Perinatal psychiatry

Question 1

main psychiatric dx of pregnant women who died from suicide 3

Answer 1

psychosis

severe depressive illness

drug dependency

Question 2

how does pregnancy effect psychatric disorders risk

Answer 2

no evidence of increased risk
-but pregnancy can modify the presentation of illness

mental illness can also alter the outcomes of pregnancy

Question 3

types of postnatal psychatric disorders 3

Answer 3

50-80%- baby blues

10-15% postnatal depression

0.2% postpartum psychosis

Question 4

which psychatric disorders hvae a particular risk of recurrence post nataly 2

Answer 4

bipolar affective disorders

schiizophrenia

Question 5

when is postnatal depression onset common
*-important point

Answer 5

at 6-8weeks

varying severity

*-significant effects on child if untreated

Question 6

main risk factors for postnatal depressoin 5

Answer 6

past psych hx

psych problems during pregnancy

poor martial relationship

lack of social support

stressful life events

Question 7

managemnet of post natal depression 3

Answer 7

social support and non-directive counselling (primary care)

psychological therapies

antidepressatns

Question 8

when should a postnatally depressed mother be referred to psych 3

Answer 8

severity significantly impairing function

ideas of self harm or harm to baby

unresponsive to medication

Question 9

when does postpartum psychosis usually present

Answer 9

usually in first 2 weeks

Question 10

presentation of postpartum psychosis 3

Answer 10

95% affective with labilty of mood

confusion

delusions

Question 11

risk factors for postpartum psychosis 3

Answer 11

hx of postparum psychossi

Hx of bipolar affective disorder

FHx of postpartum psychosis or bipolar affective disorder

Question 12

what is postpartum psychosis a variant of

Answer 12

bipolar affective disorder

Question 13

postpartum psychosis managemnt 5

Answer 13

admission

supervisoin of mother and baby
-assisting mother with childcare tasks

Antidepressant+ neuroleptic

and/or

lithium

and/or

ECT

Question 14

preventioin of postpartum psychosis 3

Answer 14

identify risk

communicate w primary care and refer to mental health services

lithium (or previously effective regime)
-prophylaixis in immediate postpartum

Question 15

points regarding prescribing psych drugs in pregnancy 5

Answer 15

start decision making prepregnancy

avoid first trimester if possible

lowest effective dose fo shortest time possible

choose drugs w best evidence base

avoid polypharmacy

Question 16

risks of use of antidepressants in prengnacy

Answer 16

possible doubling of cardiac malformations

increased risk of persistent pulmonary hypertension of the new born

Question 17

determinants of early brain development

Answer 17

shift from exclusively genetic to environmental influences

social interaction determines brain development

Question 18

effects of postnatal depression on mother and child

Answer 18

disturbed mother-infant interaction
-more self-preoccupied
-greater perception of problems

poorer infant outcomes
-poorer interactions and play facilitation
-decreased socialbility
-cognitive delay

Question 19

core principles of perinatal psychiatry 3

Answer 19

pregnancy planning in pre-exisitnig illness
-risk of illness
-risk of treatment

identification of high risk women
-personal and family history

effective and early communication
-primary care
-mental health
-maternity services
-social work services