Perinatal MH

Question 1

What is the leading cause of maternal death?

Answer 1

Suicide

generally violent 30% hanging, 30% jumping

Question 2

How should an carried out assessment?

Answer 2

screen all women for Hx or FHx of suicide or serious mental health illness

Question 3

What screening should be carried out for perinatal psych referrals?

Answer 3

all women with previous or current:
schizophrenia/psychosis 
bipolar
postpartum psychosis
severe depression 

all women on mood stabilisers

any women with a FH of bipolar, schizoaffective disorder, a Hx of any psychiatric disorder

Question 4

Describe psychiatric disorders in pregnancy

Answer 4

Psychiatric disorders are common in pregnancy
In first trimester they are slightly more common than in the general population
Mild disorders respond well to psychical interventions
The first onset of serious mental illness is rare in pregnancy
Depression and anxiety in the 3rd trimester may continue

Question 5

What are the baby pinks?

Answer 5

a normal phenomena which occurs in the first 48 hours post part
sense of euphoria and excitement
slight risk of exhaustion
will resolve without any intervention
Mildly over talkative and overactive with some insomnia

Question 6

What are the baby blues?

Answer 6

Common occurrence post partum 50-80%
most frequently day 5 but usually day 3-10
attributed to hormonal changes in combination with physical and emotional exhaustion

Question 7

What are the baby blues symptoms?

Answer 7

emotional lability, tearfulness, mild anxiety and irritability symptoms can be generally mild and not pervasive

Question 8

How long do the baby blues usually last?

Answer 8

last 48 hours and no specific treatment is required

Question 9

When is depression in mothers most common?

Answer 9

Peak onset of depressive illness is 2-4 weeks postpartum, however also a secondary peak at 3 months postpartum

Question 10

What is the prognosis for mothers with a depressive illness?

Answer 10

with prompt treatment two third of illness will resolve within 2 to 3 months

Question 11

What is the risk of recurrence?

Answer 11

if women has suffered from a previous sever depressive illness or postnatal depressive illness, the risk of developing further illness following this delivery is around 50%

Question 12

What is the risk of postpartum psychosis?

Answer 12

0.2%

Question 13

What is postpartum psychosis?

Answer 13

Characterised by sudden onset of behavioral disturbances, hallucinations, delusions, fear and perplexity

Question 14

How is post partum psychosis managed?

Answer 14

Women at risk should be identified antenatally

Postpartum psychosis has good short term progress, however it is associated with significant morbidity and mortality generally requires admission to a Mother and Baby Unit for high intensity care

Question 15

In which conditions is post partum psychosis a risk?

Answer 15

99% of postpartum psychosis are either bipolar or schizoaffective disorder