Psychiatry in Pregnancy Flashcards
Are children of depressed mothers more likely to be SGA or macrocosmic?
SGA
When should meds be considered being stopped?
Only if having no positive effect
Consider changing
What is the most important step in management?
Prep
- plan pregnancy
- if high risk of postnatal conditions - discuss
- if stopped lithium in pregnancy discuss restarting
The best drug at the beginning of the pregnancy is the same best drug throughout. T/F?
F - best drug varies throughout trimesters
What is the first line antidepressants in pregnancy?
Still SSRIs
Fluoxetine
Sertraline
Antipsychotics are bad in pregnancy. T/F?
F - v.little risk
esp. olanzapine
Just gestational diabetes risk in second gen.
What anti-epeletic/mood stabiliser MUST be avoided?
What is the time frame in which it causes problems?
Sodium valproate
By 28 days - neural` tubes are closed by then
Should lithium be avoided in pregnany? Why?
Yes - but can be given just needs additional monitoring
Can cause Ebstein’s anomaly
Why are benzos avoided in later pregnancy?
Have sedation affect - “floppy baby”
Is there more or less drug exposure in uterus or breastmilk?
What is the one exception?
Breastmilk has less exposure - typically if drug used in 3rd trimester safe in breastfeeding
Lithium - more concentrated in breastmilk must be AVOIDED
Baby is born with low nasal bridge, smooth philtrum, small eyes, small head and thin upper lip. What is this baby at risk of, which is cause of death in 20% of kids with same condition?
Wernick’s encephalopathy
Foetal alcohol syndrome
Is female suicide more frequent postnatally?
No but more emotive
What are red flag symptoms of suicide in mothers?
- Signficiant change in mental state
- Violent self harm
- Estrangement from baby (useless or no feelings towards baby)
Would you refer a woman with diagnosed bipolar and stable with meds to perinatal mental health team?
Yes - high risk factors
Bipolar meds could be teratogenic
Good to plan with perinatal mental health team
Also refer anyone who has had previous episodes of anet/postnatal illness
50% of women have baby blues. How long does it last?
Day 3-10
Normal hormonal reaction Tearful Irritable Anxious Poor sleep and concentration
What is puerperal psychosis?
When does it occur?
How is it managed?
Psychosis and CONFUSION post birth
Within a couple of weeks
Emergency and have to be admitted to mother-baby unit (emergency due to increased suicide and infanticide risk)
At what time does postnatal depression occur and how long does it last?
How many mothers are affected? More common than general pop?
10% - same as general pop - just tends to be worse than normal depression
Onset 2-6wks
Can last weeks to months
