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Repro > Psychiatric disorders and substance abuse > Flashcards

Psychiatric disorders and substance abuse Flashcards

1
Q

half suicides occur when

A

up to 12 weeks post natally

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2
Q

mental illness is a leading cause of what in the uk

A

maternal death

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3
Q

principles of treatment

A

drugs with low risk to bother mother and fetus
lowest dose monotherapy to avoid depot
encourage breast feeding whenever possible
increase screening of fetas-cardio and growth

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4
Q

anxiety disorders - what should be avoided and why

A

benzos - sedation in baby, cleft, neonatal withdrawal

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5
Q

BPD in how many women
risk of episode post natally
risk of what
when is the baby affected

A

1%
50% without rx
suicide
genetic risk 1/7

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6
Q

anti convulsants for BPD valproate SE

A 
neural tube defects 
craniofacial defects
CV abnormality 
IUGR
reduced IQ
cleft
genitourinary anomalities
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7
Q

BPD carbamazepine SE

A 
facial dysmorphism 
cardiac anomalities
fingernail hyperplasia 
NTD
Vit k deificieny - haemorrhagic disease of the newborn
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8
Q

Lamotrigine (safest one) SE for BPD

A

SJS if breast feeding - rare

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9
Q

BPD lithium SE
contraindicated in what
switch to what if on TCA

A

cardiac abnormalities, maternal toxicity, ebsteins anomaly, neonatal hypotonia, hypothyroidism, hypoglycaemia

in breast feeing

in preg should be stopped gradually

if on TCA switch to SSRIs
also start on SSRIs

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10
Q

schiz in how many women

risk of schiz to child

A

1%

10%

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11
Q

treatment of schiz in preg

A

anti psychotics are safe

mostly topical ones used

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12
Q

what should babies be observed for in anti psychotics

A

they are all sedating drugs so

lethargy, sedation, and appropriate developmental milestones

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13
Q

clozapine contra indicated in what and why

A

breast feeding

life threatening events in baby

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14
Q

olanzapine has an increased risk of what

A

extra pyramidal reactions in breast fed baby

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15
Q

anticholinergic drugs safe?

A

not in preg

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16
Q

eating disorders BN
anorexia
risks

A

1%
0.2%
IUGR, prematurity, hypokalaemia, hyponatraemia, met alk, miscarriage, premature delivery

17
Q

mild - mod depression

mod-severe

A

psychological treatment

pharmacological

18
Q

venlafaxine for depression

A

causes hypertension

19
Q

paroxtetine for depression

A

cardiac abnormalities

20
Q

SSRIs in depression

A

use with caution after 20 weeks may lead to pulmonary hypertension in child

21
Q

TCA and SSRI in breast milk can lead to what

A

sedation

use low dose

22
Q

what do all anti depressants carry a risk of

A

withdrawel or toxicity in neonates which is usually self limiting and mild

23
Q

which are safer for an overdose SSRI or TCAs

A

SSRIs

24
Q

post natal depression how many women
onset
mild-mod
mod-severe

A

10%. 1/3 lasts more than 1 yr
2-6 weeks postnatally, lasts weeks to months

self help, counselling

psychotherapy/anti depressants/admission

25% risk of reoccurrence
70& life time risk of depression

25
Q

baby blues how many women

when

A

50%
days 3-10 and it is self limiting
usually due to hormone surges

26
Q 
puerperal psychosis when 
symptoms 
how many women 
cx
risk factors for it 
ddx
A

within 2 weeks of delivery

sleep disturbance, confusion, irrational ideas
mania, delusions, hallucinations, confusion

0.1%

5% suicide risk and 4% infanticide

bipolar (50%), previous puerperal psychosis, 1st degree relative

bpd, depression, schiz, organic brain dysfunction

27
Q

PPS management

A

admission
antidepressants anti psychotics, mood stabilisers, ECT

80% 10 yr recurrence rate
25% develop bpd

28
Q

how many women have alcohol dependancy

how many have illicit drug dependance

A
  1. 7%

2. 2%

29
Q

alcoholism risks

A 
miscarriage 
facial deformaties, lower IW, neurodevelopment delay, epilepsy, heart and kidney defects, hearing 
withdrawel 
wenickes encephalopathy
korsakoff syndrome
30
Q

cocaine, amphetamine, ecstasy
lead to death via what

risks

A

stroke and arrhythmias

teratogenic 
PET
abruption
IUGR
PTL
miscarriage 
developmental delay, withdrawel
31
Q

what do opiates cause

A 
maternal deaths 1-2%
neonatal withdrawal
IUGR
SIDS
stillbirth
32
Q

what does nicotine cause

A 
miscarriage 
abruption 
IUGR
stillbirths
SIDs
33
Q

substance abuse in preg managemetn

A

methadone programme
child protection and social services
smear hhx
breastfeeding but not if alcohol >8units/week, HIV, cocaine

Repro (56 decks)

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