PsychEd Episode 45: Perinatal Psychiatry with Dr. Tuong Vi Nguyen
PsychEd: Educational Psychiatry Podcast
Pregnancy - Do You Have a Good Approach to Prescription of Medication?
I shalls peri ital psychiatry, because people tend to come with a lot of modivat to stop. It's really the pols and cons and assessing at what stage of change this person is. I think lowest therapeutic dose, that's an important concept. The other important concept is to try as much as possible to avoid poly pharmacy. Sometimes you won't be able to, but i think in most cases you can endend the fact if the family works with you too.
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers perinatal psychiatry with Dr. Tuong Vi Nguyen, Assistant Professor, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University and Scientist and Scientist, RI-MUHC, Brain Repair and Integrative Neuroscience (BRaIN) Program, Centre for Outcomes Research and Evaluation.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
- Define the field of perinatal psychiatry
- Describe the key issues that should be addressed in pre-conception psychiatric counseling
- Discuss the management approach for prescribing medications during pregnancy
- Recognize the prevalence of mood disorders during the perinatal period
- Recall the diagnostic criteria for postpartum depression
- Consider the risk factors and explanatory models for postpartum depression
- Discuss the use of screening tools for postpartum depression
- Outline the treatment for postpartum depression
- Describe the clinical presentation of postpartum psychosis and recognize the urgency of this condition
- List important risk factors for postpartum psychosis
- Discuss the management for postpartum psychosis
Guest: Dr. Tuong Vi Nguyen
Hosts: Nima Nahiddi (PGY4), Audrey Le (PGY1), and Arielle Geist (PGY2)
Produced by: Nima Nahiddi (PGY4), Audrey Le (PGY1), Rebecca Marsh (PGY2) and Arielle Geist (PGY2)
Audio editing by: Audrey Le
Show notes by: Arielle Geist
Interview content:
- Introduction - 00:00
- Learning objectives - 00:43
- Defining the field of perinatal psychiatry - 01:55
- Key issues to address in preconception counseling - 02:50
- Management approach for prescribing medications during pregnancy - 07:00
- Prevalence of mood disorders during the perinatal period - 12:11
- Diagnostic criteria for postpartum depression - 14:05
- Differentiating postpartum psychosis from postpartum depression - 16:52
- Risk factors and explanatory models for postpartum depression - 18:58
- Screening tools for postpartum depression - 20:15
- Treatment for postpartum depression - 22:13
- Pharmacotherapy - 22:20
- Psychotherapy - 27:34
- Clinical presentation of postpartum psychosis - 29:07
- Risk factors for postpartum psychosis - 30:43
- Postpartum psychosis prognosis and impacts on attachment- 32:57
- Management of postpartum psychosis -35:30
- Closing comments - 38:00
Resources:
- Bérard, A., Zhao, J. P., & Sheehy, O. (2017). Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ open, 7(1), e013372. https://doi.org/10.1136/bmjopen-2016-013372
- Boukhris, T., Sheehy, O., Mottron, L., & Bérard, A. (2016). Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children. Jama Pediatrics, 170(2), 117-24. doi: 10.1001/jamapediatrics.2015.3356.
- Brown, A. S., Gyllenberg, D., Malm, H., McKeague, I. W., Hinkka-Yli-Salomäki, S., Artama, M., Gissler, M., Cheslack-Postava, K., Weissman, M. M., Gingrich, J. A., & Sourander, A. (2016). Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy With Speech, Scholastic, and Motor Disorders in Offspring. JAMA psychiatry, 73(11), 1163–1170. https://doi.org/10.1001/jamapsychiatry.2016.2594
- Cohen, J. , Hernández-Díaz, S. , Bateman, B. , Park, Y. , Desai, R. , Gray, K. , Patorno, E. , Mogun, H. & Huybrechts, K. (2017). Placental Complications Associated With Psychostimulant Use in Pregnancy. Obstetrics & Gynecology, 130(6), 1192-1201. doi: 10.1097/AOG.0000000000002362.
- Huybrechts, K. F., Hernández-Díaz, S., Patorno, E., Desai, R. J., Mogun, H., Dejene, S. Z., Cohen, J. M., Panchaud, A., Cohen, L., & Bateman, B. T. (2016). Antipsychotic Use in Pregnancy and the Risk for Congenital Malformations. JAMA psychiatry, 73(9), 938–946. https://doi.org/10.1001/jamapsychiatry.2016.1520
- Huybrechts, K. F., Palmsten, K., Avorn, J., Cohen, L. S., Holmes, L. B., Franklin, J. M., Mogun, H., Levin, R., Kowal, M., Setoguchi, S., & Hernández-Díaz, S. (2014). Antidepressant use in pregnancy and the risk of cardiac defects. The New England Journal of Medicine, 370(25), 2397–2407. https://doi.org/10.1056/NEJMoa1312828
- Imaz, M. L., Oriolo, G., Torra, M., Soy, D., García-Esteve, L., & Martin-Santos, R. (2018). Clozapine Use During Pregnancy and Lactation: A Case-Series Report. Frontiers in Pharmacology, 9, 264. https://doi.org/10.3389/fphar.2018.00264
- Nörby, U., Forsberg, L., Wide, K., Sjörs, G., Winbladh, B., & Källén, K. (2016). Neonatal Morbidity After Maternal Use of Antidepressant Drugs During Pregnancy. Pediatrics, 138(5), e20160181. https://doi.org/10.1542/peds.2016-0181
- Nörby, U., Winbladh, B., & Källén, K. (2017). Perinatal Outcomes After Treatment With ADHD Medication During Pregnancy. Pediatrics, 140(6), e20170747. https://doi.org/10.1542/peds.2017-0747
- Reis, M., & Källén, B. (2013). Combined use of selective serotonin reuptake inhibitors and sedatives/hypnotics during pregnancy: risk of relatively severe congenital malformations or cardiac defects. A registered study. BMJ Open, 3, e002166. doi:10.1136/bmjopen-2012-002166
- Sundram S. (2006). Cannabis and neurodevelopment: implications for psychiatric disorders. Human psychopharmacology, 21(4), 245–254. https://doi.org/10.1002/hup.762
References:
- Boland, R., Verduin, M., & Ruiz, P. (2021). Psychopharmacology. In Kaplan & Sadock's synopsis of psychiatry (Twelfth edition.). Philadelphia: Wolters Kluwer.
- Jones, I., Chandra, P.S., Dazzan, P., & Howard, L.K. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet, 384(9956), 1789-1799. doi: 10.1016/S0140-6736(14)61278-2.
- Nieldson, D., Videbech, P., Hedegaard, M., Dalby, J., & Secher, N.J. (2005). Postpartum depression: identification of women at risk. An International Journal of Obstetrics and Gynaecology, 107(10), 1210-1217. https://doi-org.myaccess.library.utoronto.ca/10.1111/j.1471-0528.2000.tb11609.x
- Schiller, C.E., Meltzer-Brody, S., & Rubinow, D.R. (2015). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(1), 48-59. doi: 10.1017/S1092852914000480
- Viguera, A. (2021). Mild to moderate postpartum unipolar major depression: Treatment. UpToDate. Accessed 2021-01-18.
- Wisner, K.L., Sit, D.K.Y., & McShea, M.C. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490-498. doi:10.1001/jamapsychiatry.2013.87
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
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