Psychiatric disorders and substance abuse in pregnancy Flashcards
screening for mental health issues
- risk factors?
- 3 screening questions used at every appointment?
- what should be asked about in Hx?
-young/single/domestic issues/lack support/substance abuse/unplanned/unwanted preg/pre-existing mental illness
-last month have you felt down, depressed or hopeless?
in the last month have you been bothered by having little interest in doing things
is it something you feel you need or want help with?
-symptoms, PMH, FH, Meds, substance misuse
Psychiatric disorders in pregnancy what should be considered in terms of: -medication? -monitering? -capacity?
-consider stopping/changing meds or lowering dose
discuss toxicology issues
- plan monitoring and support throughout
- make contingency plans- advanced directive incase capacity becomes compromised
When should you refer an expectant women/women planning pregnancy to psychiatry?
Psychosis
Severe anxiety, depression, suicidal, self neglect, self harm
signifisctn interference with daily functioning
Hx bipolar/schitzophrenia/puerperal psychosis
Psychotropic meds
if moderate mental illness in late pregnancy
mild- moderate illness but 1st degree relative with bipolar o puerperal psychosis
prev inpatient on mental health unit
Anxiety disorders
- features?
- predicts what?
- what drugs should be avoided?
-Pervasive/episodic fear, avoidance and autonomic arousal
often with depression
phobias, OCD, PTSD
-Avoid benzos (cleft, neonatal withdrawal)
Bipolar disorder -when most at risk of an episode? -risk to baby? what are the SE to the foetus with the following drugs? Valproate?(8) Carbamazepine? (5) Lamotrigine? (2) Lithium? ( -what should mothers be in to reduce effects? -which is considered safest? -what is lithium contraindicated in?
- postnatally
- 1 in 7
-Valproate
neural tube defects, craniofacial defects, CV abnormality, IUGR, Reduced IQ, cleft, genitourinary abnormalities
Carbamazepine
facial dysmorphia, cardiac abnormalities, fingernail hyperplasia, vit K def and haemorrhagic disease of the newborn
Lamotrigine
cleft palate, Steven Johnson syndrome to baby if breast fed
Lithium
cardiac abnormalities, maternal toxicity, Epstein’s anomaly, neonatal hypotonia, hypothyroidism, hypoglycaemia
- 5mg folic acid
- lamotrigine
- breast feeding
Schizophrenia
- what is the risk of schizophrenia to child?
- give the SE of atypical antipsychotics?
- what typical antipsychotics can be used in pregnancy?
- which are contraindicated in breast feeding?
- what drugs used for extrapyramidal SE should not be used in pregnancy?
- 10%
- clozapine, olanzapine, risperidone, quetiapine cause GDM, IUGR
- Haloperidol & chlorpromazine
- Clozapine, Olanzapine
- Anti-cholinergics
Eating disorders
- risk to foetus during pregnancy?
- effect on disorder?
- IUGR, prematurity, Hypokalaemia, hyponatraemia, Metabolic alkalosis, miscarriage, prematurity
- tend to improve
Anti-depressant medication
- which are contra-indicated?
- SSRIs?
- TCAs?
-Venlafaxine (hypertension)
Paroxtetine (cardiac abnormalities)
-use with caution after 20 wks
present in breast milk (citalopram & fluoxetine at high levels) sertraline ok
-also present in breastmilk, amitriptyline, nortryptiline safe in preg and ok for breast feeding
Postnatal depression
-when does to occur and what symptoms?
onset 2-6 weeks postnatally, can last weeks to months
-tearfulness, irritability, anxiety, lack of enjoyment, poor sleep, weight loss, can present as concerns re. baby
effects on bonding, child development, marriage, suicide risk
Baby blues
-what is it? when?
brief period of emotional instability, tearful, irritable, anxiety and poor sleep
day 3-10, self limiting
Puerperal psychosis
- presents when and how?
- risk factors?
- treatment?
-within 2 wks of delivery
sleep disturbance, confusion and irrational ideas leading to mania, delusions, hallucinations, confusion
-bipolar, prev puerperal psychosis, 1st degree relative with hx
-Emergency!!
admit to specialised unit an give antidepressants, antipsychotics, mood stabilisers and ECT
Substance abuse in pregnancy
- What are the association conditions in mother?
- in foetus
-mental illness
nutritional def
HIV, HepC, HepB, VTE, STIs, Endocarditis, sepsis, opiate tolerance/withdrawl, overdose & death, domestic abuse,
-IUGR, Stillbirth, SIDs, PTD
Alcoholism
- risks to baby?
- To mother?
-risk of miscarriage
Foetal alcohol syndrome
(facial deformity, lower ID, neurodevelopment delay, epilepsy, hearing, heart and kidney defects)
Withdrawl
-Wernicke’s encephelopathy
Korsakoff syndrome
Coacaine, amphetamine, ecstasy
- SE of mother?
- SE for baby?
-death via stroke, arrhythmia,
-teratogenic PET abruption IUGR PTl Miscarriage developmental delay, SIDS, withdrawal
opiates cause what?
maternal death, neonatal withdrawal, IUGR, SIDS, stillbirth
Nicotine causes miscarriages, IUGR, stillbirths and SIDS
