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28 Cards in this Set
- Front
- Back
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Describe 3 psychosocial stresses of becoming a mother. (5)
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- Role change to 'mother' (loss of working bread-winner role)
- Relationship change w/ partner (to a 3 person relationship) - Financial pressure - Change in social networks (to families with babies b/c they understand) - Intrapsychic Distress (Coping w/ dependence, Own parenting experiences) |
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What percentage of women are unlikely to experience the blues?
A 99.9 B 80-85 C 50 D 30 E 15 |
D ~30
A Puerperal psychosis B Postnatal depression |
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How long after birth does Postnatal depression set on?
A 1-2 days B 3-5 days C 0-3 wks D 12-26 months |
D (gradual onset 12-26 months)
C Puerperal psychosis (0-3wks) B The blues (3-5 days) |
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Postnatal depression has all of the symptoms of a Non-melancholic Major Depressive Disorder + one more, is it:
A Anxiety B Behavioural disturbance C Confusion D Indecisiveness E Lability of mood |
A Anxiety (incl. irritability, panic, OCD)
C (confusion) and D (indecisiveness) are more typical of a puerperal psychosis E Mood lability is more typical of the blues. |
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Which of the three main mood disorders following pregnancy has a gradual onset and is most likely to be chronic?
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Post natal depression
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Which of the following is not a causal factor for Postnatal depression
A Dysfunctional personality style B An odd number of children (1,3,5...etc.) C Poor relationships D Poor supports |
B
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What does DSM-IV specify as postpartum?
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within 4 wks
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Post partum (w/in 4 wks) onset of postnatal depression is more likely to be melancholic
T/F |
T
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Name three problems that the infant could suffer, due to mum's depression impairing her response to infant cues.
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Attachment difficulties (never separate mum and baby on hospital ward!)
Cognitive impairment Behavioural problems |
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Which of the following is not an established Risk Factor for Postnatal depression?
Age Poor parenting Life event stress Nutrition in the perinatal period Hormonal status |
Nutrition in the perinatal period
Age (SOCIODEMOGRAPHIC FACTOR) Poor parenting (EARLY LIFE EXPERIENCE FACTOR) Life event stress (SOCIAL ENVIRONMENT FACTOR) Hormonal status (INTERNAL ENVIRONMENT FACTOR) |
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What are the 3 types of support a mother needs within the first 40 days (40 day rule) . BONUS POINTS WILL BE AWARDED FOR GOOD EXAMPLES).
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KNOWLEDGE SUPPORT - Wisdom of the elders
PRACTICAL/INSTRUMENTAL SUPPORT - Household chores EMOTIONAL SUPPORT - Discuss joys/disappointments. NB. Antenatal marital dis harmony reduces the last two supports and therefore predicts PND |
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Which of the following has no demonstrated efficacy in PND
Non-directive counselling CBT Interpersonal therapy (IPT) SSRIs TCAs MAOIs Oestrogen W-3 fatty acids |
MAOIs are dirty drugs
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Which has a higher prevalence, ANTEnatal depression or POSTnatal depression?
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Same..Antenatal is more difficult to treat though because of risk of antidepressants to foetus (antenatal depression/anxiety may affect foetal development)
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In which trimester is the mother most at risk of puerperal psychosis?
A Premenstrually B 1st C 2nd D 3rd E 1st 3 months after birth |
E
NB. Risk of recurrence of puerperal psychosis is 500 times higher i.e. ~0.1% (general pop.) x 500 = 50% chance |
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There is an association between bipolar disorder and puerperal disorder
T/F |
T
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The premorbid personality most linked with puerperal psychosis is schizotypal
T/F |
Obsessional premorbid personality is most associated with PP
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Which of the following is just an effect of medications on the foetus (M) and which is just an effect of mothers psychiatric illness (PI)
and which is BOTH A Growth impairment B Preterm delivery C Metabolic effects (later for infant) D Attachment problems E Behavioural neurotoxicity |
A Growth impairment BOTH
B Preterm delivery PI C Metabolic effects (later for infant) M D Attachment problems PI E Behavioural neurotoxicity M |
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The first 2 weeks of life is when the embryo is most susceptible to teratogens.
T/F |
F - It is usually not as in these preembryonic stages the teratogen will only affect some cells, and the rest will regenerate for it without defect or it will effect all of them and no one will know of the conceptus.
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Lithium and what other group of psychiatric medications are most likely to cause physical malformations?
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Lithium and Anticonvulsants (Neural Tube Defects)
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Which drug is mostlikely to cause neonatal toxicity and which is least likely?
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MOST Lithium
LEAST TCAs |
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- SSRIs can cause a 2-fold increase in heart defect risk T/F
- SSRIs can cause Persistent Pulmonary Hypertension prescribed after gestational age 20 weeks T/F - SSRIs can cause a withdrawal syndrome in the infant - SSRIs increase risk of gestational diabetes in mother T/F T/F |
TTTT
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Which system is not affected by Seratonin Reuptake inhibitor-induced neonatal behavioural syndrome?
A CNS B Sleep preoblems C Motor system D Sensory system E Somatic (fever/hypothermia..) F GI system G Cardioresp |
D Sensory system is unaffected, on the other hand the motor system is grossly effected with +/- agitation, hyperreflexia, dystonia..
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Is there an indication for antipsychotics in the 1st trimester of pregnancy?
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For emergent manic symptoms in a mother with bipolar disorder (lithium is absolutely contraindicated)
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The longer you can take the full dose of lithium up till conception the lower the risk of symptom recurrence
T/F |
F Gradual dose reduction down to 0 for conception has a much later 50% risk of recurrence than a rapid stop. (18 months cf. 5 months)
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What increases the risk of heart defect more:
A SSRIs B Lithium C TCAs |
A SSRIs 16:1000
B Lithium 60:1000 (15 x more ebstein's anomalies (tricuspid regurge plus atrial septal defect)) C TCAs 8:1000 (population average) 1 in 125 babies |
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Which level of Lithium should you aim for during preganancy? And when is it safe to do so?
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From late 2nd trimester you can do 0.2-0.6 mM
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What is the most toxic antiepileptic drug?
How can one work around this? |
Valproate 15 x RR for Neural Tube defect...LOWER THE DOSE and can be very appropriate
NB Normal pop. NTD 6/10000 Val 1/100 |
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What type of drug is lamotrigine and what abnormality is it known to increase the risk of?
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Anticonvulsant (thought to be particularly good in rapid cycling bipolar) Cleft palate 9/1000
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