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Flashcards in Perinatal Psychiatry Deck (52):
1

What are the red flag perinatal presentations?

recent signif change in mental state; new thoughts or acts of violent self harm; persistent expressions of incompetency or estrangment

2

What is the differencein methods between suicide perinatally and femal suicide in general?

perinatally methods are much more violent

3

What are the risk factors for mental health issues in pregnnacy?

young/single; domestic issues; lack support; substance abuse; unplanned/unwanted pregnancy; pre-existing metnal health problem

4

When should a woman be referred to the psych team?

psychosis; severe anxiety; depression; suicidal; self-neglect; self harm; symptoms with signif interference in ADLs; hx of bipolar; SZ or puerperal psychosis; psychotropic medications; mod illness in late pregnancy or early postpartum; mild/mod but FHx; prev inpatietn

5

What is the general rule with pregnancies effect on mental health?

not protective

6

What are the risks associated with eating disorder in pregnancy?

IUGR; prematurity; hypokalaemia; hyponatraemia; metabolic alkalosis; miscarriage

7

How common in baby blues?

50% women

8

What is the baby blues?

brief period of emotional instability- tearful; irritable; anxiety; poor sleep; confusion

9

When does baby blues tend to occur?

days 3-10: self-limitng

10

What is the treatment for the baby blues?

support and reassurance

11

What is the differential for puerperal psychosis?

episode of bipolar; unipolar depression; SZ; organic brain dysfunction

12

When does puerperal psychosis usually present?

within 2 weeks of delivery

13

What are the early symptoms of puerperal psychosis?

sleep disturbance and confusion; irrational ideas

14

What are the symtpoms of puerperal psychosis?

mania; delusions; hallucinations; confusion--- different to otehr psychoses; very changeable

15

What are the risk factors for developing puerperal psychosis?

bipolar disorder; previous puerperal psychosis; FHx

16

What is the treatment for puerperal psychosis?

admission to mother-baby unit; antidepressants; antipsychotics; mood stabilisers and ECT

17

How common is postnatal depression?

10%

18

What are the symptoms of postnatal depression?

tearfulenss; irritable; anxiety; lack of enjoyment; poor sleep; weight loss; concerns re baby

19

When does postnatal depression start?

2-6 weeks postnatally

20

What are the child of untreated depression?

low birth weight; preterm delivery; emotional and conduct problems; ADHD; poor bonding with child- cognitive development affected

21

What type of preparations should be avoided in pregnancy?

depot

22

What is the risk to the fetus generally in the 1st trimester with drugs?

teratogenicity

23

What is the risk to the fetus generally in 3rd trimester with drugs?

neonatal withdrawal

24

Why is there no need generally to stop a drug that was used during pregnnacy in breast feeding?

exposure in breat milk is uually less than in utero

25

What antidepressant carries the greatest risk of fetal malformation?

paroxetine- heart defects

26

What is general teratogenic risk with antidepressants?

no increase in major malformations or spontaneous abortion

27

What is there an increased risk of with antidepressants in the third trimester?

neonatal withdrawal (milld and self-limiting); neonatal persistent hypertension; low birth weight/prematurity

28

Which antidepressants in crease the risk of neonatal persistent pulmonary hypertension?

SSRIs and venlafaxine taken after 20 weeks

29

What SSRIs carry the lowest risk in the 3rd trimester?

sertraline and fluoxetine

30

What TCAs carry the lowest risk in the 3rd trimester?

imipramine/amitriptyline

31

Do TCAs or SSRIs carry the higher risks in the 3rd trimester?

SSRIs

32

What antidepressants should be avoided in breastfeeding?

citalopram and doxepin

33

What antidepressants are good in breastfeeding?

sertraline; paroxetine; imipramine

34

Why should BZDs be avoided in the first trimester?

increase risk of fetal malformation eg cleft palate

35

Why should BZDs be avoided in the 3rd trimester?

increased risk of floppy baby syndrome

36

What are the symptoms of floppy baby syndrome?

hypothermia; hypotonia; respiratory depression; withdrawal effets

37

Why should BZDs be avoided in breastfeeding?

risks of neonatal lethargy and weight loss and accumulation of long acting drugs (developing liver metabolism)

38

Why should clozapine be avoided in pregnancy?

agranulocytosis- no way to easily check fetus blood

39

What are the risks in pregnancy associated iwth olanzapine?

GDM and weight gain

40

What is the risk of lithium in the 1st trimester?

increased Ebstein's abnormality

41

Even though there is teratogenic risk with lithium what should not be done?

sudden discontinuation

42

Why should serum lithium levels be monitored very closely in 3rd trimester?

changes in volume of distribution and lithium toxicity can mimic PET

43

How often should lithium levels be monitored from week 36?

weekly

44

Can lithium be usedi n breastfeeding?

no-high quantities in breast milk

45

What are the risks associated with sodium valproate in the first trimester?

neural tube defects; craniofacial defects and intellectual devleopment - increased autism

46

When does the neural tube close?

day 28

47

Is valproate safe to use when breastfeeding?

yes- no evidence of adverse effects

48

What are the risks associated with carbamazepine in pregnancy?

NTDs; GI and cardiac; neonatal anticonvulsant syndrome

49

why should lamotrigine be avoided in the 1st trimester?

increased risk of oral cleft

50

What is the risk with lamotrigine in breastfeeding?

risk of SJS in infant

51

What are the fetal risks with substance abuse?

IUGR; stillbirth; SIDs and preterm labour

52

What are the symptoms of fetal alcohol syndrome?

facial deformities; lower IQ; neurodevelopmental delay; epilepsy; hearing; heart and kidney defects