Psychiatric Disorders in Pregnancy Flashcards
List some risk factors for mental illness in pregnant women
Young female Single mother Domestic issues Lack of support Substance misuse Unplanned pregnancy Pre-existing mental illness
When should a pregnant patient be referred to psychiatry?
Psychosis Severe anxiety/depression/suicidal/self-harm History of bipolar/schizophrenia History of puerperal psychosis If on psychiatric medication
What is the principle of psychiatric medication treatment in pregnancy?
Low dose monotherapy, taken at increased frequency if need be
When should a foetal anomaly scan be carried out in someone pregnant and on psychiatric medication?
16 weeks
Breastfeeding should be encouraged whenever possible in psychiatric pregnant patients. True/False?
True
Unless drug toxicity/contraindication
Why should benzodiazepines be avoided in pregnancy?
Cause cleft and neonatal withdrawal
What is the risk of a baby developing bipolar disorder if a mother has it and is not on treatment?
50%
What foetal defects can sodium valproate cause?
Neural tube defects Craniofacial defects IUGR Reduced IQ Cleft
Which mood stabiliser/anticonvulsant is considered safest to use in pregnancy?
Lamotrigine
What effects does carbamazepine have on a foetus?
Vitamin K deficiency
Haemorrhagic disease of newborn
It is normally ok to breastfeed if you are on an anticonvulsant. True/False?
True
What foetal defect can lithium cause?
Ebstein’s anomaly
Is lithium contraindicated in breastfeeding?
Yes
Which antipsychotics - typical or atypical - are generally safe to use in pregnancy?
Typicals
Which antipsychotic is contraindicated in pregnancy because of its liability to induce life-threatening events in an infant?
Clozapine
Can anticholinergic drugs be used in pregnancy?
No
Which antidepressant can cause cardiac abnormalities in an infant?
Paroxetine
All antidepressants can cause withdrawal and toxicity in neonates. True/False?
True
Usually self-limiting though
When does postnatal depression typically onset?
2-6 weeks postnatally
List clinical features of postnatal depression
Anxiety, tearfulness
Lack of enjoyment
Poor sleep
Concerns re baby
How does postnatal depression differ from “baby blues”?
Baby blues is more brief and self-limiting
List clinical features of puerperal psychosis
Sleep disturbance Confusion Delusions, hallucinations Irrational ideas Mania
Puerperal psychosis is an emergency. True/False?
True
Needs urgent admission to mother-baby unit
List features of foetal alcoholic syndrome
Facial deformity Lower IQ Neurodevelopmental delay Epilepsy Hearing defect Cardiac + renal defects
What should be considered management-wise if substance abuse is occurring in pregnancy?
Methadone programmes
Social work/child protection
Labour planning
Postnatal plan
