Mental Health Conditions

Question 1

Risk of Post-partum psychosis
- No mental illness
- No Fhx mental illness

Answer 1

1/1000

Question 2

Risk of PPP
- No Pmhx mental Hx
- Mother or sister had PPP

Answer 2

3/100

Question 3

Risk PPP
- Hx Bipolar/schizoaffective disorder
- No Family Hx
- 1st pregnancy

Answer 3

1/4

Question 4

Risk PPP
- Hx Bipolar/schizoaffective disorder
- Mother/Sister had PPP

Answer 4

1/2

Question 5

Risk PPP
- Hx Bipolar/schizoaffective disorder
- 2nd pregnancy, no PPP in 1st pregnancy

Answer 5

1/10

Question 6

Risk PPP
- Hx Bipolar/schizoaffective disorder
- Hx PPP in previous pregnancy

Answer 6

1/2

Question 7

PPP occurs in what % of women with no risk factors?

Answer 7

50%

Question 8

When is PPP most likely to present

Answer 8

Within 2 weeks
50% onset Day 1-3

Question 9

Symptoms of PPP

Answer 9

A wide variety of psychotic phenomena such as delusions and hallucinations, the content of which is often related to the new child.

Affective (mood) symptoms, both elation and depression.

Disturbance of consciousness marked by an apparent confusion, bewilderment or perplexity.

Question 10

Differential PPP

Answer 10

Primary cerebral or systemic disease (such as eclampsia or infection) should be excluded

Exogenous toxic substances or hormones

Other psych: PP blues, PN depression (would not have hallucination/delusions)

Question 11

Management PPP

Answer 11

Admit to hospital, psychiatric emergency (ideally mother and baby unit)

Pharmacological treatment

Question 12

What questions can be asked to screen for depression?

Answer 12

Whooley depression screen

1) During the past month, have you often been bothered by feeling down, depressed or hopeless?
2) During the past month, have you often been bothered by having little interest or pleasure in doing things?

Question 13

What questions can be asked to screen for anxiety?

Answer 13

Generalized Anxiety Disorder scale (GAD-2):

1) During the past month, have you been feeling nervous, anxious or on edge?
2) During the past month have you not been able to stop or control worrying?

Question 14

Scoring system for Whole and GAD-2?

Answer 14

1. Not at all: 0
2. Several days: 1
3. More than half the days: 2
4. Nearly every day: 3

Question 15

If women scores highly >3 on whooley questionnaire?

Answer 15

1) Using the Edinburgh Postnatal Depression Scale (EPDS) or the Patient Health Questionnaire (PHQ-9) as part of a full assessment OR

2) Referring the woman to her GP or, if a severe mental health problem is suspected, to a mental health professional.

Question 16

If woman scores highly > 3 on GAD-2

Answer 16

1) Using the GAD-7 scale for further assessment or
2) Referring the woman to her GP or, if a severe mental health problem is suspected, to a mental health professional.

Question 17

How to assess for severe mental illness at booking appointment?

Answer 17

1) Any past or present severe mental illness
2) Past or present treatment by a specialist mental health service, including inpatient care
3) Any severe perinatal mental illness in a first-degree relative (mother, sister or daughter).

Consider referral to perinatal mental health team

Question 18

When to refer to perinatal mental health

Answer 18

current severe psychiatric symptom

a history of serious postpartum illness or bipolar disorder or schizophrenia

on complex psychotropic medications schemes.

Question 19

When are women most likely to comment suicide?

Answer 19

Post natal 6-9 months

Question 20

For women at risk of PPP, but stable, how long should they be followed up PP?

Answer 20

3 months

Question 21

How common is postpartum blues?
When most likely to present?

Answer 21

50-80%
3-5 days

Will be tearful/tired

Question 22

How common is perinatal depression?
When can it present>

Answer 22

25%
Anytime in pregnancy up to 1 year PP

Question 23

Depression
Name Core and minor symptoms of depression according to DSM IV

Answer 23

At least 1
- Depression mood
- Deminished interest/pleasure

4+ minor
- Changes in weight, appetite
- Insomnia/hypersomnia
- Psychomotor agitation or retardation
- Fatigue or less of energy
- Feeling worthless/guilty
- Impaired conc or indecisiveness
- Thoughts of death

Question 24

Non-pharmacological treatments for mental health conditions

Answer 24

• CBT – low intensity – computerised, high intestity individual or group CBT
• Debriefing
• Non directive counselling
• Interperonal psychotherapy
• Psychodynamic psychotherapy
• Support & education

Question 25

Who should anti-depressants be given to?

Answer 25

Moderate/severe depression

Question 26

Side effects of SSRIs to babies

Answer 26

Baby’s can have withdrawal symptoms
30% exposed babies
Usually settles 1-2 days
Or if BF – when stop mediation or stop BF
Symptoms: Resp distress, tremor, jitteriness, increased REM sleep
Extremely small increase risk neonatal pulmonary HTN, SSRI > 20 weeks

Question 27

Risks of TCAs

Answer 27

Risk of overdose to the mother

Question 28

Which antidepressants have lowest dose in infant?

Answer 28

Citalopram
Fluoxetine

Question 29

Which antidepressants have highest dose in infant?

Answer 29

Venlafaxine

Question 30

Effect of lithium on foetus

Answer 30

Cardiac abnormality, Epstein abnormality 1/100

Question 31

If continuing lithium in pregnancy, when to check levels

Answer 31

Every 4 weeks until 36 weeks then weekly

Question 32

How to manage lithium in labour

Answer 32

Stop in labour
Check levels 6-8 hours PP
Retart 12 hours PP, then measure levels 12, 24 hrs after, 2 weekly 4 weeks then weekly 4 weeks

Question 33

How is lithium excreted?

Answer 33

Renally, need good renal function

Question 34

Can you breast feed whilst taking lithium

Answer 34

No

Question 35

SSRI ans SNTI increase what risk in labour?

Answer 35

Increases risk of bleeding

Question 36

Sodium valproate risk congenital malformation, neurodevelopment disorder

Answer 36

Congenital: 10%
Neuro: 30-40%

Question 37

What other anti-epileptics have adverse outocomes for neurodevelopment?

Answer 37

Phenobarbital
Phenytoinm

Question 38

Which antivplepitv dose should be monitoee in pregnancy?

Answer 38

Lamotrigine, levels fall in pregnancy

Levels lamotrigine levetiracetam also decrease