increases the absolute # of substances to which the fetus is exposed
\u27a3may increase risk for adverse outcomes
-If stable on current med regimen, typically better to continue current regimen<\/li>\n<\/ul>\n\n\n\nAllie is a 26-year-old who has been receiving treatment for bipolar I disorder for 3 years. Her symptoms have been in remission with lithium 500 mg twice daily. She also completed 12 weeks of interpersonal and social rhythm therapy (IPSRT) upon diagnosis and used the life charting methodology to track her symptoms. She calls her PMHNP and states “I just found out I’m pregnant. My partner and I were not expecting this, but we are excited! I am worried about what lithium will do to my baby. Sh
schedule an appointment for Allie and her husband to discuss a treatment plan as soon as possible<\/p>\n\n\n\n
ask Allie to continue taking lithium at the current dose for now<\/p>\n\n\n\n
recommend that Allie begin tracking her mood, sleep schedule, and other symptoms<\/p>\n\n\n\n
Rationale: Rationale: The PMHNP should schedule an appointment as soon as possible to discuss Allie’s treatment plan during her pregnancy. Discontinuation of medications for pregnancy is associated with a relapse rate of 80-100% for clients who take mood stabilizers; therefore, the client should not abruptly cease taking lithium (Ortega et al., 2023). Clients with a diagnosis of bipolar disorder may benefit from tracking the symptoms of their illness, especially during stressful times.
Although reassurance is appropriate, the PMHNP should not minimize the potential risks of continuing medication by telling the client that no harm will come to the baby.<\/p>\n\n\n\n
Discontinuation of medications for pregnancy is associated with a relapse rate of _<\/strong><\/em><\/strong>% for clients who take mood stabilizers
80-100%<\/p>\n\n\n\nInformed consent: pregnancy
-must initiate discussion with pt regarding informed consent for tx<\/p>\n\n\n\n
\n- whether new symptoms during pregnancy or already established with care<\/li>\n\n\n\n
- risks of continuing current meds and the risks of stopping them
-help pt process their risk factors & tx hx to make an informed decision
-if must remain on high-risk medications such as valproic acid should be thoroughly evaluated by the multidisciplinary team including a perinatal psychiatrist
-Documentation should note whether the woman plans to continue with treatment or discontinue the medication<\/li>\n<\/ul>\n\n\n\nKenya is a 36-year-old who has been taking fluoxetine for three years for major depressive disorder. Her symptoms are currently in remission, and she just found out that she is 7 weeks pregnant. She calls the PMHNP to discuss whether she should continue her medication during pregnancy. After the discussion, Kenya indicates that she will remain on her medication.
Which of the following should be included in the discussion and documentation of the call with Kenya? Select all that apply.<\/p>\n\n\n\n
rare adve
rare adverse effect of persistent pulmonary hypertension in the neonate<\/p>\n\n\n\n
common adverse effect of postnatal abstinence syndrome<\/p>\n\n\n\n
potential risks of discontinuing treatment to both mother and baby<\/p>\n\n\n\n
decision to continue treatment<\/p>\n\n\n\n
Rationale: The PMHNP should disclose all common adverse effects and discuss serious adverse effects associated with the medication, regardless of incidence. The discussion should include the potential risks to both mother and baby if the medication is discontinued. Documentation should include the client’s decision whether to continue or discontinue treatment. Since fluoxetine is not a high-risk medication for pregnancy, the PMHNP need not refer the client to a perinatal psychiatrist for medication management.<\/p>\n\n\n\n
Pregnancy Safety Considerations for Common Mental Health Treatment: Meds for Depression & Anxiety
-SSRIs are first-line treatments for depression and anxiety during pregnancy
-SNRIs, tricyclic’s, & bupropion are also considered safe tx options
-most common adverse effect with SSRIs & SNRIs is neonatal withdrawal syndrome<\/p>\n\n\n\n