Perinatal Mental Health Flashcards
(26 cards)
What determines the success of a child’s attachment to its mother?
The quality of caregiver responses to the infant’s attachment behaviours repeated over time.
What influences attachment?
- Quality of mother-infant relationship (maternal sensitivity)
- Mother’s attachment experience
- Parental reflective functioning or mentalising capacity (capacity to understand her own and other’s behaviours in terms of mental state)
- Mind mindedness (mother’s ability to attribute attention to infant’s signals)
- Infant temperament
- Contextual (parental age, MH Dxs, SES)
Who is monitored by the perinatal mental health team?
Pregnancy - 12m post partum
-Pre existing MH problems who become pregnant
-MH problems develop antenatally or postnatally
and their children and family
What are the additional risk factors during the pregnancy of women with schizophrenia?
- Effects of psychotic illness
- Effects of psychotropic medication
- Poor nutritition
- Substance abuse (nicotine, EtOH, illicit drugs)
- Poverty
- Homelessness
- Poor social support
- Victims of violence
how does schizophrenia impact on pregnancy?
- Present late, avoid care
- IUGR due to poor self care
- Inc preterm, antepartum haemorrhage and placental abruption
- More difficulty managing labour, higher rates caesarian section
What is the impact of schizophrenia on neonatal outcomes?
Inc rates of:
- CV and congenital abnormality
- Stillbirth and neonatal death
- Failure to thrive
- impact on attachment and parenting abilities
How does pregnancy impact the mental health of women with a psychotic condition?
Increased risk of relapse and risk of incorporation of pregnancy / baby into delusional system
What are the effects of parental mental illness of parent-infant interaction?
- Lack of emotional warmth and intimacy
- Attentional deficits
- impaired maternal competence
What are the principles of improving maternal and perinatal mental health of women and schiozphrenia and BPAD?
- Consideration of reproductive choices in routine care
- Early detection and monitoring of pregnancy
- Team approach in pregnancy and post partum
How does depression relate to pregnancy?
- Depressive symptoms common during pregnancy, peak T3 and fall following delivery.
- Post partum blues: time limited mood disturbance in post partum period (up to 80%)
- Post natal depression
How does depression impact on the pregnancy?
- Lack of care about pregnancy
- Poor health behaviours (i.e. smoking, EtOH)
- RFx suicide, foeticide
- Increased rate spontaneous abortion
- Inc risk gestational HTN, pre eclampsia
What are the altered developmental outcomes to children exposed to maternal anxiety / depression?
– Developmental delay – Lowered IQ in adolescence – Impaired language development – increased rate of emo,onal and behavioural problems – increased rate of ADHD – Associa,on with criminality
How does mothers with high levels of depression interact differently with their infants?
- Show less behavioural synchrony with their infant
- Less responsive to their infant’s cues
- Less affirming of their infant’s behaviour
During which time of pregnancy is exposure associated with structural abnormalities?
3-12 is period of maximum vulnerability
What are the pregnancy complications of antipsychotics?
- Increased rates of gestational diabetes
- More likely to require C section
What are the neonatal outcomes of anti psychotic use in pregnancy?
- Inc rates pre term birth and lower birth weight (FGAs)
- Neonatal hypoglycemia related to hyperinsulinism
- Inc birth weight SGAs esp OLZ and clozapine
- Lower APGAR, resp difficulty
- Extrapyramidal SEs (FGAs)
How teratogenic are antipsychotics?
On balance little evidence they are teratogenic
What are the neonatal outcomes of mood stabilisers (anti epileptics)?
– Reduced head circumference-CBZ (VPA) – Lower birth weight-CBZ (VPA) – Neonatal hypoglycaemia (VPA) -Neonatal hepatotoxicity LTG, CBZ, -Coagulation defects (Vit K) CBZ – Sedation withdrawal, toxicity
What are the pregnancy complications of lithium?
Lithium toxicity
What are the neonatal outcomes of lithium?
- Occassional goite, hypothyroidism
- Nephrogenic diabetes
What are the structural abnormalities of lithium?
- Ebstein’s anomaly (displacement of tricuspid valve into RV)
1: 20000 to 1:1000
How do antidepressants influence reproductive loss?
- apparent increase in spontaneous abortion
- no suggestion of increased risk of FDIU or SB
How do antidepressants affect neonatal outcomes?
-Increase in preterm births (
What are the principles of psychotropics in pregnancy?
• Careful risk-benefit assessment
• Use psychological interventions when possible and appropriate
• Avoid 1st trimester exposure when possible
• Use the lowest effective dose for shortest appropriate/ sufficient time
• Avoid polypharmacy if at all possible
• Remember that serious mental illness has independent
adverse effects on pregnancy/infant
