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Part 2 > Mental Health > Flashcards

Mental Health Flashcards

(55 cards)

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1
Q

Mental Health and Mortality in pregnancy

A

1/4 maternal deaths
1/7 due to suicide

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2
Q

Prevalence of mental health issues in pregnancy

A

12% anxiety and 13% depression during or 12/12 postpartum
1-2 in 1000 postpartum psychosis
Pre-existing BAD/affective disorder/puerperal psychosis = 1 in 2 risk of postpartum problems

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3
Q

Postnatal Depression

A

12-13% of women
15-20% in the 12 month postpartum period
- 7x increased risk if untreated during pregnancy
- poor fetal outcomes

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4
Q

Assessment of Mental Health

A

PHQ-9
Edinburgh

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5
Q

Neonatal adaptation syndrome

A

due to SSRI
also increased risk PPH/ ASD

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6
Q

Breastfeeding and antidepressants

A

sedation, feeding changes, behavioural issues
sertraline/paroxetine preferred

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7
Q

Perinatal OCD

A

2 in 100 (pregnancy and 12/12 after)
higher risk if primip
1/3 pre-existing will worsen
eg escitalopram, citalopram, fluoxetine, paroxetine, sertraline

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8
Q

Antidepressants in Pregnancy

A

abortion/pulmonary hypertension/3 in 100 cardiac issues (bg 2 in 100)
especially first trimester
recommend hospital birth-NAS

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9
Q

Depo Antipsychotics

A

Haloperidol/Risperidone
may raise prolactin (low FSH/LH), reducing fertility

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10
Q

Sodium Valproate

A

c/i in pregnancy (wait 3 months after stopping)

ok in Breastfeeding
10% physical abnormalities (spine, face, skill)
20-30% intellectual changes
give 5mg folate

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11
Q

carbamazepine

A

neural tube defects- 3% risk
prothrombin precursor competitive inhibitor
enzyme inducer
5mg folate

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12
Q

lamotrigine

A

ok
closely monitor levels
3.2% cleft palate

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13
Q

Lithium

A

fetal heart malformations (1st trimester, especially ebstein’s)
1 in 10 abnormalities
present in breastmilk (floppy baby)
reduce levels in labour (monitor throughout pregnancy)
perinatal toxicity- hypotonia, cyanosis, goitre, diabetes insipidus

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14
Q

Breastfeeding +SSRI

A

all SSRIs but fluoxetine are present in breast milk

discourage:
clozapine
carbamazepine
lithium

recommend:
sertraline
paroxetine

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15
Q

Alcohol

A

chlodiazepoxide is ok

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16
Q

Opioids

A

Neonatal abstinence syndrome
-70-95%, even if on methadone
can take methadone/buprenorphine, may need to increase 3rd trimester
can pass into breastmilk
avoid detox in pregnancy (higher risk of relapse)

Cross placenta, increased fluctuation/withdrawal
increased risk PTB/FGR due to contractions
no associated malformations

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17
Q

Stimulants

A

Cocaines, amphetamines
vasoconstriction:
abruption
PPROM
Low birth weight
prematurity
should avoid breastfeeding

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18
Q

Anorexia

A

delay conception until well
preterm
low birth weight
anemia
IUGR
mortality

small= small/early

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19
Q

Drugs contributing to female sexual dysfunction

A

SSRIs/antipsychotics/anticonvulsants
B-blockers/thiazides
lithium
benzodiazepines
GnRH agonists/aromatase inhibitors
Spironolactone
opioids, cocaine, alcohol

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20
Q

Sexual neurotransmitters

A

Pro:
Noradrenaline
Dopamine
Oxytocin
Melanocortin
Serotonin
Anti:
Prolactin
GABA
Serotonin at some receptors

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21
Q

Genital Congestion

A

Reflex autonomic response
neurological/vascular disease can inhibit
reduced estrogen> reduced vascularity>reduced NO to clitoris and reduce vasoactive intestinal peptide to vagina

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22
Q

Diagnosis of female sexual dysfunction

A

3 of below for over 6/12, causing clinically significant distress
-absent/reduced interest
-absent/reduced fantasies
- absent/reduced initiation
-absent/reduced to others initiation
-absent/reduced pleasure
-absent/reduced response to cues
-absent/reduced sensation
in over 75% encounters

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23
Q

Female orgasmic disorder

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A

delay / infrequency/ absence or orgasms
or reduced intensity or orgasm

24
Q

Persistent Genital Arousal Disorder

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A

persistent / recurrent
unwanted and distressing sensations of arousal
over 3 months

25
Treatment of psychosexual problems
**Psychotherapy** -conflicts of early life/previous relationships **Sex therapy** -anxiety/distraction/reduced communication **Mindfulness/CBT** -catastrophising/dissociation **Reduced sensitivity/lubrication** -estrogens or DHEA | Psychotherapy=Previous
26
Vulvodynia
Discomfort, usually burning in absence of relevant visible findings classified by site provoked- on touch unprovoked- without touch
27
Treatment of vulvodynia
Local Anaesthetics TCAs: amitriptyline 10-25mg OD Nortryptyline Gabapentin 300mg OD>BD>TDS Pregabalin Surgical excision of vestibule desensitisation of pelvic floor
28
Erectile Dysfunction- assessment
HbA1c Lipid profile morning testosterone BMI/smoking TFTs LFTs U+Es
29
Erectile Dysfunction- management
PDE-5 inhibitor regardless of cause take an hour before sex on empty stomach lasts 4-5 hours
30
Erection Physiology
complex intracellular cascade/smooth muscle relaxation -sinusoidal blood flow increases -occlusion of venous outflow NO released by presynaptic cavernosal nerve fibres and endothelial cells= smooth muscle relaxation GTP->cGMP- intracellular Calcium efflux
31
PDE5 mechanism
converts cGMP to 5 GMP normalises calcium levels inhibiting this maintains erection
32
Premature Ejaculation
**Always / nearly always** **prior to or within 1 minute** of penetration from first sexual experience or significant reduction to <3minutes inability to delay ejaculation negative personal consequences
33
Treatment of Premature Ejaculation
more frequent sex / masturbation condom use squeeze and stop/go Pharmacology: SSRI daily (off-label) Apply a pea sized amount of **EMLA cream** over the underside of the head of the penis where it meets the shaft. You should apply it **15-30** minutes prior to sexual activity. Wipe off before SI. Can weaken condoms- consider polyurethane
34
mental health questionnaires
depression- phq 9 anxiety- gad 7 ptsd- pcl 5
35
Tricyclic antidepressants in pregnancy
eg amitryptilline generally safe but not first line as less evidence than ssri neonatal withdrawal syndrome -reduce 3-4/52 before delivery -risk overdose/maternal tolerability
36
1st generation antipsychotic
olanzapine no robust evidence but used for a while without adverse effects
37
2nd generation antipsychotic
increased risk LGA/hypoglycemia clozapine- floppy baby/agranulocytosis check prolactin/diabetes
38
Anti-anxiety medications
benzodiazepines **risks**>benefits gabapentin > pregabalin oestrogen and progesterone may increase concentrations of benzodiazepines and chlordiazepoxide
39
Neonatal Abstinence Syndrome presentation (Opioids)
**55-95% 24-72hrs** respiratory distress irritability reduced feeding or GI changes seizures/hypertonia
40
Transference
feelings not due to situation but repetitions of reactions to persons in early childhood counter transference- therapist transfers their emotions to the patient (but can be in reponse to patient's story)
41
Vaginismus
Involuntary spasm of pelvic floor (incl pubococcygeus) painful/difficult penetration | coccygeus iliococcygeus pubococcygeus puborectalis
42
Hyposexual desire disorder
lack of desire- clear distress, interpersonal difficulty treatment estrogen +/- testosterone **buproprion** (increase NA/DA) **flibanserin** (serotonin receptor modulator)
43
Sexual Arousal disorder
reduced/absent fantasies or desire unable to attain or maintain response to arousal rx: vibrator/suction lubricants avoid PDE-5 in women
44
Persistent Genital Arousal Disorder
spontaneous arousal unresolved by orgasm stressful rx: SSRI/SNRI Valproate topical anaesthetic
45
Anorgasmia- causes
**T11-L2** injury endocrine dermatological malignant abuse AEDs
46
Modafinil
ADHD/Narcolepsy drug **enzyme inducer**
47
SSRI of choice if BF
paroxetine or sertraline
48
TCA of choice if BF
imipramine or nortryptilline
49
TCA to avoid if BF
doxepin
50
Baby blues
1/3 F starts d3 and usually resolves by day 5 insomnia, anxiety, tearful, concentration/mood changes explain and reassure r/o other diagnoses
51
Edinburgh Scale
Postnatal Depression 10 questions, asking about **past week** max 30, >10 suggestive of depression **PHQ-9** can **diagnose** depression asks about past 2 weeks out of 27, <4= NAD >5= mild depression 10-14 moderate. Includes q about DSH/suicide Mild- wait Moderate= treat | Q=2
52
Treatment of depression in pregnancy
Single drug, lowest dose SSRI involve PNMH team 3 in 100 risk cardiac defect (background 2 in 100) 4 in 1000 of ppHTN (background 1-2 in 1000) small link to PPH/autism hospital birth to monitor neonate for withdrawal ## Footnote 1 in 100 heart, 1 in 1000 lungs
53
Penis- neurovasculature
Dorsal penile, deep penile and bulbourethral artery (all from internal pudendal) venous plexuses- dorsal veins, pudendal veins internal iliac artery and vein S2-4 SNS-pudendal nerve->dorsal nerve of penis PNS- prostatic plexus->cavernous nerves | SNS=inhibitory PNS= excitatory
54
55
Reduced impact drugs (sexual dysfunction)
mirtazipine buproprion moclobemide Nefazodone

Part 2 (20 decks)

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