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Reproductive & Sexual Health > Perinatal psychiatry > Flashcards

Perinatal psychiatry Flashcards

1
Q

What predicts maternal suicide?

A

Previous psychiatric disorder, other vulnerable factors, family history of BP disorder

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2
Q

Who should get urgent referral to a specialist perinatal mental health team?

A

Women who report;

  • recent significant change in mental state or emergence of new symptoms
  • new thoughts or acts of violent self harm
  • new and persistent expressions of incompentency as a mother or estrangement from their baby
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3
Q

When should admission to a mother and baby unit be considered?

A

If a woman has had any of the following;

  • rapidly changing mental state
  • suicidal ideation
  • significant estrangement from the infant
  • pervasive guilt or hopelessness
  • beliefs of inadequacy as a mother
  • evidence of psychosis
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4
Q

What are the risk factors for mental health issues?

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

What is the risk of relapse of bipolar disorder if untreated?

A

50% postnatally

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6
Q

What are the risks of eating disorders in pregnancy?

A
  • IUGR
  • prematurity
  • hypokalaemia
  • hyponatraemia
  • metabolic alkalosis
  • miscarriage
  • premature delivery
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7
Q

Who manages mild-moderate antenatal depression?

A

GP

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8
Q

What is the baby blues?

A

Experienced by 50% of women

Brief period of emotional instability

Tearful, irritable, anxiety, confusion and poor sleep

Usually day 3-10 after birth

Self limiting, support and reassure

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9
Q

What is the differential diagnosis of puerperal psychosis?

A
  • bipolar
  • unipolar depression
  • schizophrenia
  • organic brain dysfunciton (2ry to physical illness)
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10
Q

When does puerperal psychosis usually present?

A

within 2 weeks of delivery

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11
Q

What are the symptoms of puerperal psychosis?

A

Sleep disturbance & confusion, irrational ideas

Mania, delusions, hallucinations

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12
Q

What is the risk of suicide and infanticide in puerperal psychosis?

A

5% suicide risk

4% infanticide risk

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13
Q

What are the risk factors for puerperal psychosis?

A
  • bipolar disorder
  • previous puerperal psychosis
  • 1st degree relative with BP
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14
Q

What is the management of puerperal psychosis?

A

Emergency

Needs admission to mum and baby unit

Antiderpressants, antipsychotics, mood stabilisers and ECT

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15
Q

What percentage of mums with puerperal psychosis go on to develop bipolar disorder?

A

25%

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16
Q

How common is postnatal depression?

A

10% of women

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17
Q

What are the symptoms of post-natal depression?

A
  • tearfulness
  • irritability
  • anxiety
  • anhedonia
  • poor sleep
  • weight loss
  • can often present as concerns about baby
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18
Q

When does postnatal depression occur?

A

2-6 weeks postnatally, lasts weeks to months

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19
Q

What is the management for postnatal depression?

A
  • Mild-moderate: self-help, counselling
  • Moderate-severe: psychotherapy and antidepressants, admission?
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20
Q

What is the lifetime risk of depression after an episode of postnatal depression?

A

70%

21
Q

What issues should be considered in the treatment of perinatal disorders?

A
  1. risks of untreated illness- to mum and baby
  2. general principles of prescribing in perinatal period
  3. benefits and harms of specific treatment
22
Q

What are the risks of untreated depression to the child?

A
  • low birth weight
  • pre-term delivery
  • adverse childhood outcomes
    • emotional & conduct problems, ADHD
  • poor engagement/bonding with child
    • reduced infant learning and cognitive development
23
Q

What is the first line antidepressant in pregnancy?

A

SSRIs

  • sertraline has least placental exposure
  • fluoxetine is thought to be safest
24
Q

What are the risks of SSRI’s in pregnancy?

A
  • persistent hypertension of the newborn
  • lower birth weight
  • increased early birth (days)
  • post partum haemorrhage
25
Q

Why is paroxetine not used?

A

Least safe SSRI

Increased congenital cardiac malformations, less safe than others

26
Q

Describe the use of tricyclics in pregnancy

A

Don’t seem to cause major problems

May be some mild & self-limiting neonatal withdrawal

27
Q

Describe the use of venlafaxine in pregnancy

A

Less evidence

Cardiac defects and cleft palate, neonatal withdrawal

28
Q

What are the first and second generation antipsychotics?

A

1st- Chlorpromazine, Haloperidol

2nd- Olanzapine, quetiapine

29
Q

What are the risks of antipsychotics in pregnancy?

A

Gestational diabetes

30
Q

How do antipsychotics decrease fertility?

A

Raise prolactin levels

31
Q

Which antipsychotics are recommended in pregnancy?

A

Olanzapine and quetiapine

32
Q

What are the risks of bipolar affective disorder ?

A

Induction or C-section

Pre-term delivery

Small babies

33
Q

What are the best mood-stabilisers in pregnancy?

A

There is no safe mood stabiliser

Valproate and carbamazepine (most teratogenic) increase neural tube defects and should be avoided

Lamotrigine is less bad than other anti-convulsants

34
Q

What should be done if mum is on lithium pre-pregnancy?

A
  • Consider slow reduction preconception
  • can be reintroduced in 2nd or 3rd trimester
  • consider reintroduction post-partum
35
Q

What are the recommendations for treatment of bipolar affective disorder?

A

switch to a safer antipsychotic - Quetiapine

Increased monitoring if lithium is required

May need to consider ECT

36
Q

What is the first line medication in anxiety?

A

SSRIs

37
Q

Describe the use of benzodiazepines for anxiety in pregnancy?

A

Benzodiazepines

  • not major teratogens
  • 3rd trimester risk of floppy baby
  • generally thought to be problematic and to be avoided
38
Q

Which drugs are secreted in breast milk?

A

All psychotropics are excreted in breast milk

39
Q

Drugs with <__% relative infant dose (RID) are regarded as safe

A

Drugs with <10% relative infant dose (RID) are regarded as safe

40
Q

What are the priority of treatment in breastfeeding?

A
  • treatment of mental health is the highest priority, especially if relapse risk is high
  • lowest possible dose
  • avoid combinations of medications
  • time doses to feeds
    • give dose before longest break between feeds
  • there is LESS exposure during breast feeding than in utero so if a drug has been used in 3rd trimester then if is reasonably safe to continue to use it in breastfeeding
41
Q

What are the risks of substance abuse in pregnancy?

A
  • nutritional deficiency
  • HIV, Hep C, Hep B
  • VTE
  • STI
  • Endocarditis/sepsis
  • poor venous access
  • opiate tolerance/withdrawal
  • drug overdose/death
  • domestic abuse and suicide
  • IUGR, Stillbirth, SIDs, pre-term labour
42
Q

RCOG suggests abstinence from alcohol but no evidence than _ units/week is detreimental

A

2

43
Q

What are the risks of alcoholism in pregnancy?

A
  • miscarriage
  • foetal alcohol syndrome- facial deformities, Lower IQ, neurodevelopmental delay, epilepsy, hearing, heart and kidney defects
  • withdrawal
  • risk of wernnicke’s encepahlopathy- 20% die (B1 deficiency)
  • korsakoff syndrome - permanent
44
Q

How do mums die from cocaine, amphetamines and ecstasy?

A

Death via steoke and arrhythmias

45
Q

What are the risks with cocaine, amphetamines and ecstasy?

A
  • teratogenic (microcephaly, cardiac, genitourinary, limb defects)
  • pre-eclampsia
  • abruption
  • IUGR
  • pre-term labour
  • miscarriage
  • developmental delay, SIDS, withdrawal
46
Q

What do opiates cause?

A

Maternal deaths, neonatal withdrawal, IUGR, SIDS, stillbirth

47
Q

What does nicotine cause?

A

Miscarriages, abruption, IUGR, stillbirths and SIDS

48
Q

Describe antenatal care in substance abuse?

A
  • consider methadone programme
  • child protection and social work referral
  • smear history
  • breastfeeding (not if alcohol >8, HIV, cocaine)
  • labour plan re analgesia and labour ward delivery
  • early IV access
  • postnatal contraception plan

Reproductive & Sexual Health (54 decks)

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