Psychiatric disorders and substance abuse Flashcards
half suicides occur when
up to 12 weeks post natally
mental illness is a leading cause of what in the uk
maternal death
principles of treatment
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
anxiety disorders - what should be avoided and why
benzos - sedation in baby, cleft, neonatal withdrawal
BPD in how many women
risk of episode post natally
risk of what
when is the baby affected
1%
50% without rx
suicide
genetic risk 1/7
anti convulsants for BPD valproate SE
neural tube defects craniofacial defects CV abnormality IUGR reduced IQ cleft genitourinary anomalities
BPD carbamazepine SE
facial dysmorphism cardiac anomalities fingernail hyperplasia NTD Vit k deificieny - haemorrhagic disease of the newborn
Lamotrigine (safest one) SE for BPD
SJS if breast feeding - rare
BPD lithium SE
contraindicated in what
switch to what if on TCA
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
schiz in how many women
risk of schiz to child
1%
10%
treatment of schiz in preg
anti psychotics are safe
mostly topical ones used
what should babies be observed for in anti psychotics
they are all sedating drugs so
lethargy, sedation, and appropriate developmental milestones
clozapine contra indicated in what and why
breast feeding
life threatening events in baby
olanzapine has an increased risk of what
extra pyramidal reactions in breast fed baby
anticholinergic drugs safe?
not in preg
eating disorders BN
anorexia
risks
1%
0.2%
IUGR, prematurity, hypokalaemia, hyponatraemia, met alk, miscarriage, premature delivery
mild - mod depression
mod-severe
psychological treatment
pharmacological
venlafaxine for depression
causes hypertension
paroxtetine for depression
cardiac abnormalities
SSRIs in depression
use with caution after 20 weeks may lead to pulmonary hypertension in child
TCA and SSRI in breast milk can lead to what
sedation
use low dose
what do all anti depressants carry a risk of
withdrawel or toxicity in neonates which is usually self limiting and mild
which are safer for an overdose SSRI or TCAs
SSRIs
post natal depression how many women
onset
mild-mod
mod-severe
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
baby blues how many women
when
50%
days 3-10 and it is self limiting
usually due to hormone surges
puerperal psychosis when symptoms how many women cx risk factors for it ddx
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
PPS management
admission
antidepressants anti psychotics, mood stabilisers, ECT
80% 10 yr recurrence rate
25% develop bpd
how many women have alcohol dependancy
how many have illicit drug dependance
- 7%
2. 2%
alcoholism risks
miscarriage facial deformaties, lower IW, neurodevelopment delay, epilepsy, heart and kidney defects, hearing withdrawel wenickes encephalopathy korsakoff syndrome
cocaine, amphetamine, ecstasy
lead to death via what
risks
stroke and arrhythmias
teratogenic PET abruption IUGR PTL miscarriage developmental delay, withdrawel
what do opiates cause
maternal deaths 1-2% neonatal withdrawal IUGR SIDS stillbirth
what does nicotine cause
miscarriage abruption IUGR stillbirths SIDs
substance abuse in preg managemetn
methadone programme
child protection and social services
smear hhx
breastfeeding but not if alcohol >8units/week, HIV, cocaine
