Interesting topic in OBGYN that involves psychiatry??

[Analyzethis]

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Hey all-I was hoping some of you obgyns would be kind enough to help me out-I am doing my obgyn rotationa and have to do a presentation on something relating psych to OB-the problem is I dont want to do the obvious things-ie. Post-partum depression/psychosis.

I was wondering what you as residents think would be good knowledge that would also be practical?

I was thinking about doing something like "safe psych drugs in pregnancy" and giving the residents 1 drug to remmeber and use in their pregnant patients. Ie. One drug for depression, bipolar, anxiety etc. Just one that they could remember and that is safe in the pregnant lady so next time their patient comes in with a diagnosis and is not on meds or needs to be started they could get them started instead of ordering a psych consult or atleast get them started while waiting to see a psychiatrist.

Would that be helpful? or any other topics? thanks!

 

[BayAreaOB]

Other good topics that the residents might find interesting: eating disorders (often present to Gyn with menstrual abnormalities), psych drugs and breastfeeding, depression and pregnancy (which meds are best, who and when to consider stopping meds), PTSD in rape survivors.

Hope this helps! Good luck with your rotation.

 

[MiesVanDerMom]

I think OBs should work more on recognzing when their pregnant patients are suffering depression/anxiety. I had serious depression while pregnant and my OB's missed some really obvious red flags. The pregnant woman assumes it's all a normal part of pregnancy until it's too late.

 

[Analyzethis]

thanks everyone! Could you give me some specific examples of what was missed-than maybe I could hit on some really "obvious" signs that tend to be missed. It is no surprised, after doing my rotation this month and seeing how busy and overworked those obgyns are, it is easy to see how they would not even recognize or care about psych issues-to me it is a shame-every field I have worked in other than psych completely disregards psych issues as "real problems" but geez I cannot see more of a tolling experience, especially for a pregnant lady than severe or eve moderate depression. thanks guys!

 

[tiredmom]

The above sound like great topics. I recently sent a patient to the psych ER from ob triage after discovering she was suicidal. The resident was teasing me for getting the patient who came in at 10 pm on a weeknight (having to get someone to drop her off and watch her kids) for vaginal discharge that she was already on treatment for to admit to suicidal thoughts with a plan. Something about that just seemed wrong, and as a MS4, I had the time to pull up a chair and chat for a few more minutes. Turns out she's in the midst of severe domestic violence and currently suicidal, and looking for help, just didn't realize that's why she came in.
I think domestic violence topics and community resources in the area you are in are always helpful topics. Residents also don't get much exposure to breastfeeding help/ what's safe or not, at least in the program here.

 

[AtYourCervix]

great catch, tiredmom. never ceases to amaze me what med students elicit from patients. kudos.

 

[Diane L. Evans]

One topic that is often missed is ttp. Drug addiction is another good topic. Smoking addictions. Physical abuse and pregnancy is common but seldom discussed. Also existing Bipolar/ Pschotropics and pregnancy outcomes-- could find u/s pictures of malformations.

Personally I would pick ONE topic but have an intro slide that lists Psychosis in pregnancy and differentials

Good luck.

 

[Doula-2-OB]

What about birth trauma? Or from a more general perspective, the emotional impact of the birth experience on the mother/parents. There are so many directions you could go with it, too. This is a gigantic, expansive topic that has really huge effects on so many issues from sexuality to parenting to PTSD - all kinds of things.

 

[montessori2md]

I think doing something on moms w/ diagnosed disorders would be great, especially if you could somehow follow them all the way through.

I had a friend in ugrad who was convinced that having kids would make being bipolar better (because she'd have something to think about besides herself, was her rationale).

Also add my "here here" to anything that uses the words breastfeeding and drugs in the same sentence. As a mom who nursed bboy for a year, it's really irritating to be told over and over "gosh, I don't know" everytime you wanted an Rx for anything. It would also be interesting to weigh the risks/consequences of not taking/taking psych drugs for nursing moms -on the one hand, taking drugs, not breastfeeding could theoretically be bad for infant/mo relationship (less "bonding", mom could feel guilty/inadequate for not nursing baby if she cared), on the other hand, meds could theoretically (I emphasize the theoretically here, depending on drug) be bad for baby.

Also, what is the role that pregnancy hormones, and postpartum hormonal fluctuations play on psych disorders? Are the meds as necessary? More necessary? How do women w/ psych disorders adapt/change during preg/post-partum period?