Perinatal Psychiatry

Question 1

List some red flag presentations in pregnant/post natal women:

Answer 1

Significant change to mental state
New emergence of symptoms
New thoughts/acts of violent self harm
New/persistent expressions of incompetency as a mother or estrangement from baby

Question 2

List reasons for when admission to the mother and baby unit be considered?

Answer 2

• Rapidly changing mental state
• Suicidal intent
• significant estrangement from infant
• evidence of psychosis
• pervasive guilt / hopelessness / inadequacy

Question 3

What 5 of women suffer form baby blues?

Answer 3

Up to 50%

Question 4

Give some characteristics of baby blues:

Answer 4

Brief period of emotional instability
Tearful
Irritable
Anxiety
Confusion
Poor sleep

Question 5

What is the timeline of baby blues?

Answer 5

From about Day 3 - day 10 post birth

Question 6

Give some symptoms of puerperal psychosis:

Answer 6

Sleep disturbance 
Confusion
Irrational ideas
Mania
Delusions
Hallucinations

Question 7

What is the time of onset in puerperal psychosis?

Answer 7

Usually within 2 weeks of delivery

Question 8

What % of women suffer from puerperal psychosis

Answer 8

0.1%

Question 9

What are the two serious outcomes you wish to avoid in puerperal psychosis

Answer 9

Suicide

Infanticide

Question 10

State 3 risk factors for puerperal psychosis

Answer 10

Bipolar disorder
previous episode
1st degree relative with Hx

Question 11

__ % of cases with puerperal psychosis will go on to develop ______ _______

Answer 11

25%

Bipolar Disorder

Question 12

How is puerperal psychosis managed

Answer 12

Emergency admission to mother-baby unit
Anti-depressants
Anti-psychotics
Mood stabilizers
ECT

Question 13

What % of women who suffer from puerperal psychosis will have a re occurrence within 10 years

Answer 13

80%

Question 14

What is the usual time of onset for postnatal depression?

Answer 14

2-6 weeks postnatal

Question 15

What % of women suffer from postnatal depression

Answer 15

10%

Question 16

Women who suffer post natal depression have a __% chance of developing _______ later in life

Answer 16

70%

Depression

Question 17

Treatment for mild-moderate postnatal depression

Answer 17

elf help

Counselling

Question 18

Treatment for moderate-severe postnatal depression

Answer 18

Psychotherapy
Antidepressants
Admission may be required

Question 19

What is the risk of recurrence in post natal depression

Answer 19

25%

Question 20

Give 4 risks to the child if depression goes untreated during pregnancy:

Answer 20

low birth weight
Pre-term delivery
Adverse childhood outcomes
Poor engagement and bonding

Question 21

What is the main risk of prescribing anti-depressants/anti-psychotics in the 1st trimester?

Answer 21

Risk of teratogenicity

Question 22

What is the main risk of prescribing anti-depressants/anti-psychotics in the 3rd trimester?

Answer 22

Risk of neonatal withdrawal

Question 23

Which anti-depressant is not encouraged during 1st trimester and why?

Answer 23

Paroxetine

Increased risk of fetal heart defects

Question 24

What antidepressants are considered safest during pregnancy?

Answer 24

Fluoxetine

Sertraline

Question 25

What negative effects can benzodiazepines have on a baby?

Answer 25

Fetal malformations
Floppy baby syndrome
Weight loss and lethargy

Question 26

What anti-psychotic should be voided at all times and why?

Answer 26

Clozapine

Risk of agranulocytosis

Question 27

Which anti-psychotic has an increased risk of gestational diabetes?

Answer 27

Olanzapine

Question 28

Why should depot anti-psychotics and anti-cholinergics be avoided?

Answer 28

Risk of extra-pyramidal side effects

Question 29

Can lithium be given during pregnancy?

Answer 29

Yes if clinically indicated to outweigh risk

CANNOT breastfeed

Question 30

What drug must not be taken by women o childbearing age unless they are on contraception?

Answer 30

Sodium Valproate

Question 31

What are some of the characteristics of foetal alcohol syndrome?

Answer 31

Facial deformities
Lower IQ
Epilepsy
Neurodevelopmental delay
Low birth weight
Heart & kidney defects

Question 32

Other than foetal alcohol syndrome, what are two other diseases caused by alcoholism during pregnancy?

Answer 32

Wernickes encephalopathy

Korsakoff syndrome

Question 33

What medication programme can be used for pregnant women with substance abuse problems?

Answer 33

Methadone programme