Pre and post natal Flashcards Preview

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Flashcards in Pre and post natal Deck (56):
1

What percent of pregnant women will meet criteria for a MDE during pregnancy?

14-23%

2

What percent of women have some symptoms of a MDE postpartum?

50%

3

What percent of women have some type of mood disturbance postpartum?

85%

4

True or false: antenatal or postpartum depression increases the likelihood of a later MDE

True

5

More or less education is a risk factor for postpartum depression?

Less

6

Increased or decreased physical symptoms with pregnancy is a risk factor for postpartum depression?

Increased

7

True or false: a distant h/o depression is a risk factor for postpartum depression

True

8

What are the "baby blues"?

Mood disorder that presents within the first few days after delivery, and usually resolves within 2 weeks

9

What is the incidence of baby blues?

50-85% of women

10

What are the s/sx of baby blues? (4)

-Mood lability
-Tearfulness
-Anxiety
-Irritability

11

What is the duration of baby blues?

Peak on 4th-5th day, and last from a few hours, to a few days

12

True or false: the baby blues in and of themselves are not a disorder

True

13

When is evaluation for baby blues needed?

If longer than 2 weeks

14

When does postpartum depression begin?

Usually emerges 2-3 months postpartum, but must occur within 4 weeks of delivery

15

True or false: postpartum depression is clinically indistinguishable from depression at other times

True

16

What is the depression scale for postpartum depression?

Edinburgh postnatal depression scale

17

What is the correlation between serum levels of hormones with postpartum depression?

There is none

18

True or false: postpartum anxiety is equally common as postpartum depression

True

19

What are the anxiety disorders that can appear postpartum? (4)

-GAD (adequacy of parenting)
-Panic attacks
-Hypochondriasis
-OCD (thoughts of harming baby)

20

Who in particular is worried about parenting skills?

Those who had bad childhood experiences with their parents

21

Why are panic attacks more common during pregnancy? (2)

-Hotter than usual during pregnancy--may predispose to panic attacks
-Baby kicks and hyperfocus on body

22

What is the common presentation of OCD in new mothers?

Involves thoughts of harming the baby

23

True or false: excessive thoughts of harming a baby in the postpartum period is common

True

24

What is postpartum psychosis?

Typically a mixed or manic episode as part of a bipolar illness

25

When do s/sx of postpartum psychosis usually begin?

2-3 days or within 2 weeks

26

What percent of women who develop postpartum psychosis have no psych history?

50%

27

What are the three major initial symptoms of postpartum psychosis?

-Restlessness
-Irritability
-Insomnia

28

What are the later s/sx of symptoms of postpartum psychosis? (4)

-Rapidly confusing or shifting depressed or elated mood
-Confusion
-Erratic behavior
-Delusions or hallucinations

29

What is the major concern with postpartum psychosis?

Risks for suicide and infanticide are high

30

What four things must be judged to assess for postpartum psychosis?

-Judgement
-Reality testing
-Anger control
-Intent

31

What is the way to talk about the thoughts of harming infants (if not psychotic)?

-High stress--normal
-"Thoughts are not behavior"

32

What are the risks to the baby of untreated depression during pregnancy?

-Preterm
-Low birth weight
-SMGA

33

What is the best predictor of long term neurocognitive outcomes with maternal depression?

Maternal mood--not medication exposure

34

What are the primary treatments for intrapartum depression? (2)

-Interpersonal psychotherapy
-CBT

35

What is the pharmacotherapy for intrapartum depression?

SSRIs

36

True or false: medication risks are similar to untreated depression during pregnancy

True

37

What are the fetal abnormalities with SSRIs?

Septal heart defects

38

True or false: there is an elevated risk of miscarriage with SSRIs

True?

39

True or false: there is not a risk of preterm birth with SSRIs intrapartum

False

40

What is the SSRI of choice for pregnant women? Which is contraindicated?

-Sertraline is good
-Paroxetine is bad

41

What is the role of SNRIs in pregnancy?

Not used, but not studied enough

42

What are the s/sx of the SSRI use in the neonate? (6)

-Restlessness
-Tremor
-Rigidity
-Tachypnea
-Hypoglycemia
-Szs

43

What is the treatment for pregnant women with mild to moderate depression?

Therapy

44

What is the treatment for pregnant women with severe depression?

Meds

45

What is the treatment for pregnant women with bipolar disorder?

Medications--really need to control it

46

What should be done with pregnancy if a woman is already on an SSRI? Why?

Take their preference into account

-6x increase in depression relapse if taken off

47

If a woman is on an SSRI that is not recommended in pregnancy, should she switch to one that is more studied in pregnancy?

No--leads to possible increased switching.

Unless she asks to change

48

What are the bipolar drugs that have a high risk of teratogenic effects?

Tegretol (carbamazepine) and depakote (valproic acid)

49

What is the safest bipolar drug in pregnancy?

Li

50

What is the major risk of valproic acid in pregnancy?

autism or congenital malformations (ASDs, cleft palate)

51

What are the risks of untreated postpartum depression? (3)

-Less mother-child bonding
-Poorer mental and motor development at 1 yr
-Insecurity / behavioral disturbance

52

What are the most common complications in modern obstetrics?

Postpartum depression

53

Why are depressive symptoms common postpartum?

Very high expectations and demands

54

The safest medication to treat depression while breastfeeding is what?

Whatever medication is likely to get the woman well

55

True or false: postpartum depression is highly resistant to treatment

False

56

Why is postpartum depression / anxiety underreported?

Shame around being depressed, or anxious thoughts