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4.14 OB/GYN and Psych
By Dr. Conrad
50
Psychology
Professional
04/14/2012

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Cards

Term
Chronic pelvic pain is most often caused by...
Definition
endometriosis and pelvic adhesions
Term
Unexplained pelvic pain is often associated with...
Definition
depression, somatic symptoms, substance abuse sexual dysfunction (physical and sexual abuse)
Term
How should you treat patients with unexplained pelvic pain?
Definition
multidisciplinary, individualized treatment to address somatic, social and psychological influences
Term
What is vulvodynia?
Definition
chronic burning, stinging or pain of the vulva in the absence of objective clinical or laboratory findings
Term
What are the two types of vulvodynia?
Definition
vulvar vestibulitis, dysesthetic vulvodynia
Term
What is vulvar vestibulitis?
Definition
restricted burning and pain of the vestibule solicited by touch
Term
What is dyesthetic vulvodynia?
Definition
pain not restricted to the vestibule which may occur with or without touch or pressure
Term
What is the etiology of vulvodynia?
Definition
unknown, possibly neuropathic
Term
How do you treat vulvodynia?
Definition
SNRIs may be helpful (no controlled trials)
Term
Vulvodynia is often comorbid with...
Definition
depression, fibromyalgia, and interstitial cystitis
Term
What are typical situations in which denial of pregnancy occur?
Definition
schizophrenic patients, older patients attributing amenorrhea to menopause, younger passive patients in strict families without much knowledge about reproduction
Term
What is the frequency of pregnancy denials?
Definition
1 case per 475 births
Term
What is the term for hysterical pregnancy?
Definition
pseudocyesis
Term
What physical symptoms can occur in false pregnancy?
Definition
may stop menstruating, have a distended abdomen, even lactate, etc.
Term
T/F Pseudocyesis has been reported in men.
Definition
true
Term
Is the incidence of pseudocyesis increasing or decreasing?
Definition
decreasing
Term
T/F Pregnancy protects against depression.
Definition
false
Term
What percent of pregnant women have depressive symptoms?
Definition
20%
Term
What percent of pregnant patients have full MDE?
Definition
10%
Term
What are the risk factors for MDE?
Definition
previous MDE, marital discord, lower socioeconomic status, unwanted pregnancy
Term
In what ways does maternal depression adversely affect the developing fetus?
Definition
preterm birth, lower birth weight, smaller head circumference, lower apgar scores
Term
What non-pharmacologic managment can be used to treat depression during pregnancy?
Definition
psychotherapy and electroconvulsive shock therapy
Term
When do maternity blues start?
Definition
day 1 to 10
Term
What are the prevalence of maternity blues?
Definition
30-70% prevalence
Term
What percent of patients with maternity blue progress to MDE?
Definition
20%
Term
What causes maternity blues?
Definition
probably related to changes in progesterone levels and will subside
Term
At what time post partum are patients at highest risk for psychiatric illness?
Definition
first 3 months postpartum
Term
What is the prevalence of postpartum depression?
Definition
10-20%
Term
What are the risk factors for postpartum depression?
Definition
younger and older age, history of depression, lack of support, unemployment, hormonal factors not consistently related
Term
Postpartum depression can be secondary to _______ in a small subset of patients.
Definition
postpartum autoimmune thyroiditis
Term
How can you decrease the exposure of a breast feeding infant to mom's SSRIs?
Definition
"pump and dump"
Term
What is the prevalence of postpartum psychosis?
Definition
1-2 per 1,000 births
Term
What are the characteristics of postpartum psychosis?
Definition
extreme agitation, confusion, sleeplessness, hallucinations, delusions
Term
What is the typical onset of postpartum psychosis?
Definition
sudden onset, usually between day 3 and 14 postpartum
Term
Why do some mothers with pospartum psychosis commit infanticide or suicide?
Definition
infanticide often in response to command hallucination and/or suicidal urges and desire not to leave child behind
Term
T/F Most antidepressants are relatively safe in pregnancy.
Definition
true; although areas of concern exist, particularly some evidence of higher risk of preterm birth, neonatal adaptation difficulties, and congenital cardiac malformations
Term
Which SSRI has a warning for heart malformations?
Definition
paroxetine
Term
What are the teratogenic effects of lithium?
Definition
ebstein's anomaly, no neurobehavioral differences, most common toxic effects "floppy baby" syndrome in neonate
Term
What are the lithium levels of cord blood?
Definition
equivalent to maternal blood
Term
What are the teratogenic effects of valproate?
Definition
neural tube defects, neurobehavioral: mental retardation suggested in "fetal valproate syndrome" but not definitive; neonatal toxicity (liver toxicity and withdrawal symptoms such as irritability and feeding difficulties and abnormal tone)
Term
What are the rates of neural tube defects with valproate use?
Definition
5-9%; dose related in use 17 to 30 days postconception
Term
What is the concentration of valproate in cord blood?
Definition
two times higher in cord serum than in maternal serum
Term
What are the teratogenic effects of carbamazepine?
Definition
craniofacial defects (11%), neural tube defects (0.5-1%); no neurobehavioral dysfunctions detected; 2 case reports of transient hepatic toxicity
Term
What are the cord blood levels of carbamazepine?
Definition
fetal serum levels are 50-80% of maternal levels
Term
What are the teratogenic effects of lamotrigine?
Definition
major defects identified in patients on monotherapy (2%); similar to general population; US pregnancy registry shows increased risk of cleft lip or palate; no neurobehavioral delays noted
Term
What are the cord levels of lamotrigine?
Definition
metabolism by glucuronidation immature in fetus and neonate leading to only a 25% decrease relative to cord blood
Term
Taking antipsychotics increases the rate of congenital malformations by what compared to women not taking antipsychotics?
Definition
psychotic women, whether they are taking drugs or not, have rates of malformation twice that of the normal population
Term
What are the effects of antipsychotics during fetal development in newborns?
Definition
withdrawal and EPS possible in infant, no neurobehavioral defects noted
Term
What are the specific malformation and perinatal complications that can occur with antipsychotics?
Definition
possible increase in cardiovascular defects and nearly double the risk of gestationl diabetes
Term
What are the psychological symptoms of menopause?
Definition
irritability, mood swings, depressed mood, forgetfulness, low sex interest, sleep difficulties
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