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Perinatal psychiatry (Antenatal
illness (BPD (Management (Conservative
…
Perinatal psychiatry
Antenatal
illness
BPD
Pathophysiology
High risk of relapse if stop meds abruptly
(which many do when they realise they are preg)
Management
Conservative
Post-natal care plan (monitoring, med changes, inpatient admissions, community midwife support)
-
Medical
Indication: all BPD
E.g. antipsychotics, Li
-
Schizophrenia
-
-
Complications
Mother: poor compliance with appointments,
neglect, substance misuse
Baby: premature birth, low birth weight
Anxiety
-
Clinical presentation
Generalised anxiety disorder
OCD
Panic disorder
PTSD (previous loss or traumatic birth)
Tokophobia (fear of childbirth)
Management
-
Psychological
Indication: mild, mod-severe
E.g. CBT
-
-
Antenatal
depression
Complications
Mother: poor compliance to appointments,
self neglect, alcohol/smoking/drugs
Child: poor obstetric outcome (lifestyle), preterm labour
and low birth weight (high cortisol from maternal stress)
Pathophysiology
Underlying depression increased relapse
risk during pregnancy
High cortisol from stress is deterimental for the baby, as
is the associated negative lifestyle choices (alcohol, drugs)
-
Post-natal
illness
Baby blues
Clinical presentation
Episodic tearfulness
Labile mood
Poor concentration
Sleep disturbance
Irritability
Depression/anxiety
Feeling distant to baby
Risk factors
First pregnancy
Past history of PMT
Anxiety/depression during late pregnancy
Poor social support and SEC
-
-
-
Management
Reassurance, explanation, advice
Post-natal
depression
-
-
Risk factors
Previous PND
Mental illness e.g. depression, BPD, anxiety
Baby blues
FH perinatal illness
Lack of social support, low SEC
Life events
-
Clinical presentation
Per unipolar depression
Low mood, anhedonia, fatigue
Diagnosis
History - depression symptoms >2wk
Examination - MSE, Edinburgh Post-Natal
Depression Scale (EPDS)
-
Complications
Mother: neglect, self harm, suicide
Child: neglect, cognitive/emotional/behavioural/social deprivation
Post-partum
psychosis
Risk factors
Previous PPP
Mental illness e.g. BPD, schizophrenia
FH PPP
Clinical presentation
Delerium/acute confusion
Paranoid, suspicious
Delusions (self, baby)
Hallucinations
Racing thoughts
Neglect to self and baby
Agitated, irritable
Labile mood
Depression, anxiety, mania
-
Management
Perinatal psychiatry, often admission (mother & baby unit)
Medication per psychosis/mania
-
Complications
Poor compliance
Impulsivity
Neglect (self, baby)
Infanticide (rare)
-
-
Perinatal
prescribing
Antenatal
-
Risk to child
Overall
Early (6-8w): teratogenicity (dose/time dependent)
Late: neonatal toxity, withdrawal
SSRIs
Cardiac/lung deformity (early preg), pulmonary HTN (late preg), preterm labour, small BW, withdrawal (irritable/agitated, convulsions)
Mood
stabilisers
Valproate
NTDs, spina bifida, limb/digital defects, heart degects, low IQ
Carbamazepine
Spina bifida, fingernail hyperplasia, dev delay, craniofacial abnormalities, growth retardation
-
-
Benzos
Oral cleft defects (1st trimester), floppy baby syndrome
(3rd trimester; poor tone and feeding)
Prescribing rules
-
Drugs to avoid
Valproate (if needed, high dose folic acid during pregnancy and postnatal vit K for mum and baby [thrombocytopenia])
Lithium (if needed, monitor and foetal USS and ECHOs)
Benzodiazepines
-
Postnatal
Prescribing rules
-
-
Avoid
Antipsychotics if possible
Long-acting benzos e.g. diazepam,
if needed use short acting e.g. lorazapam
Risk
to child
-
-
-
Benzos
Long acting risk lethargy, weight loss, CNS depression
Definition
Psychiatric sub-specialty of
psychiatric conditions in women
during pregnancy and first year post-natal