Perinatal mental health

Question	Answer
What are the specific recommendations that have come from the various confidential enquiries into maternal death?	1. All women should be screened at booking for a prev Hx or of current psych disorder. 2. Women with a prev Hx of serious affective disorder or psychoses should be referred in pregnancy for psych assessment and management even if well. 3. Psych services should have priority carer pathways for pregnancy and post partum women. These include a lower threshold for referral and intervention, and a rapid response time for women in late pregnancy and the first 6 weeks following delivery. 4. Risk assessments for pregnant/ppartum women should take into account risk associated with prev Hx, the distinctive nature of perinatal disorders and violent methods of suicide. 5. Caution needs to be exercised when diagnosing psychiatric disorder if the only symptoms are either unexplained physical symptoms or or distress and agitation. Esp when they woman has no prev psych Hx or when she does not speak English/comes from an ethnic minority.
Who should be referred for psychiatric assessment?	All women with previous or current: schizophrenia or psychosis, bipolar disorder, postpartum psychosis, severe depression. All women on mood stabilisers. Any woman with a family history of bipolar affective disorder or schizoaffective disorder AND a personal history of any psychiatric disorder.
Give an overview of psychiatric disorders in pregnancy.	Pychiatric disorders are common in pregnancy, these disorders are slightly inccreased in the 1st trimester in comparison to the general population. They are usually mild and likely to improve. Milder psychiatric disorders respond to psychosocial interventions. The first onset of serious mental illness in rare in pregnancy. Depression and anxiety in the 3rd trimester may continue in the postpartum as postnatal depression.
What is the prevalence of psychiatric disorders in the perinatal period?	15-30% "Depression" 10% Depressive episode 3-5% Moderate/severe depressive episode 2% Referred psychiatry 0.2% Psychosis.
What are "The Pinks"?	They are a normal phenomena which occur in the first 48 hours postpartum. The Pinks are characterised by excitement and a sense of euphoria. A woman may also present as mildly over talkative and overactive with some insomnia. Though there is a slight risk of exhaustion, the Pinks will resolve without any intervention.
What are "The Blues"?	The Blues are a common occurrence in the postpartum period, 50-80%. They most frequently present about day 5 but usually present between day 3 to 10. The Blues are attributed to hormonal changes in combination with physical and emotional exhaustion. The typical symptoms of the Blues are emotional lability, tearfulness, mild anxiety and irritability. Though the presentation of the Blues can be varied, the symptoms are generally mild and not pervasive. The Blues generally last 48 hours and no specific treatment is required.
Describe depressive illness in the postpartum period.	Depressive illnesses occurring in the postpartum period are similar to illnesses occurring at other times, with guilt and concerns about parental ability commonplace. The peak onset of depressive illness is between 2 to 4 weeks post partum, however, there also exists a secondary peak at round 3 months postpartum. With prompt and appropriate treatment two thirds of illnesses will resolve within 2 to 3 months. Without treatment it can take 6 months or more to recover.
What is the risk of recurrence of post natal depressive illness?	50% with next delivery.
Describe the features of postpartum/Puerperal Psychosis.	In gen population the risk is 0.2%. Postpartum psychosis is characterised by sudden onset of behavioural disturbances, hallucinations, delusions, fear and perplexity. 50% present by day 7, 75% by day 16 and 95% present by day 90. Due to the early and sudden onset of postpartum psychosis it is essential that wherever possible at risk women are identified antenatally, so we can effectively manage the risks. 99% of postpartum psychoses are either bipolar or schizoaffective disorder.
What is the risk of postpartum psychosis in a woman with bipolar disorder or a previous postpartum psychosis?	50%
What should be included in a birth plan for a woman referred to psychiatric services during her pregnancy?	Should be in place by 35 weeks gestation, including: Monitoring her mental health immediately following delivery. A requirement for liaison between all health professionals. Use of prophylactic medication, where appropriate. Consideration of child protection. Emergency contact details.
Bipolar disorder is the psychiatric disorder most commonly associated with postpartum psychosis, True or False?	True
Women with a family history of suicide are not at increased risk of suicide, True or False?	False
With postpartum psychosis, there are usually warning signs in the woman's mental state 2 weeks before the diagnosis, True or False?	False
A woman with a history of self harm elicited at booking should always be referred to a psychiatric service, True or False?	False
Depression in the postnatal period most commonly presents at about 6 weeks after delivery, True or False?	False
A woman with a diagnosis of personality disorder elicited at booking should not be referred to the perinatal psychiatric service, True or False?	True
With a history of postpartum psychosis, increased monitoring of the woman's mental state should begin at day 5 postpartum, True or False?	False
Women with a history of mild depression treated by their GP should be referred to Perinatal Psychiatry, True or False?	False
The risk of developing postpartum psychosis in a woman with a history of postpartum psychosis is 1 in 4, True or False?	False
1 in 10 women will suffer some form of mental disorder postnatally, True or False?	True
When a postpartum psychosis is developing, the most common first symptoms are auditory hallucinations, True or False?	False
The "Blues" usually start to resolve after 3 weeks, True or False?	False

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Perinatal mental health

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	Created by Anna Walker about 9 years ago