5 - PSY - Perinatal Psychiatry

Question 1

Estimated % of mental illness resulting in suicide that could have been identified antenatally?

Answer 1

50%

Question 2

What must be done at antenatal appts for all women?

Answer 2

screen all women for past/family Hx of serious mental illness - refer identified at risk pts to perinatal psych services

Question 3

Who to refer at screening?

Answer 3

Stage 1 –> does she have mental illness Hx OR FHx of serious mental illness –> Stage 2 –> Hx OR FHx of…
-schiz/psychosis
-bipolar
-puerperal psychosis
-severe depression
OR Rx mood stabilisers ?????? —–> refer to psych

Question 4

Mild to moderate depressive episode successfully treated in primary care with AD’s……does she need referring?

Answer 4

Not recommended - not severe enough - can always be referred if she deteriorates

Question 5

Would you refer this lady? - previous dep episode treated by psychiatrist?

Answer 5

YES - required 2ndary care

Question 6

when are psych disorders more common in pregnancy than general population

Answer 6

1st trimester

Question 7

normally, how severe are psych disorders during pregnancy

Answer 7

usually mild and likely to improve

Question 8

What can continue from 3rd trimester to postpartum?

Answer 8

depression and anxiety –> postnatal depression

Question 9

The Pinks - describe

Answer 9

• first 48h after
• excitement, euphoria, over-activity with possible insomnia
• risk of exhaustion, but normally resolve without intervention

Question 10

The Blues - describe

Answer 10

• 50-80% postpartum
• attributed to hormone changes + physical and emotional exhaustion
• emotional lability, tearfulness, mild anxiety, irritable
• 48h and no specific Tx

Question 11

Peak onset of depressive illness postpartum?

Answer 11

2-4 weeks - also secondary peak at 3 months

Question 12

Risk of recurrence of severe/postnatal depressive illness following delivery??

Answer 12

50%

Question 13

Postpartum psychosis - risk in gen pop?

99% are either —– OR —-?

Answer 13

0.2%

bipolar or schizoaffective disorder

Question 14

A birth plan for each patient at risk should be in place when?

Answer 14

35 weeks gestation

Question 15

What should a birth plan for an at risk patient contain

Answer 15

monitor mental health immediately after partum
liason between MDT
prophylactic medication if appropriate
consider child protection
emergency contact details