Mental Health

Question 1

SSRIs of choice for OCD.

Answer 1

Sertraline
Fluvoxamine

Question 2

Main area of the brain implicated in Obsessive-Compulsive Disorder.

Answer 2

Orbitofrontal cortex.

Involved in decision-making and evaluating the consequences of actions. Overactivity of this region is commonly associated with OCD.

Question 3

What is postpartum psychosis and why is it considered a psychiatric emergency?

Answer 3

Postpartum psychosis is a severe psychiatric emergency that occurs shortly after childbirth, characterised by a sudden onset of psychotic symptoms. It requires immediate medical attention due to the high risk it poses to both the mother and the infant.

Question 4

What is the prevalence of postpartum psychosis?

Answer 4

Postpartum psychosis affects approximately 1-2 patients per 1,000 births.

Question 5

When does postpartum psychosis typically present?

Answer 5

It typically presents within the first two weeks postpartum, with a rapid onset and progression of symptoms.

Question 6

List the key risk factors for developing postpartum psychosis.

Answer 6

Key risk factors include primiparity (first-time mothers), history of bipolar disorder or psychosis, family history of postpartum psychosis or other psychiatric disorders, and discontinuation of psychiatric medications during pregnancy.

Question 7

Explain the pathophysiology of postpartum psychosis.

Answer 7

The pathophysiology involves complex interactions between hormonal changes, genetic predisposition, and neurobiological factors. Key elements include rapid changes in oestrogen and progesterone levels postpartum, dysregulation of neurotransmitters and circadian rhythms, and immune system changes.

Question 8

What are the early symptoms of postpartum psychosis?

Answer 8

Early symptoms include insomnia, anxiety, mood fluctuations, and irritability.

Question 9

Describe the psychotic symptoms associated with postpartum psychosis.

Answer 9

Psychotic symptoms include delusions, hallucinations, disorganised thinking, and paranoia.

Question 10

What mood symptoms might a patient with postpartum psychosis exhibit?

Answer 10

Mood symptoms can include severe mood swings, mania, or depression.

Question 11

Identify the cognitive symptoms of postpartum psychosis.

Answer 11

Cognitive symptoms include confusion, disorientation, and impaired judgment.

Question 12

What behavioural symptoms are commonly seen in postpartum psychosis?

Answer 12

Behavioural symptoms include agitation, restlessness, and potentially harmful behaviours towards self or infant.

Question 13

How is postpartum psychosis diagnosed?

Answer 13

Diagnosis is primarily clinical, based on the rapid onset of symptoms postpartum. It involves assessing the timing of symptoms (typically within the first two weeks after delivery), the presence of psychotic symptoms such as delusions and hallucinations, and excluding other causes such as postpartum depression, OCD, infections, metabolic disturbances, and substance use.

Question 14

What are the key components of managing postpartum psychosis?

Answer 14

Key components include immediate safety and stabilisation (hospitalisation and monitoring), pharmacological treatment (atypical antipsychotics, mood stabilisers, benzodiazepines), psychosocial interventions (supportive therapy, family involvement), and long-term management (regular psychiatric follow-up, prophylactic treatment).

Question 15

Why is hospitalisation often necessary in cases of postpartum psychosis?

Answer 15

Hospitalisation is often necessary to ensure the safety of the mother and infant, provide continuous monitoring for suicidal ideation and risk of harm to the infant, and to stabilise the patient’s condition.

Question 16

Which pharmacological treatments are preferred for postpartum psychosis and why?

Answer 16

Atypical antipsychotics (e.g., quetiapine) are preferred due to their safety profile. Mood stabilisers like lithium are commonly used, especially in patients with bipolar disorder. Benzodiazepines may be used short-term to manage acute agitation and insomnia.

Question 17

What role do psychosocial interventions play in the management of postpartum psychosis?

Answer 17

Psychosocial interventions provide emotional support and psychoeducation to the patient and family, engage family members in the care plan to ensure a supportive environment, and help address the psychological and social aspects of the condition.

Question 18

What is the importance of long-term management in postpartum psychosis?

Answer 18

Long-term management is important to monitor for recurrence, manage ongoing mental health needs, and consider prophylactic treatment in future pregnancies for those with a history of postpartum psychosis.

Question 19

When might electroconvulsive therapy (ECT) be considered for postpartum psychosis?

Answer 19

ECT may be considered if all other treatment options have failed or when the situation is thought to be life-threatening.

Question 20

Discuss the prognosis for women with postpartum psychosis.

Answer 20

The prognosis varies; many women recover fully with appropriate treatment, but there is a significant risk of recurrence in subsequent pregnancies and a high likelihood of developing chronic psychiatric conditions such as bipolar disorder.

Question 21

Why is a multidisciplinary approach essential in managing postpartum psychosis?

Answer 21

A multidisciplinary approach is essential to ensure comprehensive care, addressing the medical, psychological, and social needs of the patient, and ensuring the safety and well-being of both the mother and the infant.