Perinatal Psychiatry Flashcards
(106 cards)
What is the leading cause of maternal death in the UK?
Mental illness
Half of all maternal suicides occur up to ___ weeks post-natal
12 weeks
The rate of maternal death by suicide remains unchanged since 2003 and maternal suicides is now the leading cause of direct maternal deaths occurring within a year after the end of pregnancy
T
Suicide is the leading cause of maternal death occurring within a year of the end of pregnancy
T
2/3rd of women who kill themselves following birth have already suffered a mental health condition at some stage in their life
T
Women who report what are given an urgent referral to a specialist perinatal mental health team?
- Recent significant change in mental state or emergence of new symptoms
- New thoughts or acts of violent self-harm.
- New and persistent expressions of incompetency as a mother or estrangement from their baby.
A woman with significant change in mental state or emergency of new symptoms …
Urgent referral to a specialist perinatal mental health team
A woman with new thoughts or acts of violent self-harm
Urgent referral to a specialist perinatal mental health team
A woman with a new and persistent feeling of incompetency as a mother or estrangement from baby
Urgent referral to a specialist perinatal mental health team
What should always be discussed at booking?
Current or past history of mental health problems
When should admission to a mother and baby unit always be considered?
If a woman presents with any of the following …
- Rapidly changing mental state.
- Suicidal ideation (particularly of a violent nature).
- Significant estrangement from the infant.
- Pervasive guilt or hopelessness.
- Beliefs of inadequacy as a mother.
- Evidence of psychosis.
Good questions to ask include …
Do you have new feelings and thoughts which you have never had before, which make you disturbed or anxious?
Are you experiencing thoughts of suicide or harming yourself in violent ways?
Are you feeling incompetent, as though you can’t cope, or estranged from your baby? Are these feelings persistent?
Do you feel you are getting worse?
With regard to screening for mental health issues, what should be done/addressed at the booking appointment?
- History of mental health problems, previous treatment and family history.
- Identification of risk factors.
What are the risk factors for mental health issues in relation to pregnancy?
- Young/single.
- Domestic issues.
- Lack support.
- Substance abuse.
- Unplanned/unwanted pregnancy.
- Pre-existing mental health problem.
** What screening questions should be used at every appointment? **
- During the last month have you been bothered by feeling down, depressed or hopeless?
- During the last month have you been bothered by having little interest or pleasure in doing things?
- Is this something you feel you need or want help with?
In what situations should the psychiatric team see a woman?
- Psychosis
- Severe anxiety, depression, suicidal, self-neglect, self-harm
- Symptoms with significant interference with daily functioning
- History of bipolar or schizophrenia
- History of puerperal psychosis
- Psychotropic medications
- If developed moderate mental illness in late pregnancy or early postpartum
- Mild- moderate illness but 1st degree relative with bipolar or puerperal psychosis
- Previous in-patient admissions to mental health unit
Pregnancy is/is not protective against maternal mental health conditions
IS NOT
How does pregnancy tend to affect bipolar disorder?
It is associated with a high rate of relapse postnatally (50% if untreated).
How might eating disorders be affected by pregnancy?
They may be improved
What risks are associated with pregnancy in someone with an eating disorder?
- IUGR.
- Prematurity.
- Hypokalaemia.
- Hyponatraemia.
- Metabolic alkalosis.
- Miscarriage.
- Premature delivery.
What % of women with antenatal depression will relapse if they stop meds in pregnancy?
68%
What self-help strategies may be used in the treatment of antenatal depression?
CBT
If a woman with antenatal depression has a mild relapse, what can be done?
If mild and on treatment, consider stopping and referring for psychological treatment
If antenatal depression is mild-moderate, who might it be managed by?
GP
