Psychiatric disorders and substance abus in pregnancy

Question 1

what are the three screening questions for mental health issues in pregnancy?

Answer 1

• during the past month have you been bothered about feeling down/depressed/hopeless?
• during last month have you been bothered by having little interest/pleasure in doing things?
• is there something you feel you need or want help with?

Question 2

What warrants a psych team referral during pregnancy? 8

Answer 2

• psychosis
• hx bipolar/puerperal psychosis
• psychotropic medications
• severe anxiety/depression/suicide/self-neglect/self har
• sx signif. interefering with daily functioning
• mod. mental illness in late preg./early post-partum
• mild-mod illness but 1st degree relative with bipolar/puerperal psychosis
• previous in pt admission to mental health unit

Question 3

What anxiety drug is avoided in pregnancy?

Answer 3

Benzodiazepines: cleft lip/neonatal withdrawal

Question 4

Bipolar affective disorder:

-sodium valproate risks in pregnancy

Answer 4

NTD
Craniofacial defects
IUGR
decreased IQ
Cleft palate
GU abnormalities

Question 5

Bipolar affective disorder:

-Carbamazepine risks in pregnancy

Answer 5

• Cleft palate
• vit K deficiency: haemorrhagic disease of the newborn
• cardiac abnormalities
• fingernail hypoplasia
• facial dysmorphism

Question 6

Bipolar affective disorder:

-Lamotrigine risks in pregnancy

Answer 6

-Cleft palate
-steven-johnson syndrome if baby is breast fed
(stevens Johnson syndrome is a severe and sometimes fatal form of erythema multiforme)

Question 7

If continuing anti-convulsants:

• can you breast feed?
• what supplement is needed to be taken?

Answer 7

• can breastfeed: s/e is rare

- folic acid 5mg

Question 8

Lithium:

• what should be done with this drug?
• what are the risks?
• can you breast feed?

Answer 8

• Gradually decrease dose gradually: use SSRI’s to keep dose low, if use TCA can switch to mania)
• risks: cardiac abnorm, risk maternal toxicity, neonatal hypotonia/hypothyroidism/hypoglycaemia
• no breastfeeding

Question 9

Are typical and atypical antipsychotics considered safe in pregnancy? what is looked for in the baby after birth? are they safe in breastfeeding?

Answer 9

yes
-atypical can cause GDM/IUGR

Look for lethargy, sedation, approp. development milestones (as antipsych have long T1/2)

Breastfeeding:

• clozepine increases risk of extrapyramidal reactions in breast fed babies
• Clozapine contraindicated in breast feeding

Question 10

Can anticholinergic drugs for extrapyramidal side effects be used in pregnancy?

Answer 10

no

Question 11

What is the risk of venlafaxine in pregnancy?

Answer 11

hypertension

Question 12

What is the risk of paroxetine in pregnancy?

Answer 12

cardiac abnormalities

Question 13

Can you breast feed with citalopram and fluoxetine?

Answer 13

no

Question 14

Can you breast feed with sertraline?

Answer 14

yes

Question 15

Are TCAs safe in pregnancy? can you breast feed

Answer 15

Safe and yes

Question 16

Postnatal depression:

• when does this usually occur?
• what is the treatment?

Answer 16

Occurs: 2-6wks post natal

Treatment: mild/mod = self help and counselling, mod/severe = psychotherapy and adepressants

Question 17

Baby blues:

• is this common?
• when does this occur and what is seen?
• treatment?

Answer 17

Yes - 50% women

Days 3-10, self limiting brief period of emotional instability
-tearfulness, irritability, anxiety, poor sleep, confusion

Treatment: reassurance

Question 18

Puerperal psychosis

• is this serious?
• when does this onset?
• what are the symptoms?

Answer 18

EMERGENCY

Onset: within 2 weeks

Sx: sleep disturbance, confusion, irritationak ideas, mania, delusions, hallucinations

Question 19

Puerperal psychosis:

• risk factors
• treatment
• prognosis

Answer 19

Risk factors:

• bipolar 50%
• previous puerperal psychosis
• first degree relative with Hx

Treatment:

• admission to mother and baby unit
• adepressant/apsychotics/mood stabilisers/ECT

Prognosis:

• 80% 10yr recurrence
• 10% bipolar risk