Perinatal mental illness Flashcards
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
4 - all of pregnancy and 1 year following birth
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
2 - number of times a woman has been pregnant, regardless of if the baby grew to term
- privigravida = woman’s 1st pregnancy
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
3 - number of times a women has delivered a child after viability (<24 wks in the UK)
- multiparous = multiple children carried beyond 24 weeks
Are people who have had mental illness previously more likely to have perinatal mental illness?
- yes
- predictive of current and future mental illness
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
3 - dementia
- affective disorders are those that affect the mood: bipolar, anxiety, depression etc..
- puerperal psychosis = medical emergency and is very dangerous
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
4 - all of the above
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
2 - past psychiatric history
- this is a psychological factor
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
1 - fertility medication
- this is a biological factor
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
4 - substance misuse
- this is a biological factor
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
7 - all of the above
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
3 - depression
5 - anxiety
- often under diagnosed
Which of the following is a fear or pregnancy and childbirth?
1 - tokophobia
2 - obiang nguema
3 - vaginismus
4 - phallophobia
1 - tokophobia
- toko = greek for children
- phobia = something to be scared of
- can lead to women wanting C-section or termination
Tokophobia is a fear or pregnancy and childbirth. This can be primary of secondary. Which is more common in 1st time mums?
- primary
- secondary is more common in women who have been pregnant or given birth and have had a traumatic experience
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
6 - Alcohol and drug abuse
- most of these can be treated with CBT
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
2 - arrhythmias
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
2 - 1 in 100
- increases to 3 in 100 post-partum
- 2-3% develop OCD post-natally
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
3 - symptoms must impact upon ADLs
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%
2 - 15%
- normally occurs in 1st 6 months
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%
1 - 3-5%
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
2 - 3-5 days
- women are not a threat to babies in this period
Typically when would post-partum psychosis occur if a women developed this?
1 - <30 days
2 - <12 weeks
3 - <6 months
4 - <12 months
1 - <30 days
- more severe depression can also develop early
- can both be associated with risk to the child
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
5 - all of the above
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
4 - new dependency on drugs and alcohol
- may occur, but not as likely as the other factors
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
2 - 1-10 days
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
3 - 1-2 per 1000
- typically occurs few days after birth
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
3 - insight is present
- can be present, but if psychotic, patients typically do not have insight
Is post-partum psychosis dangerous?
- yes
- medical emergency
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
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
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)
3 - always allow mother to remain with child
- only if there is no risk to the child
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
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
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
3 - can cause mania with no mood stabiliser or anti-psychotic
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
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
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
5 - all of the above
- vulnerabilities, we need to think mental illness, substance misuse and domestic abuse.
- ALWAYS THINK INFANT. MUM, FAMILY
