Perinatal Psychiatry Flashcards
What percentage of women who suffer a perinatal psychiatric condition have pre-exisiting mental health problems?
2/3
What are the red flags in the perinatal period?
Recent significant change in mental state 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
What symptoms would warrant admission in a perinatal patient?
Rapidly changing mental state Suicidal ideation Significant estrangement from the infant Pervasive guilt/hopelessness Beliefs of inadequacy Evidence of psychosis
What questions can help to determine the mental state of a new mum?
Do you have feelings/thoughts which you have never had before?
Are you experiencing thoughts of suicide or harming yourself?
Are you feeling incompetent as thought you can’t cope or estranged from your baby?
Do you feel you are getting worse?
State the screening questions for pregnant women’s mental health
Have you been feeling down, depressed, hopeless?
Have you had little interest in doing things?
Is this something you feel you want/need help with?
What is the rate of relapse of bipolar during/after pregnancy?
50%
What are the risks of an eating disorder?
IUGR, prematurity, hypokalaemia, metabolic alkalosis, miscarriage, premature delivery
What are baby blues and how many women experience them?
50% women - brief period of emotional instability
Tearful, irritable, anxiety, poor sleep and confusion
Day 3-10 self limiting
Support and reassure
When and how will puerperal psychosis present?
Two weeks post delivery
Early symptoms - sleep disturbance, confusion, irrational ideas
Progression - mania, delusions, hallucinations, confusion
What are the risk factors for puerperal psychosis?
Bipolar
Previous episode (50%)
1st degree relative with bipolar
How is puerperal psychosis managed?
Same day psychiatric assessment - emergency
When and how does post natal depression present?
10% women, onset 2-6 weeks
Tearful, irritable, anxiety, lack of enjoyment, poor sleep, weight loss, concerns re. baby
How is post natal depression managed?
Mild-moderate - self help
Moderate - severe - psychiatry
What are the risks to the baby if mental health is left untreated?
Low birth weight
Pre-term delivery
Adverse childhood outcomes
Poor engagement
What medication is used first line for depression?
SSRIs - best evidence and not thought to be teratogenic
Which SSRIs should/should not be used?
Sertraline and fluoxetine (best) should be used
Paroxetine should not be used due to risk of malformation
What can tricyclics cause?
Self limiting neonatal withdrawal
Which antipsychotics can be used and which have the best evidence?
1st gen - chlorpromazine and haloperidol
2nd gen - olanzapine and quetiapine (best evidence)
What are the risks of anti-psychotics?
Gestational diabetes (particularly 2nd gen) Reduced fertility due to raised prolactin
State the risk associated with bipolar disease?
Induction/C-section
Pre-term
Small babies
What mood stabilisers must not be used?
Valproate
Carbamazepine
Which mood stabiliser seems fairly safe?
Lamotrigine
What can Lithium cause?
Ebstein’s anomaly
What is the relapse rate in patients with bipolar who come off lithium?
70% - consider reducing dose, changing in third trimester or just coming off for 1st trimester
When can lithium definitely not be used?
Breastfeeding
State the side effect of benzodiazepines?
3rd Trimester ‘floppy baby’
What drugs are safe to use in anxiety?
SSRIs
Name the effects of alcohol misuse in pregnancy
Foetal Alcohol Syndrome
Withdrawal
Wernicke’s encephalopathy (20% mortality)
Korsakoff
Describe foetal alcohol syndrome
Facial deformities, lower QI, neurodevelopment delay, epilepsy, heart and kidney defects
What are the risks of cocaine/ectasy/amphetamine?
Death via stroke and arrhythmias
Teratogenic, pre-eclampsia, abruption, IUGR, preterm, miscarriage, SIDS, developmental delay
Describe the effect of opiate consumption during pregnancy
Maternal death, neonatal withdrawal, IUGR, SIDS, stillbirth,
What can nicotine do if taken during pregnancy?
Miscarriage, abruption, IUGR, stillbirth, SIDS
State three breastfeeding contraindications
Alcohol >8
HIV
Cocaine
How are women with substance abuse generally managed?
Consider methadone, social work referral, smear history, labour plan, early IV access, contraception
