Psych

Question 1

Incidence of postpartum psychosis

Incidence of schizophrenia

Answer 1

1-2:1000

1:100

Question 2

Maternal deaths related to mental health

Answer 2

1.27:100000 maternal deliveries

2nd most common cause of maternal deaths

Question 3

What to do if woman has taken psychotropic med with known teratogenic risk in first trimester

Answer 3

Confirm the pregnancy asap
Explain that switching med may no remove risk of fetal malformations
Offer screening for fetal abnormalities and counselling about continuing the pregnancy
Explain the need for additional monitoring and the risks to the fetus if she continues to take the med

Question 4

Peak onset for puerperal psychosis following delivery

Answer 4

<7 days

Question 5

Risks with sodium valproate

Answer 5

NTD
Fetal valproate syndrome
Organ malformations
Neurobehavioral effects

Question 6

Incidence of mental health illness during or after pregnancy

Answer 6

1:10

Question 7

Red flags in perinatal mental health:psychosis and suicide

Answer 7

Recent or rapidly changing significant alterations in mental state
Emergence of new symptoms, which can include psychotic symptoms or severe anxiety
Psychotic symptoms that involve the infant
Thoughts of violent self-harm or suicide
Acts of violent self-harm or suicide
New ideas and expression of inadequacy as a mother
Pervasive guilt and hopelessness
Deterioration in function as a consequence of symptoms
Not eating
Severe insomnia
Psychomotor retardation

Question 8

Screening questions for pregnant women

Answer 8

1. During the past month, have you been bothered by feeling down, depressed, or hopeless
2. Month, have you even bothered by having little interest or pleasure doing things
3. Is this something with which you would like help

Question 9

Sensitivity and specificity of EPDS

Answer 9

34-100%

44-100%

Question 10

Indications for referral to PMH services

Answer 10

Woman with current illness where there are symptoms of mental health disorder
Woman with hx bipolar or schizophrenia
Woman with previous serious postpartum mental illness
Women on complex psychotropic medication regimens

Consider referral in those with first degree relatives history

Question 11

Percentage of women with baby blues

Answer 11

50-80%

Generally peaks day 5

Question 12

symptoms of depressive episode

Answer 12

Persistent sadness/low mood
Loss of interest or pleasure
Fatigue or low energy

Disturbed sleep
Poor concentration
Low self-confidence
Poor or increased appetite
Suicidal thoughts or acts
Agitation or flowing of movements
Guilt or self-blame
Impaired functioning

Question 13

Risk of recurrence in future pregnancies

Answer 13

1;2 to 1:3

Question 14

Assessment of severity of BPD

Answer 14

Frequency and number of episodes
Treatment compliance
Basic social factors
Capacity to care for baby

Question 15

Mood stabilizers NOT to use

Answer 15

Valproate

Carbamazepine

Question 16

Risk to baby with lithium

Answer 16

Epstein’s anomaly

Question 17

Medication-free pregnancy and PP period eligibility for BPD

Answer 17

Few episodes
Log periods of mood stability (>1yr)
Low risk self harm
Good supports
Able to identify early warning signs

Question 18

Partial prophylaxis in BPD

Answer 18

Med free 1st trimester

Reintroduce lithium after orgogenesis complete

Question 19

SSRIs risks in pregnancy

Answer 19

Small increased risk for heart defect
Avoid. Parole time. And fluoxetine
Risk of poor. Neonatal. Adaptation syndrome

In BF,, fluoxetine can lead to jittery infant

Question 20

Neonatal adaptation syndrome

Answer 20

After exposure in. Utero to ssris//snris - overstimulation of the sertoronergic system during development
Symptoms:
Respiratory distress
Feeling jittery
Feeding difficulty
Temperature instability
Sleep problems
Tremors
Jaundice
Hypoglycaemia
Irritability

Question 21

Postnatal care in a woman with BPD

Answer 21

Avoid sleep. Deprivation
Monitor first month
Support parenting skills
If relapse co-admit to mother and baby unit

Question 22

Risk factors for postpartum depression

Answer 22

Previous depression
Fam hx
Antenatal depression
Baby blues
Recent stressful events
Inadequate social supports
Poor marital supports
Low self-esteem
Difficult infant temperament

Single marital status
Unplanned or unwanted pregnancy
Low SES

Question 23

Generalized anxiety disorder definition

Answer 23

Anxiety that is generalized and persistent in any particular environment
Nervousness
Trembling
Muscular tensions
Sweating
Lightheaded ness
Palpitations
Dizziness
Epigastric discomfort
Fears that she or baby will become ill shortly or have an accident expressed often

Question 24

PTSD definition

Answer 24

Flashbacks
Hyperarousal
Avoidance
Psychological distress

Question 25

Primary tocophobia

Answer 25

Morbid fear of childbirth in a woman who has no previous experience of pregnancy

Question 26

Secondary tocophobia

Answer 26

Morbid fear of childbirth developing after a traumatic obstetric event in a previous pregnancy