Perinatal mental illness

Question 1

What is the time period included in perinatal?

1 - time during pregnancy
2 - 1 year following pregnancy
3 - from birth to 1 year following birth
4 - all of pregnancy and 1 year following birth

Answer 1

4 - all of pregnancy and 1 year following birth

Question 2

What does the term gravida refer to in terms of pregnancy?

1 - number of babies a women has delivered
2 - number of times a woman has been pregnant, regardless of if the baby grew to term
3 - number of times a women has delivered a child after viability (<24 wks in the UK)
4 - all of the above

Answer 2

2 - number of times a woman has been pregnant, regardless of if the baby grew to term

• privigravida = woman’s 1st pregnancy

Question 3

What does the term parous refer to in terms of pregnancy?

1 - number of babies a women has delivered
2 - number of times a woman has been pregnant, regardless of if the baby grew to term
3 - number of times a women has delivered a child after viability (<24 wks in the UK)
4 - all of the above

Answer 3

3 - number of times a women has delivered a child after viability (<24 wks in the UK)

• multiparous = multiple children carried beyond 24 weeks

Question 4

Are people who have had mental illness previously more likely to have perinatal mental illness?

Answer 4

• yes
• predictive of current and future mental illness

Question 5

We know that previous mental health illness is predictive of current and future perinatal mental illness. Which of the following mental health disorders is NOT particularly associated?

1 - bipolar disorder
2 - recurrent depression
3 - dementia
4 - post-partum depression
5 - puerperal psychosis

Answer 5

3 - dementia

• affective disorders are those that affect the mood: bipolar, anxiety, depression etc..
• puerperal psychosis = medical emergency and is very dangerous

Question 6

According to the NICE guidelines in antenatal and postnatal care of women require questions about family history of mental health illness. Which of the following disorders must be asked about in relation to a 1st degree relative (sister, mum, etc)

1 - bipolar disorder
2 - post-partum depression
3 - post-partum psychosis
4 - all of the above

Answer 6

4 - all of the above

Question 7

When having a consultation with a women during preconception, we must consider biological, psychological and social factors. Which of the following is NOT a biological factor?

1 - fertility medication
2 - past psychiatric history
3 - weight
4 - nutrition
5 - substance misuse

Answer 7

2 - past psychiatric history
- this is a psychological factor

Question 8

When having a consultation with a women during preconception, we must consider biological, psychological and social factors. Which of the following is NOT a psychological factor?

1 - fertility medication
2 - past psychiatric illness
3 - risks of relapse or recurrence of psychiatric disorder
4 - current mental health care package

Answer 8

1 - fertility medication
- this is a biological factor

Question 9

When having a consultation with a women during preconception, we must consider biological, psychological and social factors. Which of the following is NOT a social factor?

1 - relationships
2 - support networks
3 - housing, safeguarding, community
4 - substance misuse
5 - culture and beliefs

Answer 9

4 - substance misuse
- this is a biological factor

Question 10

Which of the following can be caused by common and severe mental disorders?

1 - miscarriage and still birth
2 - inter-uterine growth and development
3 - prematurity and low birth weight
4 - bleeding in pregnancy and post-partum
5 - gestational diabetes
6 - pre-eclampsia and eclampsia (high BP)
7 - all of the above

Answer 10

7 - all of the above

Question 11

Which 2 are the most common mental health disorders that are seen in pregnancy?

1 - bipolar disorder
2 - schizophrenia
3 - depression
4 - OCD
5 - anxiety

Answer 11

3 - depression
5 - anxiety

• often under diagnosed

Question 12

Which of the following is a fear or pregnancy and childbirth?

1 - tokophobia
2 - obiang nguema
3 - vaginismus
4 - phallophobia

Answer 12

1 - tokophobia
- toko = greek for children
- phobia = something to be scared of

• can lead to women wanting C-section or termination

Question 13

Tokophobia is a fear or pregnancy and childbirth. This can be primary of secondary. Which is more common in 1st time mums?

Answer 13

• primary
• secondary is more common in women who have been pregnant or given birth and have had a traumatic experience

Question 14

Tokophobia is a fear or pregnancy and childbirth. Which of the following has NOT been linked with causing Tokophobia?

1 - Hormonal changes
2 - Hearing stories of traumatic births from friends or family
3 - Anxiety disorder
4 - Psychological factors such as low self-esteem or previous trauma
5 - Fears relating to perceived loss of control or lack of pain relief
6 - Alcohol and drug abuse
7 - Past abuse

Answer 14

6 - Alcohol and drug abuse

• most of these can be treated with CBT

Question 15

Tokophobia is a fear or pregnancy and childbirth. Which of the following is NOT a common symptom in Tokophobia?

1 - sleep problems
2 - arrhythmias
3 - panic
4 - anxiety

Answer 15

2 - arrhythmias

Question 16

How common is OCD in perinatal time period?

1 - 1 in 10
2 - 1 in 100
3 - 1 in 1000
4 - 1 in 10,000

Answer 16

2 - 1 in 100
- increases to 3 in 100 post-partum

• 2-3% develop OCD post-natally

Question 17

What is the typical criteria for diagnosing a women in the perinatal or post-partum period with OCD?

1 - patient and 1st degree relative have this
2 - symptoms for >6 months
3 - symptoms must impact upon ADLs
4 - symptoms for >12 months

Answer 17

3 - symptoms must impact upon ADLs

Question 18

Post-natal period of pregnancy refers to 6-8 weeks following birth. What % of women are likely to experience a new depressive symptoms in the post-natal period?

1 - 1.5%
2 - 15%
3 - 30%
4 - 50%

Answer 18

2 - 15%
- normally occurs in 1st 6 months

Question 19

Post-natal period of pregnancy refers to 6-8 weeks following birth. What % of women are likely to experience severe depressive symptoms in the post-natal period?

1 - 3-5%
2 - 10-15%
3 - 30-40%
4 - 50-60%

Answer 19

1 - 3-5%

Question 20

Post-natally women are likely to have acute mood changes that is not depression, often called the baby blues. How long does this typically last for?

1 - 1-3 days
2 - 3-5 days
3 - 7-10 days
4 - 14-21 days

Answer 20

2 - 3-5 days
- women are not a threat to babies in this period

Question 21

Typically when would post-partum psychosis occur if a women developed this?

1 - <30 days
2 - <12 weeks
3 - <6 months
4 - <12 months

Answer 21

1 - <30 days
- more severe depression can also develop early
- can both be associated with risk to the child

Question 22

Which of the following factors are risk indicators (antenatal and postnatal) for maternal death?

1 - uncharacteristic behaviour, change from normal
2 - extreme panic /anxiety attacks
3 - overvalued ideas that seem out of context or extreme
4 - self harm in new onset severe mental illness
5 - all of the above

Answer 22

5 - all of the above

Question 23

Which of the following factors is NOT a red flag for risk of maternal death in the perinatal (from pregnant to 12 months following birth) period?

1 - significant changes in mental state or emerging new symptoms
2 - new thoughts or acts of violent self harm
3 - new and persistent expressions of incompetency as a mother and estrangement from infant
4 - new dependency on drugs and alcohol
5 - high risk period starts 1-10 days post-partum, up to 10 weeks

Answer 23

4 - new dependency on drugs and alcohol
- may occur, but not as likely as the other factors

Question 24

What is the high risk period post-partum for maternal death?

1 - 1-2 days
2 - 1-10 days
3 - 15-30 days
4 - >30 days

Answer 24

2 - 1-10 days

Question 25

How common is post-partum psychosis?

1 - 1-2 per 10
2 - 1-2 per 100
3 - 1-2 per 1000
4 - 1-2 per 10,000

Answer 25

3 - 1-2 per 1000
- typically occurs few days after birth

Question 26

Post-partum psychosis is a rare (1-2 per 1000) but dangerous mental health disorder. Which of the following is NOT an aspect of post-partum psychosis that would be present during a mental state examination?

1 - abnormal behaviour, restless or withdrawn
2 - mood labile or very low, euphoria
3 - abnormal thoughts /delusions may involve baby, may be bizarre and persecutory
3 - insight is present
4 - hallucinations and abnormal perceptions
5 - fluctuating concentration and appear confused

Answer 26

3 - insight is present
- can be present, but if psychotic, patients typically do not have insight

Question 27

Is post-partum psychosis dangerous?

Answer 27

• yes
• medical emergency

Question 28

Post-partum psychosis is a medical emergency. Which of the following is NOT a common aspect of management of these patients?

1 - support and reassurance
2 - physical examination of mother and ensure baby safety
3 - risk assessment (immediate dangers)
4 - exclude organic causes (i.e. infection)
5 - involve support network – midwives, family, health visitor
6 - GP to manage in community

Answer 28

6 - GP to manage in community
- patients ideally need to be admitted to a mother and baby unit
- can use mental health act if patient lacks capacity

Question 29

Patients with post-partum psychosis are ideally admitted to help manage them more effectively and ensure mum and baby are safe. In an initial phase of treating a patient with post-partum psychosis, which of the following is NOT common?

1 - rapid tranquillisation
2 - consider whether breast feeding and support (breast pumps)
3 - always allow mother to remain with child
4 - high level observation
5 - physical observation is essential (DVT, PE)

Answer 29

3 - always allow mother to remain with child
- only if there is no risk to the child

Question 30

Patients with post-partum psychosis are ideally admitted to help manage them more effectively and ensure mum and baby are safe. In an initial phase of treating a patient with post-partum psychosis, which of the following is the most common medication prescribed?

1 - lithium
2 - olanzapine
3 - diazepam
4 - sertraline

Answer 30

2 - olanzapine
- can be used in breastfeeding
- lithium can also be used if the women is NOT breastfeeding
- ECT may be considered in extreme cases

Question 31

Why are women with post-partum psychosis and severe depression not prescribed an anti- depressant alone?

1 - not strong enough
2 - found in breast milk
3 - can cause mania with no mood stabiliser or anti-psychotic
4 - all of the above

Answer 31

3 - can cause mania with no mood stabiliser or anti-psychotic

Question 32

What is the critical time for development in a child’s life following birth?

1 - first 12 days
2 - first 101 days
3 - first 1001 days
4 - first 2001 days

Answer 32

3 - first 1001 days

• children affected in this time period may go on to develop long-term negative effects on the infant’s cognitive, social, emotional and
  behavioural development

Question 33

Which of the following are safeguarding concerns for mother and infant?

1 - domestic abuse
2 - vulnerabilities
3 - impact of mental illness on infant
4 - impact on child development
5 - all of the above

Answer 33

5 - all of the above
- vulnerabilities, we need to think mental illness, substance misuse and domestic abuse.
- ALWAYS THINK INFANT. MUM, FAMILY