Perinatal Psychiatry

Question 1

How are psychiatric problems screen for in pregnancy?

Answer 1

Booking visit questions

Question 2

What percentage of mothers experience the baby blues?

Answer 2

50%

Question 3

How long postnatal do the baby blues occur?

Answer 3

3 - 10 days

Question 4

How long postnatal does postnatal depression occur?

Answer 4

2-6 weeks

Question 5

How long postnatal does puerperal psychosis occur?

Answer 5

Less than 2 weeks

Question 6

How does the baby blues present?

Answer 6

Irritable, teary, anxious, lack of sleep

Question 7

What is the management of the baby blues?

Answer 7

Reassure, self-limiting

Question 8

What percentage of mothers experience postnatal depression?

Answer 8

10%

Question 9

How does postnatal depression present?

Answer 9

Anhedonia, concerned for baby, anxious, lack of sleep, weight loss, irritable etc.

Question 10

What is the management of mild postnatal depression?

Answer 10

Self help / counselling

Question 11

What is the management of moderate - severe postnatal depression?

Answer 11

CBT, antidepressant, consider admission

Question 12

-Rapidly changing mental state
-Suicidal ideation
-Significant estrangement from infant
-Guilt or hopelessness
-Believe inadequate mother
-Psychosis
Are all indications for what?

Answer 12

Admission to a mother and baby unit

Question 13

Preterm births increase the likeliness of postnatal depression. T or F

Answer 13

True

Question 14

What are the risks to the child of untreated postnatal depression?

Answer 14

Emotional / conduct / cognitive problems e.g. ADHD

Question 15

How might puerperal psychosis initially present?

Answer 15

Sleep problem, confusion, irrational

Question 16

What is the management of puerperal psychosis?

Answer 16

Admit to mother-baby unit, antidepressant, antipsychotic

Question 17

Puerperal psychosis has a high recurrence. T or F

Answer 17

True

Question 18

Puerperal psychosis has a 5% risk of what?

Answer 18

Suicide

Question 19

Facial deformity, low IQ, neurological / developmental delay, epilepsy, hearing problems, hear and kidney defects are all associated with what?

Answer 19

Fetal alcohol syndrome

Question 20

Smoking in pregnancy increases the risk of sudden infant death, stillbirths, IUGR, miscarriage and what cause of PV bleeding?

Answer 20

Placental abruption

Question 21

Opiate use in pregnancy might cause in the neonate?

Answer 21

Withdrawal

Question 22

What is the risk of taking paroxetine in pregnancy?

Answer 22

In 1st trimester can cause heart defects

Question 23

What antidepressants should be avoided in pregnancy?

Answer 23

Citalopram and doxepin

Question 24

Antidepressants in pregnancy are associate with [low/high birth weight]

Answer 24

Low birth weight

Question 25

Name 4 antidepressants that are generally safe in pregnancy?

Answer 25

Imipramine, amitriptyline, sertraline, fluoxetine

Question 26

Are benzos safe in the first trimester? If no, why not?

Answer 26

Fetal malformation e.g. cleft palate

Question 27

Are benzos safe in the third trimester? If no, why not?

Answer 27

Floppy baby syndrome | (hypothermia, resp depression, hypotonia) and neonate withdrawal

Question 28

Are benzos safe in breastfeeding?

Answer 28

Avoid

Question 29

Are mood stabilisers safe in pregnancy?

Answer 29

All fine except lithium

Question 30

Are mood stabilisers safe when breastfeeding?

Answer 30

All fine except lithium

Question 31

Is lithium safe in the first trimester? If no, why not?

Answer 31

Fetal abnormality e.g. heart defect

Question 32

Since lithium is unsafe in the first trimester, a patient should immediately stop taking it when they discover they're pregnant. T or F

Answer 32

False, sudden discontinuation has more risks than the risk to pregnancy

Question 33

Lithium toxicity can mimic what syndrome of pregnancy?

Answer 33

Pre-eclampsia

Question 34

Is lithium safe in the third trimester? If no, why not?

Answer 34

Safe but requires regular monitoring

Question 35

Is lithium safe in breastfeeding?

Answer 35

No

Question 36

Which antipsychotic is most associated with GDM?

Answer 36

Olanzapine

Question 37

Most antipsychotics are unsafe in pregnancy and when breastfeeding. T or F

Answer 37

False, most are safe (especially 1st generation)

Question 38

Is valproate safe in the first trimester? If no, why not?

Answer 38

Neural tube and craniofacial defects, intellect, autism

Question 39

When does the neural tube close?

Answer 39

``` Day 28 (Hence no neural tube defect risk if discover pregnant later) ```

Question 40

Is valproate safe in breastfeeding?

Answer 40

Yes

Question 41

Which antiepileptic drug is associated when Stevens Johnson synd in neonates?

Answer 41

Lamotrigine

Question 42

Is lamotrigine safe in the 1st trimester?

Answer 42

No