Perinatal Psychiatry

Question 1

Red flags that required urgent referral to perinatal mental health team

Answer 1

1. Significant change in mental state
2. New thoughts or acts of violent self harm
3. New and persistent expressions of incompetency as a mother or estrangement from their baby

Question 2

What is the ‘baby blues’

Answer 2

Brief period of emotional instability- tearful, irritable, anxiety, poor sleep

Question 3

how common is the baby blues

Answer 3

50% of women

Question 4

What is puerperal psychosis

Answer 4

early symptoms: sleep disturbance/confusion, irrational ideas

Mania, delusion, hallucinations

EMERGENCY ADMISSION

Question 5

Risk factors for puerperal psychosis

Answer 5

Bipolar disorder (50%)
Previous episode
1st degree relative with history

Question 6

How common is post natal depression? when does it present?

Answer 6

10% of women

2-6 weeks post natal, lasts weeks-months

Question 7

what is the major risk to a fetus with paroxetine? (an SSRI)

Answer 7

fetal heart defects

Question 8

Which TCA and SSRI are safe in breast feeding

Answer 8

Amytriptilline

Sertraline

Question 9

what antidepressant should be avoided in breast feeding

Answer 9

citalopram (SSRI)

Question 10

what drug used in treatment of anxiety should be avoided in pregnancy + breast feeding

Answer 10

Benzodiazepines

Question 11

risk of benzodiazepine use in pregnancy

Answer 11

cleft palate

Neonatal withdrawal

Question 12

fetal side effects of sodium valproate (used as a mood stabiliser)

Answer 12

Neural tube defects
IUGR
Reduced IQ
Cardiovascular abnormalities

Question 13

fetal side effects of carbamazepine (used as a mood stabiliser)

Answer 13

Facial dysmorphism
Cardiac abnormalities
Neural tube defects
Vitamin K deficiency – haemorrhage disease of the newborn

Question 14

fetal side effect of lamotrigine (mood stabiliser) in breast feeding

Answer 14

Steven Johnson syndrome

Question 15

fetal side effects of lithium

Answer 15

Ebstein’s anomaly- congenital heart defect

Neonatal hypotonia, hypothyroidism, hypoglycaemia

Question 16

is lithium safe in breast feeding?

Answer 16

NO

Question 17

why should the anti-psychotic clozapine be avoided

Answer 17

risk of agranulocytosis

Question 18

side effects of olanzapine

Answer 18

increased risk of gestational diabetes and weight gain

Question 19

features of fetal alcohol syndrome

Answer 19

facial deformities 
low IQ
Neurodevelopmental delay
Epilepsy
Hearing, Heart, kidney defects

Question 20

what is wernicke’s encephalopathy

Answer 20

Neurological disorder caused by vitamin B1 deficiency

Usually due to chronic alcoholism

Question 21

Effects of opiate use

Answer 21

maternal deaths
neonatal withdrawal
IUGR
SIDS (sudden infant death syndrome)
still birth

Question 22

effects of nicotine consumption

Answer 22

Miscarriage 
placental abruption 
IUGR
stillbirths 
SIDS