Perinatal Psychiatry

Question 1

How many suicides occur up to 12 weeks postnatally?

Answer 1

Half

Question 2

What 3 questions are very important for screening for mental health issues?

Answer 2

1. During the last month have you been bothered by feeling down, depressed or hopeless?
2. During the last month have you ever been bothered by having little interest or pleasure in doing things?
3. Is there something you feel you need or want help with?

Question 3

What are the 7 things that can indicate mental health issues?

Answer 3

Appearance and behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight

Question 4

What tests can be done for screening someones mental health?

Answer 4

Lithium levels
Toxicology
FBC
WBC
U&E's
LFT's
Glucose
CRP
CT of head

Question 5

What is important to do when a psychiatric patient becomes pregnant?

Answer 5

Make a plan with the patient regarding delivery, their medications and monitoring/support etc.

Question 6

What are the 4 principles of treating a pregnant psychiatric patient?

Answer 6

Drugs with low risk to mother and fetus
Lowest dose monotherapy (avoid depot)
Increase screening of fetus-cardio and growth
Encourage breastfeeding whenever possible

Question 7

What should be avoided in pregnant women and why?

Answer 7

Benzodiazepines

Can cause cleft palates and neonatal withdrawl

Question 8

What is the risk of the baby developing bipolar disorder if the mother has it?

Answer 8

1 in 7

Question 9

What are fetal abnormalities caused by valproate (anticonvulsant-mood stabiliser) for bipolar disorder?

Answer 9

Craniofacial defects
CV abnormality
IUGR
Reduced IQ
Cleft
Genitourinary anomalies
NTD

Question 10

What are side effects of the anticonvulsant, Carbamazepine?

Answer 10

Facial dysmorphism
Cardiac anomalies
Fingernail hypoplasia
NTD (Neural tube defect)
Vit K deficiency
Haemorrhagic disease

Question 11

What side effects of Lamotrigine can occur?

Answer 11

Cleft

Steven Johnson syndrome if baby is breast fed

Question 12

What cardiac issues can be caused by Lithium?

Answer 12

Maternal toxicity

Ebstein’s anomaly

Question 13

What other abnormalities can be caused by lithium?

Answer 13

Hypotonia
Hypothyroidism
Hypoglycaemia

Question 14

Can lithium just be stopped or does it need to be stopped gradually?

Answer 14

Gradually

Question 15

What is the risk of the child developing schizophrenia if the mother has it?

Answer 15

10%

Question 16

If the mother is on antipsychotics during the pregnancy, what should the baby be monitored for and why?

Answer 16

Lethargy
Sedation
Milestones
Due to antipsychotics being sedative and having long half-lives

Question 17

Name 3 atypical antipsychotics

Answer 17

Clozapine
Risperidone
Olanzapine

Question 18

What are the risks of atypicals in pregnancy?

Answer 18

gestational diabetes

IUGR

Question 19

Name 2 typical antipsychotics

Answer 19

Haloperidol
Chlorprmazine
Appear safe

Question 20

What drug shouldn’t be used during breastfeeding?

Answer 20

Clozapine

Question 21

What can olanzapine cause in the baby while baby is being breastfed?

Answer 21

Extrapyramidal reactions

Question 22

Can anticholinergics be used in pregnancy? (Used for extrapyramidal side effects)

Answer 22

No

Question 23

What problems regarding pregnancy can be caused by eating disorders?

Answer 23

IUGR
Prematurity
Hypokalaemia
Hyponatraemia
Metabolic alkalosis
Miscarriage 
Premature delivery

Question 24

When should SSRI’s be used with caution and why?

Answer 24

After 20 weeks

Due to pulmonary hypertension

Question 25

What 2 SSRI's have higher levels present in breast milk?

Answer 25

Citalopram | Fluoxetine

Question 26

What 2 TCA's are safe in pregnancy and OK in breastfeeding?

Answer 26

Amitriptilline | Nortryptilline

Question 27

What percentage of women suffer from postnatal depression?

Answer 27

10% - 1/3 for a year or more

Question 28

What are the features of postnatal depression?

Answer 28

``` Tearfulness Irritable Anxiety Lack of enjoyment Poor sleep Weight loss ```

Question 29

When does postnatal depression usually occur?

Answer 29

2-6 weeks postnatally

Question 30

What can postnatal depression have an effect on?

Answer 30

Bonding Child development Marriage Risk of suicide

Question 31

What is baby blues?

Answer 31

Brief period of emotional instability

Question 32

What % of women get baby blues?

Answer 32

50

Question 33

What are features of baby blues?

Answer 33

Tearful Irritable Anxiety Poor sleep confusion

Question 34

How do you manage baby blues?

Answer 34

Support and reasurrance

Question 35

How do you treat mild-moderate postnatal depression?

Answer 35

Self help and counselling

Question 36

How do you treat severe postnatal depression?

Answer 36

Psychotherapy Antidepressants Possible admission

Question 37

What are differentials of Puerperal psychosis?

Answer 37

Episode of bipolar Unipolar depression Schizophrenia Organic brain dysfunction (secondary to physical illness)

Question 38

When does Puerperal psychosis usually present?

Answer 38

Within 2 weeks of delivery

Question 39

What are early symptoms of Puerperal psychosis?

Answer 39

Sleep disturbances Confusion Irrational ideas

Question 40

What are other symptoms of Puerperal psychosis?

Answer 40

Mania Delusions Hallucinations Confusion

Question 41

What % of women get Puerperal psychosis?

Answer 41

0.1

Question 42

What are the risks of suicide and infanticide in women with Puerperal psychosis?

Answer 42

5% suicide | 4% infanticide

Question 43

What are risk factors for Puerperal psychosis?

Answer 43

Bipolar (50%) | 1st degree relative

Question 44

How do you manage Puerperal psychosis?

Answer 44

It's an emergency! Admit to specialised mother-baby unit Antidepressants, antipsychotics, mood stabilisers and ECT

Question 45

What % of women have a 10 year recurrence and what % go onto develop bipolar?

Answer 45

10 year recurrence = 80% | Bipolar = 25%

Question 46

What fetal problems are assoc. with substance abuse in pregnancy?

Answer 46

IUGR Stillbirth SIDs PTD

Question 47

How many women of child bearing age have dependence on alcohol and illicit drugs?

Answer 47

Alcohol = 4.7% | Illicit drugs = 2.2%

Question 48

What problems regarding pregnancy can alcohol cause?

Answer 48

``` Miscarriage Facial deformities Lower IQ neurodevelopmental delay Epilepsy Hearing Heart and kidney defects Withdrawl ```

Question 49

What causes Wernicke's encephalopathy?

Answer 49

B1 deficiency

Question 50

How long does Karsakoff syndrome last?

Answer 50

Permanent

Question 51

How can Cocaine, amphetamine and ecstasy cause death?

Answer 51

Stroke | Arrhythmias

Question 52

What fetal abnormalities can Cocaine, amphetamine and ecstasy cause?

Answer 52

``` Teratogenic (microcephaly) Cardiac Genitourianary Limb defects PET Abruption IUGR PTL Miscarriage Developmental delay SIDS Withdrawal ```

Question 53

What antenatal care should be considered regarding substance abuse?

Answer 53

Consider methadone programme Child protection and social work referral Smear Hx Breastfeeding - not if alcohol, HIV or cocaine Early IV access Postnatal contraception