Perinatal Psychiatry

Question 1

Are post-natal suicides normally via non-violent methods?

Answer 1

No, they are usually violent.

This is unusual for women.

Question 2

What are red flag symptoms found in post-natal women?

Answer 2

A significant change in mental state
New thoughts/acts of self-harm
New and persistent expressions of incompetence as a mother or estrangement from their baby

Question 3

What is the fear of childbirth known as?

Answer 3

Tokophobia

Question 4

What is a major risk factor for a post-natal psychiatric disorder?

Answer 4

Bipolar disorder

Question 5

What % of women get the ‘baby blues’?

Answer 5

50%

This is a self-limiting condition lasting only a few days.

Question 6

Is puerperal psychosis an emergency?

Answer 6

Yes

Question 7

What may be the cause of puerperal psychosis?

Answer 7

Bipolar
Depression
Mania
Delirium

Question 8

How should puerperal psychosis be treated?

Answer 8

Admittance to mother-baby unit with drugs or ECT given.

Question 9

Can fathers develop post-natal mental health issues?

Answer 9

Yes

Question 10

How long after delivery does post-natal depression present?

Answer 10

4-6 weeks

Question 11

What formulation of psychiatric medication is best suited to pregnancy?

Answer 11

A low dose monotherapy.

Question 12

What are the first-line psychiatric medications in pregnancy?

Answer 12

SSRIs

Fluoxetine is safest.

Question 13

Do tricyclic antidepressants cause issues in pregnancy?

Answer 13

No

Question 14

What are the 2 best preferred anti-psychotics during pregnancy?

Answer 14

Olanzapine

Quetiapine

Question 15

Can sodium valproate and carbamazepine be used during pregnancy?

Answer 15

No, avoid at all costs.

They cause neural tube defects.

Question 16

What is the best mood-stabiliser for pregnancy?

Answer 16

Lamotrigine

Best to avoid all mood-stabilisers.

Question 17

When is the neural tube closed?

Answer 17

28 days into pregnancy.

Can be prior to mother knowing of pregnancy.

Question 18

Can lithium be taken in pregnancy?

Answer 18

No, it risks Ebstein’s anomaly.

Avoid in the first trimester.

Question 19

Can all psychiatric medications be taken whilst breastfeeding?

Answer 19

Yes, the only exception is lithium as this concentrates in breast milk.

Question 20

Can clozapine be given whilst breastfeeding?

Answer 20

No, it risks agranulocytosis of the infant.

Question 21

What is the preferred anti-depressant whilst breastfeeding?

Answer 21

Sertraline