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3 Reproduction and Sexual Health > Perinatal Psychiatry > Flashcards

Perinatal Psychiatry Flashcards

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1
Q

leading cause of maternal death in UK?

A

mental illness

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2
Q

when do most maternal suicides occur after birth?

A

first 3 months after delivery

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3
Q

red flags for referral to perinatal MH team?

A
  1. significant change in mental health or new symptoms
  2. new thoughts or acts of violent self harm
  3. new or persistent expressions of incompetence as a mother
  4. estrangement from baby
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4
Q

what MH screening should be done at booking?

A

current/past MH problems
previous treatment
FH

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5
Q

what is a mother and baby unit?

A

a unit dedicated to treating mothers with MH problems eg puerperal psychosis and can stay with their baby

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6
Q

what would prompt a referral to a mother and baby unit?

A 
rapidly changing mental state
suicidal ideation
significant estrangement from baby
pervasive guilt/hopelessness
beliefs of inadequacy as a mother
evidence of psychosis
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7
Q

how do women with puerperal psychosis tend to attempt suicide?

A

violently - more violent than female population as a whole

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8
Q

questions to ask a mum about MH?

A
  • new thoughts and feelings that are new? do they disturb or worry you?
  • thoughts of suicide/harming yourself?
  • feeling incompetent/cant cope or estranged from baby? is this persistent?
  • do you feel it’s getting worse?
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9
Q

when would you refer someone to psychiatry for their MH?

A

psychosis
if it’s really severe
Hx of BPD/schizphrenia/PP
previous admissions to MHU

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10
Q

risk factors for MH issues in pregnancy?

A 
young/single
domestic issues
lack of support
substance abuse
unplanned pregnancy
pre-existing MH problems
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11
Q

when would a MH problem be considered as severe?

A

suicidal
psychosis
self neglect
harm

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12
Q

presentation of baby blues?

A 
tearful
irritable
anxiety
poor sleep
confusion
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13
Q

when do baby blues tend to occur?

A

day 3-10 after delivery

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14
Q

DDx of puerperal psychosis

A

episode of bipolar
depression
schizphrenia

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15
Q

when does PP present?

A

within 2 weeks of delivery

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16
Q

early symptoms of PP?

A

sleep disturbance
confusion
irrational ideas

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17
Q

risk factors for PP

A

BPD!!
previous PP
1st degree relative with Hx

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18
Q

Tx of PP?

A 
admission to mum and baby unit
antidepressants
antipsychotics
mood stabilisers
ECT
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19
Q

onset of postnatal depression?

A

2-6 weeks postnatally

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20
Q

how long does postnatal depression last?

A

6 weeks to months

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21
Q

presentation of postnatal depression?

A 
tearfulness
irritable
anxiety
lack of enjoyment
poor sleep
weight loss
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22
Q

how is postnatal depression different than baby blues?

A

occurs much later (baby blues is within the 1st week, PND occurs a few weeks later)

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23
Q

Tx of mild-moderate PND?

Study These Flashcards
A

self help

counselling

24
Q

Tx of moderate-severe PND?

Study These Flashcards
A

psychotherapy
antidepressants
admission

25
risks to baby of untreated depression?
LBW pre-term delivery risk of autism/ADHD in baby poor engagement with child
26
how should you make decisions on whether to prescribe in the perinatal period?
their past history frequency and severity of episodes response to treatment
27
what should you aim for when you prescribe in pregnancy?
use drugs with low risk | lowest dose monotherapy
28
what psychiatric drug is contraindicated in breastfeeding?
lithium
29
when does the neural tube form? what impact does this have on prescribing
5-6 weeks | usually by the time a woman has found out she's pregnant the neural tube has a already formed
30
how should you stop teratogenic drugs in pregnancy?
don't stop immediately | try and titrate it down
31
main drug risk to baby in 1T?
tertogenicity
32
main drug risk to baby in 3T?
neonatal withdrawal
33
should you stop a drug used in pregnancy for breastfeeding?
no, conc of drug given to baby is lower in breast milk so if they were fine in utero they should be fine now
34
what antidepressant is worst in 1T?
paroxetine
35
what SSRI is best in 3T?
sertraline | fluoxetine
36
what antidepressants have the lowest risk in 3T?
tricyclics eg imipramine/amitryptylline
37
best antidepessants during breastfeeding?
sertraline paroxetine imipramine
38
what psychiatric drugs are contraindicated in pregnancy and why?
benzodiazepines | cause fetal malformation/floppy baby syndrome
39
what antipsychotics should be avoided in pregnancy?
clozapine olanzapine and other weight gain drugs depot injections
40
can you take lithium in pregnancy?
yes but its risky so only give if they really need it
41
what has to be done if a woman of child-bearing age still wants to use valproate?
written consent by woman evidence she is on adequate contraception reassess yearly
42
you're 3x more likely to have what mental illnesses if you abuse substances?
perosnality disorder depression anxiety
43
what conditions are screened for in mothers with substance abuse?
HIV hep c hep b STIs
44
what acute illnesses are more common in women who abuse substances?
VTE sepsis endocarditis
45
if you cant get venous access to a woman, where should you go to next?
interosseus
46
can opiate abusers receive diamorphine in labour?
yes
47
drinking more than _ units per week puts you at increased risk of affecting the baby
8
48
patients who abuse oral recreational drugs are at more risk of what pregnancy complications?
``` placental abruption IUGR preterm labour miscarriage fetal anomalies pre-eclampsia SIDS withdrawal ```
49
nicotine should be stopped in pregnancy T or f
T
50
risks of nicotine use in pregnancy?
``` miscarriages abruption IUGR stillbirth SIDS ```
51
what interventions should you take with a pregnant mother who is substance abusing?
``` consider methadone programme child protection/social work referral via "unborn baby protocol" smear history breastfeeding if free of substances early IV access ```
52
when can a woman not breastfeed if theyre substance abusing?
if alcohol intake is > 8 units HIV cocaine
53
what should you do if you find out theyre at risk of abuse?
keep them in a safe place ie the hospital until you get them involved with social work etc
54
why do you get heartburn in pregnancy?
progesterone relaxes spincters
55
Tx of bulimic patients with heartburn?
ranitidine
56
massive PPH involves what volume of blood?
1500ml ++

3 Reproduction and Sexual Health (51 decks)

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