POSTPARTUM PSYCHOSIS

Question 1

Baby blues

• Incidence
• Prognosis
• Diagnosis confirm

Answer 1

• 70 % postnatal women
• complete recovery/self lmiting
• diagnosis by time as rapid improvement

Question 2

Baby blues
starts which day
symptoms

Answer 2

• 3rd to 5th day , may be upto 2 weeks, but improvement

- Feeling of anxiety, loss of concentration , inadequace

Question 3

depression

Answer 3

10% women postnatally

Question 4

psychological disease prevalence depends overall

Answer 4

• positive family HX
• Positive personal HX
• taking medications

Question 5

postnatal blues VS postnatal depression

Answer 5

NOT in same woman

Question 6

puerperial psychosis prevalence

Answer 6

• 2/1000, 0.5 %
• incidence increase if past hX of puerperial psychosis then 50 %
• HX of bipolar disorder then 25 %

Question 7

puerperial psychosis diagnosis

Answer 7

delusions, hallucinations, someone talking evil things, suicidal ideation, homicide

Question 8

symptoms common to depression and psychosis

Answer 8

lack of concentration, labile moods

Question 9

Baby blues MX

Answer 9

family support
reassurance
friends
improve by time 
then discharge

Question 10

depression MX

Answer 10

• admission to hospital
• psychological counselling
• group therapy
• antidepressant after psychological counselling

Question 11

p. psychosis MX

Answer 11

• First step separate the baby,
• Admit to mental health unit, in labour ward
• psychological counselling
• referral consultation by psychiatrist (obs last step)
• antipsychotic medicine by psychiatrist (OBs can prescribe antidepressant)

Question 12

psychological disorders medicine

Answer 12

antidepressant
antipsychotics
mood stabilizers

Question 13

antidepressant

Answer 13

• TCA: impiramine, amytryptyline

- SSRI: fluxetine, paroxetine

Question 14

SSRI in pregnancy

Answer 14

paroxetine contraindicated in pregnancy and breast feeding

Question 15

In pregnancy what anti-depressant more suitable in pregnancy

Answer 15

SSRI:

• TCA more teratogenic
• toxicity threshold, safety margin is limited

Question 16

During lactation what antidepressant

Answer 16

TCA superior b/c excretion in breast milk less than SSRI.

SSRI in large amount almost 1/4 th

Question 17

Antipsychotics

Answer 17

• Typical anti psychotics: Haloperidol, chloropromazine

- New generation: olanzapine

Question 18

olanzapine

Answer 18

gestational diabetes

OGTT regularly when receiving.

Question 19

olanzapine depot

Answer 19

a

Question 20

Antipsychotic medications: phenothaizine, chloropromazine, - Seeking infertility then what hormone important to check

Answer 20

• hyperprolactinemia

Question 21

CBT indication

Answer 21

1 - mild depressive illness
2 - generalized anxiety disorder
3 - CBT is only treatment in post- trauma stress disorder
4 - Only treatment in eating diorder

Question 22

mode stablizer

Answer 22

lithium carbonate (most important)
carmazapine (not used these days)

Question 23

lithium carbonate

Answer 23

• strong mode stablizer, 50% within 1 mont
• 50% severe rebound and detrioration
• regularly taking preconception should continue,
• so follow up levels, every 4 weeks, all through pregnancy, from 36 weeks weekly until delivery.
• stopped in labour
• measure 12 hours post delivery
• start ASAP
• ebstein cardiac anomaly

Question 24

Sertraline , ssri

Answer 24

class 3 FDA