Perinatal Psychiatry Key Points for GPs Dr Zena

Perinatal Psychiatry Key Points for GPs Dr Zena Schofield June 2018

Red Flags • ‘Red Flag’ presentations which should prompt urgent senior psychiatric assessment • -- Recent significant change in mental state or emergence of new symptoms • -- New thoughts or acts of violent self-harm • -- New and persistent expressions of incompetency as a mother or estrangement from the infant

Summary • Anti-depressants in pregnancy- TCAs and SSRIs • Anti-depressants in breast feeding- preference for SERTRALINE or Imipramine • Anti-psychotics in pregnancy- get 2 ndary MH services involved • Active management of serious perinatal mental illnesses by our specialist team • Milder perinatal MH difficulties are managed in primary care

Differences Perinatal vs Adult • Lower threshold because: – Can rapidly change early postpartum or late pregnancy – Violent means of suicide • Changes in presentation is important • Mum & baby (& family)- risks, social services • Not always looking to prevent admission to MBU • Involve perinatal at an early stage

Who to refer • Serious mental illness-whether well or ill • PHx severe depression- esp post-partum • Current symptoms of mod depression or modsevere anxiety disorder • Pre-conceptual counselling appts • Accept from 13/40 to max 12/12 pp • Advice given at any stage in pregnancy by perinatal team

Perinatal Team contact details • • • Office 0115 952 9477 (normal working hours) not-tr. perinatalpsychiatry@nhs. net Urgent referrals phone first Refer by secure email or letter or fax Advice available from perinatal team Address from 5. 6. 18: Green Haven Perinatal Unit, Hopewood, Foster Drive, Nottingham, NG 5 3 FL