Perinatal And CAMHS

Question 1

Who should be referred to perinatal psychiatry

Answer 1

Anyone with previous or current:
- schizophrenia or psychosis
- bipolar
- postpartum psychosis
- severe depression

Anyone on mood stabilisers

Question 2

What are the ‘pinks’

Answer 2

Normal phenomena which occur first 48 hours after postpartum
Excitement and a sense of euphoria
Mildly over talkative and overactive with some insomnia
Resolves without any intervention (slight risk of exhaustion)

Question 3

What are the ‘blues’

Answer 3

Common occurrence in the postpartum period (50-80%)
Presents around day 5
Attributed to hormonal changes in combination with physical and emotional exhaustion

Sx:
- emotional lability
- tearfulness
- mild anxiety and irritability

Usually lasts 48 hours and no specific treatment required

Question 4

Risk of postpartum psychosis in general population

Answer 4

0.2%

Question 5

Features of postpartum psychosis

Answer 5

Sudden onset of behavioural disturbances
Hallucinations
Delusions
Fear
Perplexity

Question 6

What should a birth plan (made at 35 weeks gestation) include

Answer 6

• monitoring for mental health following delivery
• requirement for liaison between all health professionals
• use of prophylactic medication
• consideration of child protection
• emergency contact details

Question 7

Define intellectual disability

Answer 7

Sub average intellectual functioning
IQ below 70
Deficits or impairments in adaptive behaviour, taking into account age
Onset of intellectual impairment before the age of 18

Question 8

Features of a mild learning difficulty

Answer 8

IQ score 50-69
Often not recognised as learning disability
Often can sustain relationships and hold a routine job

Question 9

Features of a moderate learning difficulty

Answer 9

IQ score 35-49
Often capable of substantial autonomy in daily living with some supervision
Normally able to communicate adequately and do simple household jobs
May need a supervised environment

Question 10

Features of a severe learning difficulty

Answer 10

IQ score 20-34
Need help with daily living, can be able to wash and usually continent; often physically disabled
Capable of only limited communication often not by speech
Need continuous care

Question 11

Features of a profound learning difficulty

Answer 11

IQ score <20
Extensive help required
Minimal ability of communication
Needs continuous care

Question 12

Epidemiology of intellectual disabilities

Answer 12

Males > females
Higher in lower social classes
Association with overcrowding, poverty, irregular unskilled employment

Question 13

Aetiology of intellectual disabilities

Answer 13

30% have no identifiable cause
Polygenic inheritance of low intelligence
Social and educational deprivation

Genetic / chromosomal
Pre natal
Perinatal
Postnatal

Question 14

Describe genetics / features of Down syndrome

Answer 14

Trisomy 21
Most common cause of ID
Associated with characteristic physical abnormalities
Increased risk of deafness, cataracts, hypothyroidism and early onset Alzheimer’s

Question 15

Describe the genetics / features of fragile X syndrome

Answer 15

2nd most common cause of ID
Abnormality on long arm of chromosome X
More common in males
Physical abnormalities include elongated face and protruding ears

Question 16

Describe genetic features of cri du chat syndrome

Answer 16

Deletion of short arm of chromosome 5

Question 17

Describe the genetics / features of tuberous sclerosis

Answer 17

Mutation in the tumour suppressor gene on chromosome 9 or 16
Can result in autism and epilepsy with ID
Characteristic skin changes and tumours of the brain and other organs

Question 18

Describe the genetics / features of neurofibromatosis

Answer 18

Mutation of gene on chromosome 17
Usually with mild ID
Cafe au lair spots and abnormalities of skin, soft tissues, nervous system and bone

Question 19

Describe genetics / features of phenylketonuria

Answer 19

1/10,000 birth incidence
Autosomal recessive
High serum phenylalanine
ID with short stature, hyperactivity, irritability, epilepsy, lack of pigment and eczema

Question 20

What are 3 classical impairments in autism

Answer 20

1. Social interaction
2. Communication
3. Imagination / repetition/ rout

Question 21

Features of depression in ID

Answer 21

Family history of depression
Diurnal mood or activity variation
Agitation may lead to wandering
Loss of appetite
Sleep disturbance
Speech / motor retardation
Observed anxiety
Exaggeration of a need for sameness
Depressive / suicidal ideas rare and poorly planned

Question 22

Features of mania / bipolar in ID

Answer 22

FH of bipolar disorder
Challenging behaviour
Giggling
Overactivity and excitement
Inappropriate masturbation / exposure
Delusions not as elaborate

Question 23

Features of schizophrenia in ID

Answer 23

Hard to diagnose with IQ <45
Commoner with more severe intellectual disability
Poverty of thought
Less elaborate delusions
Simpler and repetitive hallucinations
Distinguish negative symptoms from developmental history
Persecutory delusions and thought disorder less common
Earlier onset
Can present with: fear, withdrawal, challenging behaviour, sleep disturbances

Question 24

Causes of challenging behaviour

Answer 24

Social / environmental factor
Mental illness
Side effects of medication
Physical illness
- ear infections
- dental problems
- UTI
- resp infections
- thyroid problems