Perinatal Psychiatry

Question 1

when should a woman be urgently referred to a specialist perinatal mental health team?

Answer 1

recent significant change in mental state
new thoughts/acts of violent self harm
new and persistent expressions of incompetency as a mother/estrangement of their baby

Question 2

what are the “baby blues”?

Answer 2

a brief period of emotional instability within the first 10 days of birth

Question 3

how is “baby blues” managed?

Answer 3

support and reassurance

Question 4

when does puerperal psychosis usually present?

Answer 4

within 2 weeks of delivery

Question 5

what are the early symptoms of puerperal psychosis?

Answer 5

sleep disturbance
confusion
irrational ideas

Question 6

what are the later symptoms of puerperal psychosis?

Answer 6

mania
delusions
hallucinations
confusion

Question 7

what are the risk factors for puerperal psychosis?

Answer 7

bipolar disorder
previous puerperal psychosis
1st degree relative with bipolar

Question 8

how is puerperal psychosis managed?

Answer 8

emergency admission to mother baby unit

antidepressants, antipsychotics, mood stabilisers and ECT can be used

Question 9

what are the possible risks associated with puerperal psychosis?

Answer 9

5% suicide risk

4% infanticide risk

Question 10

how does postnatal depression present?

Answer 10

tearfulness
irritability
anxiety
lack of enjoyment
weight loss
concerns for baby

Question 11

when does postnatal depression come on?

Answer 11

2-6 weeks postnatally

Question 12

how is mild/moderate postnatal depression managed?

Answer 12

self help

counselling

Question 13

how is moderate/severe postnatal depression managed?

Answer 13

psychotherapy
antidepressants
consider admission

Question 14

what are the first line antidepressants in pregnancy?

Answer 14

SSRIs

sertraline or fluoxetine usually best

Question 15

what are the possible risks of SSRIs in pregnancy?

Answer 15

PPHN
lower birth weight
increased risk of early birth
PPH

Question 16

which SSRI is less safe in pregnancy and why?

Answer 16

paroxetine

increased risk of congenital cardiac malformations

Question 17

what possible problem can be caused by use of tricyclic antidepressants in pregnancy?

Answer 17

mild and self limiting neonatal withdrawal, no major problems

Question 18

name two first generation antipsychotics

Answer 18

chlorpromazine

haloperidol

Question 19

name two second generation antipsychotics

Answer 19

olanzapine

quetiapine

Question 20

what is a possible risk of antipsychotic use in pregnancy?

Answer 20

gestational diabetes especially with second generation drugs

Question 21

what effect can antipsychotics have on fertility?

Answer 21

reduced fertility due to raised prolactin levels

Question 22

are antipsychotics safe in pregnancy?

Answer 22

yes

Question 23

what two antipsychotics have the best evidence base for use in pregnancy?

Answer 23

olanzapine

quetiapine

Question 24

what are the risks associated with bipolar disorder in pregnancy?

Answer 24

higher chance of induction or CS
pre term delivery
smaller babies

Question 25

what mood stabilisers should be avoided in pregnancy and why?

Answer 25

valproate + carbamazepine increase risk of neural tube defects

Question 26

which mood stabiliser is the best option in pregnancy?

Answer 26

lamotrigine

Question 27

is lithium safe in pregnancy and why?

Answer 27

no has a known association to ebstein's anomaly

Question 28

what is the first line management of anxiety in pregnancy?

Answer 28

SSRIs

Question 29

are benzodiazepines safe in pregnancy?

Answer 29

thought to be problematic, should be avoided

Question 30

what is a possible risk of benzodiazepines in the third trimester?

Answer 30

risk of floppy baby