Perinatal Psychiatry Flashcards
what are the ‘pinks’ and when do they occur
first 48 hours post partum - excitememt euphoria
patient is usually mildly insomniac and overtalkative
what are the ‘baby blues’
physical and emotional exhaustion combined with hormonal changes leading to emotional lability, tearfulness, mild anxiety and irritability
when do the baby blues occur
days 3-10 postpartum
when is the mean peak of the baby blues
peaks at day 5
how long do baby blues typically last for
48 hours
do you treat baby blues
no
what are the prevalence of baby blues
50-80%
how does a depressive illness typically present around the time of birth
peaks 2-4 weeks postpartum, with a secondary peak around 3 months after
what is the prognosis of post-partum depression
2/3 resolve in 2-3 months with proper treatment
without treatment, it is 6+ months
what is the treatment for postpartum depression
same as any other depression
what are some risk factors for postpartum depression and how much do they affect the chances
previous history of depression or postpartum depression
50% risk of further postnatal illness
what is the prevalence of postpartum psychosis
0.2%
when does postpartum psychosis typically present
50% by day 7
75% by day 16
95% by day 90
what proportion of postpartum psychosis patients are bipolar or schizoaffective psychoses
99% `
what are some risk factors for post partum mania and by what percentage do they modulate the risk
previous history
current bipolar
50%
what is the prognosis of postpartum psychosis
good short term prognosis but has some significant morbidity and mortality
generally requires admission to mother and baby unit
when is psychiatric admission highest, before or after childbirth
after
What should be done if a pregnant patient has: schizophrenia bipolar disorder postpartum psychosis severe depression
or a family history of bipolar/schizoaffective disorder AND a personal history of any psychiatric disorder
All women place on a mood stabilizer
birth plan must be in place before 35 weeks, including:
MSE immediately after delivery
a requirement for mental health professional liason
prophylactic medication where appropriate
consider child protection
emergency contact details
what are complications of depression around childbirth
impaired bonding neglect of baby/infanticide suicide development of bipolar citalopram and fluoxetine are found in breastmild
what antidepressants are recommended for breastfeeding mothers
paroxetine and fluoxetine
complications of psychosis around childbirth
suicide
infantcide
antipsychotics found in breast milk
lack of evidence base for effective treatment
child should be screened for developmental milestones if mother is on antipsychotics
what antipsychotic is best for breastfeeding mothers
olanzipine - but this still is detected
