PSYCHIATRIC DISORDERS (AB) Flashcards by Shiela Micah Gascon

What physiological changes contribute to psychiatric disorders in pregnancy?

Shifts in sex steroid and monoamine neurotransmitter levels, HPA axis dysfunction, thyroid dysfunction, immune response alterations

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What does SAD-DAS stand for?

Schizophrenia - Dopamine, Anxiety, Depression - Serotonin

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What percentage of women develop a nonpsychotic postpartum depressive disorder within 6 months of delivery?

Up to 15 percent

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When does maternity blues usually peak and normalize?

Peaks on the 4th or 5th postpartum day and normalizes by day 10

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What are the signs of postnatal depression?

Feeling anxious, exhausted, empty and teary, worrying about baby, scared of being alone, trouble sleeping, very low mood

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What behaviors indicate possible postpartum depression?

Staying in room, not eating, not bathing or combing hair, feeling of loneliness/nothingness

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What is a red flag for suicide in postpartum depression?

Giving away things, saying ‘I want to disappear’, looking well suddenly

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What are the signs of maternity blues?

Emotional lability, insomnia, weepiness, depression, poor concentration, irritability

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What is the management of maternity blues?

Supportive care, being present, focusing on the mother, close monitoring

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When should perinatal screening be done?

At least once during perinatal period and during postpartum

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Who are considered high-risk for perinatal psychiatric disorders?

History of abuse, illicit substance use, personality disorder, smoking, obesity, eating disorders

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Which questions in EPDS are scored normally and which are reverse scored?

Q1,2,4 scored 0-3; Q3,5-10 reverse scored 3-0

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What EPDS score indicates possible depression?

10 or greater

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Which EPDS item is critical for detecting suicidal thoughts?

Item 10

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What is the focus of treatment considerations in perinatal psychiatric disorders?

Maternal and infant safety

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What are the pregnancy outcomes associated with psychiatric disorders?

Preterm birth, low birthweight, perinatal mortality, PTSD, domestic abuse

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What manual is used to classify psychiatric disorders?

DSM-5

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What are the types of depressive disorders?

Major depression, manic depression (bipolar), dysthymia

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What are common symptoms of major depression?

Hopelessness, sadness, guilt, irritability, fatigue, insomnia, appetite change, thoughts of suicide

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How can pregnancy affect depression?

Hormonal changes can precipitate or exacerbate depressive tendencies

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What is the prevalence of antenatal depression?

0.11

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What percentage of women develop postpartum depression?

10 to 20 percent

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What is the recurrence rate for postpartum depression?

Up to 70%

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What increases the risk for major depression postpartum?

Prior puerperal depression and current maternity blues

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What are risk factors for postpartum depressive symptoms?

Young age, antenatal depression, unmarried status, smoking, NICU babies, stressors

What are the consequences of untreated postpartum depression?

Suicide, insecure attachment, behavioral problems in children

What is the treatment for mild to moderate depression?

CBT and light to moderate exercise

What is the treatment for moderate to severe depression?

Antidepressants and psychotherapy

What is first-line pharmacologic treatment for severe depression?

SSRIs such as Sertraline

How long should antidepressant medication be continued if effective?

Minimum of 6 months

What are common SSRIs used in pregnancy?

Citalopram, sertraline, fluoxetine, paroxetine

What adverse effects are linked to SSRIs in pregnancy?

Heart defects, neonatal withdrawal, pulmonary hypertension

What are examples of non-SSRI antidepressants?

Bupropion, duloxetine, nefazodone, venlafaxine

What are examples of tricyclic antidepressants?

Amitriptyline, desipramine, doxepin, imipramine, nortriptyline

Are tricyclic antidepressants teratogenic?

No evidence of teratogenicity, but not commonly used

What are examples of typical antipsychotics?

Chlorpromazine, fluphenazine, haloperidol, thiothixene

What are examples of atypical antipsychotics?

Aripiprazole, clozapine, olanzapine, risperidone, ziprasidone

What is a side effect of lithium in pregnancy?

Ebstein anomaly (cardiac defect)

What is the teratogenic risk of valproic acid?

Neural-tube defects

What syndrome is associated with carbamazepine?

Hydantoin syndrome

What fetal defect is associated with paroxetine?

Ventricular septal defect

What condition may SSRIs after 20 weeks gestation cause?

Persistent pulmonary hypertension of the newborn

What is brexanolone?

FDA-approved treatment for postpartum depression, an allopregnanolone analogue

What is the proposed mechanism behind brexanolone’s effect?

Failure of GABA-A receptors to adapt to postpartum hormone changes

When is ECT used in pregnancy?

For severe depression unresponsive to medication, safe in 1st trimester

What precautions are taken before ECT?

Fasting, antacid, airway protection, IV line, cardiotocogram, right hip wedge

Why is a wedge placed under the right hip in pregnancy during ECT?

To prevent aortocaval compression and maternal hypotension

What should be monitored in postpartum psychiatric cases?

Suicidal thoughts, psychosis, therapy response

What is a primary cause of death during the perinatal period?

Self-harm

What is the prevalence of manic-depression illness?

0.044000000000000004

Which chromosomes are possibly linked to manic-depression illness?

Chromosomes 16 and 8

What is the risk that monozygotic twins are both affected by bipolar disorder?

40 to 70%

What is the risk for first-degree relatives to have bipolar disorder?

5 to 10%

How is mania described in terms of mood?

Abnormally raised, expansive, or irritable

What are some potential organic causes of mania?

Substance abuse, hyperthyroidism, CNS tumors

What are adverse perinatal outcomes associated with bipolar disorder in pregnancy?

Preterm birth, severe postpartum relapses

When do women with a tendency to mania present with exacerbations postpartum?

Earlier in the postpartum period

What is the management approach for bipolar disorder in pregnancy?

Co-managed with Psychiatry, mood stabilizers

Which medication for bipolar disorder is linked to Ebstein anomaly?

Lithium

What fetal assessment is recommended for lithium-exposed fetuses?

Fetal 2D echo during mid-pregnancy

Which mood stabilizer is associated with a higher chance of fetal defects?

Valproic acid

Which medications are preferred over valproic acid for lower fetal defect risks?

Lamotrigine or levetiracetam

What is postpartum psychosis usually associated with?

Bipolar disorder or major depression

What is the incidence of postpartum psychosis?

1:1000 deliveries

In which group is postpartum psychosis more common?

Nulliparous women with obstetrical complications

What is the recurrence risk of postpartum psychosis?

10 to 15-fold; 50% in the next pregnancy

When does postpartum psychosis usually manifest?

Within 2 weeks of delivery, usually 1-2 days after

What is the median duration of postpartum psychosis?

40 days

What are manic symptoms seen in postpartum psychosis?

Excitement, energy, talkativeness, insomnia, confusion, disorientation

What is the management for postpartum psychosis?

Immediate lithium therapy, hospitalization, pharmacological treatment, psychiatric care

What extreme risk should be monitored in postpartum psychosis?

Infanticide

What is the prevalence of anxiety disorders in childbearing-aged women?

High

What are anxiety disorders in pregnancy associated with?

Preterm birth, fetal-growth restriction, poor neurobehavioral development, ADHD

What is the first-line treatment for anxiety disorders in pregnancy?

Psychotherapy and SSRIs at the lowest therapeutic dose

What is a potential neonatal risk with benzodiazepine use in the third trimester?

Neonatal withdrawal syndrome

What domains define schizophrenia spectrum disorders?

Delusions, hallucinations, disorganized thinking, abnormal motor behavior, negative symptoms

What is the mnemonic for types of schizophrenia?

CUPDR

What symptoms are associated with paranoid schizophrenia?

Hallucinations and/or delusions

What is characteristic of disorganized schizophrenia?

Disorganized speech and behavior

What characterizes catatonic schizophrenia?

Psychomotor abnormalities and behavioral dysregulation

What is seen in undifferentiated schizophrenia?

Lack of emotional depth, simple ideation

What is residual schizophrenia?

Recovery phase with fading symptoms

What is the risk of schizophrenia if one parent is affected?

5 to 10%

Which syndrome is associated with schizophrenia?

Velocardiofacial syndrome

At what age do signs of schizophrenia typically begin?

Around 20 years

What is advised regarding therapy for schizophrenia in pregnancy?

Continued therapy

Which antipsychotics are used for schizophrenia in pregnancy?

Typical and atypical antipsychotics

Which atypical antipsychotics can cause blood dyscrasia?

Clozapine and Olanzapine

Which maternal complications are increased in schizophrenia?

Placental abruption, vague fetal distress

What behavior characterizes bulimia nervosa?

Binge eating followed by purging or excessive fasting

What are DSM-5 diagnostic criteria for bulimia nervosa?

Binge eating with loss of control and compensatory behavior at least once a week for 3 months

What characterizes anorexia nervosa?

Refusal to maintain normal body weight

What are DSM-5 diagnostic criteria for anorexia nervosa?

Restricted intake, intense fear of weight gain, distorted body image

What risks does anorexia nervosa pose in pregnancy?

Low birthweight, small head circumference, small-for-gestational-age newborns, poor wound healing, breastfeeding difficulties

What is the cornerstone of eating disorder treatment?

Psychological treatment, especially CBT

How is anorexia nervosa treated?

Motivational interaction with meal planning

Which drugs are included in substance-related disorders?

Caffeine, tobacco, cannabis, hallucinogens, opioids, anxiolytics, stimulants

What is the risk of excessive caffeine intake during pregnancy?

Can cause abortion

What are the fetal risks of substance use in pregnancy?

Fetal-growth restriction, low birthweight

What are the 3 clusters of personality disorders?

Cluster A: odd/eccentric, Cluster B: dramatic/erratic, Cluster C: anxious/fearful

What disorders are in Cluster A?

Paranoid, schizoid, schizotypal

What disorders are in Cluster B?

Antisocial, borderline, histrionic, narcissistic

What disorders are in Cluster C?

Avoidant, dependent, obsessive-compulsive

How are personality disorders characterized?

Chronic use of maladaptive coping mechanisms

What is a pregnancy-related concern for women with borderline personality disorder?

Higher risk for adolescent and unintended pregnancies

When is a mother’s ability to care for her newborn impaired in personality disorder?

When coupled with depression