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Complex care 2 > Module 9 > Flashcards

Module 9 Flashcards

1
Q

antenatal psychiatric disorders

A

Most first-onset conditions are mild depressive and anxiety disorders and the cause is commonly psychosocial
* Relapses of the following disorders may occur: depressive and anxiety disorders, obsessive compulsive disorder, schizophrenia, bipolar disorder and substance misuse
* It is important to enquire for a previous history of serious mental illness at the booking visit
* Identifying women with a past or family history of bipolar disorder or puerperal psychosis is particularly important because of the high risk of postpartum relapse (one in two).
* Psychiatric medication should not automatically be discontinued once the woman becomes pregnant. This is a frequent cause of relapse.
* Mild to moderate disorders may be managed in primary care. Past or current severe illness should be referred to specialist psychiatric services, preferably to a perinatal psychiatric service
* Good communication between all health professionals both in primary and secondary services is crucial

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2
Q

complications antenatal psychiatric disorders

A

Poor attendance in antenatal clinic
* Smoking and substance misuse
* Poor general health and nutrition
* Deliberate self-harm and suicide
* Low birth weight and pre-term deliveries
* Problems with mother–infant attachment
* Neglect or harm to infant and other children; safeguarding issues
* Possible long-term developmental and behavioural problems in the child
* Mental health problems in the woman’s partner

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3
Q

preconception issues and care antenatal psychiatric disorders

A
  • Risk of recurrence of mental illness in perinatal period
  • Risks and benefits of medication in pregnancy
  • Some psychiatric medications reduce fertility and should be changed if pregnancy is planned
  • Avoid certain drugs (especially sodium valproate) due to high rates of birth defects
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4
Q

pregnancy issues antenatal psychiatric disorders

A

Fetal growth retardation
* Low birth weight
* Prematurity
* Long-term developmental and behavioural problems in the child Mental illness may be associated with other behaviours that could indirectly affect her health and that of the baby. These include:
* Smoking
* Alcohol and substance misuse * Poor dietary habits * Lack of exercise * Self-harming behaviour * Lack of engagement with services

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5
Q

medical management and care antenatal psychiatric disorders

A
  • Mild to moderate depressive and anxiety symptoms are the most frequent psychiatric problems in pregnancy
  • Psuchological therapies such as cognitive behaviour therapy, interpersonal therapy or self-help strategies
  • Advice sorted from specialist psychiatric services
  • All women with serious mental illness should be referred to specialist services
  • Risk-benefit ratio of psychotropic medication is assessed and decisions regarding medication during pregnancy
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6
Q

midwifery management antenatal psychiatric disorders

A
  • Booking in – screen for past or present serious mental health – refer to perinatal psych
  • trusting relationship
  • advice regarding smoking, diet, exercise, BF, birth prep and support services
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7
Q

labour issues antenatal psychiatric disorders

A
  • neonatologists should be contacted if woman is on psychotropic meds
    medical management
  • discuss methods of support for labour pain to reduce anxiety
  • support in labour
  • consent
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8
Q

midwifery management labour antenatal psychiatric disorders

A
  • advice regarding continuation or discontinuing psychotropic meds prior to labour
  • drugs should be used judiciously in view of possible effects on the baby
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9
Q

postpartum issues antenatal psychiatric disorders

A
  • new symtpoms may emerge like
  • increased anxiety and agitation
  • low mood, excessive tearfulness or apathy
  • poor handling or attachment to baby
  • bizarre or unusual behaviour
  • delusions and hallucinations
  • thoughts or acts of harming herself or baby
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10
Q

medical management postpartum antenatal psychiatric disorders

A
  • specialist perinatal psychiatry contacted
  • approp. Treatment takes precedence over BF
  • transfer to specialist psychiatric mother and baby unit
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11
Q

midwifery management postnatal antenatal psychiatric disorders

A
  • observe mother and baby interaction
  • discuss rest, diet and self-care, assess how mum is coping
  • reassure if mood change is baby blues
  • observe baby if BF
  • assess risk to baby
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12
Q

postnatal psychiatric disorders

A
  • baby blues
  • PND
  • postpartum psychosis
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13
Q

general symptoms PND

A
  • Low mood, loss of interest and enjoyment, reduced energy
  • Reduced concentration and self-esteem, ideas of guilt, hopelessness, thoughts or acts of self-harm or suicide and appetite disturbance
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14
Q

postpartum psychosis

A
  • delusions and hallucinations. The onset is sudden, usually within the first 2 days postpartum.
  • Mood changes – elation, depression or irritability
  • Perplexity and confusion
  • Agitation and abnormal behaviour
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15
Q

complications postpartum psychosis

A
  • Self harm and suicide
  • Neglect of baby
  • Problems with mother-infant attachment and interaction
  • Long-term emotional, behavioural and cognitive problems
  • Relationship problems and breakdowns
  • Social, occupational and financial complications
  • Depression in the partner
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16
Q

pre-conception issues and cares postnatal psychiatric disorders

A
  • Relapse rates in women that have had postpartum psychosis 50%
  • Risk-benefit should be assessed
  • Sodium valproate not prescribed (epilepsy)
  • Discuss poor diet, smoking, substance/alcohol abuse, self-harming, relationship problems
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17
Q

pregnancy issues postnatal psychiatric disorders

A

Biological risk factors
- Past history of severe depression
- Past or family history of bipolar or postpartum psychosis
Psychosocial factors
- Lack of social support
- Recent stressful life events
- Longstanding difficulties in coping
- Sexual abuse
- DV

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18
Q

medical management pregnancy postnatal psychiatric disorders

A
  • Talking therapies or antidepressants
  • Psychotropic meds don’t discontinue
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19
Q

midwifery care pregnancy postnatal psychiatric disorders

A
  • Communicate with other professionals
  • Refer to OB
  • Refer to perinatal service
  • Trusting relo
  • Any risk to baby, referral
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20
Q

labour issues postnatal psychiatric disorders medical management

A
  • Psychotropic medication may be indicated
  • Drugs should be used judiciously
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21
Q

labour issues postnatal psychiatric disorders midwifery management

A
  • Discuss carefully
  • Consent
  • Psych and physical support
  • Avoid interventions
  • Encourage skin to skin
  • Breast feeding encouraged
22
Q

postpartum issues postnatal psychiatric disorders

A
  • Depression usually presents within 12 weeks
  • Postpartum psychosis within 2 days
  • Suicide leading causes of mortality – early detection
23
Q

medical management postpartum issues postnatal psychiatric disorders

A
  • Risk assessment
  • Admission to mother baby unit
24
Q

midwifery management postnatal issues postnatal psychiatric disorders

A
  • Observe interaction
  • Discuss sleep, diet and self-care
  • Reassure if baby blues
  • EPDS
  • Social services
25
Q

eating disorders

A
  • severe disturbances in eating behaviour
  • In anorexia there is a deliberate attempt to lose weight whereas bulimia is characterised by repeated episodes of binge eating followed by compensatory behaviours (self-induced vomiting or purging)
26
Q

anorexia nervosa

A
  • Body weight maintained at least 15% below that expected, or BMI less than 17.5
  • Weight loss, self-induced vomiting, purging, excessive exercisem appetite suppressants
  • Body image distortion
  • Endocrine disorder – hypothalamic-pituitary-gonadal axis causing amenorrhea
27
Q

anorexia associated clinical features

A
  • Amennhorrea, infertility, loss of sexual interest
  • Lethargy, weakness, anaemia
  • Hypotension, peripheral oedema, cardiac arrhythmia
  • Constipation, abdo pain, enlarged salvary glands
  • Dry skin, alopecia, lanuago hair, brittle nails, osteoporosis
  • Tooth decay, erosion of dental enamel
28
Q

bullimia nervosa

A
  • Repeated bouts of overeating and excessive preoccupation with control of body weight leading to extreme measures to counteract effects of overeating
  • Persistent preoccupation with eating, craving for food, eating large quantities in short time
  • Counteracting the fattening effects of food by self-induced vomiting, purging, periods of starving or drugs
  • Morbid dread of fatness
  • Inappropriate low target weight
  • Sometimes earlier episode of AN
29
Q

bulimia associated clinical features

A
  • Irregular periods
  • Dependence on laxatives, diarrhoea and constipation
  • Dehydration, fluid and electrolyte disturbances
  • Tooth erosion, loss of dental enamel
  • Enlarged salivary glands
30
Q

eating disorders non-pregnancy treatment

A
  • Psychotherapies such as cognitive, interpersonal, psychodynamic
  • Meds
31
Q

pre-conception care eating disorders

A
  • Counselling and support
  • Dietary and nutritional assessment
  • Polycystic ovaries
32
Q

pregnancy issues eating disorders

A
  • ED detected early
  • Maternal worries about change in weight
  • Self-induced vomiting
  • IUGR
  • Poor weight gain
  • Stillbirth and miscarriage
  • Premature labour
  • Depression/self-harm
33
Q

medical management eating disorders in pregnancy

A
  • Multidisciplinary team
  • Monitor weight and IUGR
  • Serial scans
  • Expected weight gain
  • Assess vitamin and mineral deficiencies
  • Check for cardiac complications
  • Liaise closely with GP and ED service
34
Q

midwifery management eating disorders in pregnancy

A
  • Check womans weight and BMI
  • Discuss complications in pregnancy
  • Monitor weight regularly
  • Screen for other MH
  • Give support
  • Dietary advice
  • Antenatal prep
35
Q

labour issues eating disorders

A
  • Proceed as normal
  • Higher risk of LSCS
36
Q

medical and midwifery management labour eating disorders

A
  • Advice psychotropic medication
    Midwifery
  • Methods of support for labour pain to reduce anxiety
37
Q

postpartum issues eating disorders

A
  • Relapse of worsening can occur
  • Preoccupation with weight gain
  • Exaggerated weight loss after birth
  • Excessive exercise
  • Depression
  • Self-harm, alcohol
  • Mother-infant attachment
38
Q

medical management postpartum eating disorders

A
  • Watch for signs of relapse
  • Assess risks
  • Monitor baby if woman on psychotropic meds
39
Q

midwifery mangement postpartum eating disorders

A
  • Observe mood and interaction with baby
  • Monitor weight
  • Assess nutritional advice
  • Observe attachment and caring for infant
  • Relapse – refer to ED service
40
Q

PTSD

A
  • Delayed or protracted response to a stressful event of an exceptionally threatening or catastrophic nature affecting individuals at any age or time of life
  • Previous PTSD may be exacerbated during pregnancy – 3-7.7% experience after birth
  • Avoidance of situations similar to the stressful event
  • Inability to recall the event
  • Increased arousal or hyper-vigilance
  • Sleep problems
  • Irritability and/or anger outburst
  • Poor concentration
  • Exaggerated startle response
  • Disassociating or emotional numbing
41
Q

Risk factors for PTSD in childbirth

A
  • Miscarriage and stillbirth
  • Emergency problems such as cord prolapse
  • Complicated deliveries and LSCS
  • Catheterisation
  • Intimate clinical procedures e.g VE
  • Attitude of healthcare professionals
  • Survivor of disaster or accident
42
Q

complications PTSD

A
  • Develop low self-esteem, anxiety, depression
  • Employment problems, relationship breakdown, social isolation
  • 1/3 report self-harm
  • Ptsd can occur after
  • Rape, sexual assault, childhood sexual abuse
  • Victim of violent crime or DV
  • Victim of torture, war, disaster or accident
  • Refugee or asylum seeker
  • Previous FGM
  • Occupation
43
Q

consequences of PTSD

A
  • Depression, anxiety, self-harm, suicide
  • Avoidance of intimate and sexual relationships
  • Impaired mother-infant attachment
  • Fear and avoidance of future pregnancies
  • Avoidance of VEs
  • Termination
  • Requests for LSCS
  • Requests for sterilisation
44
Q

preconception care PTSD

A
  • Detection of PTSD symptoms
  • Identification of complications
  • Discussion of plans for pregnancy
  • Referral for psychological therapies
  • Medication
45
Q

pregnancy issues PTSD

A
  • Birth plan with specific wishes
  • Failure to detect symptoms may result in poor attendance to appointments, exacerbation of symptoms, use of drugs and alcohol, self-harm
46
Q

medical management PTSD in pregnancy

A
  • Medication
  • Trauma-focused CBT and EMDR
47
Q

midwifery management PTSD in pregnancy

A
  • Booking in history important
  • Appropriate referrals
  • Reassurance
  • Desensitisation by arranging visits to birth unit
  • Include fears and wishes in birth plan
  • Communicate
48
Q

labour issues PTSD

A
  • Continuity of care
  • Familiarisation with staff
  • Empathic and sensitive care
49
Q

medical and midwifery management PTSD labour

A
  • Shared OB and midwifery care
    Midwifery
  • Birth plan written early
  • Know triggers
  • Discuss analgesia
  • Arrange meeting with anaesthetist
  • Birth support
50
Q

postpartum issues PTSD

A
  • Escalation of anxiety
  • Attachment with baby
  • Depression or irritability
  • Self-harm
  • Alcohol or illicit drug use
  • Social, relationship and work problems
51
Q

midwifery care postpartum PTSD

A
  • Identify any abnormal mood changes
  • Observe attachment
  • Discuss rest, diet and self-care
  • Be prepared for BF difficulties
  • Discuss how mum is feeling

Complex care 2 (9 decks)

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