Perinatal Psychiatry

Question 1

What is the leading cause of direct maternal death in the year after childbirth?

Answer 1

Suicide

Question 2

What are the red flag mental health presentations for recent mothers?

Answer 2

Significant change in mental state
Thoughts/acts of violent self harm
Feelings of estrangement from their baby

Question 3

When may a woman be admitted to the mother and baby unit?

Answer 3

Rapidly changing mental state
Suicidal ideation 
Estrangement from infant
Guilt or hopelessness
Beliefs of inadequacy 
Evidence of psychosis

Question 4

Pregnancy is thought to be protective of mental health problems. True/false?

Answer 4

False - not protective

Question 5

When do baby blues occur?

Answer 5

Days 3-10 postpartum

Question 6

What occurs in baby blues?

Answer 6

Brief period of emotional instability where woman is tearful/irritable/anxious

Question 7

How is baby blues treated?

Answer 7

Support and reassurance

Question 8

Puerperal psychosis is a psychiatric emergency. True/false?

Answer 8

True

Question 9

Give some features of puerperal psychosis

Answer 9

Sleep disturbance
Confusion
Mania
Delusions
Hallucinations

Question 10

What are the main risk factors for puerperal psychosis?

Answer 10

Bipolar disorder
Previous puerperal psychosis
1st degree relative with history

Question 11

What are the main risks of puerperal psychosis?

Answer 11

Suicide

Infanticide

Question 12

How is puerperal psychosis managed?

Answer 12

Admission to mother-baby unit

Antidepressants; antipsychotics; mood stabilisers; ECT

Question 13

When is the onset of postnatal depression?

Answer 13

2-6 weeks postnatally

Question 14

Give some common clinical features of postnatal depression

Answer 14

Tearful
Irritable
Anxiety
Poor sleep
Weight loss

Question 15

Most antidepressants should be avoided during pregnancy and breastfeeding. True/false?

Answer 15

False - most are pretty safe

Question 16

Which antidepressant increases risk of fetal heart defects?

Answer 16

Paroxetine

Question 17

Which SSRIs are women advised to take during pregnancy?

Answer 17

Sertraline

Fluoxetine

Question 18

Benzodiazepines should be generally avoided during pregnancy and breastfeeding. True/false?

Answer 18

True

Question 19

Give some risks of BZDs in the 1st and 3rd trimester

Answer 19

1st trimester - increased risk of fetal malformation

3rd trimester - increased risk of floppy baby syndrome

Question 20

Most antipsychotics should be avoided in pregnancy due to risk of fetal malformation. True/false?

Answer 20

False - most are pretty safe

Question 21

Which antipsychotics should be avoided in pregnancy? Why?

Answer 21

Clozapine - risk of agranulocytosis

Olanzapine - risk of gestational diabetes

Question 22

Can lithium be continued during pregnancy?

Answer 22

Yes - but caution is advised

Question 23

Lithium must be avoided during breastfeeding. True/false?

Answer 23

True

Question 24

Why should sodium valproate be avoided in all women of childbearing age?

Answer 24

Increased risk of neural tube defects and craniofacial defects

Question 25

Why should all women of childbearing age on valproate be using contraception?

Answer 25

As the neural tube defect will commonly occur before the woman realises she is pregnant

Question 26

What are the main risks of carbamazepine and lamotrigine in pregnancy?

Answer 26

Carbamazepine - neural tube defects | Lamotrigine - oral cleft

Question 27

Can women who abuse opiates be prescribed diamorphine in labour?

Answer 27

Yes - probably will need a higher dose

Question 28

Give some risks of alcoholism in pregnancy

Answer 28

Miscarriage Fetal alcohol syndrome Wernicke-Korsakoff syndrome

Question 29

Give some risks of cocaine/amphetamine use in pregnancy

Answer 29

Death (stroke/arrhythmia) Teratogenicity Pre-eclampsia IUGR

Question 30

Give some risks of opiates in pregnancy

Answer 30

IUGR SIDS Stillbirth

Question 31

Give some risks of nicotine in pregnancy

Answer 31

Miscarriage Abruption IUGR SIDS