Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Perinatal Psychiatry > Flashcards

Perinatal Psychiatry Flashcards

1
Q

What is the leading cause of death in the UK?

A

Mental illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When do half of suicides occur?

A

Up to 12 weeks postnatally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How common are mental health-related deaths after pregnancy?

A

Almost 1/3 women who die between 6 weeks and 1 year after pregnancy died of mental health related causes = 18% due to suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What presentations need an urgent referral to specialist perinatal health team?

A

Recent significant change in mental health or emergence of new symptoms
New thoughts or acts of violent self harm
new and persistent expressions of incompetency as a mother or estrangement from their baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What presentations who need admission to a mother and baby unit?

A

Rapidly changing mental state or suicidal ideation
Significant estrangement from child
Beliefs of inadequacy as mother
Pervasive guilt/hopelessness or evidence of psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risk factors for mental health issues during or after pregnancy?

A

Young or single, domestic issues, lack support, substance abuse, unplanned/unwanted pregnancy, pre-existing mental health problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What symptoms should you refer to the psychiatry team?

A

Psychosis, suicidal, self neglect/harm,

severe anxiety/depression or symptoms with significant interference with daily functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What features in a past medical history should you refer to the psychiatry team?

A

History of puerperal psychosis, bipolar or schizophrenia

Psychotropic medications or previous in-patient admission to mental health unit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should you refer to the psychiatry team?

A

If developed moderate mental illness in late pregnancy or early postpartum
Mild/moderate mental illness but first degree relative with bipolar or puerperal psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Is pregnancy protective against mental illness?

A

No = doesn’t tend to offer protective benefit, eating disorders may improve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does pregnancy affect bipolar disorder?

A

High rate of relapse postnatally = 50% if untreated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the complications associated with eating disorders during pregnancy?

A

IUGR, prematurity, hypokalaemia, hyponatraemia, metabolic alkalosis, miscarriage, premature delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does pregnancy affect antenatal depression?

A

68% relapse is the stop medication during pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the baby blues?

A

Brief period of emotional instability = self, limiting, occurs from days 3-10 after pregnancy, affects 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the symptoms and management for the baby blues?

A 
Symptoms = tearful, irritable, poor sleep, confusion
Management = support and reassurance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the differentials of puerperal psychosis?

A

Bipolar episode, unipolar depression, schizophrenia, organic brain dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When does puerperal psychosis tend to present?

A

Within 2 weeks of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the symptoms of puerperal psychosis?

A

Sleep disturbance, confusion and irrational ideas

Leads to mania, delusions, hallucinations and confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How common is puerperal psychosis?

A

Occurs in 0.1% of women = carries 5% risk of suicide and 4% risk of infanticide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk factors for puerperal psychosis?

A

Bipolar disorder, previous puerperal psychosis (50%), first degree relative with history of bipolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is puerperal psychosis managed?

A

Emergency = needs admission to mother-baby unit

Antidepressants, antipsychotics, mood stabilisers, ECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can women who suffer from puerperal psychosis go on to develop?

A

25% go on to develop bipolar disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How common is post-natal depression?

A

10% of women = 1/3 last a year or more, screened for routinely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When is the usual onset of postnatal depression?

A

2-6 weeks postnatally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the symptoms of postnatal depression?

A

Tearfulness, irritable, anxiety, lack of enjoyment, poor sleep, weight loss, may present as being concerned about baby

26
Q

What can postnatal depression have an effect on?

A

Bonding, child development, marriage and suicide risk

27
Q

How is postnatal depression treated?

A 
Mild-moderate = self help and counselling
Moderate-severe = psychotherapy and antidepressants
28
Q

What is the prognosis of postnatal depression?

A

25% recurrence and 70% lifetime risk of depression

29
Q

What are the risk posed to the child by maternal mental illness?

A

Low birth weight, preterm delivery, adverse childhood outcomes, poor engagement/bonding with child

30
Q

What should be done when prescribing in the perinatal period?

A

Preferentially use drugs with low risk to mother/foetus
Lowest dose monotherapy and increase screening
Encourage breastfeeding

31
Q

Does stopping a known teratogenic drug after pregnancy is confirmed remove the risk?

A

No = may not remove risks of foetal malformations

32
Q

What are the first line antidepressants?

A

SSRIs = sertraline has least placental exposure but fluoxetine thought to be safest

33
Q

What are the risks of using antidepressants during pregnancy?

A

Persistent hypertension of newborn, lower birth weight, increased early birth, post partum haemorrhage

34
Q

What SSRI should be avoided during pregnancy?

A

Paroxetine = may cause congenital cardiac malformations, less safe than other SSRIs

35
Q

Can tricyclic antidepressants be used during pregnancy?

A

Yes = don’t seem to cause major problems, may cause some mild and self limiting neonatal withdrawal

36
Q

What foetal abnormalities is venlafaxine associated with?

A

cardiac defects, cleft palate and neonatal withdrawal

37
Q

What are some examples of antipsychotics?

A

1st generation = chlorpromazine, haloperidol

2nd generation = olanzapine, quetiapine

38
Q

What are the risks of using antipsychotics during pregnancy?

A

Risk of gestational diabetes = especially 2nd gen

Reduce fertility due to raised prolactin levels

39
Q

What can clozapine cause in the foetus when taken during pregnancy?

A

Agranulocytosis

40
Q

When is there high risk of relapse of bipolar disorder?

A

After delivery is mood stabilisers stopped = especially in first month postpartum

41
Q

What are the risks of bipolar disorder during pregnancy?

A

Induction or C-section, preterm delivery, small babies

42
Q

What are some features of using mood stabilisers during pregnancy?

A

Carbamazepine most teratogenic
Avoid valproate and carbamazepine = neural tube defects
Lamotrigine is less bad

43
Q

Why should lithium be avoided during pregnancy?

A

Associated with Ebstein’s abnormality

44
Q

How should women taking lithium have their medication stopped?

A

Consider slow reduction preconception = may reintroduce in 2nd or 3rd trimester or immediately postpartum

45
Q

How high is the relapse rate of bipolar disorder after lithium is stopped?

A

Up to 70% after discontinuation

46
Q

How should women who were taking lithium before becoming pregnant managed?

A

Regular ECHO and enhanced US scans

47
Q

What is the first line treatment for anxiety?

A

Antidepressants = use SSRIs

48
Q

What are some treatments for anxiety that should be avoided during pregnancy?

A

Benzodiazepines = 3rd trimester risk of floppy baby

Zopiclone has some suggestion of risk

49
Q

Are psychotropics usually excreted in breastmilk?

A

Yes = drugs with <10% relative infant dose (RID) considered safe

50
Q

How should drugs be prescribed during breastfeeding?

A

Lowest possible dose and give dose before longest break in feeding

51
Q

If a drug was used in the 3rd trimester, should it be safe to use when breastfeeding?

A

Yes = less exposure during breastfeeding than in utero

52
Q

What is an example of a drug secreted into breastmilk?

A

Lithium

53
Q

What is substance abuse?

A

Mental and behavioural disorder = associated with depression, anxiety and personality disorders

54
Q

What are the complications of substance abuse?

A

Nutritional deficiency, HIV, hep B and C, VTE, STIs, sepsis, endocarditis, opiate tolerance/withdrawal, OD, IUGR, SIDs, stillbirth, preterm labour, increased risk of domestic abuse and suicide

55
Q

What are the risks associated with alcoholism during pregnancy?

A

Miscarriage, Wernicke’s encephalopathy (20%), foetal alcohol syndrome

56
Q

What are some features of foetal alcohol syndrome?

A

Facial deformities, lower IQ, neurodevelopmental delay, epilepsy, heart and kidney defects

57
Q

What are the risks associated with cocaine, amphetamine and ecstasy use during pregnancy?

A

Death due to stroke or arrhythmia
Pre-eclampsia, abruption, IUGR, preterm labour, miscarriage, withdrawal, SIDS, developmental delay
Teratogenic = microencephaly, limb/cardiac defects

58
Q

What are the risk associated with opiate use during pregnancy?

A

Maternal deaths (1-2%), neonatal withdrawal, IUGR, SIDS and stillbirth

59
Q

What are the risks associated with nicotine use during pregnancy?

A

Miscarriage, abruption, IUGR, stillbirths, SIDS

60
Q

What antenatal care is given to those suffering from substance abuse?

A

Methadone programme and social work referral

Child protection, smear history and early IV access

61
Q

When would breastfeeding be contraindicated in someone with substance abuse issues?

A

If HIV positive, using cocaine of alcohol >8

Reproduction (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions