Problems after childbirth

Question 1

PN depression Ix

Answer 1

Edinburgh PN depression scale

Question 2

PN depression Mx

Answer 2

Same as normal but caution breastfeeding
SSRIs recommended are sertraline and paroxetine
Low dose amitriptyline probably safe
Avoid lithium if possible
Hospital admission for severe or suicidal/infanticidal ideation (mother and baby unit, avoid separation if poss)
Most women respond within 1m
Early treatment important (attachment)

Question 3

PACES PND

Answer 3

?admission
Home treatment by health visitor
Dx occurs due to hormone change (up to 1:10 women)
Address concerns and support
Psych Rx: CBT
Med Rx: sertraline safe w/bf
Prognosis: most recover within 1m
PN community mental health team involvment

Question 4

Peurperal psychosis

Answer 4

May need antipsych, antidep, Li
?BZ for agitation
?ECT in severe (can be life saving, tends to respond well)
Admission usually req. ideally to MBU
Most pts recover after 6-12wks
NB. Suicide leading cause of maternal mortality in first year after pregnancy (caution depressive delusions and behaviour w/baby)

Question 5

PACES peuperal psychosis

Answer 5

ADMIT
explain link to hormone changes causing brain imbalance
Rx: antipsych
Explain necessary to keep safe in MBU
Recovery 6-12wks
30% risk recurrence

Question 6

Bipolar disorder in pregnancy

Answer 6

NOT Li to pregnant/trying women (unless antipsych ineffective)
If taking Li and becomes pregnant consider stopping gradually over 4wks ?switch to antipsych (safe except clozapine)
Risks: foetal malform. (heart esp. Ebsteins), Li may be highly expressed in milk
Monitoring
- every 4wks, weekly from w36
Ensure birth in hospital
NB. antipsychs can reduce fertility bc hyperprolactinaemia

Question 7

Learning disability prevention

Answer 7

Education (risk of alcohol in pregnancy)
Improved AN/PN care
Genetic counselling
Early detection of reversible causes eg PKU

Question 8

Learning disability Mx

Answer 8

Treat physical and psych comorb
Educational support
Psych therapy:
- counselling, group  therapy, modified CBT
ABC (antecedent, behaviour, consequence)
Practical support
Prognosis:
lifelong, life expectancy reduced (physical illness and unmet health needs) very vulnerable, behaviour change may be way of communicating stress