PsychEd Episode 45: Perinatal Psychiatry with Dr. Tuong Vi Nguyen

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Jun 29, 2022

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INSIGHT

Postpartum Depression Onset

Postpartum depression often starts during pregnancy but goes undetected.
It becomes a full-blown episode postpartum, sometimes 9-10 months later.

ADVICE

Screening for Perinatal Issues

Screen for perinatal mental health issues, even if support systems are lacking.
Consequences of not screening can be detrimental to the entire family.

ADVICE

Medication in Pregnancy

Prioritize patient well-being over safety data when prescribing medication during pregnancy.
Consider patient history, current stability, and personal preferences.

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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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