Perinatal mental health

Question 1

What are the Ix for baby blues?

Answer 1

Bedside: Hx, MSE

Question 2

What is the Mx for baby blues?

Answer 2

Reassure is normal

Safety net - come back if you feel worse, come back if your feelings have not gone in a few days

Question 3

What are the Ix for post natal depression?

Answer 3

Bedside: Hx, MSE - depression identification questions (2)
Edinburgh postnatal depression Scale >12 is dep
Mood disorder questionnaire to assess BPD risk
Bloods: TFTs, FBC
Imaging: Brain CT or MRI
Other: Urine drug screen

Question 4

What is the Mx for post natal depression?

Answer 4

Mild:
1) GP/ midwife referral
BIO: -
PSYCH: Facilitated self help, computerised CBT, counselling, CBT/IPT within 1 month of presentation
SOCIAL: support groups/organisations - PANDAs

Moderate/severe:
1) Community perinatal mental health services, if severe also refer to mother and baby unit urgently
BIO: Antidepressants - SSRIs, TCAs
PSYCH: High intensity CBT/IPT
SOCIAL: support groups/organisations - PANDAs

If bipolar depression, seek specialist advice

Question 5

What are the Ix for puerperal psychosis?

Answer 5

Bedside: Psychiatric + Medical Hx (ask about STIs, headache, head injury, seizure)
Collateral Hx if possible
Physical exam (neurological exam + complete MSE)
Bloods: FBC, metabolic profile - U&Es, serum creatinine, TFTs, urine tox, PTH, calcium, vB12, folate, niacin, serum LFTs
Imaging: Brain CT or MRI

Question 6

What is the Mx for puerperal psychosis?

Answer 6

1) Get senior help, admission to Mother and Baby unit
2) Liaise with GP, health visitor, maternity and other professionals (specialist perinatal psychiatrist within 4 hrs)

BIO: Antipsychotics - Olanzapine, Ariprazole (take care of breastfeeding)
Lorazepam if acutely agitated in A&E
PSYCHO: Psychotherapy
SOCIAL: Family support, breastfeeding support, supervision of care of baby, education