Psychiatric disorders and substance abuse

Question 1

half suicides occur when

Answer 1

up to 12 weeks post natally

Question 2

mental illness is a leading cause of what in the uk

Answer 2

maternal death

Question 3

principles of treatment

Answer 3

drugs with low risk to bother mother and fetus
lowest dose monotherapy to avoid depot
encourage breast feeding whenever possible
increase screening of fetas-cardio and growth

Question 4

anxiety disorders - what should be avoided and why

Answer 4

benzos - sedation in baby, cleft, neonatal withdrawal

Question 5

BPD in how many women
risk of episode post natally
risk of what
when is the baby affected

Answer 5

1%
50% without rx
suicide
genetic risk 1/7

Question 6

anti convulsants for BPD valproate SE

Answer 6

neural tube defects 
craniofacial defects
CV abnormality 
IUGR
reduced IQ
cleft
genitourinary anomalities

Question 7

BPD carbamazepine SE

Answer 7

facial dysmorphism 
cardiac anomalities
fingernail hyperplasia 
NTD
Vit k deificieny - haemorrhagic disease of the newborn

Question 8

Lamotrigine (safest one) SE for BPD

Answer 8

SJS if breast feeding - rare

Question 9

BPD lithium SE
contraindicated in what
switch to what if on TCA

Answer 9

cardiac abnormalities, maternal toxicity, ebsteins anomaly, neonatal hypotonia, hypothyroidism, hypoglycaemia

in breast feeing

in preg should be stopped gradually

if on TCA switch to SSRIs
also start on SSRIs

Question 10

schiz in how many women

risk of schiz to child

Answer 10

1%

10%

Question 11

treatment of schiz in preg

Answer 11

anti psychotics are safe

mostly topical ones used

Question 12

what should babies be observed for in anti psychotics

Answer 12

they are all sedating drugs so

lethargy, sedation, and appropriate developmental milestones

Question 13

clozapine contra indicated in what and why

Answer 13

breast feeding

life threatening events in baby

Question 14

olanzapine has an increased risk of what

Answer 14

extra pyramidal reactions in breast fed baby

Question 15

anticholinergic drugs safe?

Answer 15

not in preg

Question 16

eating disorders BN
anorexia
risks

Answer 16

1%
0.2%
IUGR, prematurity, hypokalaemia, hyponatraemia, met alk, miscarriage, premature delivery

Question 17

mild - mod depression

mod-severe

Answer 17

psychological treatment

pharmacological

Question 18

venlafaxine for depression

Answer 18

causes hypertension

Question 19

paroxtetine for depression

Answer 19

cardiac abnormalities

Question 20

SSRIs in depression

Answer 20

use with caution after 20 weeks may lead to pulmonary hypertension in child

Question 21

TCA and SSRI in breast milk can lead to what

Answer 21

sedation

use low dose

Question 22

what do all anti depressants carry a risk of

Answer 22

withdrawel or toxicity in neonates which is usually self limiting and mild

Question 23

which are safer for an overdose SSRI or TCAs

Answer 23

SSRIs

Question 24

post natal depression how many women
onset
mild-mod
mod-severe

Answer 24

10%. 1/3 lasts more than 1 yr
2-6 weeks postnatally, lasts weeks to months

self help, counselling

psychotherapy/anti depressants/admission

25% risk of reoccurrence
70& life time risk of depression

Question 25

baby blues how many women | when

Answer 25

50% days 3-10 and it is self limiting usually due to hormone surges

Question 26

``` puerperal psychosis when symptoms how many women cx risk factors for it ddx ```

Answer 26

within 2 weeks of delivery sleep disturbance, confusion, irrational ideas mania, delusions, hallucinations, confusion 0.1% 5% suicide risk and 4% infanticide bipolar (50%), previous puerperal psychosis, 1st degree relative bpd, depression, schiz, organic brain dysfunction

Question 27

PPS management

Answer 27

admission antidepressants anti psychotics, mood stabilisers, ECT 80% 10 yr recurrence rate 25% develop bpd

Question 28

how many women have alcohol dependancy | how many have illicit drug dependance

Answer 28

4. 7% | 2. 2%

Question 29

alcoholism risks

Answer 29

``` miscarriage facial deformaties, lower IW, neurodevelopment delay, epilepsy, heart and kidney defects, hearing withdrawel wenickes encephalopathy korsakoff syndrome ```

Question 30

cocaine, amphetamine, ecstasy lead to death via what risks

Answer 30

stroke and arrhythmias ``` teratogenic PET abruption IUGR PTL miscarriage developmental delay, withdrawel ```

Question 31

what do opiates cause

Answer 31

``` maternal deaths 1-2% neonatal withdrawal IUGR SIDS stillbirth ```

Question 32

what does nicotine cause

Answer 32

``` miscarriage abruption IUGR stillbirths SIDs ```

Question 33

substance abuse in preg managemetn

Answer 33

methadone programme child protection and social services smear hhx breastfeeding but not if alcohol >8units/week, HIV, cocaine