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Pregnancy
Liaison Psychiatry
Introduction
Most women go through pregnancy with
no complications.
Mental health is dependent on
Type of mental illness experienced;
If the lady is on treatment if a mental illness
is present;
Recent stressful events in life;
How the lady feels about her pregnancy
Increased emotional liability;
Fears regarding inability to cope with pregnancy;
Fear of childbirth, changes in relationships or
roles;
Lack of support and being alone.
Introduction
Risk factors: Women with pre-existing mental health
problem;
Severe mental illnesses developing
much more quickly and more seriously;
Women who stop taking their
medications when they are pregnant.
How to Recognise?
Pregnancy is a duration of great
adjustments
Emotional, social, financial and physical
demands are harder to manage.
Assessment on
The severity of mental illness;
Adaptation to pregnancy, infant care, bonding
and pregnancy;
Necessity of referral to mental health service.
General
Non-Management
Pharmacological
Pharmacological
Pre-natal Counseling
Discuss and plan the
pregnancy;
Ways of maintaining mental
well-being during pregnancy.
Nutritional
recommendation
Folic acid or vitamin
supplements.
Maternal care
Maternity services;
Assess and promote maternalinfant attachment.
Depression
Antenatal
depression is
overlooked.
1 in 10 women with
recurrent risk of
50%.
Causes
Physical
Physical changes in
pregnancy.
Hormonal changes.
Symptoms
Chronic anxiety;
Sense of
hopelessness;
Suicidal ideations;
Lack of energy.
Management
Mood diary;
Meditate and positive
thinking;
Fluoxetine is
considered safe.
Anxiety
Risk Factors
Younger age;
Previous history;
Previous stillbirth or
miscarriage;
Other life events.
Symptoms
Panic attacks;
Persistent worries;
Feeling on the edge
Generalised Anxiety
Disorder
Panic Disorders or
phobias.
Obsessive Compulsive
Disorder
Increased risk of
exacerbation or onset.
Bipolar Disorder
Usually a preexisting condition.
Most likely on
maintenance
therapy
Mood stabilisers
have teratogenic
risks.
Need to plan a
pregnancy and the
care.
Management
Combination of
mood stabilisers
Psychological
therapy;
Lifestyle advise.
Schizophrenia
Generally have less
children.
Usually a preexisting condition.
Increased risk of
Pregnancy
complications;
Birth complications;
Low birthweight;
Congenital
cardiovascular
anomalies.
Usually on
maintenance
antipsychotic
medication.
Relapse rate is high;
Needs to continue
medication unless
contraindicated;
Haloperidol or
trifluoperazine is
preferable.
Psychotropic Drugs
in pregnancy
Prescribing in pregnancy
Clear indication for drug and absence of effective
alternative treatment
Lowest effective dose for shortest time necessary
Drugs with better evidence base on absence of
harm
Individual assessments of benefits and risks
Avoid prescribing in first trimester if possible
Avoid polypharmacy
risk of synergistic teratogenicity
Reduced compliance
50% of pregnant women fear harming the fetus and
do not comply with prescription
Antidepressants
Types
Effects
Conclusion
MAOI
Teratogenic in animals
AVOID
Antipsychotics
Types
Effects
Conclusion
1st generation
2nd generation
Depot
Avoid if possible
Continue if risk of
discontinuation in
schizophrenic is highly
significant
Mood stabilisers
Types
Lithium
Effects
Conclusion
10% risk of congenital
Fetal echo at 16-20 weeks if
abnormality
prescribed in first trimester
Higher risk in later trimesters
Sodium valproate
Lamotrigine
Anxiolytics
Types
Effects
Conclusion
ECT
Effective and relatively safe
Both normal and high-risk pregnancies
Careful attention to obstetric and anaesthetic factors
Low rate of ECT-related complications and no cases
of premature labour
Preparation
Intravenous hydration
Elevation of patients right hip
External fetal cardiac monitoring
Breastfeeding
Pros
General benefits of breastfeeding
Reduced fetal withdrawal symptoms if
psychotropes taken antenatally
Cons
Less disturbed sleep
Increased practical support from others
Avoidance of transmitted drugs
All psychotropic medication passes into breast
milk at 1% of maternal serum level