A 30-year-old woman develops postnatal depression. She is treated with antidepressants by her
GP and gradually makes a full recovery. She stopped her antidepressants for a few months before
she conceiving again.

1) What is the most likely outcome following this pregnancy?

2) Treating depressive disorders in pregnancy is important because:

. Postpartum psychosis is a psychiatric emergency usually needing admission.
What is the incidence of postpartum psychosis in the general population?

A woman comes to the antenatal clinic at 16 weeks' gestation. She tells you that following her
previous pregnancy, she was admitted to the MBU for "a few weeks". She is unable to tell you what
her diagnosis was, and is adamant that "she does not want to go back there again". She declines an
outpatient appointment with the perinatal team. She says that she currently has no psychiatric
symptoms and is not on any medication.

5) Lithium

A woman with a history of severe depression presents with mild depression in pregnancy or
the postnatal period.
What is the best plan of care?

A woman presents 5 days post-delivery on the labour ward. On initial assessment she is tearful
and visibly distressed, but moments later she starts laughing and then becomes highly irritable. She
is reported to have disclosed to staff that she believes her 5-day-old son is able to communicate with
God.
Contact her GP for an immediate assessment with a view to an adult psychiatric ward
admission

8) When is the peak onset for puerperal psychosis following delivery?

Mental disorders during pregnancy and the postnatal period can have serious consequences on
the health of the mother and her baby. It is vital that these women be managed by the appropriate
health-care professionals.
Which health-care professional(s) should care for pregnant women with a history of postpartum
psychosis?

10) Postpartum psychosis is most commonly associated with which of the following?

. A woman presents to her general practitioner 2 weeks after delivery. She appears on-edge and
says that she is worried about germs in the practice that might affect her baby. She asks to wash her
hands as soon as she enters the room and you can see that her hands look red and raw.

A woman is seen 12 weeks postpartum with a low mood. Her husband is concerned that she is
not eating well and has no energy to do anything, including looking after the baby.

13) Lorazepam

A 22-year-old primigravida attends the breastfeeding clinic on the 7th day following her
delivery. She is tearful due to her inability to feed the baby and feels completely worthless. She lives
alone and says life means nothing to her now and talks about harming herself. She looks emaciated
and dehydrated.

15) Risperidone

A 23-year-old woman is seen 4 days postnatally in obstetric triage after self- presenting after
cutting her wrists at 03:00 hours There is no ongoing bleeding from her injuries. She reports that she
had got upset as her boyfriend had been out and came home late. They are now joking with each
other and appear very affectionate.

17) The definition of postpartum psychosis includes:

A 21-year-old woman with known bipolar disorder on regular medication attends for
preconception counselling. She is on fluoxetine and is on regular follow-up.

19) Which one of the following statements is correct in relation to postpartum depression?

20) Olanzapine

A woman presents 5 days after delivery. She is very tearful and says that she is struggling to
feed her baby and is not sleeping well

A 40-year-old woman is 2 weeks postnatal after her first pregnancy. She had a caesarean
section and she has no past medical or mental health history. She has not been sleeping, and has
been feeling very low and crying a lot. The baby has been readmitted due to excessive weight loss

23) Which of the following has the highest rate of adverse consequences of antenatal exposure?

A woman in the first postpartum week presents with mood swings ranging from elation to
sadness, irritability, anxiety and decreased concentration. Care of the baby is not impaired and the
woman does not feel suicidal.
What is the most likely diagnosis?

. A primigravida aged 30 attends the antenatal clinic for booking. She is known to have
Bipolar Disorder and was taking lithium, which was stopped preconceptually due to
concerns over fetal toxicity. Her mother is known to have bipolar disorder.
What is her risk of developing postpartum psychosis?

A single woman has schizophrenia experienced her first schizophrenic episode requiring
inpatient psychiatric care, 8 months prior to pregnancy. She has been well controlled on haloperidol
depot injections since. She is currently at 36 weeks of gestation and is well. She lives alone and has
limited social support.

27) The most common time of presentation of postnatal depression is

What is the approximate risk of a woman developing postnatal depression if she has a history
of depression and a first-degree family member with a history of postnatal depression?

A woman presents to the antenatal clinic at 37/40 weeks of gestation with symptoms suggestive
of a depressive episode. She is low in mood with anhedonia, sleep disturbance, increased anxiety
and reduced appetite. She reports feeling hopeless and worthless and discloses suicidal thoughts. On
further questioning, she has thoughts of jumping in front of a train but has not made any suicidal
plans. She has a past history of postnatal depression and a family history of depression.

29) What is the best course of action?

A 38-year-old woman has had her first baby by caesarean section 7 days ago. She is seen by her
community midwife and appears to be low in mood with reduced appetite and is sent to hospital for
review. There is no suicidal ideation or thoughts to harm her baby, and she is diagnosed with mild
depression. The woman s case notes indicate that her mother suffered from bipolar disorder and
committed suicide.
What would be the most appropriate action?

A 31-year-old woman is 3 days postdelivery and presents with anxiety She appears very
frightened and exhibits paranoid ideation that her family is trying to take her baby away. She has a
history of schizophrenia but has been stable without treatment for 5 years.

All health-care professionals providing assessment and interventions for mental health
problems in pregnancy and the postnatal period should understand the variations in their
presentation and course.
Along with this there should be knowledge of how these variations affect treatment, and the context
in which they are assessed and treated (e.g., maternity services, health visiting and mental health
services. When a woman with a known or suspected mental health problem is referred in postnatal
period within what time frame should assessment for treatment be initiated?

A 29-year-old woman is attending the GP surgery for breast engorgement. She was a victim of
road traffic accident recently and lost her baby at term due to placental abruption. She was induced
and had vaginal delivery and discharged later from the hospital. She was prescribed cabergoline
following the delivery. On examination, there is very mild breast tenderness with no engorgement
and is extremely tearful.

A 34-year-old woman attends the postnatal clinic feeling tired with lack of appetite and feeling
unwell on the 4th day following her delivery. She is complaining of severe pain in the episiotomy site
and vaginal bleeding. She had a prolonged labour following induction and a forceps delivery. She is
very upset about the whole event. Physical examination reveals normal findings and stable vital
parameters

35) Sodium valproate

At a woman s first contact with primary care or her booking visit and during the early postnatal
period efforts should be made to ask about the woman s mental health and well-being using the 2
item GAD2 Scale:
What is the GAD-2 scale used for?

A woman presents to her general practitioner at 5 days postnatal. She appears agitated and
says that she has not slept for 3 days. She is talking fast and appears confused about why she is
there.

A 24 year-old woman has delivered her first baby by caesarean section. She is seen by the
midwife 3 days postpartum with emotional instability, insomnia and agitation. She seems to improve
a little over the following 72 hours but continues to have similar symptoms intermittently over the
next 6 weeks. The baby is well looked after.

A 30-year-old woman presents to the delivery suite at 32 weeks gestation with severe
backache. She denies any vaginal watery loss or bleeding. On examination, her vital signs are found to be stable, with a soft uterus. Vaginal examination was not performed as she does not consent.
Her recent growth scan has been normal. On further questioning, she lacks coherence and says she
heard voices the night before, which instructed her to go to the hospital immediately.

. A woman in the second postpartum week presents with confusion, bewilderment, delusions
and hallucinations. She feels hope- less and care of the baby has been affected.
What is the most likely diagnosis?

41) Fluoxetine