Mental health in pregnancy

Question 1

Mx of pregnancy - hx of BPAD

Answer 1

AN Mx plan - depends on hx of PP
- MDI - psych, SW (?previous hx of PP)
- Med compliance/safety - congen abn vs risk of relapse -> FGR/PTB/LBW

Lithium safety
- congen malform/Ebstein’s anomaly
- narrow therapeutic range in preg
- impact on thyroid function

AN mx
- Avoid triggers - sleep -> psychosis
- Foetal echo ?cardiac anomaly
- reg Psych F/U - ax & rx efficacy

Postpartum mx
- high risk for postpartum psychosis
- PNHM rv, extended stay, consider mother/baby unit
- avoid sleep deprivation
- continue mood stabilizer -> reduce PP recurrence if previous hx
- breast feeding - avoid lithium (limited safety data) -> guided by psych team

Question 2

Mx of suicidal tendency in preg

Answer 2

• MDI: Obs/PNMH/SW/Paeds
• Assess - intent, plan,
• Initial mx - hospitalization
• Underlying factors - precipitant, psych disorders, life circumstances
• Rx options - meds, psychotherapy, support
• Ensure adequate AN care…
• Postpartum MH care
• ?CP requirements

Question 3

Mx of high EDPS score

Answer 3

• MDI: Obs/PNMH
• Q10 -> immediate mx
• Score 10-12 -> monitor & rpt 2/52
• Awareness +/- refer to service
• Rx options - CBT vs SSRI
• Crisis support contact
• Regular AN F/U
• Postpartum F/U

Question 4

Mx of PTSD/SNRI therapy in preg

Scenario 1 - multi, previous hx of abruption -> emCS -> PTSD (no specific competency listed re: PTSD…)

Scenario 2 - 38yo, P1 c/b massive PPH -> developed PTSD -> dx & rx received.

Answer 4

• MDI - PNMH support/GP/private psych
• rv of hx of previous hx
• education of SNRI safety
• all safe except paroxetine
• pros - avoid preg cx assoc with untreated MH - reduce diet/weight/GWG/PTB/LBW, not teratogenic
• cons - assoc with NAS/ pHTN
• alternative mx -> psychotherapy
• reg rv w EPDS at AN visit +/- referral
• document intrapartum plan
• document postpartum plan

Postpartum plan
- Single room, extended stay
- Monitor mood, interaction w baby
- Monitor appetite, sleep
- Monitor for mat MH deterioriation -> self-harm/suicidal thoughts
- Monitor for NAS
- I/P rv by psych team postpartum
- Encourage breastfeeding
- Follow-up plan - LMO/psych team OPC