Perinatal Psychiatry

Question 1

What are the red flag perinatal presentations?

Answer 1

recent signif change in mental state; new thoughts or acts of violent self harm; persistent expressions of incompetency or estrangment

Question 2

What is the differencein methods between suicide perinatally and femal suicide in general?

Answer 2

perinatally methods are much more violent

Question 3

What are the risk factors for mental health issues in pregnnacy?

Answer 3

young/single; domestic issues; lack support; substance abuse; unplanned/unwanted pregnancy; pre-existing metnal health problem

Question 4

When should a woman be referred to the psych team?

Answer 4

psychosis; severe anxiety; depression; suicidal; self-neglect; self harm; symptoms with signif interference in ADLs; hx of bipolar; SZ or puerperal psychosis; psychotropic medications; mod illness in late pregnancy or early postpartum; mild/mod but FHx; prev inpatietn

Question 5

What is the general rule with pregnancies effect on mental health?

Answer 5

not protective

Question 6

What are the risks associated with eating disorder in pregnancy?

Answer 6

IUGR; prematurity; hypokalaemia; hyponatraemia; metabolic alkalosis; miscarriage

Question 7

How common in baby blues?

Answer 7

50% women

Question 8

What is the baby blues?

Answer 8

brief period of emotional instability- tearful; irritable; anxiety; poor sleep; confusion

Question 9

When does baby blues tend to occur?

Answer 9

days 3-10: self-limitng

Question 10

What is the treatment for the baby blues?

Answer 10

support and reassurance

Question 11

What is the differential for puerperal psychosis?

Answer 11

episode of bipolar; unipolar depression; SZ; organic brain dysfunction

Question 12

When does puerperal psychosis usually present?

Answer 12

within 2 weeks of delivery

Question 13

What are the early symptoms of puerperal psychosis?

Answer 13

sleep disturbance and confusion; irrational ideas

Question 14

What are the symtpoms of puerperal psychosis?

Answer 14

mania; delusions; hallucinations; confusion— different to otehr psychoses; very changeable

Question 15

What are the risk factors for developing puerperal psychosis?

Answer 15

bipolar disorder; previous puerperal psychosis; FHx

Question 16

What is the treatment for puerperal psychosis?

Answer 16

admission to mother-baby unit; antidepressants; antipsychotics; mood stabilisers and ECT

Question 17

How common is postnatal depression?

Answer 17

10%

Question 18

What are the symptoms of postnatal depression?

Answer 18

tearfulenss; irritable; anxiety; lack of enjoyment; poor sleep; weight loss; concerns re baby

Question 19

When does postnatal depression start?

Answer 19

2-6 weeks postnatally

Question 20

What are the child of untreated depression?

Answer 20

low birth weight; preterm delivery; emotional and conduct problems; ADHD; poor bonding with child- cognitive development affected

Question 21

What type of preparations should be avoided in pregnancy?

Answer 21

depot

Question 22

What is the risk to the fetus generally in the 1st trimester with drugs?

Answer 22

teratogenicity

Question 23

What is the risk to the fetus generally in 3rd trimester with drugs?

Answer 23

neonatal withdrawal

Question 24

Why is there no need generally to stop a drug that was used during pregnnacy in breast feeding?

Answer 24

exposure in breat milk is uually less than in utero

Question 25

What antidepressant carries the greatest risk of fetal malformation?

Answer 25

paroxetine- heart defects

Question 26

What is general teratogenic risk with antidepressants?

Answer 26

no increase in major malformations or spontaneous abortion

Question 27

What is there an increased risk of with antidepressants in the third trimester?

Answer 27

neonatal withdrawal (milld and self-limiting); neonatal persistent hypertension; low birth weight/prematurity

Question 28

Which antidepressants in crease the risk of neonatal persistent pulmonary hypertension?

Answer 28

SSRIs and venlafaxine taken after 20 weeks

Question 29

What SSRIs carry the lowest risk in the 3rd trimester?

Answer 29

sertraline and fluoxetine

Question 30

What TCAs carry the lowest risk in the 3rd trimester?

Answer 30

imipramine/amitriptyline

Question 31

Do TCAs or SSRIs carry the higher risks in the 3rd trimester?

Answer 31

SSRIs

Question 32

What antidepressants should be avoided in breastfeeding?

Answer 32

citalopram and doxepin

Question 33

What antidepressants are good in breastfeeding?

Answer 33

sertraline; paroxetine; imipramine

Question 34

Why should BZDs be avoided in the first trimester?

Answer 34

increase risk of fetal malformation eg cleft palate

Question 35

Why should BZDs be avoided in the 3rd trimester?

Answer 35

increased risk of floppy baby syndrome

Question 36

What are the symptoms of floppy baby syndrome?

Answer 36

hypothermia; hypotonia; respiratory depression; withdrawal effets

Question 37

Why should BZDs be avoided in breastfeeding?

Answer 37

risks of neonatal lethargy and weight loss and accumulation of long acting drugs (developing liver metabolism)

Question 38

Why should clozapine be avoided in pregnancy?

Answer 38

agranulocytosis- no way to easily check fetus blood

Question 39

What are the risks in pregnancy associated iwth olanzapine?

Answer 39

GDM and weight gain

Question 40

What is the risk of lithium in the 1st trimester?

Answer 40

increased Ebstein's abnormality

Question 41

Even though there is teratogenic risk with lithium what should not be done?

Answer 41

sudden discontinuation

Question 42

Why should serum lithium levels be monitored very closely in 3rd trimester?

Answer 42

changes in volume of distribution and lithium toxicity can mimic PET

Question 43

How often should lithium levels be monitored from week 36?

Answer 43

weekly

Question 44

Can lithium be usedi n breastfeeding?

Answer 44

no-high quantities in breast milk

Question 45

What are the risks associated with sodium valproate in the first trimester?

Answer 45

neural tube defects; craniofacial defects and intellectual devleopment - increased autism

Question 46

When does the neural tube close?

Answer 46

day 28

Question 47

Is valproate safe to use when breastfeeding?

Answer 47

yes- no evidence of adverse effects

Question 48

What are the risks associated with carbamazepine in pregnancy?

Answer 48

NTDs; GI and cardiac; neonatal anticonvulsant syndrome

Question 49

why should lamotrigine be avoided in the 1st trimester?

Answer 49

increased risk of oral cleft

Question 50

What is the risk with lamotrigine in breastfeeding?

Answer 50

risk of SJS in infant

Question 51

What are the fetal risks with substance abuse?

Answer 51

IUGR; stillbirth; SIDs and preterm labour

Question 52

What are the symptoms of fetal alcohol syndrome?

Answer 52

facial deformities; lower IQ; neurodevelopmental delay; epilepsy; hearing; heart and kidney defects