Psychiatry in Pregnancy Flashcards

1
Q

When should someone be urgently referred to the perinatal mental health team?

A

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

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2
Q

When should someone be admitted to the mother and baby unit?

A
rapidly changing mental state
sucidal ideation
significant estrangement from the baby
guilt or hopelessness
beliefs of inadequacey as a mother
evidence of psychosis
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3
Q

When can admission to the mother and baby unit be arranged?

A

before the baby is born or after

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4
Q

What mental health questions should be asked at every appointment?

A

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

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5
Q

How does biopolar react to pregnancy?

A

50% relapse rate

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6
Q

How do eating disorders react to pregnancy?

A

may improve

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7
Q

What are some risks of those with eating disorders being pregnant?

A
IUGR
prematurity
hypokalaemia, hyponatreamia
metabolic alkalosis
miscarriage
premature delivery
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8
Q

How does pre existing depression react to pregnancy?

A

68% relapse if medication stopped in pregnancy

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9
Q

How is mild-moderate depression managed?

A

GP led

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10
Q

How is severe depression managed?

A

refer to psychiatry

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11
Q

What are baby blues?

A

50% of women

brief period of emotional instability

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12
Q

How long should baby blues last?

A

3-10 days - self limiting

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13
Q

How do baby blues present?

A
tearful
irritable
anxiety
confusion
poor sleep
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14
Q

What is puerperal psychosis?

A

affects 0.1% of women but 5% suicide risk, 4% infanticide

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15
Q

How does puerperal psychosis present?

A
early = sleep disturbance, confusion, irrational ideas
late = mania, delusions, hallucinations and confusion
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16
Q

How should a mother with puerperal psychosis be treated?

A
emergency admission to the mother and baby unit
antidepressants
antipyschotics
mood stabalisers 
ECT
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17
Q

What type of follow up is usual for those with puerperal psychosis?

A

80% 10 yr reccurance

25% go on to develop bipolar

18
Q

How does post natal depression present?

A
tearfulness
irritability
anxiety
lack of enjoyment
poor sleep
weight loss
concerns about baby
19
Q

How common is post natal depression?

A

10% of women

70% life time depression risk

20
Q

When does post natal depression come on?

A

2-6 weeks post natally

21
Q

How long does post natal depression last?

A

weeks -> months

22
Q

How do you treat mild/moderate post natal depression?

A

self help

counselling

23
Q

How do you treat severe post natal depression?

A

pyschotherapy and antidepressants

maybe admit

24
Q

What is the main risk with presribing in the 1st trimester?

A

teratogenicity

25
Q

What is the main risk with presribing in the 3rd trimester?

A

risk of neonatal withdrawal - whatever the mum is on the baby is too

26
Q

What is the safest antidepressant?

A

fluoxetine

27
Q

Which SSRI leads to the least placental exposure?

A

sertraline

28
Q

What affect can Paroxetine have on the baby?

A

increased congenital cardiac malforamtions

29
Q

What general risks can SSRIs have on pregnancy?

A

persistant hypertension of the new born
lower birth weight
increased early birth
post partum haemorrhage

30
Q

What antipsychotics are best for pregnancy?

A

olanzapine and quetiapine - 2nd gens

31
Q

What antipsychotic should never be given in pregnancy?

A

clozapine - due to agranulocytosis

32
Q

What side effects do 2nd gen antipyshcotics have?

A

gestational diabetes

reduced fertility due to raised prolactin

33
Q

Can you breastfeed on lithium?

A

NO

34
Q

What problems can lithium cause to the baby?

A

ebsteins anomaly - cardiac malformation

35
Q

How should lithium be managed around pregnancy?

A

slowly reduced pre conception

immediately restarted post partum

36
Q

What type of drugs are safe to be given during breastfeeding?

A

drugs with a <10% relative infant dose

37
Q

Are antipsychotics excreted in breast milk?

A

YES

38
Q

What is foetal alcohol syndrome?

A
facial deformities
lower IQ
neurodevelopmental delay
epilepsy
hearing, heart + kidney defects
39
Q

Over what alcohol limit can you NOT breastfeed?

A

8 units a week

40
Q

What affects can cocaine, amphetamine and ecstasy have on pregnancy?

A
death via stroke and arrythmias
tetarogenic - microcephaly, cardiac, GU, limb defects
PET
abruption
IUGR
pre term labour
miscarriage
developmental delay and withdrawal
41
Q

How does nicotine affect pregnancy?

A
miscarriages
abruption
IUGR
stillbirths
SIDS -cot death
42
Q

How do opiates affect pregnancy?

A
1-2% of maternal deaths
neonatal withdrawal 
IUGR
SIDs
stillbirth