Perinatal

Question 1

Risk of spontaneous malformation in pregnancy

Answer 1

2-3%

(Drugs account for 5%)

Question 2

PMS treatment drugs

Answer 2

Severe PMS:
SSRIs/serotinergic TCA (response rate 60-90%)

Fluoxetine (appears most effective); sertraline; SNRI venlafaxine, clomipramine

Question 3

Risk of depression in pregnancy

Answer 3

7-15% (10%) during

10% post-partum (higher in previous depression/bipolar)

Question 4

Risk of post-partum psychosis (background)

Answer 4

1/1000 (0.1%)

Question 5

Risk of post-partum psychosis previous episode

Answer 5

50-90%

Question 6

Risk of postpartum psychosis:

1. First degree family member, person no mental illness
2. First degree family member and BPAD 1/schizoaffective
3. Personal history, but no FH 1st pregnancy

Answer 6

1. 3%
2. 50%
3. 20%

Question 7

BPAD/schza and 2nd pregnancy (no postpartum 1st)

Answer 7

10% risk

Question 8

Sodium valproate risk of neural tube defect

Answer 8

1/100 (1%)

Question 9

Sodium valproate
Risk of any congential malformation

Answer 9

1/10 (10%)

40% of children may have a developmental disorder, including ASD (4%)

VSD, ASD
Spina bifida, anencephaly
Polydactyly, camptodactyly
Hypospadias

Question 10

Background risk of
1. Miscarriage
2. Birth defects

Answer 10

1. 10-20%
2. 1/40 (2.5%)

Question 11

Incidence of puerperal psychosis

Answer 11

1/1000

Question 12

Most vulnerable period for foetal malformation

Answer 12

Weeks 6-10

Question 13

Bipolar depression and delivery

Answer 13

5 fold increased risk of a relapse into depression after delivery

Question 14

Risk of baby blues

Answer 14

50-70% resolves by day 14 post-partum

Question 15

Ebstein abnormality risk

Answer 15

Background absolute risk: 1/20,000

1/10 chance if Lithium continued in 1st trimester

RR is 10-20× higher
Absolute risk low, 1:1000
Maximum risk 2-6 weeks

Extra scan 6-18 weeks

Lithium foetal toxicity; hypotonia, lethargy, resp difficulties, poor reflex, cardiac arrythmia

Question 16

Risk of relapse in stopping lithium

Answer 16

70% within 6 months
Faster discontinuation, higher risk of relapsing

Question 17

Breast feeding SSRI

Answer 17

Fluoxetine and citalopram found at high concentrations, sertraline less

Question 18

Bipolar relapse if not taking mood stabiliser immediately after delivery

Answer 18

50%

Question 19

Postnatal depression

Answer 19

Risk factors:

Previous depression (30% risk if no AD in post-natal); psychological problems in pregnancy; poor social support/marital relationship; recent adverse events; severe baby blues

Question 20

Post natal depression

Answer 20

Peaks at 6 weeks; similar to other depressive sx but may see obsessional sx and intense fear of causing harm to baby. Less common true infanticidal thoughts.