Perinatal Psych

Question 1

How common is baby blues?

Answer 1

50-75% of women

Question 2

Describe how baby blues present

Answer 2

Presents in the first few days after delivery
Teary, labile mood, difficulty sleeping
Lasts <1 week

Question 3

What is the management of baby blues?

Answer 3

Reassure!! Very common, usually lasts for a few days
Some women may go on to have postnatal depression
Safety net:
-If you still feel this way or worse in about a week -> GP
-Any thoughts of self-harm or harm to anyone else -> medical attention

Question 4

What is postnatal depression? How common is it?

Answer 4

Depression occuring in the 12 months post-partum

1/10 women experience PND

Question 5

What are the risk factors for postnatal depression?

Answer 5

• Previous Hx of depression
• Poor support
• Younger age
• Marital problems
• Low socioeconomic status
• Family Hx

Question 6

Describe the features of postnatal depression

Answer 6

• Symptoms lasting for >2 weeks
• Same symptoms as depression eg. core, biological, cognitive
• Cognitive are often related to the baby eg. guilt over being a bad mother, feeling like a failure

Question 7

What are the important symptoms to ask about in women with suspected postnatal depression?

Answer 7

Cognitive symptoms!!!! Because most mothers will have poor sleep, concentration, energy

• Feelings of guilt
• Feeling like a failure
• Recurrent intrusive thoughts of harming baby

Question 8

What is the management of postnatal depression?

Answer 8

Risk assessment!! Consider admission/crisis team/FU

• Severe and high risk: admission to mother and baby unit (MBU)
• Mild-mod: low intensity psych therapy eg. self-guided CBT -> high intensity eg CBT or SSRIs
• Mod-severe: high intensity CBT +/or SSRIs

Question 9

What is the prognosis for postnatal depression?

Answer 9

Most women respond well within 1 month

Question 10

What can be used to assess the severity of postnatal depression?

Answer 10

Edinburgh Postnatal Depression Scale

Question 11

Which medications are safe to use in breastfeeding mothers? Which are not recommended?

Answer 11

-Sertraline
-TCAs
-Olanzapine
Not recommended: Lithium, Valproate, benzos

Question 12

What is puerperal psychosis? How common is it?

Answer 12

Psychosis occuring in the 12 months post-delivery

Occurs in 1/500-1000 women

Question 13

How does puerperal psychosis present?

Answer 13

Usually rapid-onset about 10 days post-delivery
3 main forms:
-Mood-related symptoms eg. mania, psychotic depression
-Schizophreniform: delusions and hallucinations usually related to the baby eg. baby is evil/cursed
-Delirium
-Thoughts of self-harm or harm to baby

Question 14

What are the risk factors for puerperal psychosis?

Answer 14

• Personal history of psychosis of BPAD
• Family Hx
• Obstetric complications

Question 15

Describe the management of puerperal psychosis

Answer 15

Risk assessment!!!

• Admission is usually required- MBU with 1:1 nursing
• Antipsychotics eg. olanzapine
• Consider the need for benzos for agitation

Question 16

What is the prognosis for puerperal psychosis?

Answer 16

Usually resolves in 6-12 weeks

1/3 will have further psychosis/puerperal psychosis

Question 17

What is important to do in risk assessment for postnatal mental health conditions?

Answer 17

• Risk to self eg self-harm, suicide
• Risk to baby eg. infanticide, harm
• Neglect eg. care for baby, care for self
• Risk from others eg. domestic violence at home

Question 18

What are some complications to the baby of mental health medications used in pregnancy?

Answer 18

SSRIs: neonatal withdrawal syndrome, PPH
Lithium: teratogenic
Valproate: teratogenic
Benzos: drowsiness