Connect Meeting 10.4.08

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Connect Meeting 10.4.08

• Dr Simon Belderbos
• Consultant Psychiatrist

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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

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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)

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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

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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

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Treatment

• Puerperal Psychosis
• ? Prophylaxis antipsychotics
• Share information prior to delivery
• CMHT input, postnatal CATT
• Mother and Baby unit
• Thumbswood QEII Welwyn

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Antidepressants

• Lowest risk during pregnancy TCAs or Fluoxetine
• PPH in neonates with SSRI gt 20 weeks
• Avoid Paroxetine fetal heart defects
• Venlafaxine High blood pressure
• Brest feeding Sertraline, imipramine lower
  levels in brest milk

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Antipsychotics

• Raised prolactin reduce chances of conception
• Gestational diabetes especially Olanzapine
• Avoid Clozapine and depot

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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

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