Psychiatric disorders in pregnancy & postpartum

Question 1

what are the symptoms of baby blues? when do they peak?

Answer 1

• mood lability
• tearfulness
• anxiety
• irritability
• peak 4th or 5th day postpartum

Question 2

how long do the baby blues last?

Answer 2

few hours to a few days

Question 3

when do baby blues symptoms warrant evaluation?

Answer 3

longer than 2 weeks

Question 4

when does postpartum depression emerge? when must it occur if peripartum specifier is used?

Answer 4

• 2-3 months postpartum

- within 4 weeks

Question 5

what is the gold standard for evaluating for postpartum depression?

Answer 5

edinburgh postnatal depression scale

Question 6

what disorders can occur with postpartum anxiety?

Answer 6

• GAD
• panic attacks
• OCD
• hypochondriasis

Question 7

what is the onset for postpartum psychosis? what are the features / symptoms?

Answer 7

• symptoms start 2-3 days postpartum
• usually within 2 weeks
• manic / mixed episode (not shizophrenia)
• rapidly shifting depressed or elated mood
• confusion
• erratic or disorganized behavior
• delusional beliefs
• auditory command hallucinations

Question 8

thoughts of harming their baby is common in women with what overlying disorder?

Answer 8

anxiety / OCD / both

Question 9

what do you need to assess in depressed mothers?

Answer 9

• judgment
• reality testing
• anger control
• intent

Question 10

what is a good long term predictor of neurocognitive outcome?

Answer 10

maternal mood (better than medication exposure)

Question 11

in pregnant women with untreated depression there is an elevated risk of ____________

Answer 11

• preterm delivery
• low birth weight
• small for gestational age / reduced body and head growth

Question 12

what is the go-to option for depression during pregnancy treatment?

Answer 12

psychotherapy (interpersonal)

Question 13

what are the most commonly prescribed medications during pregnancy?

Answer 13

SSRIs

Question 14

when should you consider medication treatment during pregnancy?

Answer 14

• if depression is mild-moderate and the woman would like to try therapy alone, this is reasonable
• if depression is severe, the woman has not responded to therapy or prefers to avoid it, consider medication
• BPAD and psychosis suggest medication

Question 15

what is important in determining medicating pregnant women with depression?

Answer 15

patient preference

Question 16

what should you do for a pregnant woman who comes in already on medication?

Answer 16

• avoid changing to a “safer” medication
• may change if original medication is not working
• may change prior to conception unless there are multiple failed trials of other medications

Question 17

what is the most difficult condition to treat during pregnancy?

Answer 17

BPAD

Question 18

what is the safest medication to take for a pregnant woman with BPAD?

Answer 18

lithium (still risks, but lower than depakote)

Question 19

what can result in a child to a mother with untreated postpartum depression?

Answer 19

attachment issues

Question 20

what is the best drug to use during breastfeeding for women with postpartum depression?

Answer 20

whichever one is most likely to get the woman well (based on past medical history, family history)