Psych CASC / OSCE · Psychopharmacology — pregnancy and lactation
Counselling psychotropics in an unplanned pregnancy (CASC)
CASC-style station: shared decision on perinatal psychopharmacology — untreated illness risk, valproate switch hierarchy, lithium absolute-risk framing, and safety-net with obstetrics.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
A 29-year-old woman with bipolar I disorder and her partner attend after a positive home pregnancy test (about 5–6 weeks). She takes valproate 1000 mg daily and is terrified after reading online that 'all psychiatric drugs cause birth defects'. She wants to stop medication today. Partner asks whether lithium is 'poison'.
Station instructions (candidate)
You have 7 minutes. Explore understanding and fear without dismissing it. Explain why stopping everything today is not automatic. Name that valproate is the agent of greatest concern for major malformations and learning/developmental outcomes and outline a switch plan. Frame lithium with modern small absolute cardiac risk language if relevant to her history. Include postpartum risk, obstetric liaison, and a clear safety-net. Do not guarantee zero risk from any option.[1][2][4]
References6ShowHide
- [1]Viguera AC, Whitfield T, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation Am J Psychiatry, 2007.PMID 18056236
- [2]Tomson T, Battino D, Bonizzoni E, et al. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry Lancet Neurol, 2011.PMID 21652013
- [3]Meador KJ, Baker GA, Browning N, et al. Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs N Engl J Med, 2009.PMID 19369666
- [4]Patorno E, Huybrechts KF, Bateman BT, et al. Lithium Use in Pregnancy and the Risk of Cardiac Malformations N Engl J Med, 2017.PMID 28591541
- [5]Bergink V, Rasgon N, Wisner KL Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood Am J Psychiatry, 2016.PMID 27609245
- [6]Betcher HK, Wisner KL Psychotropic Treatment During Pregnancy: Research Synthesis and Clinical Care Principles J Womens Health (Larchmt), 2020.PMID 31800350