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 2ndary 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 mod-severe anxiety disorder Pre-conceptual counselling appts Accept from 13/40 to max 12/12pp 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, NG5 3FL