5: Perinatal psychiatry Flashcards

1
Q

What is the leading cause of maternal death in the year following birth?

A

Suicide re: mental illness

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2
Q

Women who develop post-partum mental health problems often have a history of what?

A

Mental health problems

so it doesn’t come out of nowhere

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3
Q

What are three red flags for mental illness in a pregnant women?

A

Recent significant change in mental state

New thoughts of violence / self-harm

New thoughts of estrangement from baby

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4
Q

If a pregnant woman has red flag symptoms for mental illness, where should she be admitted?

A

Perinatal mental health unit

which is referred to as the ‘Mother and baby unit’

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5
Q

What mental health screening questions should be asked at antenatal clinic?

A

Do you have any new feelings which are making your disturbed or anxious?

Do you have any thoughts of self-harm or suicide?

Do you feel a sense of distance or estrangement from your baby?

Do you feel you are getting worse in general?

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6
Q

When do pregnant women have their first appointment with their midwife?

A

12 weeks

At which point you should be screening for mental health

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7
Q

Pregnant women with a history of which disorders should be referred to psychiatry?

A

Anxiety

Depression

Bipolar

Psychosis

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8
Q

What is the recurrence rate of peurperal psychosis?

A

50%

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9
Q

Under what circumstances should you refer a pregnant / post-natal woman to psychiatry?

A

Severe anxiety, depression, bipolar or psychotic symptoms

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10
Q

Pregnancy is (protective / not protective) for pre-existing mental health problems.

A

not protective

Pregnant women being so elated that their mental disorders disappear is a myth

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11
Q

What are baby blues?

A

Mild periods of emotional instability during pregnancy

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12
Q

What is the course of baby blues?

A

Up to 10 days

Self-limiting

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13
Q

What percentage of pregnant women develop peurperal psychosis?

A

0.1%

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14
Q

What are the symptoms of puerperal psychosis?

A

Delusions

Hallucinations

Mania

Confusion (separating from standard psychosis)

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15
Q

What is the prevalence of puerperal psychosis?

A

1 in 1000 pregnant women

or 0.1%

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16
Q

How is puerperal psychosis managed?

A

Admission to antenatal mental health unit

Antidepressants, antipsychotics, mood stabilisers, ECT

17
Q

Puerperal psychosis has a (high / low) relapse rate.

A

high relapse rate

18
Q

What do many women with undiagnosed postnatal depression worry about?

A

Effect of diagnosis on possession of child

19
Q

How do you differentiate baby blues from postnatal depression?

A

Baby blues lasts up to 2 weeks and is self-limiting

Postnatal depression has a later (2 weeks+) onset and negatively affects relationship with child

20
Q

Does maternal depression have physical effects on the child?

What are some examples?

A

Yes

Low birth weight, premature delivery, poor relationship

21
Q

What are the principles for drug treatment of psychiatric problems in pregnancy?

A

Avoid high risk drugs (which change with trimester)

Use lowest dose monotherapy

Consider interactions

Encourage breastfeeding (exception: lithium)

22
Q

Adverse effects re: teratogenic drugs may have occurred before the ___ is discovered.

A

before pregnancy is discovered

23
Q

Which psychiatric drugs are notably teratogenic?

A

Lithium

Sodium valproate

24
Q

Which sedative drugs should be avoided in pregnancy?

A

Benzodiazepines

25
Q

In general, antipsychotics are safe to use during pregnancy.

Which specific drugs should be avoided?

A

Clozapine - agranulocytosis

Olanzapine - obesity, diabetes

26
Q

Why should depot injections be avoided in pregnant women?

A

High concentration of drug can accumulate in foetus

27
Q

Which drug, used in bipolar disorder and epilepsy, is contraindicated in pregnancy?

Why?

A

Sodium valproate

Neural tube defects (which often occur before the pregnancy is discovered)

28
Q

If a woman of childbearing age is on sodium valproate, she should be using ___.

A

contraception

29
Q

What lifestyle disorder increases a pregnant woman’s chances of mental health problems?

A

Substance abuse

30
Q

Which bloodborne viruses should be tested for in pregnant women?

A

HIV

Hep B & C

31
Q

Pregnant women who abuse alcohol are at risk of ___ deficiency.

A

nutrient deficiency

particularly thiamine (Vitamin B1)

32
Q

Why are substance users more likely to contract STIs?

A

“Chaotic lifestyle”

33
Q

People who inject drugs are at risk of which vascular complication?

A

Venous thromboembolism

e.g DVT leading to PE, MI, stroke

34
Q

Can women with a history of opiate abuse be given opiates during labour?

A

Yes

It’s analgesia

May even require an increased dose due to tolerance

35
Q

What are the guidelines re: alcohol consumption for pregnant women?

A

Abstain if possible

Otherwise < 2 units / week

36
Q

What is a foetal consequence of alcohol abuse during pregnancy?

A

Foetal alcohol syndrome

look up presentation

37
Q

What cardiovascular diseases occur secondary to the use of cocaine, amphetamine and ecstasy during pregnancy?

A

Arrythmias

Stroke

38
Q

What are the guidelines re: smoking in pregnancy?

A

Don’t

Linked to miscarriage, placental abruption, IUGR