Psychiatry Flashcards
what is the leading cause of maternal deaths occurring within a year after the end of pregnancy
Suicide
what are red flag presentations needing an urgent referral to specialist perinatal mental health team
recent significant change in mental state or emergence of new symptoms
new thoughts or acts of violent self harm
new and persistent expressions of incompetence as a mother or estrangement from their baby
when would you consider admission to a mother and baby psychiatric unit
rapidly changing mental state suicidal ideation significant estrangement from infant pervasive guilt or hopelessness beliefs of inadequacy as a mother evidence of psychosis
questions to ask a mother who may have mental health difficulties
do you have new feelings and thoughts which you have never had before, which make you disturbed or anxious?
are you experiencing thoughts of suicide or harming yourself?
are you feeling incompetent as though you can’t cope or estranged from your baby? are these feelings persistent?
do you feel you are getting worse?
when are mental health issues screened for
booking appointment
EVERY antenatal appointment
how does pregnancy effect pre-existing mental health problems
high rate of relapse for bipolar postnatally
eating disorders often improve in pregnancy (if not risks of IUGR, prematurity etc)
depression often gets worse in pregnancy as mothers want to stop meds. Only stop if v mild and refer for psychological treatment.
what are ‘baby blues’
50% of women
brief period of emotional instability
tearful, irritable, anxiety and poor sleep confusion
day 3-10 - self limiting
need support and reassurance
what causes puerperal psychosis
bipolar, depression, schizophrenia, organic brain dysfunction
what is peurperal psychosis
emergency - needs admission to mother and baby unit
usually presents within 2 weeks of delivery
early symptoms are sleep disturbance and confusion, irrational ideas
mania, delusions, hallucinations and confusion
5% suicide risk
4% infanticide
what is post natal depression
tearfulness, irritable, anxiety, lack of enjoyment, poor sleep, weight loss - can present as concerns re baby
onset 2-6 weeks postnatally - lasts weeks to months
effects on bonding, child development, marriage, risk of suicide
what issues need to be considered in the treatment of perinatal disorders
risks of untreated illness (to mum and baby)
general principles of prescribing in perinatal period
benefits and harms of specific treatments
what risks are there to the baby in untreated depression
Low birth weight
-depends on severity
Pre-term delivery
-depends on severity
Adverse childhood outcomes
-emotional and conduct problems
Poor engagement/bonding with child
-reduced infant learning and cognitive development
general principles of psychiatric prescribing in pregnancy
- try to plan pregnancy
- decisions personal to patient
- discuss toxicology issues
- consider stopping meds, changing meds or lowering dose
- plan (antenatal monitoring and support, contingency plan, place of delivery, postnatal management)
use drugs with low risk lowest dose possible be aware of altered pharmacokinetics increased screening of fetus encourage breast feeding
what do you do if a woman falls pregnant on lithium or sodium valproate
dont stop it
refer to obstetrics asap
what are first line antidepressants used in pregnancy
SSRIs
no major teratogens
