Complex care 2 > Module 9 > Flashcards

Module 9 Flashcards

(51 cards)

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1
Q

antenatal psychiatric disorders

A

Most first-onset conditions are mild depressive and anxiety disorders and the cause is commonly psychosocial
* Relapses of the following disorders may occur: depressive and anxiety disorders, obsessive compulsive disorder, schizophrenia, bipolar disorder and substance misuse
* It is important to enquire for a previous history of serious mental illness at the booking visit
* Identifying women with a past or family history of bipolar disorder or puerperal psychosis is particularly important because of the high risk of postpartum relapse (one in two).
* Psychiatric medication should not automatically be discontinued once the woman becomes pregnant. This is a frequent cause of relapse.
* Mild to moderate disorders may be managed in primary care. Past or current severe illness should be referred to specialist psychiatric services, preferably to a perinatal psychiatric service
* Good communication between all health professionals both in primary and secondary services is crucial

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2
Q

complications antenatal psychiatric disorders

A

Poor attendance in antenatal clinic
* Smoking and substance misuse
* Poor general health and nutrition
* Deliberate self-harm and suicide
* Low birth weight and pre-term deliveries
* Problems with mother–infant attachment
* Neglect or harm to infant and other children; safeguarding issues
* Possible long-term developmental and behavioural problems in the child
* Mental health problems in the woman’s partner

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3
Q

preconception issues and care antenatal psychiatric disorders

A
  • Risk of recurrence of mental illness in perinatal period
  • Risks and benefits of medication in pregnancy
  • Some psychiatric medications reduce fertility and should be changed if pregnancy is planned
  • Avoid certain drugs (especially sodium valproate) due to high rates of birth defects
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4
Q

pregnancy issues antenatal psychiatric disorders

A

Fetal growth retardation
* Low birth weight
* Prematurity
* Long-term developmental and behavioural problems in the child Mental illness may be associated with other behaviours that could indirectly affect her health and that of the baby. These include:
* Smoking
* Alcohol and substance misuse * Poor dietary habits * Lack of exercise * Self-harming behaviour * Lack of engagement with services

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5
Q

medical management and care antenatal psychiatric disorders

A
  • Mild to moderate depressive and anxiety symptoms are the most frequent psychiatric problems in pregnancy
  • Psuchological therapies such as cognitive behaviour therapy, interpersonal therapy or self-help strategies
  • Advice sorted from specialist psychiatric services
  • All women with serious mental illness should be referred to specialist services
  • Risk-benefit ratio of psychotropic medication is assessed and decisions regarding medication during pregnancy
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6
Q

midwifery management antenatal psychiatric disorders

A
  • Booking in – screen for past or present serious mental health – refer to perinatal psych
  • trusting relationship
  • advice regarding smoking, diet, exercise, BF, birth prep and support services
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7
Q

labour issues antenatal psychiatric disorders

A
  • neonatologists should be contacted if woman is on psychotropic meds
    medical management
  • discuss methods of support for labour pain to reduce anxiety
  • support in labour
  • consent
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8
Q

midwifery management labour antenatal psychiatric disorders

A
  • advice regarding continuation or discontinuing psychotropic meds prior to labour
  • drugs should be used judiciously in view of possible effects on the baby
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9
Q

postpartum issues antenatal psychiatric disorders

A
  • new symtpoms may emerge like
  • increased anxiety and agitation
  • low mood, excessive tearfulness or apathy
  • poor handling or attachment to baby
  • bizarre or unusual behaviour
  • delusions and hallucinations
  • thoughts or acts of harming herself or baby
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10
Q

medical management postpartum antenatal psychiatric disorders

A
  • specialist perinatal psychiatry contacted
  • approp. Treatment takes precedence over BF
  • transfer to specialist psychiatric mother and baby unit
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11
Q

midwifery management postnatal antenatal psychiatric disorders

A
  • observe mother and baby interaction
  • discuss rest, diet and self-care, assess how mum is coping
  • reassure if mood change is baby blues
  • observe baby if BF
  • assess risk to baby
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12
Q

postnatal psychiatric disorders

A
  • baby blues
  • PND
  • postpartum psychosis
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13
Q

general symptoms PND

A
  • Low mood, loss of interest and enjoyment, reduced energy
  • Reduced concentration and self-esteem, ideas of guilt, hopelessness, thoughts or acts of self-harm or suicide and appetite disturbance
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14
Q

postpartum psychosis

A
  • delusions and hallucinations. The onset is sudden, usually within the first 2 days postpartum.
  • Mood changes – elation, depression or irritability
  • Perplexity and confusion
  • Agitation and abnormal behaviour
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15
Q

complications postpartum psychosis

A
  • Self harm and suicide
  • Neglect of baby
  • Problems with mother-infant attachment and interaction
  • Long-term emotional, behavioural and cognitive problems
  • Relationship problems and breakdowns
  • Social, occupational and financial complications
  • Depression in the partner
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16
Q

pre-conception issues and cares postnatal psychiatric disorders

A
  • Relapse rates in women that have had postpartum psychosis 50%
  • Risk-benefit should be assessed
  • Sodium valproate not prescribed (epilepsy)
  • Discuss poor diet, smoking, substance/alcohol abuse, self-harming, relationship problems
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17
Q

pregnancy issues postnatal psychiatric disorders

A

Biological risk factors
- Past history of severe depression
- Past or family history of bipolar or postpartum psychosis
Psychosocial factors
- Lack of social support
- Recent stressful life events
- Longstanding difficulties in coping
- Sexual abuse
- DV

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18
Q

medical management pregnancy postnatal psychiatric disorders

A
  • Talking therapies or antidepressants
  • Psychotropic meds don’t discontinue
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19
Q

midwifery care pregnancy postnatal psychiatric disorders

A
  • Communicate with other professionals
  • Refer to OB
  • Refer to perinatal service
  • Trusting relo
  • Any risk to baby, referral
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20
Q

labour issues postnatal psychiatric disorders medical management

A
  • Psychotropic medication may be indicated
  • Drugs should be used judiciously
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21
Q

labour issues postnatal psychiatric disorders midwifery management

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A
  • Discuss carefully
  • Consent
  • Psych and physical support
  • Avoid interventions
  • Encourage skin to skin
  • Breast feeding encouraged
22
Q

postpartum issues postnatal psychiatric disorders

Study These Flashcards
A
  • Depression usually presents within 12 weeks
  • Postpartum psychosis within 2 days
  • Suicide leading causes of mortality – early detection
23
Q

medical management postpartum issues postnatal psychiatric disorders

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A
  • Risk assessment
  • Admission to mother baby unit
24
Q

midwifery management postnatal issues postnatal psychiatric disorders

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A
  • Observe interaction
  • Discuss sleep, diet and self-care
  • Reassure if baby blues
  • EPDS
  • Social services
25
eating disorders
- severe disturbances in eating behaviour - In anorexia there is a deliberate attempt to lose weight whereas bulimia is characterised by repeated episodes of binge eating followed by compensatory behaviours (self-induced vomiting or purging)
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anorexia nervosa
- Body weight maintained at least 15% below that expected, or BMI less than 17.5 - Weight loss, self-induced vomiting, purging, excessive exercisem appetite suppressants - Body image distortion - Endocrine disorder – hypothalamic-pituitary-gonadal axis causing amenorrhea
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anorexia associated clinical features
- Amennhorrea, infertility, loss of sexual interest - Lethargy, weakness, anaemia - Hypotension, peripheral oedema, cardiac arrhythmia - Constipation, abdo pain, enlarged salvary glands - Dry skin, alopecia, lanuago hair, brittle nails, osteoporosis - Tooth decay, erosion of dental enamel
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bullimia nervosa
- Repeated bouts of overeating and excessive preoccupation with control of body weight leading to extreme measures to counteract effects of overeating - Persistent preoccupation with eating, craving for food, eating large quantities in short time - Counteracting the fattening effects of food by self-induced vomiting, purging, periods of starving or drugs - Morbid dread of fatness - Inappropriate low target weight - Sometimes earlier episode of AN
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bulimia associated clinical features
- Irregular periods - Dependence on laxatives, diarrhoea and constipation - Dehydration, fluid and electrolyte disturbances - Tooth erosion, loss of dental enamel - Enlarged salivary glands
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eating disorders non-pregnancy treatment
- Psychotherapies such as cognitive, interpersonal, psychodynamic - Meds
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pre-conception care eating disorders
- Counselling and support - Dietary and nutritional assessment - Polycystic ovaries
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pregnancy issues eating disorders
- ED detected early - Maternal worries about change in weight - Self-induced vomiting - IUGR - Poor weight gain - Stillbirth and miscarriage - Premature labour - Depression/self-harm
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medical management eating disorders in pregnancy
- Multidisciplinary team - Monitor weight and IUGR - Serial scans - Expected weight gain - Assess vitamin and mineral deficiencies - Check for cardiac complications - Liaise closely with GP and ED service
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midwifery management eating disorders in pregnancy
- Check womans weight and BMI - Discuss complications in pregnancy - Monitor weight regularly - Screen for other MH - Give support - Dietary advice - Antenatal prep
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labour issues eating disorders
- Proceed as normal - Higher risk of LSCS
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medical and midwifery management labour eating disorders
- Advice psychotropic medication Midwifery - Methods of support for labour pain to reduce anxiety
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postpartum issues eating disorders
- Relapse of worsening can occur - Preoccupation with weight gain - Exaggerated weight loss after birth - Excessive exercise - Depression - Self-harm, alcohol - Mother-infant attachment
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medical management postpartum eating disorders
- Watch for signs of relapse - Assess risks - Monitor baby if woman on psychotropic meds
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midwifery mangement postpartum eating disorders
- Observe mood and interaction with baby - Monitor weight - Assess nutritional advice - Observe attachment and caring for infant - Relapse – refer to ED service
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PTSD
- Delayed or protracted response to a stressful event of an exceptionally threatening or catastrophic nature affecting individuals at any age or time of life - Previous PTSD may be exacerbated during pregnancy – 3-7.7% experience after birth - Avoidance of situations similar to the stressful event - Inability to recall the event - Increased arousal or hyper-vigilance - Sleep problems - Irritability and/or anger outburst - Poor concentration - Exaggerated startle response - Disassociating or emotional numbing
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Risk factors for PTSD in childbirth
- Miscarriage and stillbirth - Emergency problems such as cord prolapse - Complicated deliveries and LSCS - Catheterisation - Intimate clinical procedures e.g VE - Attitude of healthcare professionals - Survivor of disaster or accident
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complications PTSD
- Develop low self-esteem, anxiety, depression - Employment problems, relationship breakdown, social isolation - 1/3 report self-harm - Ptsd can occur after - Rape, sexual assault, childhood sexual abuse - Victim of violent crime or DV - Victim of torture, war, disaster or accident - Refugee or asylum seeker - Previous FGM - Occupation
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consequences of PTSD
- Depression, anxiety, self-harm, suicide - Avoidance of intimate and sexual relationships - Impaired mother-infant attachment - Fear and avoidance of future pregnancies - Avoidance of VEs - Termination - Requests for LSCS - Requests for sterilisation
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preconception care PTSD
- Detection of PTSD symptoms - Identification of complications - Discussion of plans for pregnancy - Referral for psychological therapies - Medication
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pregnancy issues PTSD
- Birth plan with specific wishes - Failure to detect symptoms may result in poor attendance to appointments, exacerbation of symptoms, use of drugs and alcohol, self-harm
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medical management PTSD in pregnancy
- Medication - Trauma-focused CBT and EMDR
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midwifery management PTSD in pregnancy
- Booking in history important - Appropriate referrals - Reassurance - Desensitisation by arranging visits to birth unit - Include fears and wishes in birth plan - Communicate
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labour issues PTSD
- Continuity of care - Familiarisation with staff - Empathic and sensitive care
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medical and midwifery management PTSD labour
- Shared OB and midwifery care Midwifery - Birth plan written early - Know triggers - Discuss analgesia - Arrange meeting with anaesthetist - Birth support
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postpartum issues PTSD
- Escalation of anxiety - Attachment with baby - Depression or irritability - Self-harm - Alcohol or illicit drug use - Social, relationship and work problems
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midwifery care postpartum PTSD
- Identify any abnormal mood changes - Observe attachment - Discuss rest, diet and self-care - Be prepared for BF difficulties - Discuss how mum is feeling
Complex care 2
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