Perinatal Psychiatry

Question 1

What are the baby blues?

Answer 1

A transient, self-limiting condition seen in up to 75% of new mothers
Most often 3-5 days after delivery

Question 2

What are the symptoms of baby blues?

Answer 2

Tearful
Anxious
Irritable
Lasts 1-2 days, but can be up to 2 weeks

Question 3

What is the management for baby blues?

Answer 3

Reassurance from midwifery
Increased social/family support
If symptoms fail to resolve - psychiatric review

Question 4

What are the risk factors for post-natal depression?

Answer 4

History of postpartum depression
Unipolar/bipolar depression
Unplanned pregnancy
Lack of support
Marital problems
Social circumstances
Sleep deprivation 
Hormonal changes

Question 5

What is the natural history of postnatal depression?

Answer 5

Usually resolves within 6 months

Still need to treat!

Question 6

What can be used to screen for post natal depression?

Answer 6

Edinburgh postnatal depression scale (EPDS)

Question 7

What is the management for postnatal depression?

Answer 7

Refer to MDT in mother and baby units
Involve the father
Counselling and input from GP/psychiatrist and health visitor
Close follow-up
CBT/antidepressants - may need to monitor babies for side effects/stop breast feeding - TCAs and SSRIs not very detectable in breast milk except fluoxetine
ECT if strongly suicidal/not eating or drinking

Question 8

What are the symptoms of postpartum psychosis?

Answer 8

Peak onset at 2 weeks postpartum
Psychotic episode with prominent affective symptoms (depression or mania)
Rapidly fluctuating symptoms
Mood lability
Insomnia
Disorientation

Question 9

What are the risk factors for postpartum psychosis?

Answer 9

Previous postpartum psychosis
Single parenthood
Reduced social support
Previous mental illness

Question 10

How can postpartum psychosis be prevented?

Answer 10

High-risk patients need an individualised care plan

Need antenatal specialist perinatal mental health input

Question 11

What is the management for postpartum psychosis?

Answer 11

Emergency referral to a specialist team
Affective symptoms - mood stabiliser/antidepressants/ECT
Psychotic symptoms - atypical antipsychotics and long-acting benzodiazepine
Therapy, reassurance and emotional support (with and for the family)
Referral to local mental health services and health visitors at discharge

Question 12

Why is early detection and emergency referral essential in postpartum psychosis?

Answer 12

Due to risks to self and baby
Infanticide is a rare, but serious risk
Hospitalisation is often necessary.