Psychiatric disease and pregnancy

Question 1

What percentage of women suffer depression and/or anxiety during pregnancy?

Answer 1

10-15%

Question 2

Describe the core symptoms of depression

Answer 2

Low mood
Lethargy
Anhedonia
Poor sleep 
Poor appetite

Question 3

What added ruminations might be present in anxiety/depression related to pregnancy

Answer 3

Worries/ruminations about childbirth and caring for the baby - lack of support available

Question 4

What should be done in the case of severe depression, risk of self harm/suicide, bipolar disorder or other severe mental illness or family history of suicide/severe mental illness?

Answer 4

Referral to specialist mental health services

Question 5

What is postnatal depression?

Answer 5

Depressive episode within the first twelve months postpartum

Question 6

When is the peak incidence of postnatal depression?

Answer 6

first 2 months post partum

Question 7

What is the baby blues?

Answer 7

Period of low mood and irritability

Question 8

When does the baby blues start?

Answer 8

3-4days after birth

Question 9

How long does the baby blues last for?

Answer 9

7 days

Question 10

Does baby blues require treatment?

Answer 10

No

Question 11

What are the symptoms of postnatal depression

Answer 11

Negative cognitions about motherhood and coping skills

Anxiety - focus around the baby, worries the baby may get ill. not being able to care for them adequately or that they may harm them and hopelessness about the future

Question 12

When should an urgent referral to specialist mental health services be made for postnatal depression?

Answer 12

Severe depression

Risk of self harm or suicide

Evidence of self neglect

Psychotic symptoms

Manic features

Previous definite or possible diagnosis of bipolar disorder or any other severe mental illness

Family history of severe mental illness or suicide

Question 13

Describe the management of severe postnatal depression

Answer 13

Social support
Psychological treatments
Medication - moderate/severe depression, risks or non responsive to other treatments

Question 14

What considerations need to be made when prescribing for postnatal depression

Answer 14

Breastfeeding - risk benefit should be discussed

Question 15

What is post partum pscyhosis

Answer 15

Extremely severe form of mental illness that needs to be recognised early to avoid harm to either mother or baby

Question 16

When can post partum psychososi develop?

Answer 16

Develops rapidly a few days to weeks after delivery

Question 17

How many women does post partum psychosis affect?

Answer 17

1 in 1000

Question 18

Which patients are at greater risk of developing post partum psychosis

Answer 18

Mental health issues - bipolar or psychotic illness
History of post partum psychosis (50% chance of it returning)
Family of post partum psychosis in mum or sister

Question 19

Describe how post partum psychosis presents

Answer 19

Confusion
Distracted 
Quiet
Withdrawn 
Agitated
Distressed
Express bizzare ideas - paranoid/grandiose delusions
Report or respond to auditory hallucinations
Manic 
Talking rapidly 
Being more active
Sleep disturbance

Question 20

Describe the management of post partum psychosis

Answer 20

Specialist mental health service
Risk assesssment - suicidal ideation, thoughts of harm to or bizarre ideas about the baby, self neglect, ability to provide care for the baby
Inpatient treatment under the mental health act - specialist mother and baby unit or admit under general psychitric ward

Pharmacological treatment - antipsychotic and or mood stabiliser

Question 21

What is the prognosis of post partum psychosis

Answer 21

Usually good - most women have severe symptoms for 2-12 weeks and take 6-12 months to recover fully
Earlier diagnosis after childbirth appears to reduce the likelihood of long term difficulties

50% chance of it recurring in subsequent pregnancy - close monitoring during future pregnancies and after delivery