perinatal psych

Question 1

if mental illness is left untreated during pregnancy what are the risks to the mother

Answer 1

increased risk suicide, substance misuse, poor compliance, poor lifestyle and self care

Question 2

if mental illness is left untreated during pregnancy what are the risks to the infant

Answer 2

LBW, pre term, poor attachment

Question 3

when would you get withdrawal syndrome in baby

Answer 3

if drugs are used in 3rd trimester

Question 4

when are malformations most likely (which trimester) due to drugs

Answer 4

1st

Question 5

bipolar medication

Answer 5

maintain on medication if severe and high risk relapse. avoid valproate- neural tube defects. can use lithium but teratogenic- cardiac malformations

Question 6

schizophrenia in pregnancy medication

Answer 6

take antispychotics at every stage. olanzapine

Question 7

depression treatment pregnancy

Answer 7

delay until 2nd and 3rd trimester. amitryptilline, nortryptilline, fluoxetine

Question 8

what are the baby blues

Answer 8

brief period low mood, tearful, emotional lability. 2-3 days after, and lasts 2-3 days. 75% new mums

Question 9

what is post natal depression

Answer 9

significant depressive episode within 6 months of delivery. 10-15% new mums

Question 10

what is postpartum psychosis

Answer 10

rapidly evolving abrupt onset. confusion and disorientation with psychotic features. high risk suicide and infanticide. 2-4 weeks after birth

Question 11

management post partum depression

Answer 11

psychotherapy

Question 12

management post partum psychoses

Answer 12

antipsychotics. ECT can be used

Question 13

antidepressants

Answer 13

use TCAs, sertraline if SSRI.

Question 14

what antidepressants are present in breast milk at low levels

Answer 14

imipramine, nortryptyline, amitriptyline.

Question 15

mood stabilisers

Answer 15

don’t use in breastfeeding

Question 16

what is the risk of using antidepressants

Answer 16

withdrawal or toxicity in neonates

Question 17

what are preferred to mood stabilisers in prescribing in pregnancy

Answer 17

antipsychotics- haloperidol, chlorpromazine

Question 18

what can benzos cause in the neonate

Answer 18

cleft palate, fetal malformations, floppy baby syndrome

Question 19

what does lithium increase your risk of

Answer 19

Epsteins anomaly (downward displacement of triscupid valve into right ventricle)

Question 20

which mood stabilisers cause neural tube defects

Answer 20

valproate and carbamazepine

Question 21

guiding prescribing in pregnancy

Answer 21

avoid all in first trimester

Question 22

what do you need to do with benzos, TCAs, SSRIs in the weeks prior to delivery

Answer 22

gradually withdraw