Perinatal psychiatry Flashcards
(48 cards)
What predicts maternal suicide?
Previous psychiatric disorder, other vulnerable factors, family history of BP disorder
Who should get urgent referral to a specialist perinatal mental health team?
Women who report;
- recent significant change in mental state or emergence of new symptoms
- new thoughts or acts of violent self harm
- new and persistent expressions of incompentency as a mother or estrangement from their baby
When should admission to a mother and baby unit be considered?
If a woman has had any of the following;
- rapidly changing mental state
- suicidal ideation
- significant estrangement from the infant
- pervasive guilt or hopelessness
- beliefs of inadequacy as a mother
- evidence of psychosis
What are the risk factors for mental health issues?
- young/single
- domestic issues
- lack of support
- substance abuse
- unplanned/unwanted pregnancy
- pre existing mental health problem
What is the risk of relapse of bipolar disorder if untreated?
50% postnatally
What are the risks of eating disorders in pregnancy?
- IUGR
- prematurity
- hypokalaemia
- hyponatraemia
- metabolic alkalosis
- miscarriage
- premature delivery
Who manages mild-moderate antenatal depression?
GP
What is the baby blues?
Experienced by 50% of women
Brief period of emotional instability
Tearful, irritable, anxiety, confusion and poor sleep
Usually day 3-10 after birth
Self limiting, support and reassure
What is the differential diagnosis of puerperal psychosis?
- bipolar
- unipolar depression
- schizophrenia
- organic brain dysfunciton (2ry to physical illness)
When does puerperal psychosis usually present?
within 2 weeks of delivery
What are the symptoms of puerperal psychosis?
Sleep disturbance & confusion, irrational ideas
Mania, delusions, hallucinations
What is the risk of suicide and infanticide in puerperal psychosis?
5% suicide risk
4% infanticide risk
What are the risk factors for puerperal psychosis?
- bipolar disorder
- previous puerperal psychosis
- 1st degree relative with BP
What is the management of puerperal psychosis?
Emergency
Needs admission to mum and baby unit
Antiderpressants, antipsychotics, mood stabilisers and ECT
What percentage of mums with puerperal psychosis go on to develop bipolar disorder?
25%
How common is postnatal depression?
10% of women
What are the symptoms of post-natal depression?
- tearfulness
- irritability
- anxiety
- anhedonia
- poor sleep
- weight loss
- can often present as concerns about baby
When does postnatal depression occur?
2-6 weeks postnatally, lasts weeks to months
What is the management for postnatal depression?
- Mild-moderate: self-help, counselling
- Moderate-severe: psychotherapy and antidepressants, admission?
What is the lifetime risk of depression after an episode of postnatal depression?
70%
What issues should be considered in the treatment of perinatal disorders?
- risks of untreated illness- to mum and baby
- general principles of prescribing in perinatal period
- benefits and harms of specific treatment
What are the risks of untreated depression to the child?
- low birth weight
- pre-term delivery
- adverse childhood outcomes
- emotional & conduct problems, ADHD
- poor engagement/bonding with child
- reduced infant learning and cognitive development
What is the first line antidepressant in pregnancy?
SSRIs
- sertraline has least placental exposure
- fluoxetine is thought to be safest
What are the risks of SSRI’s in pregnancy?
- persistent hypertension of the newborn
- lower birth weight
- increased early birth (days)
- post partum haemorrhage
