Psychiatry

Question 1

Define Baby Blues.

Answer 1

Mild, self-limiting low mood in the postnatal period

Question 2

Define Postpartum Depression.

Answer 2

Pervasive low mood in the postnatal period.

Question 3

Define Postpartum/Puerperal Psychosis.

Answer 3

Acute onset of psychotic illness in the postnatal period.

Question 4

What is the prevalence of postpartum psychiatry?

Answer 4

• Baby blues – 50% new mothers
• Postpartum depression – 10-15% new mothers
• Puerperal psychosis – 0.1% new mothers

Question 5

What are the risk factors for postpartum psychiatry?

Answer 5

• Past psychiatric history or previous PPD
• Primigravidity (postnatal blues)
• Antenatal or delivery complications - traumatic, incontinence, prematurity
• Social isolation
• Antipsychotics (esp. risperidone) – dopamine inhibition and hyperprolactinaemia

Question 6

What are the signs and symptoms of baby blues?

Answer 6

• Insomnia
• Fatigue
• Tearfulness and labile mood
• Anxiety
• Irritability
• Impaired concentration
• Onset 3-5 days post-natal - recover within 10-14 days
  
  • Baby blues last <2 weeks - longer = PPD

Question 7

What are the signs and symptoms of postpartum depression?

Answer 7

• Anergia
• Anhedonia
• Low mood
• Onset during pregnancy to 1 year post-natal
• Lasts over 2 weeks
• Often recover within 4 weeks

Question 8

What are the signs and symptoms of postpartum psychosis?

Answer 8

• Delusions
• Mania
• Hallucinations
• Thoughts of self-harm:
  
  • Onset from 2-3 days post-partum to 1 year post-natal
  • Recover within 6-12 weeks
• Tends to follow three patterns:
  
  • Delirium
  • Affective - 70-80% have BPAD or schizoaffective
  • Schizophreniform

Question 9

What are the appropriate investigations for suspected postpartum psychiatric illness?

Answer 9

• MSE and Depression rating scales
  
  • Depression screening questions: low mood, anhedonia
  • Edinburgh Post-Natal Depression Scale - score >12 = likely depressive episodes
  • Safety Net
    
    • Confirm if she has had thoughts of harm to self; harm to others (baby); suicide (±plans)
    • Delusions

Question 10

What is the management of baby blues?

Answer 10

Reassurance and support (as self-limiting)

Question 11

What should you ask about in psychiatric issues related to pregnancy?

Answer 11

• Why this baby?
• Relationship between symptoms and pregnancy
• Baseline functioning
• Traumatic birth
• Adverse childhood events/experience of being parented
• Bonding issues
• Psychosexual history
• Impulsivity
• Psych history

Question 12

What are the perinatal red flags for mental illness?

Answer 12

• Recent significant changes in mental state or emergence of new symptoms
• New thoughts or acts of violent self-harm
• New and persistent expressions of incompetency as a mother or estrangement from the infant

Question 13

What is the management of postpartum depression?

Answer 13

• Same as non-pregnant depression
  
  • Self-help
  • CBT
  • Anti-depressants
    
    • Breast-feeding safe drugs = Sertraline and Paroxetine

Question 14

What is the management of postpartum psychosis?

Answer 14

• Psychiatric emergency
• Inpatient admission to a mother and baby unit
• Same as non-pregnant psychosis

Question 15

What are the complications of postpartum psychiatric illness?

Answer 15

• Poor emotional attachment to child
• Long-term psychiatric morbidity
• Suicide - up to 5% in PPP
• Infanticide - up to 4% with PPP
• Prognosis:
  
  • Postnatal depression recurrence = 30% - Ask if they have ever had this during pregnancy
  • Puerperal psychosis recurrence = 20%