, true or false
TRUE
what is the 1st line group of anti depressants used
SSRIs - sertraline and fluoxetine
Which SSRI is avoided in pregnancy
Paroxetine
Tricyclics are generally safe to use, true or false
TRUE
Venlafaxine and mirtazapine are regarded as safe to use, true or false
FALSE, not enough evidence base
Which antipsychotics are generally used in pregnancy
Olanzapine and quetiapine
What are risks of atypical antipsychotics in pregnancy
weight gain and GDM
Which antipsychotic should be avoided
clozapine - agranulocytosis
What are the teratogenic effects of lithium
cardiac defects - Ebsteins anomaly
What are the teratogenic effects of Na valproate
NTD
craniofacial defects
impaired intellectual development
Carbamazepine should be avoided in pregnancy, why
risk of NTD, facial dysmorphism, fingernail hypoplasia
Lamotrigine is the less bad anticonvulsant, true or false
TRUE - but still avoid if possible
What drug class is 1st line for anxiety in pregnancy
Antidepressants - SSRIs
Benzodiazepines can be used in pregnancy, true or false
FALSE - try to avoid
What are the risks of benzodiazepines
cleft palate
floppy baby syndrome with use in 3rd trimester
Which drug should not be used at all in breast feeding
Lithium
What is associated with substance abuse in pregnancy
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
What are the guidelines for alcohol consumption during pregnancy
no alcohol should be consumed
what can alcohol cause in pregnancy
Miscarriage
foetal alcohol syndrome
withdrawal
Wernicke-Korsakoff’s
What are the harmful effects of cocaine, ectasy and amphetamines
death via stroke or arrhythmia
teratogenic: microcephaly, cardiac, genitourinary, limb defects
pre eclampsia
placental abruption
IUGR, SID, miscarriage, prematurity, withdrawal, neurodevelopmental delay
Harmful effects of opiates
maternal death neonatal withdrawal IUGR SID stillbirth
Harmful effects of nicotine
miscarriage abruption IUGR stillbirth SID
What is the management of pregnant women and substance abuse
consider methadone programme SOCIAL WORK child protection cervical smear history breastfeeding labour plan early IV access postnatal contraception - LARC
Contraindications to breast feeding
> 8 units alcohol a week
HIV+
cocaine misuse
lithium therapy
