Peripartum
What mental illness occur during the peripartum period?
Anxiety
Depressive
Bipolar
**** post partum psychosis is more likely to occur in Bipolar pts
Charecterisc of postpaertum psychosis
occurs in a few days or 2 weeks
marked by:
Hallucinations
Delusions
Irritability
Hyperactivity
Paranoia
5% suicide rate
4% infanticide rate
particularly with CAH to kill baby or delusions baby is possessed
1. risk to mother and fetus from exposure of psychotropics
2. risk of mother & fetus d/t untreated mental illness
3. Role of provider in facilitating decision
4. medication management of pregnant pts with mental illness
Limitations to evidence d/t?
ethical concerns in conducting randomized control trials
translational results of animal studies to huma risk
care report or retrospective cohort epidemiology of unknown risk
overstimulation of fetal risk occurred
unable to determine causation
What SSRI is the following associated with?
Vomiting, decreased sleep, increased crying, diarrhea in infants exposed to breast milk
Fluoxetine
What are the common anxiety disorders in the post partum period
Panic
PTSD
OCD:
may be just obsessive
they are ego-dystonic(psychosis not)
can include compulsion and be hypervigilant
What will the PMHNP include with assessment?
connectedness to baby
Mom getting proper rest
Support from family
Hx of mental illness
family hx of Mental illness
All of the following are considered?
poor meternal behavior
increaed risk of miscarriage
incresed risk for SUD
poor nutrition
poor compliance with prenatal care
family dysfunction
relapse of mental health illness
preterm delivery
low birth rate
c-section or NICU admission
neurodevelopmental delays in offspring
increased risk for psychiatric disorders in offspring
motor delays in offspring
Risk of untreated mental illness
What do all of the SSRIs have in common with peripartum ?
Paroxetine
Fluoxetine
Fluvoxamine
Sertraline
Escitalopram
citalopram
most widely prescribed medication class in pregnancy
&
Associated increased risk for persistent pulmonary hypertension of a newborn
What is the preferred SSRIs when breastfeeding with the lowest level of exposure??
Sertraline
What is the time frame for peripartum period
during pregnancy and up to one year
What is psychopharmacoteratophobia?
How to decide what to use
1. discuss each risk assoc. with each particular drug
2. Steven's qualitative study yield:
women use past experiences in their decision making
women looking for provider to have a definitive answer.
consider support network for management during pregnancy
Which 2 SSRIs have the greatest risk of increased cardiac malformations?
Paroxetine & fluoxetine
Which SSRI has low exposure in breast milk but more likely to cause withdrawal syndrome
Paroxetine
True or False
Post partum depression is an actual dx
False
DSM5 TR has a specifier "with peripartum
the PMHNP should weigh _______ vs. _______ when prescribing
rick vs benefits
What were the FDA categories for pregnancy risk?
What were the shortcomings
ABCD & X
did not provide risk of unrelated disorders & lack of priority in human data
True or False
The use of SSRIs in postpartum
1. no increased risk of spontaneous abortion
2. small risk of low birth rate, preterm birth, and lower Apgar scores
3.evidence of pretem birth id started after 1st trimester
1. True
2. True
3. True
What have SSRIs studies shown in children when exposed in utero?
impaired psychomotor development
increased risk of Autism
****both studies have limitations
Postpartum psychosis usually occurs in women with _______ ___ disorder
What percentage has a reoccurring psychosis with subsequent pregnancies
Bipolar 1
50 %
The PMHNP should do the following when seeing pts of child bearing age?
ALWAYS address ppl of child bearing age at each encounter AND DOCUMENT
psychotropics & untreated mental illness during pregnancy
planned pregnancy is the best
What does the FDA use now?
Pregnancy & Lactation labeling Rule(PLLR)
replaces letters with a narrative summary
providers should familiarize themselves with new labeling
What are the s/s of neonatal withdrawal syndrome/poor neonatal adaption syndrome (6)
Cause?
irritability
crying
vomiting
shivering
increased muscle tone
eating /sleeping difficulties
respiratory distress
seizures
Exposure to SSRIs in utero
Which medication class is described?
may increase risk for pre-eclampsia
Neonatal Adaptation Syndrome
low birth weight
Clomipramine highest risk for adverse events
Nortriptyline lowest risk for adverse events
no difference in IQ behavior or cognitive development(limited studies)
TCA