Perinatal psych and psychosexual disorders

Question 1

What is baby blues and how should it be managed?

Answer 1

• transient low mood seen in 75% mothers, most often 3-5 days after delivery, pts feel tearful, anxious, irritable
• lasts 1-2 days usually but may last for 2 weeks
• reassurance from midwife and increased social/ family support is sufficient usually

Question 2

Give 4 RFs for postnatal depression

Answer 2

• history of post partum depression
• young maternal age
• unplanned pregnancy
• lack of support
• marital problems
• social circumstances
• sleep deprivation
• hormonal changes

Question 3

What consequences can post natal depression have?

Answer 3

• inpair cognitive and social skills of the infant due to poor attachment
• may lead to self harm/ suicide of mother

Question 4

How should postnatal depression be managed?

Answer 4

• low threshold to refer to MDT
• involve father
• may arrange emergency admission under mental health act if indicated
• Anti depressants: SSRI and TCA, AVOID FLUOEXETINE, stop breast feeding if large dose
• MBU admission + ECT considered if severe
• most should resolve within 6 months

Question 5

How does post partum psychosis present?

Answer 5

• peak onset 2 weeks post partum
• psychotic episode with prominent affective symptoms (depression or mania) occurring with rapidly fluctuating symptoms
• labile mood
• Usually starts w/ insomnia, restlessness
• disorientation
• RFs: single parent, reduced social support, previous mental health

Question 6

How should post partum psychosis be managed?

Answer 6

• any suspicion should trigger emergency referral to specialist ream as risk of infanticide
• mother and baby unit admission
• combination of medication to treat affective symptoms (mood stabilisers, antidepressants or ECT)
• psychotic symptoms (second gen antipsychotics, long acting benzos)
• combined with therapy, reassurance and emotional support
• discharge: local mental health services and health visitors

Question 7

What should be asked in the history of someone presenting with a psychosexual disorder?

Answer 7

• early experiences
• present practices
• hints towards transsexualism
• commercial sex work or drug abuse
• orientation to either or both sexes
• difficulties with other partners
• history of current relationship

Question 8

name one medication that can cause each of the following: erectile dysfunction, delayed ejaculation, loss of libido

Answer 8

ED: hypotensives, alcohol (also think about organic and psychological causes)
Delayed ejaculation: SSRIs (can also be used as an treatment for premature ejaculation)
Loss of libido: B blockers, finasteride, OCP, penothiazines