Psychiatric Disease

Question 1

How should depression during pregnancy be managed?

Answer 1

Urgent referral to specialist mental health services

Explore social support

Antidepressant therapy

Question 2

Define postpartum depression

Answer 2

Depressive episode within the first twelve months postpartum

Question 3

What is postpartum (puerperal) psychosis

Answer 3

Symptoms vary, and can change rapidly = high mood (mania), depression, confusion, hallucinations and delusions

Question 4

How should puerperal psychosis be managed?

Answer 4

Assessment by Specialist Mental Health services

Most women suffering from postpartum psychosis need to be treated as an inpatient, possibly under the Mental Health Act. = specialist Mother and Baby units

Antipsychotics: chlorpromazine + procyclidine

Question 5

Outline postpartum blues

Answer 5

Hormonal drop in progesterone

Self-limiting, 48h-2w

Normal, reassurance essential

Question 6

How is perinatal MH assessed?

Answer 6

Risk assessment =
• Brief screen - Whooley and Arrol
• Then asked about anxiety with 2 item generalised anxiety scale (GAD-2)

Question 7

What should and shouldn’t be prescribed during breast feeding for psychotic illness?

Answer 7

Recommended =

• Paroxetine/sertraline (antidepressant)
• Olanzapine (antipsychotic)

Avoid mood stabilizers =
- Lorazepam/zolpidem (sedative)