Postpartum MH Flashcards

1
Q

What is postnatal depression?

A

development of a depressive illness following childbirth (within 1y)

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2
Q

Epidemiology of postnatal depression

A

~10% women

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3
Q

6 Risk factors for postnatal depression

A

Hx MH problems.
Psychological disturbance during pregnancy.
Poor social support.
Poor relationship with partner.
Baby blues.
Recent major life events.

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4
Q

Give 6 symptoms of postnatal depression

A

Low mood.
Loss of enjoyment + pleasure.
Low energy levels.

Difficulty bonding with baby
Withdrawal from social contacts
Thoughts of harming baby

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5
Q

What tool can be used to screen for pregnancy/ postnatal depression?

A

Edinburgh postnatal depression scale
indicates how the mother has felt over the previous week
>13 indicates depressive illness

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6
Q

What is management for sub-threshold depressive symptoms, or mild depression postnatally?

A

Self-guided help

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7
Q

What is management for women with a history of severe depression presenting with depressive symptoms?

A

TCA or SSRI

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8
Q

What is the management for moderate or severe postnatal depression?

A

High-intensity psychological intervention (e.g. CBT)

TCA, SSRI or (S)NRI if preference for meds/ declines psychological intervention

If severe: admit to mother + baby unit

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9
Q

What SSRIs should be used in the postnatal period?

A

Sertraline
Paroxetine

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10
Q

Which SSRIs should be avoided in the postnatal period?

A

Fluoxetine (due to long half life)

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11
Q

What are baby blues?

A

Emotional lability, low mood, tearfulness + anxiety
Occurs within 2w of birth
Often recover promptly

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12
Q

What is management of baby blues?

A

Reassurance + support

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13
Q

Epidemiology of baby blues

A

60-70% women
More common in primips

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14
Q

What is puerperal psychosis?

A

Psychosis often with mania +/or depressive Sx manifesting within days to 2-3w of birth

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15
Q

What causes puerperal psychosis?

A

May be linked to hormonal changes, causing chemical imbalances in brain

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16
Q

What is the risk of recurrence of puerperal psychosis?

A

1 in 2
(50%)

17
Q

Give 3 symptoms of puerperal psychosis

A

Severe mood swings

Hallucinations

Delusions e.g. baby is possessed

18
Q

Epidemiology of puerperal psychosis

A

0.1%
(1 in 1000)

19
Q

Give 4 risk factors for puerperal psychosis

A

Hx of puerperal psychosis
Type I Bipolar disorder
Schizoaffective disorder
FH puerperal psychosis

20
Q

What is management of puerperal psychosis?

A

Admit to mother + baby unit
Benzos for agitation (Lorzaepam)
Antipsychotics: Olanzapine (Lithium if NOT breastfeeding)

Referral to Children + Families Social Service

21
Q

What is the prognosis of puerperal psychosis?

A

Most recover in 6-12w

22
Q

What is the management for a woman taking Lithium for Bipolar disorder who has become pregnant?

A

Stop Lithium gradually over 4w
Switch to an antipsychotic- Haloperidol, Risperidone

23
Q

Are antipsychotics safe in pregnancy?

A

Antipsychotics are safe in pregnancy (except clozapine)

24
Q

What are the risks of taking Lithium during pregnancy and postpartum?

A

Ebstein’s anomaly
Lithium highly expressed in breast milk

25
Q

What monitoring is required for bipolar women during pregnancy?

A

More frequent- every 4w
Weekly from 36w

26
Q

What are pregnant women with bipolar disorder at higher risk of?

A

Puerperal psychosis
Postnatal depression
Relapse