Kk&s Ch.30 Reproductive Psychiatry

Front 1

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PDD) occur during the ? luteal phase of the menstrual cycle and are usually relieved by the onset of menses or shortly thereafter.

Back 1

late

Front 2

A woman's risk of abuse by her husband or boyfriend (decreases or increases) during pregnancy
particularly during the (first, second, or 3rd) trimester. One study found that ? percent of pregnant women are abused.

Back 2

A woman's risk of abuse by her husband or boyfriend increases during pregnancy, particularly during the first trimester. One study found that 6 percent of pregnant women are abused.

Front 3

Menopause, the cessation of ovulation, generally occurs between ? and ? years of age

Back 3

Menopause, the cessation of ovulation, generally occurs between 47 and 53 years of age

Front 4

Postpartum depression is characterized by a depressed mood, excessive anxiety, insomnia, and change in weight. The onset is generally within ? weeks after delivery

Back 4

12

Front 5

Compare Baby blues to Depression

Back 5

Characteristic
“Baby Blues”
Postpartum Depression

Incidence 30% to 75% of women who give birth 10% to 15% of women who give birth

Time of onset 3 to 5 days after delivery vs Within 3 to 6 months after delivery
Duration Days to weeks vs Months to years, if untreated

Associated stressors No Yes, especially lack of support

Sociocultural influence No; present in all cultures and socioeconomic classes vs Strong association

History of mood disorder No association vs Strong association

Family history of mood disorder No association vs Some association

Tearfulness Yes Yes

Mood lability Yes Often present, but sometimes mood is uniformly depressed

Anhedonia No Often

Sleep disturbance Sometimes vs Nearly always

Suicidal thoughts No vs Sometimes

Thoughts of harming the baby Rarely vs Often

Feelings of guilt, inadequacy Absent or mild vs Often present and excessive

Front 6

As many as ? of the patients have a second episode of an underlying affective disorder during the year after baby's birth.

Back 6

two thirds

Front 7

The symptoms of postpartum psychosis can often begin within days of the delivery, although the mean time to onset is within ? weeks and almost always within ? weeks of delivery.

Back 7

The symptoms of postpartum psychosis can often begin within days of the delivery, although the mean time to onset is within 2 to 3 weeks and almost always within 8 weeks of delivery.

Front 8

PPP:
In one study, ? percent of patients committed suicide and ? percent committed infanticide

Back 8

In one study, 5 percent of patients committed suicide and 4 percent committed infanticide

Front 9

Postpartum psychosis is a psychiatric emergency.
Best tx?

Back 9

Antipsychotic medications and lithium (Eskalith), often in combination with an antidepressant, are the treatments of choice.

Front 10

Pregancy risk of SSRI's?
TCA's?

Back 10

Although no antidepressant medications have been associated with intrauterine death or major birth defects, both selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are associated with a transient perinatal syndrome.

Studies demonstrate that fluoxetine (Prozac) has been found in amniotic fluid.

Front 11

Risk of Mood stabilizers

Back 11

Mood stabilizers are associated with more consequential teratogenic risks, namely cardiac anomalies and neural tube defects, but women with bipolar disorder are at a significant risk of relapse without medication maintenance

Front 12

Risk of lithium

Back 12

Lithium has been associated with an increased risk of Ebstein's anomaly, a congenital downward displacement of the tricuspid valve into the right ventricle.

Front 13

What are risk categories in pregnancy

Back 13

A No fetal risks in controlled human studies
B No fetal risk in animal studies, but no controlled human studies or fetal risk in animals, but no risk in well-controlled human studies

C Adverse fetal effects in animals and no human data available

D Human fetal risk seen (may be used in life-threatening situation)
X Proved fetal risk in humans (no indication for use, even in life-threatening situations)

Front 14

What class of risk are the following drugs:
Acetaminophen
Aspirin
CPZ
Ethanol
Haloperidol
Iron
Li
Thalidomide
Tetracycline
Valproic Acid

Back 14

Acetaminophen B
Aspirin C
CPZ C
Ethanol D
Haloperidol C
Iron A
Li D
Thalidomide X
Tetracycline D
Valproic Acid

Front 15

Up to ? percent of all women experience some alteration in mood, sleep, or somatic symptoms during the premenstrual period, and about ? percent of these women have at least mild to moderate premenstrual symptoms prompting them to seek medical advise. ? percent of women have symptoms that meet the full diagnostic criteria for PMDD.

Back 15

Up to 80 percent of all women experience some alteration in mood, sleep, or somatic symptoms during the premenstrual period, and about 40 percent of these women have at least mild to moderate premenstrual symptoms prompting them to seek medical advise. Only 3 to 7 percent of women have symptoms that meet the full diagnostic criteria for PMDD.

Front 16

Pseudocyesis (false pregnancy) is the development of the classic symptoms of pregnancy—?—in a nonpregnant woman

Back 16

amenorrhea, nausea, breast enlargement and pigmentation, abdominal distention (Fig. 30-2), and labor pains

Front 17

Pseudocyesis demonstrates the ability of the psyche to dominate the soma, probably via central input at the level of the hypothalamus. Predisposing psychological processes are thought to include a

Back 17

pathological wish for, and fear of, pregnancy;

ambivalence or conflict regarding gender, sexuality, or childbearing;

and a grief reaction to loss following a miscarriage, tubal ligation, or hysterectomy

Front 18

?, occurs in some cultures in which the father of the child undergoes simulated labor, as though he were giving birth. In those societies ? is a normal phenomenon.

Back 18

couvade

Front 19

? is the repeated ingestion of nonnutritive substances, such as dirt, clay, starch, sand, and feces. This eating disorder is most often seen in young children, but is common in pregnant women in some subcultures, most notably among African American women in the rural South, who may eat clay or starch (e.g., Argo). The cause of ? is unknown, but it may be related to ? in the mother

Back 19

Pica

nutritional defiencies