Perinatal Mental Health

Question 1

What are the main symptoms of perinatal depression that you need at least one of for most days, most of the time for at least 2 weeks to diagnose?

Answer 1

1) Broken sleep
2) Extreme tiredness
3) Anhedonia - lack of joy in pregnancy, feelings of guilt and incompetence
4) Lack of interest
5) Low mood

Question 2

What are other symptoms of perinatal depression?

Answer 2

1) Mood variation
2) Loss of appetite and weight
3) Tearfulness
4) Diurnal variation in mood
5) Poor concentrations/short term memory loss
6) Suicidal thoughts
7) Reduced self-esteem/self-confidence
8) Morbid fears about mother’s and baby’s health
9) Bleak pessimistic thoughts re future
10) Withdrawal or agitation, restlessness

Question 3

What are the features of perinatal depression?

Answer 3

• Persistence over > 2 weeks
• Severity depends on number of symptoms
• Impact on functioning

Question 4

What is peripartum depression?

Answer 4

Onset during pregnancy or 4 weeks postpartum

Question 5

What is postpartum depression?

Answer 5

Onset 6 weeks postpartum

Question 6

What other mental disorders can occur perinatally?

Answer 6

Anxiety disorders, PTSD, psychosis

Question 7

What does SMI stand for?

Answer 7

Severe mental illness

Question 8

What risk increases one week following deliver?

Answer 8

• One week following delivery, huge spike in relative risk of being admitted to psychiatric hospital compared to other times around pregnancy
• In first pregnancy, risk is higher

Question 9

What is psychosis?

Answer 9

• Losing touch with reality
• e.g. hallucinations - sensing things that are not there, mainly hearing and seeing
• Delusions - fixed false beliefs not based in reality

Question 10

Why is there a much increases risk in the first postpartum month of psychosis even in women without previous psychiatric diagnosis?

Answer 10

• Birth is traumatic
• Hormones - loss of oestrogen
• Less sleep

Question 11

What is a big risk factor for postpartum psychosis?

Answer 11

Previous psychiatric diagnoses

Question 12

What are two risk factors for becoming mentally unwell perinatally?

Answer 12

1) Women with bipolar disorder have a big risk of becoming unwell in postpartum period
2) Risk at any time is lack of sleep esp. in postpartum

Question 13

How does mental illness affect the experience of childbearing (preconception of motherhood)?

Answer 13

1) Guilt
2) Fear of custody loss
3) Impact on the child - genetic, environmental, secondary stigma
4) Importance of motherhood
5) Stigma
6) Coping with dual identities
7) Isolation

Question 14

What should be done about medication for mental illness in pregnancy?

Answer 14

• Conflicting information re medication (risks for fetus)
• Present patient with evidence and risks and benefits if they are competent to decide esp. to women with bipolar disorder as risk of relapse during pregnancy increases

Question 15

What are differential diagnosis of postpartum psychosis?

Answer 15

1) Manic episode in someone with underlying BPD
2) Alcohol/drugs
3) Infection e.g. UTI making pt delirious
4) Loss of blood - PPH

Question 16

What are the risks of the mother taking lithium during pregnancy/breastfeeding?

Answer 16

• Increases risk fo Ebstein’s anomaly - abnormality of tricuspid valve
• But many use it if benefit outweighs risks

Question 17

What type of drug is fluoxetine?

Answer 17

SSRI

Question 18

Why is maternal mental health important?

Answer 18

1) Pregnancy not protective against mental illness - prevalence of mental disorders similar to other times in women’s lives
2) Increased risk of relapse if prophylactic medication stopped
3) Important cause of maternal death
4) Associated with adverse fetal outcomes, deficits in maternal-infant interaction and adverse child development