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Y3 OBS AND GYNAE > Psychiatric Disorders in Pregnancy > Flashcards

Psychiatric Disorders in Pregnancy Flashcards

1
Q

List red flag presentations for perinatal mental health problems

A

Recent significant change in mental state or emergence of new symptom
New thoughts or act of violent self-harm
New and persistent expressions of incompetency as a mother or estrangement from their baby

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2
Q

Give examples of screening questions used in pregnancy for mental health issues

A

During last month have you been bothered by feeling down, depressed or hopeless?
During last month, have you been bothered by having little interest/ pleasure in doing things?
Is this something you feel you need or want help with?

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3
Q

List some risk factors for mental illness in pregnant women

A 
Young female/ Single mother
Domestic issues
Lack of support
Substance misuse
Unplanned pregnancy
Pre-existing mental illness
Personal or family history of mental illness
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4
Q

List indications for referral to psychiatry team in pregnancy

A 
Psychosis
Severe anxiety/depression/suicidal/self-harm
History of bipolar/schizophrenia
History of puerperal psychosis
If on psychiatric medication
Previous admission to mental health unit
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5
Q

When does puerperal psychosis typically onset?

A

Within 2 weeks of delivery

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6
Q

List clinical features of puerperal psychosis

A 
Sleep disturbance
Confusion
Delusions, hallucinations
Irrational ideas
Mania
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7
Q

Puerperal psychosis is an emergency. True/False?

A

True

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8
Q

List major risk factors for puerperal psychosis

A

Bipolar disorder (50%)
Previous puerperal psychosis
1st degree relative with history

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9
Q

Outline management options for puerperal psychosis

A

Needs urgent admission to mother-baby unit

Antidepressants, antipsychotics, mood stabilisers, ECT

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10
Q

What is the percentage risk of puerperal psychosis recurrence in further pregnancies?

A

80%

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11
Q

Postnatal depression occurs in __ of women

A

10%

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12
Q

When does postnatal depression typically onset?

A

2-6 weeks postnatally

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13
Q

List clinical features of postnatal depression

A 
Anxiety, irritability, tearfulness
Lack of enjoyment
Poor sleep
Weight loss
Concerns re baby
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14
Q

How does postnatal depression differ from “baby blues”?

A

Baby blues is more brief and self-limiting

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15
Q

Baby blues occur in __ of women

A

50%

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16
Q

When does baby blues usually occur?

A

Day 3-10 post-partum

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17
Q

How are baby blues managed?

A

Support from MDT
Reassurance and education
Warning signs of post-natal depression

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18
Q

How is mild-moderate postnatal depression managed?

A

Self help

Counselling

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19
Q

How is moderate-severe postnatal depression managed?

A

Psychotherapy
Antidepressants (option to start at 36 weeks partum)
Consider admission

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20
Q

What is the percentage risk of postnatal depression recurrence in further pregnancies?

A

25%

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21
Q

Outline risks to child of untreated perinatal mental health disorders

A

Low birth weight
Preterm delivery
Adverse childhood outcomes e.g. ADHD
Poor engagement/ bonding with child

22
Q

What is the principle of psychiatric treatment in pregnancy?

A

Low dose monotherapy, consider stopping/changing
Increased screening of fetus (cardiac, growth scans)
Contingency plans if they get unwell

23
Q

When should a foetal anomaly scan be carried out in someone pregnant and on psychiatric medication?

A

16 weeks

24
Q

What is the main risk associated with psychiatric medications during the 1st trimester?

A

Risk of teratogenicity

25
Q

What is the main risk associated with psychiatric medications during the 3rd trimester?

A

Risk of neonatal withdrawal

26
Q

What is the main risk associated with psychiatric medications during breastfeeding?

A

Risk of medications passing into breast milk

27
Q

Breastfeeding should be encouraged whenever possible in psychiatric pregnant patients. True/False?

A

True

Medications used in pregnany should be continued (generally in utero risk greater than exposure in milk)

28
Q

Which antidepressant can cause fetal heart defects in an infant during the 1st trimester?

A

Paroxetine

29
Q

All antidepressants can cause withdrawal and toxicity in neonates. True/False?

A

True

Usually self-limiting though

30
Q

What is the main risk to the fetus of using SSRI’s after 20 weeks?

A

Neonatal pulmonary hypertension

31
Q

State the lowest risk SSRIs and TCAs respectively, safe to use during pregnancy

A

SERTRALINE, fluoxetine

Imipramine, amitriptyline

32
Q

SSRIs are generally safe during breastfeeding. Which should be avoided?

A

Citalopram

Doxepin

33
Q

Why should benzodiazepines be avoided in pregnancy and breastfeeding?

A

Fetal malformations
Floppy baby syndrome
Lethargy, weight loss

34
Q

Which antipsychotics - typical or atypical - are generally safe to use in pregnancy?

A

Typicals

35
Q

Which antipsychotics are contraindicated in pregnancy?

A

Clozapine can cause agranulocytosis

Olanzapine can cause GDM and weight gain

36
Q

Can anticholinergic drugs be used in pregnancy?

A

No

37
Q

What foetal defect can lithium cause?

A

Ebstein’s anomaly

38
Q

Is lithium contraindicated in breastfeeding?

A

Yes

39
Q

What foetal defects can sodium valproate cause?

A 
Neural tube defects
Craniofacial defects
IUGR
Reduced IQ
Cleft
40
Q

Sodium valproate is safe to use in breastfeeding. True/ False

A

True

However, should be stopped before planning pregnancy and avoided in women of child-bearing age

41
Q

It is normally ok to breastfeed if you are on an anticonvulsant. True/False?

A

True

42
Q

What effect does carbamazepine have on the newborn?

A

Vitamin K deficiency

Haemorrhagic disease of newborn

43
Q

Which mood stabiliser/anticonvulsant is considered safest to use in pregnancy?

A

Lamotrigine

44
Q

List risks to mother of substance abuse during pregnancy

A 
Other mental health conditions
HIV, Hep B, Hep C
Nutritional deficiency
VTE
STIs
Endocarditis/ sepsis
Poor venous access
Opiate tolerance/ withdrawal
Drug overdose/ death
Risk of domestic abuse
45
Q

What is the RCOG advice on alcohol during pregnancy?

A

Abstinence best but no evidence that 2 units a week is detrimental

46
Q

List risks associated with alcoholism during pregnancy

A 
Miscarriage
Foetal alcohol syndrome
Withdrawal
Wernicke's encephalopathy (B1 deficiency)
Korsakoff syndrome
47
Q

List features of foetal alcoholic syndrome

A 
Facial deformity
Lower IQ
Neurodevelopmental delay
Epilepsy
Hearing defect
Cardiac + renal defects
48
Q

List fetal risks of substance abuse during pregnancy

A 
Teratogenic
Abruption
IUGR
Preterm labour, miscarriage
Developmental delay
Withdrawal
49
Q

What should be considered management-wise if substance abuse is occurring in pregnancy?

A 
Methadone programmes
Social work/child protection
Labour planning - analgesia, anaesthesia
Postnatal contraception plan
Smear history
50
Q

Breastfeeding is contraindicated in which cases of substance misuse?

A

Alcohol intake >8 units
Maternal HIV
Use of cocaine

Y3 OBS AND GYNAE (44 decks)

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