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Mental Health In Pregnancy - Coggle Diagram
Mental Health In Pregnancy
Perinatal Model of Care
Hub and Spoke Model
Full MDT
Mother and Baby Unit - we don't have
Psychiatric Disorders of Pregnancy
Common Presentations
Anxiety
Adjustment Disorder
Bipolar disorders
Eating disorders
Addiction
Psychosis
Bereavement
May be related to physiological changes around time of delivery
Depression
Epidemiology
Women experience new onset and recurrent mood, anxiety and psychostic symptoms as their non pregnant counterparts
20% pregnant women - Major/ minor depression
Premature discontinuation of antidepressants can precipitate a relapse
Effects of Psychiatric Disorders on Foetal / Obstetric outcome
Maternal nutrition
Sleep
Substance abuse
Adherence to medical advice
Myths
Pregancy protects women from illness
All medication in pregnancy is detrimental to foetus and should be contraindicated
Postpartum Blues
Epidemiology
Up to 80% of women develop a mild slef limiting mood disorder
Presentation
Treafulness
Duration 3-10 days postpartum
Emotional lability
Anxiety
Postnatal Depression
Epidemiology
Up to 10% of women
Presentation
Persistent feelings of hopelessness
Feelings of inadequacy
Decrease in coping skills
Poor sleep
Poor appetite
Complications
Can effect emotional development of child
Peurperal Psychosis
Epidemiology
1/1000 women
Risk is subsequent pregnancies up to 30%
Chance of relapse of pre-existing psychiatric disorder - 75%
Presentation
Hallucinations
Delusions
Thoughts of infanticide
Medical emergency
Admission to inpatient facility
Postpartum Grief
Epidemiology
20% pregnancies miscarry
Presentation
Feelings of failure and inadequacy
Managment
Counselling at various intervals
Allowed to see / hold dead / dying baby - fulfil sense of parental obligation
Paretns of Children with physical / mental disabilty often feel they cannot grieve
Prevention
Antenatal 1st Visit
Hx / physical
PHx
Substance abuse hx
Past psychiatric hx
Medications
Screening Questions
Have you or a member of your family ever seen a psychiatrist or a therapies?
Have you taken medications for your emotions or your thinking?
Have you ever been admitted to a hopsital for treatment of a mental illness?
Previous Psychiatric History
Diagnosis
Major depressive
Anxiety
Psychotic disorder
Bipolar disorder
+/- Suicidal ideation
Evaluation
Have a high index of suscpicion
Enquire about symptoms
Use screening tools - EPND
Refer if unsure
Goals of Treament
Attain mental helath stability minimising risks to mother and foetus
Discuss all options + document
Decision Making
No decision is risk free
Minimise the risk
Focus on mother and child wellbeing
Informed consent
Weigh up risk and benefits with each pt
Document reasons for choosing a particular course of treatment
Treatment Options
Non Pharmacological
Mediation
Relaxation techniques
Psychotherapy / eduction
Consider before medication
Sleep hygiene
Exercise
Electroconvulsive therapy ECT
Pharmacological
Types
Hormonal replacement therapy
Antidepressants :
Fluoxetine
Citalopram / sertraline
Paroxetine
Amitriptyline
Avoid in 1st trimester
Venlaflaxine
C/I
MOAs
Sodium valproate
Lithium in 1st trimester
Antipsychotics
Lithium
Suspected Teratogen in 1st timester
Complications
CVS abnormalities
Ebstein's anomaly
Hypotonia - poor suck
Hypoglycaemia
Cyanosis
Absoloute risk 1%
Regimen
Multiple daily doses to avoid peaks of fetal exposure
Monitor levels closely - no higher than 0.9
Discontinue days prior to delivery
Chorpromazine
No conclusive evidence of teratogeniciy
Avoid during labor - hypotension
Avoid near term - neonatal withdrawal
Safe in small doses
Haloperido
Reported use withou negative effects
Olanzapine
Caution required
Metabolic syndromes - Gestation DM
Benzodiazepines
May be teratogenic
1st trimester - cleft lip / palate
3rd trimester
Floppy baby syndrome
Hypotonia
Withdrawal
Poor feeding
Apnoea + low apgar scores
Anticonvulsants
Cabamazapine
Foetal abnormalities in 1st trimester
Facial abormalities
Spina bifida
Cardiac malformations
Urinary tract defects
Consider when non-pharm fails to maintain psychiatric well being
Risk of mental illness to mother and foetus outweigh risk of medication