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A - MSRA Obstetrics [16] > [55] Post-Partum Psychosis > Flashcards

[55] Post-Partum Psychosis Flashcards

1
Q

What is post-partum psychosis?

A

A severe mental illness which develops acutely in the early post-natal period

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2
Q

When does post-partum psychosis develop?

A

Usually within first month following delivery

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3
Q

What is the importance of postpartum psychosis?

A

It is a psychiatric emergency

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4
Q

What is the epidemiology of post-partum psychosis?

A

Occurs in 1-2/1000 deliveries

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5
Q

What are the leading causes of late maternal death in the UK?

A

Suicide and psychiatric disorders

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6
Q

What are the risk factors for post-partum psychosis?

A
  • Past history of post-partum psychosis
  • Past history of bipolar disorder
  • Family history of post-partum psychosis or bipolar disorder
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7
Q

What is post-partum psychosis thought to be?

A

May be a manifestation of underlying bipolar disorder

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8
Q

What are the possible contributing factors to the develoment of post-partum psychosis?

A
  • Sleep deprivation
  • Hormonal changes
  • Stress
  • Genetic influences
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9
Q

How can the symptoms of post-partum psychosis progress?

A

Can rapidly progress from mild anxiety to severe psychosis

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10
Q

What is the result of the rapid progression of symptoms in post-partum psychosis?

A

The diagnosis can easily be missed

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11
Q

How can you avoid missing the diagnosis of post-partum psychosis?

A

All significant changes to mental state in the postnatal period should be closely monitored, and should trigger referral to specialist services

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12
Q

What are the categories of symptoms of post-partum psychosis?

A
  • Depressive symptoms
  • Manic symptoms
  • Delusions
  • Hallucinations
  • Odd beliefs about the baby
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13
Q

What are the depressive symptoms of post-partum psychosis?

A
  • Withdrawal
  • Confusion
  • Loss of competence
  • Distraction
  • Catatonia
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14
Q

What are the manic symptoms of post-natal psychosis?

A
  • Elation
  • Lability
  • Agitation
  • Rambling
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15
Q

What delusions may be present in post-partum psychosis?

A
  • Paranoia
  • Jealousy
  • Persecution
  • Grandiosity
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16
Q

What hallucinations may be present in post-partum pscyhosis?

A
  • Auditory
  • Visual
  • Olfactory
  • Tactile
17
Q

What are the differential diagnoses of post-partum psychosis?

A
  • Major depression with psychotic features
  • Schizophrenia
  • Bipolar disorder with post-partum onset
  • Organic causes
18
Q

What are the organic differentials for post-partum psychosis?

A
  • Ischaemic or haemorrhagic stroke
  • Hypoglycaemia or hyperglycaemia
  • Side effects of medication
  • Thyroid or parathyroid abnormalities
19
Q

Where will investigation to confirm the diagnosis of post-natal psychosis take place?

A

Secondary care

20
Q

What will investigations to confirm the diagnosis of post-natal psychosis be guided by?

A

Presentation

21
Q

What might the investigations to confirm the diagnosis of post-partum schizophrenia involve?

A

Blood tests and possibly CT/MRI scanning

22
Q

What is meant by post-partum psychosis being a medical emergency?

A

It requires urgent assessment, referral, and usually admission

23
Q

Where should a mother with post-partum psychosis be admitted?

A

Preferably to a specialist mother and baby unit

24
Q

What is the primary management of post-partum psychosis?

A

Pharmacological

25
Q

How is the drug used in post-partum psychosis decided?

A

The guidance is the same as for other causes of psychosis, however the choice of medication must take breast-feeding into account

26
Q

What does the medication for post-partum psychosis usually involve?

A

An anti-psychotic and/or mood stabilising drug

27
Q

When should mothers on treatment for post-partum psychosis be advised not to breastfeed?

A

If they are on lithium treatment

28
Q

Why should mothers taking lithium be encouraged not to breastfeed?

A

Due to toxicity to the infant

29
Q

What anti-psychotic medication should not be used in breastfeeding women?

A

Clozapine

30
Q

Are anti-psychotics excreted in breast milk?

A

Most are

31
Q

Does excretion of anti-psychotics into the breast milk cause harm to the baby?

A

Little evidence that it causes harm

32
Q

What should be done when anti-psychotics are prescribed to a breast-feeding woman?

A

The baby should be monitored for side effects

33
Q

What management for post-partum psychosis can be considered in some cases?

A

ECT

34
Q

What non-medical management is important in post-partum psychosis?

A
  • Education and supportive therapy for woman and her family
  • Child protection services may need to be alerted
  • Discharge should only occur with close follow up in place
35
Q

What is the prognosis of post-partum psychosis?

A

Prognosis for complete recovery is good, but there is a significant risk of recurrence

36
Q

What is the risk of recurrence of post-partum psychosis in subsequent pregnancies?

A

1 in 2

37
Q

What should happen to women who have been diagnosed with post-partum psychosis if they become pregnant again?

A

They should be monitored very closely, and referred early

A - MSRA Obstetrics [16] (61 decks)

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