Perinatal depression and psychosis

Question 1

Depression - antenatal

Answer 1

1. Depression is as common antenatally as it is postnatally
2. Characterised by (5):
   - Low mood, lack of energy or increased fatiguability
   - Loss of enjoyment or interest in usual activities; poor concentration
   - Low self-esteem, feelings of guilt, worthlessness or hopelessness
   - Change in appetite (leading to weight loss or gain)
   - Suicidal ideation
3. Associated with an increased risk of suicide. Can be effectively treated with pharmacological and psychological therapy

Question 2

Anxiety disorders - antenatal

Answer 2

1. Panic disorder, generalised anxiety disorder and OCD are all relatively common in pregnancy
2. Symptoms = pervasive or episodic fearfulness, avoidance and autonomic arousal; excessive reassurance-seeking may be a presenting feature
3. Must identify any concurrent depression requiring treatment
4. High antenatal anxiety is a predictor for postnatal depression
5. Psychological management (including CBT) is preferable to anxiolytics, but access within timescale of pregnancy may be limited. Avoid benzodiazepine use

Question 3

Bipolar affective disorder - antenatal

Answer 3

1. 1% of women of childbearing age
2. Characterized by severe episodes of depression or mania (elevated
   mood, excitability, irritability, overactivity) often associated with
   psychotic symptoms. Can pose significant risk to mother and fetus
3. Associated with a 2-fold higher risk of admission postnatally than at
   other times
4. Decision to stop medication in existing patients when pregnancy is discovered should be made only after a careful risk/benefit review (?)
5. Associated with a high suicide rate

Question 4

Schizophrenia - antenatal

Answer 4

1. Affects 71% of women of childbearing age
2. Clinical features vary, but include delusions, hallucinations, and abnormalities of affect, speech, and volition
3. Maintenance medication is usually required throughout pregnancy
4. Significant proportion of patients are unable to care for the child
5. The lifetime risk of schizophrenia for a child with one affected parent is in the order of 10%