9) Maternal Medicine - Psychiatry

Question 1

What percentage of women will develop mental health problems during or after pregnancy?

Answer 1

10%

Question 2

Most common mental health problem in pregnancy

Answer 2

Anxiety

Question 3

Incidence of depression in pregnancy

Answer 3

12%

Question 4

Incidence of anxiety in pregnancy

Answer 4

13%

Question 5

Which questionnaires should be used as initial screening tools for anxiety/depression?

Answer 5

GAD-2 and Whooley questions

Question 6

Incidence of postpartum psychosis

Answer 6

1-2 in 1000

Question 7

If concern is raised on the depression screening Qs what further assessment tools could be used?

Answer 7

Edinburgh PND Scale

PHQ-9

Question 8

If concern is raised on the anxiety screening Qs what further assessment tools could be used?

Answer 8

GAD-7

Question 9

How quickly should women be seen after referral with sudden onset symptoms suggesting of postpartum psychosis?

Answer 9

4 hours

Question 10

How quickly should a woman be seen after referral to secondary care?

Answer 10

Assess for treatment within 2 weeks and psychological interventions within 1 month.

Question 11

Treatment of mild–>moderate depression

Answer 11

Facilitated self help

Question 12

Treatment of moderate–>severe depression

Answer 12

• CBT
• TCA/SNRI/SSRI
• CBT in combination with medication

Question 13

Treatment of mild anxiety

Answer 13

Facilitated self help

Question 14

Treatment of anxiety disorder

Answer 14

• Low or high intensity psychological intervention

- High intensity recommended for PTSD and social anxiety

Question 15

What to measure in women on antipsychotics planning a pregnancy?

Answer 15

Prolactin

Question 16

What screening test to offer in pregnancy for women on antipsychotics?

Answer 16

GTT

Question 17

When to use depot antipsychotics?

Answer 17

Only if stable on them and previous non-compliance with oral antipsychotics.

Question 18

Which drugs should not be used for mental health problems in pregnancy?

Answer 18

Valproate/Carbemazepine

Question 19

What to do with antipsychotics in pregnancy?

Answer 19

If stable and likely to relapse without it then continue.

Question 20

When to use lithium?

Answer 20

Only if antipsychotics have not been effective

Question 21

What to do with lithium in pregnancy?

Answer 21

• Can stop gradually over 4 weeks if well
• If not well or high risk of relapse then can consider gradually switching to an antipsychotic, stopping lithium and restarting in 2nd trimester or continuing with lithium.

Question 22

Risk of relapse in women with bipolar disorder who stop medication

Answer 22

2 x increased risk

Question 23

How often to measure lithium plasma levels?

Answer 23

Every 4 weeks and then weekly from 36th week

Question 24

What to do with lithium in labour?

Answer 24

Stop during labour and check plasma lithium levels 12 hours after last dose

Question 25

What percentage of women with a mental health problem require inpatient treatment?

Answer 25

4%

Question 26

When does postpartum psychosis occur?

Answer 26

Frequently occurs early - 50% within first 3 days postpartum.

Question 27

Risk of postpartum psychosis in a woman with bipolar disorder

Answer 27

>25%

Question 28

Risk of postpartum psychosis in a woman with bipolar disorder and a family history of postpartum psychosis

Answer 28

50%

Question 29

Recurrence risk of postpartum psychosis

Answer 29

50%

Question 30

Risk of suicide with postpartum psychosis

Answer 30

2%

Question 31

Incidence of suicide

Answer 31

1 in 100,000

Question 32

What percentage of women who committed suicide had a diagnosis of a severe affective illness?

Answer 32

60%

Question 33

What percentage of women who develop postpartum psychosis have no risk factors?

Answer 33

50%

Question 34

Incidence of chronic serious mental illness (bipolar/schizophrenia)

Answer 34

2 in 1000

Question 35

Incidence of severe depressive illness

Answer 35

30 in 1000

Question 36

Incidence of PTSD

Answer 36

30 in 1000

Question 37

Incidence of adjustment disorders and distress

Answer 37

150-300 in 1000

Question 38

Incidence of postpartum blues

Answer 38

50-80%

Question 39

When do postpartum blues occur?

Answer 39

D3-D10, lasting 48 hours

Question 40

Risk of postnatal depression if you have history of depression

Answer 40

15%

Question 41

Risk of postnatal depression if you have a history of depression and FHx of postpartum depression

Answer 41

40%

Question 42

What proportion of women with PND develop depression before or during pregnancy?

Answer 42

1/2

Question 43

When does PND occur?

Answer 43

Gradual onset during first 2 weeks after birth, with two peak presentations 2-4 and 10-14 weeks postnatal.

Question 44

Risk of recurrence of PND

Answer 44

2-3 x increased

Question 45

What percentage of women take antidepressants in pregnancy?

Answer 45

3%

Question 46

Criteria for referral to specialised perinatal mental health service:

Answer 46

- Current severe psychiatric symptoms - Hx severe postpartum illness/schizophrenia/bipolar - Complex psychotropic medications Referral should be considered for those with moderate symptoms developed late in pregnancy/early postpartum, or mild symptoms and a family history of BP/PP.