Transcript Connect Meeting 10.4.08

Connect Meeting 10.4.08
Dr Simon Belderbos
Consultant Psychiatrist
Antenatal and Postnatal Mental
Health
• ‘Baby Blues’
– 50%
– Symptoms peak 3rd – 4th Day
– Short lived episodes irritability, crying,
emotional lability.
• Postnatal depression
– 10-15%
– 2-6 weeks postpartum
– Past history depression
Puerpural Psychosis
• 1 in 500 Live births
• Onset day 3-14
• Personal / family history Psychotic Illness
• High rate of recurrence purpural &
non-purpural psychosis (50%)
NICE ‘Antenatal and postnatal
mental health’ April 2007
• Prediction
– Past Hx Depression
– Past Hx Psychotic Illness
– Family Hx Psychotic illness
• Detection
– Depression
• Low mood, anhedonia, lethergy, hopeless
• Do they want help?
– Psychosis• ‘change’, confusion, ununderstandable
Treatment
• Mild – Moderate depression
– Brief psychological treatment
• Enhanced Primary Care Psychology Service
• CBT or IPT 4-6 sessions
– Social support
• Moderate- Severe depression
– CMHT
– Psychology, social support & medication
Treatment
• Puerperal Psychosis
– ? Prophylaxis antipsychotics
– Share information prior to delivery
– CMHT input, postnatal CATT
– Mother and Baby unit
• Thumbswood QEII Welwyn
Antidepressants
• Lowest risk during pregnancy TCA’s or
Fluoxetine
• PPH in neonates with SSRI > 20 weeks
• Avoid Paroxetine – fetal heart defects
• Venlafaxine – High blood pressure
• Brest feeding – Sertraline, imipramine
lower levels in brest milk
Antipsychotics
• Raised prolactin reduce chances of
conception
• Gestational diabetes especially Olanzapine
• Avoid Clozapine and depot
Mood Stabilisers
• Avoid Valproate in women of childbearing
age
• Lamotrigine & Carbamazepine stop and
use atypical antipsychotic
• Lithium Consider stopping unless high risk
of relapse or consider stopping and
restarting in 2nd trimester