Perinatal Psychiatry

Question 1

What are some red flag presentations for perinatal psychiatry?

Answer 1

Recent significant change in mental state or emergence of new symptoms
New thoughts or acts of violent self harm
New and persistent expressions of incompetence as a mother or estrangement from their baby

Question 2

What are some risk factors for mental health issues in pregnancy?

Answer 2

Young
Single
Domestic issues
Lack of support
Substance abuse
Unwanted/unplanned pregnancy
Pre-existing mental health problem

Question 3

What is the baby blues?

Answer 3

Brief episodes of emotional lability, irritability and tearfulness
50% of women
Occurs 2-3 days postpartum and resolves in a few days
Managed with support and reassurance

Question 4

What are some features of puerperal psychosis?

Answer 4

Onset within first 2 weeks following delivery
Disorientation and confusion
Delusional ideas that child is deformed, evil, or affected in some way
Potential attempts to kill the child or suicide

Question 5

How is puerperal psychosis treated?

Answer 5

Emergency admission to specialised mother-baby unit
Antidepressants
Antipsychotics
Mood stabilisers
ECT

Question 6

What are some features of postnatal depression?

Answer 6

Tearfulness
Irritability
Anxiety
Lack of enjoyment
Poor sleep
Weight loss
Concerns around baby
Usually occurs in first 3 months
Lack of emotional bonding with baby as a consequence

Question 7

What is the management of postnatal depression?

Answer 7

Mild-moderate: self-help, counselling
Moderate-severe: psychotherapy and antidepressants, consider admission

Question 8

What antidepressants are used in perinatal psychiatry?

Answer 8

1st line: sertraline

No need to change from drug used during pregnancy

Question 9

What antidepsychotics are used in perinatal psychiatry?

Answer 9

Best evidence for olanzapine and quetiapine
Avoid clozapine

Question 10

What mood stabilisers are used in perinatal psychiatry?

Answer 10

Antipsychotics
Avoid lithium and valproate