Pregnancy Flashcards
What are the types of parental attachment are there?
- Secure - Parent responds sensitively - 55-65%
- Insecure Anxious/Resistant - Parent responds intrusively or erratically - 8-10%
- Insecure Avoidant - Parent responds punitively - 10-15%
- Disorganised - Parent is chaotic or frightening - 10-27%
What should you ask about in psychiatric issues related to pregnancy?
- Why this baby?
- Relationship between symptoms and pregnancy
- Baseline functioning
- Traumatic birth
- Adverse childhood events/experience of being parented
- Bonding issues
- Psychosexual history
- Impulsivity
- Psych history
How long does it take for postpartum psychosis to occur?
Rapid onset following pregnancy - within 2 weeks
What are the risk factors for postpartum psychosis?
- Live childbirth
- Medication
- History of relationship with menstrual cycle
- Instability of mood
- Psychiatric illness - schizophrenia, bipolar type I, schizoaffective disorder
- Previous postpartum psychosis
What are the risk factors for postnatal depression?
- Biological
- Higher levels of oxytocin in mid-pregnancy
- Younger age
- Psychosocial
- Unemployed
- Childhood - attachment with own parents, childhood abuse
- Pregnancy - wanted/fertility treatment, previous pregnancy loss, social support
- Personality - perfectionist
What alternative diagnosis should be considered instead of postpartum psychosis or postnatal depression?
- Baby blues - 50-80% of women
- Psychiatric illness - first presentation precipitated by pregnancy
- Organic condition - brought on by stress of pregnancy
What are the specific features of maternal OCD?
- Thoughts/images of them or others harming their child
- Thoughts/images of child being harmed by accident - e.g. dropping their baby or baby drowning in the bath
What are the perinatal red flags for mental illness?
- Recent significant changes 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 the infant
Which mood stabiliser is contra-indicated in all girls/women of child-bearing age?
Sodium valproate - teratogenic
What is the management plan for a pregnant lady on a mood stabiliser?
- Folic Acid (5mg) - preconception until end of 1st trimester
- Lithium is still recommended
- Referral to a perinatal psychiatrist + pre-birth planning/meeting
Which psychiatric drugs can interfere with lactation?
- Dopamine and histamine centred drugs
- Aripirazole and Promethazine
