Lecture 41 - Women's Psych

Question 1

d/o related to the menstrual cycle;

Answer 1

PMS – premenstrual syndrome

PMDD – premenstrual dysphoric disorder

Question 2

PMS

physical and behavioral symptoms

what phase?

duration?

Answer 2

Irritabily, breast tenderness, salt craving,

Behavioral: labile, irritiable, foregetful, fatigue

luteal phase (between ovulatin and menses)

1-2 weeks

Question 3

PMDD –
EPI
Sx
phase

Answer 3

1.8% of women

Last week of luteal phase
resolves post menses

interferes with life

Depression, hopeless, anxious, labile, irritabily, sleep disturbance

breast tenderness, joint and muscle pain

Question 4

Pathophysiology of PMS, PMDD

NTs?
what about hormones?

Answer 4

Serotonin deficient?– can treat with SSRIs

GABA

No link to estrogen;

some women are particularly sensitive to the fluctuation of hormones

Question 5

Treatment of PMDD

Answer 5

SSRIs – effective in days; for some reason no delay on onset of effectivness.
can treat in only luteal phase

OCPs – can help with premenstrual complaints but worsen depressin

NSAIDs for myalgias, arthralgias

Ca/Mg2+

Question 6

Post partum mood disorders

Answer 6

Postpartum blues (aka “baby blues”)

Postpartum depression

Postpartum psychosis

Question 7

Post Partum Blues

EPI`
course
treatment?

Answer 7

50-85% of moms after delivery
Brief intense changes in mood, tearfulness, irritability, laughter

last 3-5 days

self limiting and resolves within 14 days

tx - reassurance

Question 8

Post partum depression
aka
EPI
Course
sx 
Tx 

Long term effect of PPD on kids?

Answer 8

10-16%

Major deperssion with peripartum onset (4 weeks before delivery)

3-14 months if untreated

All sx of MDD + anxiety

Tx – SSRI; maintain for 6-12 months after remission, or indefinitely

Poor parenting leading to kids that have developmental delay, behavioral problems, cognitive decline

Question 9

RF for PPD

Answer 9

depression in current pregnancy, prenatal anxiety, severe postpartum blues

past PPD or depression

Recent stressful life events,

inadequate social supports,

poor marital relationship

Low self-esteem

Childcare stress

Difficult infant temperament (colicky)

Single marital status, low SES, unplanned or unwanted pregnancy

Question 10

Post Partum Psychosis
EPI

first steps in treatment?
Onset?

Answer 10

rare

psychiatric emergency; 24 observation

Rapid onset with 24-72 hours after delivery: dramatic, bizarre behavior, impaired thinking; looks like delirium

Question 11

what population is much more at risk for PPP

Answer 11

25% of deliveries for women with BP

Persons with BP, mood d/o or family member with PPP

likely that they had a d/o, and just didn’t know it yet

Question 12

Treatment of PPP

Answer 12

lithium resumed within 24 hrs delivery: 5-fold reduction in risk of PPP

Question 13

what is the leading cause of maternal death?

Answer 13

Suicide is a LEADING cause of maternal mortality (1/3 of maternal deaths)

Most women who die from suicide are psychotic

Question 14

what is the leading cause of death in pregnant and postpartum women in Maryland

Answer 14

Homicide; intimate partner violence

Question 15

Treatment for anxiety

Answer 15

CBT

BZD – caution; addiction; rebound anxiety

Antidepressants: SSRIs, TCAs

Question 16

differentiating sx of depression vs pregnancy

Answer 16

Excessive guilt
Feeling like a bad or inadequate mother
Hopelessness, helplessness, impending doom
Any odd beliefs about the baby

Question 17

effects of antenatal depression on the baby

Post partum depression on the baby

Answer 17

Premature birth (OR 1.96)
Low birth weight
Small for gestational age + smaller head circumference
Lower APGAR scores
Neonatal complications
Admission to the NICU
Fetal demise

lower quality of interactions with mom
FTT
Higher rates of developmental delay and behavior problems

Question 18

Risk of medication in pregnancy

Answer 18

Major birth defects – rare

Neonatal adaptation –
<25% are transient,

Persistent Pulmonary HTN: rare

Later neuropsych development in the child – no differences

Question 19

Risk of Specific meds in pregnancy

Benzos

Anti-depressants -

Antipsychotics

Mood stabilizers

Answer 19

Benzos – cleft palate with first trimester exposure; floppy baby at delivery

Anti-depressants – debatable evidence

Antipsychotics – debatable evidence

Mood stabilizers
Lamotrigine – Mild increase in facial clefts;

Carbamezepine – small risk for neural tube deficits

Question 20

Lithium birth defects?

considerations during pregnancy

Considerations during breast feeding

Answer 20

Ebstein's Anomaly -- 
displaced tricuspid valve/ASD
risk is 7-20x more likely
but the baseline rate is so low
(really only increases the risk of birth defect from 3% to 3.05%) 

if taking during pregnancy – increased renal clearance and therefore need to increase dose in third trimester;
Reduce post partum

Don’t breastfeed while taking LI– neonate dehydration –
USE FORMULA INSTEAD

Question 21

Depkaote (Valproate)

Birth defects?
other effects?

Answer 21

4% risk of neural tube defects

facial/CV/limb abn

Delivery complications

Neurobehavioral outcomes: developmental delay, mental retardation

Linked to autism

have to document contraception if patient is taking Valproate acid

Question 22

ECT
general resentments/indications

contraindications

Answer 22

most efficacious, fastest and safest treatments for medication refractory depression, catatonia, mania and psychosis

recent hemorrhagic stroke, severe heart disease, large or unstable intracranial mass

Question 23

ECT in pregnancy – fetal effects

Answer 23

Fetal arrythmias during ECT – however this was found to be due to IVC compression as mom was laying flat; simply need to have mom lay on wedge