Week 1: Common PMH disorders

Question 1

What is the perinatal period?

Answer 1

Pregnancy, birth and up until 6 weeks following birth of the child

Question 2

What is perinatal mental illness?

Answer 2

period from conception to 1 year following birth of child

Question 3

What is perinatal mental health?

Answer 3

the emotional well-being of women and their children, partner and families from conception to 1 year following birth of child

Question 4

What is the impact of stress in pregnancy?

Answer 4

Stress in pregnancy is thought to relate to Corticotrophin Releasing Hormone (CRH) released by the Hypothalamus, which has a profound effect on mother and fetus stress response. Natural increases in the hormone are important for fetal maturation – but if levels are altered in response to stress they can program the fetal nervous system with long term consequences Delayed fetal nervous system maturation Restricted neurotransmitter development and altered stress response of the neonate Impaired mental development and increased fearful behaviour in the infant Potential reduced grey matter in children; Increased risk for emotional and cognitive impairment

Question 5

What associated and aggravating factors of perinatal mental illness?

Answer 5

Psychosocial Factors Social Factors Family Factors Biological Factors Personal History Still Birth

Question 6

What are the risk factors that predispose women to perinatal mental illness?

Answer 6

Family history of anxiety disorders Personal history of depression or anxiety Thyroid imbalance Low socioeconomic status Unplanned or unwanted pregnancy Childcare stress Personal characteristic

Question 7

What are the poor outcomes associated with anxiety during pregnancy?

Answer 7

Pre-eclampsia Increased nausea and vomiting Longer sick leave during pregnancy Increased visits to obstetrician Spontaneous preterm labour and preterm delivery More difficult labour and delivery with increase of PTSD symptoms related to birth Elective caesarean section Admission of infant to neonatal care Low birth weight and low APGAR scores Breastfeeding difficulties

Question 8

What types of anxiety disorders are there in the perinatal period?

Answer 8

Anxiety disorder in the antenatal period is one of the strongest risk factors for developing postnatal depression

Question 9

What are the symptoms of anxiety disorders?

Answer 9

Anxiety; Apprehension expectation; Nervousness; Fatigue; excessive, intrusive and persistent worries; A pervasive feeling of apprehension or dread; Inability to tolerate uncertainty; Difficulty concentrating or focusing on things; Muscle tension; Sleep disturbance; Feeling edgy, restless or jumpy; Stomach problems, nausea, diarrhoea

Question 10

How are panic disorders affected by the perinatal period?

Answer 10

women with a history of mild panic symptoms experience a worsening of these symptoms within the first 2 or 3 weeks after birth.

Women with this need air and space

Question 11

What is tokophobia?

Answer 11

An irrational fear of an object or a situation leading to avoidance. Tokophobia is the extreme fear of childbirth and can lead to a woman avoiding pregnancy, terminating pregnancy of a wanted baby or demanding a C-section. It may be primary predating childbirth or secondary and relate to previous birth trauma. Studies show up to 80%, of low risk pregnant women describe common childbirth anxieties, with 5.5% to 10% reporting pathological levels of fear.

Question 12

What are the symptoms of OCD?

Answer 12

Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby; Compulsions, where the woman may do certain things over and over again to reduce her fears and obsessions e.g. those related to cleaning/washing and checking; Fear of being left alone with the infant; Hyper vigilance in protecting the infant; Loss of appetite; Tremendous guilt and shame. Affects 1 to 3% in pregnancy rising to 9% in post natal period.

Question 13

Symptoms and risks of PTSD

Answer 13

Can be a consequence of a birth trauma real or perceived. Risk factors include: Domestic abuse; sexual abuse/rape; previous adverse reproductive events; history of mental health problems; migration; or type of delivery undergone. Symptoms include: Anxiety and panic attack; recurrent intrusive memories; flashbacks or nightmares; avoidance of stimuli associated with the event; depressive symptoms; fear of sexual intimacy; restricted range of affect. Prevalence: caused by childbirth ranges from 2-3%-25% in postnatal women

Question 14

What are the diagnostic features of perinatal depression?

Answer 14

Depressed mood; Anhedonia; Insomnia or hyper insomnia; Psychomotor retardation or agitation; Loss of energy or fatigue; Worthlessness or guilt; Change in appetite; Impaired concentration; Anxiety; Irritability; Hopelessness; Feelings of isolation; Physical signs of tension; Risk to mother; Risk to infant.

Question 15

What are the risks of perinatal depression?

Answer 15

Past history of mental illness; Antenatal anxiety; Major life events/stresses; Low social support (especially poor support from current partner and experience of intimate partner violence); History of childhood trauma and poor parenting; Substance misuse; Long standing personality vulnerabilities

Question 16

What are the physical symptoms of perinatal depression?

Answer 16

Tired all the time; Lack of energy; Crying, sad; Sleep disruption; Changes in weight; Pain; Loss of libido; Personal neglect; Psychomotor agitation or retardation;

Question 17

What are the psychological symptoms of perinatal depression?

Answer 17

Self-blame, criticism, guilt; Impaired concentration; Hopelessness; Depressed mood; Withdrawal from family and friends; Loss of motivation; Suicidal ideation; Anhedonia

Question 18

What are the behavioural symptoms of perinatal depression?

Answer 18

Self-neglect/avoidance Insomnia/hypersomnia

Question 19

Postpartum psychosis?

Answer 19

Half to most women that have it, it’s their 1st pregnancy Around half of the affected women have FH of mood disorders Close relation to mood disorders- bipolar or major depressive disorder a.k.a puerperal psychosis

Question 20

Bipolar disorder?

Answer 20

Episodes of mania or depression are experienced either alternately or together. During periods of mania symptoms may include: increased energy; loss of inhibitions; delusions of grandeur; euphoric mood or irritability and rapid speech. During bouts of depression, the usual symptoms associated with lowered mood are experienced and the individual may be at risk of suicide. Women with a history of bipolar need careful management before conception, throughout pregnancy and during the postpartum period! Increased risk of episodes following childbirth

Question 21

What is schizophrenia and what are the symptoms?

Answer 21

Severe mental illness The symptoms of schizophrenia include psychotic symptoms, negative symptoms and cognitive symptoms make it difficult for a women to parent. Each individual will present with a unique set of symptoms which can have profound effects on self-care and functioning raising safeguarding issues in motherhood

Question 22

What are the positive and negative symptoms of schizophrenia?

Answer 22

Question 23

What is the schizoaffective disorder?

Answer 23

Severe mental illness Includes both symptoms of schizophrenia e.g. delusions and hallucinations and mood disturbance e.g. depression or mania. Positive, negative and cognitive symptoms can all affect parenting capacity. Perinatally women with schizoaffective disorder have an increased risk of relapse and higher rates of postpartum psychosis

Question 24

How can pregnancy affect a woman with personality disorder?

Answer 24

Pregnancy and childbirth in women with personality disorders (particularly borderline PD) can evoke many issues relating to trauma in their past, which in turn can affect their ability to cope with becoming or being a mother and caring for their baby. Difficulties in thought patterns, emotions, interpersonal functioning and impulse control can be problematic. PD’s are associated with: higher rates of substance misuse, DS-H, suicidality, increased risk of social services

Question 25

What are the effects of eating disorders on pregnancy?

Answer 25

Question 26

Psychotropic medicine in pregnancy and breastfeeding?

Answer 26

If treatment is necessary, monotherapy with the lowest effective dose and for the shortest duration is prudent. Safety data is generally more robust with older agents, which are more preferable to use than newer agents with less established safety profiles. Almost all drugs will enter breast milk. The exposure to the infant is described as a percentage of the maternal dose— that is, how much of the dose is actually excreted into the breast milk. When less than 10% of a mother’s dose of medication is excreted into the breast milk, it is generally considered compatible with breastfeeding (with some exceptions) since these low serum levels are unlikely to lead to adverse effects in the infant

Question 27

Questions for Personal Reflection

Answer 27

Can I confidently state why Perinatal Mental Health is Important?

How can I change my own practice to improve detection of perinatal mental illness through my knowledge of mental health conditions?

What should I be aware of when caring for women of childbearing potential who have new or existing mental health disorders?

Do I know the associated risk factors and signs of perinatal mental illness that require urgent treatment

Question 28

Extra points from lecture

Answer 28

Suicide is the leading cause of death in pregnancy and one year after birth

A large body of work in the last three decades has demonstrated that children of mothers with a mental illness can experience considerable behavioural, social or learning difficulties and fail to fulfil their potential

The relationship between the mother and her partner may also be adversely affected

Studies show that the partners of mothers with postnatal depression are themselves more likely to experience distress and depression because of the mother’s depression

Anhedonia- lack of pleasure in things

Personality disorder- tend to do better when baby is small and dependent but struggle with child growing

Sodium valcrate- dangerous drug for mental illness in peurperium, lithium- can still breastfeed but can be problematic

Medications and mother’s milk- book

Women taking antipsychotics should have a SGTT