Psychiatric disorders in pregnancy & postpartum Flashcards
what are the symptoms of baby blues? when do they peak?
- mood lability
- tearfulness
- anxiety
- irritability
- peak 4th or 5th day postpartum
how long do the baby blues last?
few hours to a few days
when do baby blues symptoms warrant evaluation?
longer than 2 weeks
when does postpartum depression emerge? when must it occur if peripartum specifier is used?
- 2-3 months postpartum
- within 4 weeks
what is the gold standard for evaluating for postpartum depression?
edinburgh postnatal depression scale
what disorders can occur with postpartum anxiety?
- GAD
- panic attacks
- OCD
- hypochondriasis
what is the onset for postpartum psychosis? what are the features / symptoms?
- symptoms start 2-3 days postpartum
- usually within 2 weeks
- manic / mixed episode (not shizophrenia)
- rapidly shifting depressed or elated mood
- confusion
- erratic or disorganized behavior
- delusional beliefs
- auditory command hallucinations
thoughts of harming their baby is common in women with what overlying disorder?
anxiety / OCD / both
what do you need to assess in depressed mothers?
- judgment
- reality testing
- anger control
- intent
what is a good long term predictor of neurocognitive outcome?
maternal mood (better than medication exposure)
in pregnant women with untreated depression there is an elevated risk of ____________
- preterm delivery
- low birth weight
- small for gestational age / reduced body and head growth
what is the go-to option for depression during pregnancy treatment?
psychotherapy (interpersonal)
what are the most commonly prescribed medications during pregnancy?
SSRIs
when should you consider medication treatment during pregnancy?
- if depression is mild-moderate and the woman would like to try therapy alone, this is reasonable
- if depression is severe, the woman has not responded to therapy or prefers to avoid it, consider medication
- BPAD and psychosis suggest medication
what is important in determining medicating pregnant women with depression?
patient preference
what should you do for a pregnant woman who comes in already on medication?
- avoid changing to a “safer” medication
- may change if original medication is not working
- may change prior to conception unless there are multiple failed trials of other medications
what is the most difficult condition to treat during pregnancy?
BPAD
what is the safest medication to take for a pregnant woman with BPAD?
lithium (still risks, but lower than depakote)
what can result in a child to a mother with untreated postpartum depression?
attachment issues
what is the best drug to use during breastfeeding for women with postpartum depression?
whichever one is most likely to get the woman well (based on past medical history, family history)
