5: Perinatal psychiatry

Question 1

What is the leading cause of maternal death in the year following birth?

Answer 1

Suicide re: mental illness

Question 2

Women who develop post-partum mental health problems often have a history of what?

Answer 2

Mental health problems

so it doesn’t come out of nowhere

Question 3

What are three red flags for mental illness in a pregnant women?

Answer 3

Recent significant change in mental state

New thoughts of violence / self-harm

New thoughts of estrangement from baby

Question 4

If a pregnant woman has red flag symptoms for mental illness, where should she be admitted?

Answer 4

Perinatal mental health unit

which is referred to as the ‘Mother and baby unit’

Question 5

What mental health screening questions should be asked at antenatal clinic?

Answer 5

Do you have any new feelings which are making your disturbed or anxious?

Do you have any thoughts of self-harm or suicide?

Do you feel a sense of distance or estrangement from your baby?

Do you feel you are getting worse in general?

Question 6

When do pregnant women have their first appointment with their midwife?

Answer 6

12 weeks

At which point you should be screening for mental health

Question 7

Pregnant women with a history of which disorders should be referred to psychiatry?

Answer 7

Anxiety

Depression

Bipolar

Psychosis

Question 8

What is the recurrence rate of peurperal psychosis?

Answer 8

50%

Question 9

Under what circumstances should you refer a pregnant / post-natal woman to psychiatry?

Answer 9

Severe anxiety, depression, bipolar or psychotic symptoms

Question 10

Pregnancy is (protective / not protective) for pre-existing mental health problems.

Answer 10

not protective

Pregnant women being so elated that their mental disorders disappear is a myth

Question 11

What are baby blues?

Answer 11

Mild periods of emotional instability during pregnancy

Question 12

What is the course of baby blues?

Answer 12

Up to 10 days

Self-limiting

Question 13

What percentage of pregnant women develop peurperal psychosis?

Answer 13

0.1%

Question 14

What are the symptoms of puerperal psychosis?

Answer 14

Delusions

Hallucinations

Mania

Confusion (separating from standard psychosis)

Question 15

What is the prevalence of puerperal psychosis?

Answer 15

1 in 1000 pregnant women

or 0.1%

Question 16

How is puerperal psychosis managed?

Answer 16

Admission to antenatal mental health unit

Antidepressants, antipsychotics, mood stabilisers, ECT

Question 17

Puerperal psychosis has a (high / low) relapse rate.

Answer 17

high relapse rate

Question 18

What do many women with undiagnosed postnatal depression worry about?

Answer 18

Effect of diagnosis on possession of child

Question 19

How do you differentiate baby blues from postnatal depression?

Answer 19

Baby blues lasts up to 2 weeks and is self-limiting

Postnatal depression has a later (2 weeks+) onset and negatively affects relationship with child

Question 20

Does maternal depression have physical effects on the child?

What are some examples?

Answer 20

Yes

Low birth weight, premature delivery, poor relationship

Question 21

What are the principles for drug treatment of psychiatric problems in pregnancy?

Answer 21

Avoid high risk drugs (which change with trimester)

Use lowest dose monotherapy

Consider interactions

Encourage breastfeeding (exception: lithium)

Question 22

Adverse effects re: teratogenic drugs may have occurred before the ___ is discovered.

Answer 22

before pregnancy is discovered

Question 23

Which psychiatric drugs are notably teratogenic?

Answer 23

Lithium

Sodium valproate

Question 24

Which sedative drugs should be avoided in pregnancy?

Answer 24

Benzodiazepines

Question 25

In general, **antipsychotics** are safe to use during pregnancy. Which specific drugs should be avoided?

Answer 25

**Clozapine** - agranulocytosis **Olanzapine** - obesity, diabetes

Question 26

Why should **depot injections** be avoided in pregnant women?

Answer 26

**High concentration of drug can accumulate in foetus**

Question 27

Which drug, used in **bipolar disorder** and **epilepsy**, is contraindicated in pregnancy? Why?

Answer 27

**Sodium valproate** Neural tube defects (which often occur before the pregnancy is discovered)

Question 28

If a woman of childbearing age is on sodium valproate, she should be using \_\_\_.

Answer 28

**contraception**

Question 29

What lifestyle disorder increases a pregnant woman's chances of mental health problems?

Answer 29

**Substance abuse**

Question 30

Which **bloodborne viruses** should be tested for in pregnant women?

Answer 30

**HIV** **Hep B & C**

Question 31

Pregnant women who abuse alcohol are at risk of ___ deficiency.

Answer 31

**nutrient deficiency** particularly thiamine (Vitamin B1)

Question 32

Why are substance users more likely to contract STIs?

Answer 32

**"Chaotic lifestyle"**

Question 33

People who inject drugs are at risk of which vascular complication?

Answer 33

**Venous thromboembolism** e.g DVT leading to PE, MI, stroke

Question 34

Can women with a history of opiate abuse be given opiates during labour?

Answer 34

**Yes** **It's analgesia** **May even require an increased dose due to tolerance**

Question 35

What are the guidelines re: alcohol consumption for pregnant women?

Answer 35

**Abstain if possible** **Otherwise \< 2 units / week**

Question 36

What is a foetal consequence of alcohol abuse during pregnancy?

Answer 36

**Foetal alcohol syndrome** look up presentation

Question 37

What cardiovascular diseases occur secondary to the use of **cocaine, amphetamine** and **ecstasy** during pregnancy?

Answer 37

**Arrythmias** **Stroke**

Question 38

What are the guidelines re: smoking in pregnancy?

Answer 38

**Don't** Linked to miscarriage, placental abruption, IUGR