Psychiatry in Pregnancy Flashcards
When should someone be urgently referred to the perinatal mental health team?
recent significant change in mental state or emergance of new symptoms
new thoughts of violence or acts of self harm
new and persistant expressions of incompetency as a mother or estrangment from their baby
When should someone be admitted to the mother and baby unit?
rapidly changing mental state sucidal ideation significant estrangement from the baby guilt or hopelessness beliefs of inadequacey as a mother evidence of psychosis
When can admission to the mother and baby unit be arranged?
before the baby is born or after
What mental health questions should be asked at every appointment?
during the last month have you been bothered by feeling down, depressed or hopeless?
during the last month have you ever been bothered by having little interest or pleasure in doing things?
is there something you feel or want help with
How does biopolar react to pregnancy?
50% relapse rate
How do eating disorders react to pregnancy?
may improve
What are some risks of those with eating disorders being pregnant?
IUGR prematurity hypokalaemia, hyponatreamia metabolic alkalosis miscarriage premature delivery
How does pre existing depression react to pregnancy?
68% relapse if medication stopped in pregnancy
How is mild-moderate depression managed?
GP led
How is severe depression managed?
refer to psychiatry
What are baby blues?
50% of women
brief period of emotional instability
How long should baby blues last?
3-10 days - self limiting
How do baby blues present?
tearful irritable anxiety confusion poor sleep
What is puerperal psychosis?
affects 0.1% of women but 5% suicide risk, 4% infanticide
How does puerperal psychosis present?
early = sleep disturbance, confusion, irrational ideas late = mania, delusions, hallucinations and confusion
How should a mother with puerperal psychosis be treated?
emergency admission to the mother and baby unit antidepressants antipyschotics mood stabalisers ECT
What type of follow up is usual for those with puerperal psychosis?
80% 10 yr reccurance
25% go on to develop bipolar
How does post natal depression present?
tearfulness irritability anxiety lack of enjoyment poor sleep weight loss concerns about baby
How common is post natal depression?
10% of women
70% life time depression risk
When does post natal depression come on?
2-6 weeks post natally
How long does post natal depression last?
weeks -> months
How do you treat mild/moderate post natal depression?
self help
counselling
How do you treat severe post natal depression?
pyschotherapy and antidepressants
maybe admit
What is the main risk with presribing in the 1st trimester?
teratogenicity
What is the main risk with presribing in the 3rd trimester?
risk of neonatal withdrawal - whatever the mum is on the baby is too
What is the safest antidepressant?
fluoxetine
Which SSRI leads to the least placental exposure?
sertraline
What affect can Paroxetine have on the baby?
increased congenital cardiac malforamtions
What general risks can SSRIs have on pregnancy?
persistant hypertension of the new born
lower birth weight
increased early birth
post partum haemorrhage
What antipsychotics are best for pregnancy?
olanzapine and quetiapine - 2nd gens
What antipsychotic should never be given in pregnancy?
clozapine - due to agranulocytosis
What side effects do 2nd gen antipyshcotics have?
gestational diabetes
reduced fertility due to raised prolactin
Can you breastfeed on lithium?
NO
What problems can lithium cause to the baby?
ebsteins anomaly - cardiac malformation
How should lithium be managed around pregnancy?
slowly reduced pre conception
immediately restarted post partum
What type of drugs are safe to be given during breastfeeding?
drugs with a <10% relative infant dose
Are antipsychotics excreted in breast milk?
YES
What is foetal alcohol syndrome?
facial deformities lower IQ neurodevelopmental delay epilepsy hearing, heart + kidney defects
Over what alcohol limit can you NOT breastfeed?
8 units a week
What affects can cocaine, amphetamine and ecstasy have on pregnancy?
death via stroke and arrythmias tetarogenic - microcephaly, cardiac, GU, limb defects PET abruption IUGR pre term labour miscarriage developmental delay and withdrawal
How does nicotine affect pregnancy?
miscarriages abruption IUGR stillbirths SIDS -cot death
How do opiates affect pregnancy?
1-2% of maternal deaths neonatal withdrawal IUGR SIDs stillbirth
