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Flashcards in Perinatal psychiatry Deck (30):

Which periods surrounding child-birth and pregnancy are most associated with psychiatric illness?

Pregnancy is generally a time of mental well-being and the development of mental disorders is unusual.

The more risky period is the puerperium period (after birth).


Which psychiatric medications are thought to be more safe in pregnancy?

1) TCAs
2) SSRIs
3) Antipsychotics although extra-pyramidal side effects may occur in neonates


Which psychiatric medications are thought NOT to be safe in pregnancy?

1) lithium and 2) benzodiazepines are probably teratogenic


What are the main puerperal (after birth) disorders?

1) Postnatal blues
2) Postnatal depression
3) Puerperal psychosis


What % of women experience the postnatal blues?



What period do the postnatal blues occur?

Within the first 10 days after delivery


What are the symptoms of the post natal blues?

1) Episodes (that peak between the 3rd and 5th day) of weepiness associated with:
2) mild depression or
3) emotional lability
4) anxiety
5) irritability


What is the aetiology of the post-natal blues thought to be? (and why)

Biological (The lack of a link between postnatal blues and life events, demographic factors or obstetric events)


What generally is the treatment required for the postnatal blues?

Reassurance (but may precede postnatal depression)


What are the risk factors for developing postnatal depression? (PND)

1) Mainly psychological ones (e.g. stressful life events, lack of a confiding relationship, etc.)

2) Obstetric complication

3) Biological risk factors are limited


What is the prevalence of PND?

10% (1 in 8 women, this is roughly the same as in the general population)


Within how long post-partum does PND usually develop?

Within 3 months


How long does PND usually last?

2-6 months


What additional symptoms occur in PND that are less common in normal depression?

1) Anxious preocupation about babies health
2) Reduced affection for the baby -> which may impair bonding
3) Obsessional phenomena which may be infanticidal


Can antidepressants be used whilst breast-feeding?

Yes, despite antidepressants having the ability to pass to through breat milk. This is not an ideal situation though.


Describe the course of puerperal psychosis.

Episodes typically
1) have a rapid onset
2) usually between day 4 to 21 days (3wks) post delivery and almost always within 8 weeks


What psychiatric condition is puerperal psychosis (in 80%) similar to?

80% of cases the presentation resembles a mood disorder with delusions and hallucinations


What are the common symptoms in puerperal psychosis?

1) insomnia
2) restlessness
3) perplexity
later progressing to:
4) suspiciousness
5) marked confusion with psychotic symptoms


How common is puerperal psychosis?

Occurs in around 1 in 500 births


How can puerperal psychosis be treated with medication?

May include antipsychotics, antidepressants and lithium.

Benzodiazepines can also be used with severe behavioural disturbances.


What is the prognosis for puerperal psychosis?

Most cases recover within 3 months (75% within 6 weeks)


What is the risk of recurrance of puerperal psychosis with future pregnancies?



Are TCAs safe in breast feeding?

The amount transmitted in breast milk is too small to be harmful.
Low dose amitriptyline appears to be safe


Are SSRIs safe in breast feeding?

Limited information available but the manufacturers advise caution.
Fluoxetine is excreted in very small amounts but has a long half-life so may accumulate


Is Lithium safe in breast feeding?

Risk of neonatal lithium toxicity as breast milk contains 40% of maternal lithium concentration


Are antipsychotics safe in breast feeding?

Only small amounts are excreted but there is a possible effect on developing nervous systems.

Avoid high doses due to risk of lethargy in infants.

Only use when benefits outweigh risks.


Are benzodiazepines and other hypnotics safe in breast feeding?

No. May cause lethargy.


If there are thoughts of infanticide what must you ascertain?

ascertain if these are repulsive thoughts to the patient or not

as if they are not repulsive they may be seriously entertained.


What can thoughts of infanticide worryingly involve?

a degree of planning


Do symptoms of puerperal psychosis fluctuate or remain constant?

They can fluctuate dramatically in their nature

and intensity

over a relatively short period of time