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perinatal psych Flashcards

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1
Q

what kinds of psychiatric problems do women have during pregnancy?

A
  1. depression

2. BPAD

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2
Q

psych probs post partum?

A
  1. baby blues
  2. peurpeural psychosis
  3. post natal depression
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3
Q

most common cause of maternal mortality is ______

A

suicide

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4
Q

rate of depression in pregnancy?

A

as for baseline

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5
Q

10% risk of depression in T1 if?

A
  1. past hx
  2. previous abortion
  3. previous IUD
  4. unwanted
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6
Q

psych admission and suicide in pregnancy are ______ common than other times

A

less

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7
Q

risks of untreated depression in mum?

A
  1. risk PND

2. risk to baby from maternal neglect

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8
Q

how to tx depression in pregnancy?

A

as for normal adult

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9
Q

can maternal anxiety affect baby?

A

yes, in terms of foetal heart activity and heart rate

high stress = 2x risk of preterm birth

affects sleep in babies and toddlers

BUT are these associations real biological?

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10
Q

cortisol and psych distress in pregnancy?

A

increased cortisol = lower fetal weight

also increased intrauterine arterial resistance = LBW

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11
Q

negative consequences of maternal depression are related to _________

A

length of illness

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12
Q

incidence of baby blues

A

50-75% new mums

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13
Q

presentation baby blues

A
  1. tearful
  2. irritable
  3. distress
  4. sometimes brief high
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14
Q

course of baby blues?

A

transient - strts 2nd day ish and lasts max 72hrs

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15
Q

tx for baby blues

A

supportive

if prolonged = risk PND

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16
Q

RFs for baby blues?

A

hx of bad PMS or mood changes on anovulant OCP

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17
Q

PND incidence?

A

10-15% all mothers

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18
Q

PND what is it?

A

not one disorder - combo:

depression
anxiety
adjustment
PTSD

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19
Q

course of PND?

A

90%

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20
Q

recurrence rate PND?

A

20%

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21
Q

symptoms of PND

A

as for depression

20% mum has trouble relating to the baby after delivery

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22
Q

RFs for PND?

A
  1. previous depression
  2. difficult labour
  3. fhx
  4. difficult pregnancy
  5. previous conflict arounf pregnanyc, MC, termination, SB
  6. lack of support
  7. lack of self esteem
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23
Q

mx of PND

A
  1. early detection
  2. prevent with education + support
  3. brief CBT
  4. meds
  5. risk assessment
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24
Q

how is PND measured?

A

Edinburgh PND scale

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25
incidence of PPP?
0.1-0.2% (1/500)
26
onset of PPP?
2 weeks after delivery
27
type of PPP?
1. affective (80%) or non affective 2. 15% schizophreniform 3. 5% organic
28
cause of PPP?
unknown
29
RFs for PPP?
``` previous hx affective psychosis fhx affective disorders previous hx of PPP previous SB, MC, termination major life event in pregnancy lack social support ```
30
risk of recurrence PPP?
60% +
31
tx of PPP?
1. risk assessment - infanticide or suicide 2. meds: antipsychotics, antidepressants, mood stabilisers 3. ECT in depressive psychosis 4. admit to mum and baby unit 5. need psych support and social support
32
when is max teratogenicity in pregnancy?
17-60 days
33
what is the normal spontaneous major malformation rate?
2-3%
34
meds + major malformations?
only account for 5%
35
1st trimester drugs _____
major malformation
36
3rd trimester drugs _______
neonatal toxicity
37
In T3 dosing may need to be ______
increased due to rise in blood volume
38
mum on drugs, monitor neonate for ________
withdrawal
39
recommendations for depression tx in pregnancy?
high risk relapse: 1. maintain on AD tx developed depression during pregnancy: 1. psych first then meds
40
what meds okay for depression in preg?
amitryptline imipramine fluoxetine
41
what antidepressant to not use in pregnancy?
paroxetine venlafaxine high risk discontinuation sx in neonate
42
prescribing for psychosis in pregnancy rules?
1. plan pregnancy 2. if high relapse rate then keep on antipsych during and post 3. try keep dose low as poss 4. maintain on whatever they are currently on unless issue with it
43
what antipsych okay in pregnancy?
chlorpromazine haloperidol olanzepine clozapine if poss switch atypical to typical - more data
44
discontinuation sx in neonate?
crying agitation increased suckling
45
folate and atypicals
low folate levels
46
prolactin and fertility?
decreases it!
47
antipsychotics are teratogenic?
no evidence
48
BPAD mx in pregnancy?
1. can withdraw meds if long time no relapse 2. don't stop suddenly- high risk relapse 3. keep on meds if high relapse 4. no mood stabiliser safe
49
lithium - must screen for ______ at ______ weeks
ebsteins anomaly 6 and 18
50
if on anticonvulsant meds need to give _______
more folate | vit K after delivery
51
_______ is associated with cleft palate
lamotrigine
52
_________ is the most teratogenic mood stabiliser
valproate
53
effects on foetus of anticonvulsants?
1. growth retarded 2. developmental delay 3. NTDs 4. specific syndromes
54
risk of ebsteins anomaly on lithium
1/1000
55
risk of relapse in BPAD maintained on lithium?
50%
56
benzos in pregnancy?
1. avoid in T1 | 2. avoid hihgh dose late in pregnancy - hypotonia, hypothermia, resp depression, withdrawal
57
diazepam can cause a ______
cleft lip
58
which psychotropic drugs are licensed in pregnancy?
none
59
psychotropics in breastfeeding?
1. monitor infants for effects/ feeding patterns/growth 2. don't stop tx 3. use lowest effective dose 4. no polypharm 5. time feeds to avoiod peak drug levels or express and give later
60
antiD in breastfeeding?
paroxetine or sertraline
61
antipsychotics in breast feeding?
olanzepine | sulpiride
62
mood stabilisers in BF?
avoid if poss | valproate if must
63
sedatives in BF?
lorazepam for anxiety | zolpidem for sleep
64
types of meds good in BF generally?
has worked before was on in pregnancy short half life

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