Perinatal Mental Health

Question 1

Name at least 3 pregnancy-related disorders which tend to reoccur later in life

Answer 1

Pre-eclampsia (as hypertension), gestational diabetes, post-partum thyroid disease, postnatal depression, puerperal psychosis

Question 2

Name at least 3 disorders which can be exacerbated by pregnancy

Answer 2

SLE, eating disorders, OCD, bipolar disorder

Question 3

Name some sub-clinical syndromes unmasked by pregnancy

Answer 3

Thyroiditis, eating disorders, OCD

Question 4

Define the ‘baby blues’ and state their prevalence (Henshaw, 2003)

Answer 4

Self-limiting depressive mood changes after delivery, prevalence 50%

Question 5

State the peri and post-natal prevalence of minor depression

Answer 5

Perinatal: 11%
Postnatal: 13%

Question 6

State the peri and post-natal prevalence of major depression

Answer 6

Perinatal: 3-5%
Postnatal: 4.7%

Question 7

What percentage of post-partum women report obsessional thoughts of harm to their baby? (Wisner et al, 1999)

Answer 7

57%

Question 8

State at least 5 risks of pharmacological intervention during pregnancy

Answer 8

Teratogenecity, obstetric complications, neonatal toxicity & withdrawal, neonatal complications, incompatibility with breastfeeding, neurodevelopmental disorders (autism), child psychopathology

Question 9

State at least 5 risks of untreated mental illness during pregnancy

Answer 9

Increased risk of hospitalisation, worsening of long-term prognosis, suicide, premature delivery, low birth weight, still birth, early infant death, attachment disorders, slow infant cognitive development

Question 10

Name 2 psychiatric disorders associated with premature delivery

Answer 10

Depression, schizophrenia

Question 11

Name 2 psychiatric disorders associated with low birth weight

Answer 11

Anorexia nervosa, schizophrenia

Question 12

Name a psychiatric disorder associated with still-birth and early infant death

Answer 12

Schizophrenia

Question 13

Name a psychiatric disorder associated with slow infant cognitive development (Stein et al, 2014)

Answer 13

Depression

Question 14

When in life is the relative risk of admission to hospital with a psychotic illness highest? (Kendell et al, 1987)

Answer 14

First 30 days after childbirth

Question 15

What percentage of women who die 6 weeks to a year after pregnancy die from psychiatric causes?

Answer 15

23%

Question 16

Describe the findings from the South London Child Development Study (SLDCS) on perinatal mental health and child development

Answer 16

Perinatal maternal depression increased the risk of child and adolescent psychopathology

Question 17

Describe the findings from the Avon Longitudinal Study of Parents and Children (ALSPAC) on perinatal mental health and child development

Answer 17

Antenatal maternal anxiety predicted behavioural and emotional problems in children, with a stronger impact on males

Question 18

Describe the Barker hypothesis

Answer 18

Developmental programming in utero modifies the risk of disease later in life

Question 19

What effects does the intrauterine environment have at an organ level?

Answer 19

It alters cellular and metabolic function, leading to altered appetite and lipogenesis

Question 20

What effects does the intrauterine environment have at a cellular level?

Answer 20

It alters the number, size, and proliferation of cells, changing intracellular organisation

Question 21

What effects does the intrauterine environment have at an epigenetic level?

Answer 21

It affects DNA methylation and modifies chromatin, leading to modified gene expression and signalling

Question 22

Name the 4 neuorbiological correlates of perinatal mental health

Answer 22

Adrenaline-cortisol pathways, serotoninergic pathways, dopaminergic pathways, and oxytocin system

Question 23

Which pathways are involved in depression?

Answer 23

Serotoninergic pathways

Question 24

Which pathways are involved in anxiety?

Answer 24

Adrenaline-cortisol pathways

Question 25

Which pathways are involved in psychosis?

Answer 25

Dopaminergic pathways

Question 26

Which pathways are involved in addiction?

Answer 26

Dopaminergic system

Question 27

How does the dopaminergic system ensure survival of the species

Answer 27

It counteracts the irritations of caring for children

Question 28

Name at least 3 classes of psychotropic medication

Answer 28

Antipsychotics/ neuroleptics, selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), mood stabilisers, anxiolytics/ sedatives

Question 29

State the method of action of antipsychotics and name at least 2

Answer 29

Dopaminergic D2 antagonists - risperidone, olanzapine, quetiapine aripiprazole

Question 30

State the method of action of SSRIs and name at least 2

Answer 30

Inhibit the reuptake of serotonin (5-hydroxytriptamine) in the synapse, increasing the bioavailable concentration and prolonging neuronal activity - fluoxetine, citalopram, escitalopram, sertraline

Question 31

State the method of action of SNRIs and name 2

Answer 31

Inhibit the reuptake of both serotonin and noradrenaline from the synapse - venlafaxine, duloxetine

Question 32

State the method of action of mood stabilisers and name at least 2

Answer 32

Reduce the excitability of neural membranes - lithium, carbamazepine, valproate, lamotrigine

Question 33

State the method of action of anxiolytics and name at least 2

Answer 33

Act on GABA receptors and promote GABAergic inhibitory neurotransmission - diazepam, lorazepam, temazepam, zopiclone, zolpidem

Question 34

Describe the ‘theory of the inflamed mind’ for mental illness

Answer 34

Inflammatory proteins act directly on the brain to change thoughts and behaviours

Question 35

Give a piece of evidence for the theory of the inflamed mind

Answer 35

1) 25% of RA patients are depressed

2) 1/3 of patients with depression have chronic inflammation