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Psychiatry pro +1700 > Pre and post natal > Flashcards

Pre and post natal Flashcards

1
Q

What percent of pregnant women will meet criteria for a MDE during pregnancy?

A

14-23%

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2
Q

What percent of women have some symptoms of a MDE postpartum?

A

50%

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3
Q

What percent of women have some type of mood disturbance postpartum?

A

85%

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4
Q

True or false: antenatal or postpartum depression increases the likelihood of a later MDE

A

True

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5
Q

More or less education is a risk factor for postpartum depression?

A

Less

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6
Q

Increased or decreased physical symptoms with pregnancy is a risk factor for postpartum depression?

A

Increased

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7
Q

True or false: a distant h/o depression is a risk factor for postpartum depression

A

True

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8
Q

What are the “baby blues”?

A

Mood disorder that presents within the first few days after delivery, and usually resolves within 2 weeks

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9
Q

What is the incidence of baby blues?

A

50-85% of women

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10
Q

What are the s/sx of baby blues? (4)

A
  • Mood lability
  • Tearfulness
  • Anxiety
  • Irritability
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11
Q

What is the duration of baby blues?

A

Peak on 4th-5th day, and last from a few hours, to a few days

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12
Q

True or false: the baby blues in and of themselves are not a disorder

A

True

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13
Q

When is evaluation for baby blues needed?

A

If longer than 2 weeks

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14
Q

When does postpartum depression begin?

A

Usually emerges 2-3 months postpartum, but must occur within 4 weeks of delivery

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15
Q

True or false: postpartum depression is clinically indistinguishable from depression at other times

A

True

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16
Q

What is the depression scale for postpartum depression?

A

Edinburgh postnatal depression scale

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17
Q

What is the correlation between serum levels of hormones with postpartum depression?

A

There is none

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18
Q

True or false: postpartum anxiety is equally common as postpartum depression

A

True

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19
Q

What are the anxiety disorders that can appear postpartum? (4)

A
  • GAD (adequacy of parenting)
  • Panic attacks
  • Hypochondriasis
  • OCD (thoughts of harming baby)
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20
Q

Who in particular is worried about parenting skills?

A

Those who had bad childhood experiences with their parents

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21
Q

Why are panic attacks more common during pregnancy? (2)

A
  • Hotter than usual during pregnancy–may predispose to panic attacks
  • Baby kicks and hyperfocus on body
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22
Q

What is the common presentation of OCD in new mothers?

A

Involves thoughts of harming the baby

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23
Q

True or false: excessive thoughts of harming a baby in the postpartum period is common

A

True

24
Q

What is postpartum psychosis?

A

Typically a mixed or manic episode as part of a bipolar illness

25
Q

When do s/sx of postpartum psychosis usually begin?

A

2-3 days or within 2 weeks

26
Q

What percent of women who develop postpartum psychosis have no psych history?

A

50%

27
Q

What are the three major initial symptoms of postpartum psychosis?

A
  • Restlessness
  • Irritability
  • Insomnia
28
Q

What are the later s/sx of symptoms of postpartum psychosis? (4)

A
  • Rapidly confusing or shifting depressed or elated mood
  • Confusion
  • Erratic behavior
  • Delusions or hallucinations
29
Q

What is the major concern with postpartum psychosis?

A

Risks for suicide and infanticide are high

30
Q

What four things must be judged to assess for postpartum psychosis?

A
  • Judgement
  • Reality testing
  • Anger control
  • Intent
31
Q

What is the way to talk about the thoughts of harming infants (if not psychotic)?

A
  • High stress–normal

- “Thoughts are not behavior”

32
Q

What are the risks to the baby of untreated depression during pregnancy?

A
  • Preterm
  • Low birth weight
  • SMGA
33
Q

What is the best predictor of long term neurocognitive outcomes with maternal depression?

A

Maternal mood–not medication exposure

34
Q

What are the primary treatments for intrapartum depression? (2)

A
  • Interpersonal psychotherapy

- CBT

35
Q

What is the pharmacotherapy for intrapartum depression?

A

SSRIs

36
Q

True or false: medication risks are similar to untreated depression during pregnancy

A

True

37
Q

What are the fetal abnormalities with SSRIs?

A

Septal heart defects

38
Q

True or false: there is an elevated risk of miscarriage with SSRIs

A

True?

39
Q

True or false: there is not a risk of preterm birth with SSRIs intrapartum

A

False

40
Q

What is the SSRI of choice for pregnant women? Which is contraindicated?

A
  • Sertraline is good

- Paroxetine is bad

41
Q

What is the role of SNRIs in pregnancy?

A

Not used, but not studied enough

42
Q

What are the s/sx of the SSRI use in the neonate? (6)

A
  • Restlessness
  • Tremor
  • Rigidity
  • Tachypnea
  • Hypoglycemia
  • Szs
43
Q

What is the treatment for pregnant women with mild to moderate depression?

A

Therapy

44
Q

What is the treatment for pregnant women with severe depression?

A

Meds

45
Q

What is the treatment for pregnant women with bipolar disorder?

A

Medications–really need to control it

46
Q

What should be done with pregnancy if a woman is already on an SSRI? Why?

A

Take their preference into account

-6x increase in depression relapse if taken off

47
Q

If a woman is on an SSRI that is not recommended in pregnancy, should she switch to one that is more studied in pregnancy?

A

No–leads to possible increased switching.

Unless she asks to change

48
Q

What are the bipolar drugs that have a high risk of teratogenic effects?

A

Tegretol (carbamazepine) and depakote (valproic acid)

49
Q

What is the safest bipolar drug in pregnancy?

A

Li

50
Q

What is the major risk of valproic acid in pregnancy?

A

autism or congenital malformations (ASDs, cleft palate)

51
Q

What are the risks of untreated postpartum depression? (3)

A
  • Less mother-child bonding
  • Poorer mental and motor development at 1 yr
  • Insecurity / behavioral disturbance
52
Q

What are the most common complications in modern obstetrics?

A

Postpartum depression

53
Q

Why are depressive symptoms common postpartum?

A

Very high expectations and demands

54
Q

The safest medication to treat depression while breastfeeding is what?

A

Whatever medication is likely to get the woman well

55
Q

True or false: postpartum depression is highly resistant to treatment

A

False

56
Q

Why is postpartum depression / anxiety underreported?

A

Shame around being depressed, or anxious thoughts

Psychiatry pro +1700 (28 decks)

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