Perinatal Psychiatry

Question 1

what are the ‘pinks’ and when do they occur

Answer 1

first 48 hours post partum - excitememt euphoria

patient is usually mildly insomniac and overtalkative

Question 2

what are the ‘baby blues’

Answer 2

physical and emotional exhaustion combined with hormonal changes leading to emotional lability, tearfulness, mild anxiety and irritability

Question 3

when do the baby blues occur

Answer 3

days 3-10 postpartum

Question 4

when is the mean peak of the baby blues

Answer 4

peaks at day 5

Question 5

how long do baby blues typically last for

Answer 5

48 hours

Question 6

do you treat baby blues

Answer 6

no

Question 7

what are the prevalence of baby blues

Answer 7

50-80%

Question 8

how does a depressive illness typically present around the time of birth

Answer 8

peaks 2-4 weeks postpartum, with a secondary peak around 3 months after

Question 9

what is the prognosis of post-partum depression

Answer 9

2/3 resolve in 2-3 months with proper treatment

without treatment, it is 6+ months

Question 10

what is the treatment for postpartum depression

Answer 10

same as any other depression

Question 11

what are some risk factors for postpartum depression and how much do they affect the chances

Answer 11

previous history of depression or postpartum depression

50% risk of further postnatal illness

Question 12

what is the prevalence of postpartum psychosis

Answer 12

0.2%

Question 13

when does postpartum psychosis typically present

Answer 13

50% by day 7
75% by day 16
95% by day 90

Question 14

what proportion of postpartum psychosis patients are bipolar or schizoaffective psychoses

Answer 14

99% `

Question 15

what are some risk factors for post partum mania and by what percentage do they modulate the risk

Answer 15

previous history
current bipolar
50%

Question 16

what is the prognosis of postpartum psychosis

Answer 16

good short term prognosis but has some significant morbidity and mortality

generally requires admission to mother and baby unit

Question 17

when is psychiatric admission highest, before or after childbirth

Answer 17

after

Question 18

What should be done if a pregnant patient has: 
schizophrenia 
bipolar disorder 
postpartum psychosis
severe depression  

or a family history of bipolar/schizoaffective disorder AND a personal history of any psychiatric disorder

Answer 18

All women place on a mood stabilizer

birth plan must be in place before 35 weeks, including:
MSE immediately after delivery
a requirement for mental health professional liason
prophylactic medication where appropriate
consider child protection
emergency contact details

Question 19

what are complications of depression around childbirth

Answer 19

impaired bonding
neglect of baby/infanticide 
suicide
development of bipolar
citalopram and fluoxetine are found in breastmild

Question 20

what antidepressants are recommended for breastfeeding mothers

Answer 20

paroxetine and fluoxetine

Question 21

complications of psychosis around childbirth

Answer 21

suicide
infantcide
antipsychotics found in breast milk
lack of evidence base for effective treatment
child should be screened for developmental milestones if mother is on antipsychotics

Question 22

what antipsychotic is best for breastfeeding mothers

Answer 22

olanzipine - but this still is detected