Perinatal Psychiatry

Question 1

What risks factors are there for mental health problems in pregnancy

Answer 1

Young/single
Domestic abuse
Lacking support
Substance abuse
Unplanned/unwanted pregnancy
Pre existing mental illness

Question 2

What should always be exluded when a women presents with changes to mood/mental health

Answer 2

anaemia
thyroid
diabetes
infection
SOL

Question 3

When would the woman be seen by the psychiatry team during pregnancy

Answer 3

Psychosis
Severe anxiety, depression, suicidal, self-neglect, self harm
Symptoms with significant interference with daily functioning
History of bipolar or schizophrenia
History of puerperal psychosis
Psycotropic meds
If developed moderate mental illness in late preg or early postpartum
Mild- mod illness but 1st degree relative with bipolar or puerperal psychosis
Previous in-patient admissions to mental health unit

Question 4

What anxiety medications should be avoided in pregnancy and why

Answer 4

Benzodiazepines

cleft palate and neonatal withdrawal

Question 5

Risks of valproate

Answer 5

craniofacial defects
CV abnormality
IUGR
reduced IQ
cleft
GU anomalies

Question 6

Risks of Carbamazepine

Answer 6

facial dysmophism
cardiac anomalies
fingernail hypoplasia
vit k deficiency - Haemorrhagic disease of newborn

Question 7

Risks of lamotrigine

Answer 7

Steven Johnson syndrome if breast fed

Question 8

are anticonvulsants safe in breastfeeding

Answer 8

yes

Question 9

What is the risks of lithium to the fetus

Answer 9

cardiac abnormalities

Ebsteins anomaly

Question 10

what are the risks of lithium to the neonate

Answer 10

hypotonia
nypothyroidsim
hypoglycaemia

Question 11

is litium safe in breastfeeding

Answer 11

no

Question 12

What can be used instad of lithium to manage bipolar

Answer 12

SSRIs

Question 13

Why are TCAs not used in bipolar

Answer 13

high risk of switching to mania

Question 14

Are antipsychtotics safe in pregnancy

Answer 14

yes

Question 15

What antipsychotics are preferable in pregnancy

Answer 15

typical

Question 16

Why are typical antipsychotics preferred in pregnancy

Answer 16

atypicals are associated with higher risk of gestational diabetes and IUGR

Question 17

What should babies born to mothers on antipsychotics be observed for

Answer 17

Lethargy, sedation and reaching developmental milestones

this is because antipsychotics are all sedating

Question 18

What antipsychotisc are not used in breastfeeding

Answer 18

Clozapine -CONTRAINICATED

Olanzapine - increased risk of extrapyramidal reaction in baby

Question 19

Are anticholinergics safe in pregnancy

Answer 19

no

Question 20

Which SSRI is associated with cardiac abnormalities

Answer 20

paroxetine

Question 21

Which SNRI is associated with hypertension

Answer 21

venlafaxine

Question 22

Are SSRIs safe in pregnancy

Answer 22

Yes - with caution after 20 weeks

Question 23

Are TCAs and SSRIs safe in breastfeeding

Answer 23

Yes however high levels of SSRIs in breastmilk so baby should be monitored for withdrawal which is usually mild

Question 24

Which SSRI is best for breastfeeding

Answer 24

Sertraline

Question 25

when does postnatal depression usually present

Answer 25

2-6 weeks post natal

Question 26

What are the ‘baby blues’

Answer 26

50% women
Brief period of emotional instability
 Tearful, irritable, anxiety and poor sleep confusion
Day 3-10 self-limiting
Support and reassurance

Question 27

What are the risk factors for puerperal psychosis

Answer 27

Bipolar, previous PP, 1st degree relative with Hx