Psych · Consultation-liaison psychiatry
Perinatal psychiatry in the general hospital
Also known as Obstetric psychiatry liaison · Maternity ward psychiatry · Perinatal consultation-liaison psychiatry · Hospital perinatal mental health · Puerperal psychiatry on the ward
Exam-exhaustive fellowship topic on perinatal psychiatry as general-hospital consultation-liaison work — maternity-ward presentations, postpartum psychosis emergency pathway, medical mimics, EPDS screening limits, mother-infant risk, capacity for obstetric decisions, pregnancy and lactation prescribing, lithium peri-delivery, ECT, mother-baby unit disposition, and multi-board guideline framing. FRANZCP-primary, globally tagged.
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10 MCQs with explanations
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Meet the patient
Day 5 after an uneventful delivery, a 31-year-old first-time mother has not slept for three nights — and is not tired. She is perplexed, rapid in her speech, and convinced the baby in the cot is not hers. The midwife found her standing at the nursery window at 4am, praying aloud.[5][8]
The obstetric team have asked whether she can be discharged home tomorrow with "some sleeping tablets." Two questions must be answered first, and they are not about sedation. Is this postpartum psychosis? And is the infant safe with her tonight? Everything below exists to answer both at consultant depth.[5][12]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
References18Show ledgerHide ledger
- [1]Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T Perinatal depression: a systematic review of prevalence and incidence Obstet Gynecol, 2005.PMID 16260528
- [2]Cox JL, Holden JM, Sagovsky R Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale Br J Psychiatry, 1987.PMID 3651732
- [3]Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry, 2021.PMID 33353391
- [4]Bergink V, Bouvy PF, Vervoort JS, Koorengevel KM, Steegers EA, Kushner SA Prevention of postpartum psychosis and mania in women at high risk Am J Psychiatry, 2012.PMID 22407083
- [5]Bergink V, Rasgon N, Wisner KL Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood Am J Psychiatry, 2016.PMID 27609245
- [6]Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis Am J Psychiatry, 2016.PMID 26514657
- [7]Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J Non-psychotic mental disorders in the perinatal period Lancet, 2014.PMID 25455248
- [8]Jones I, Chandra PS, Dazzan P, Howard LM Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period Lancet, 2014.PMID 25455249
- [9]Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child Lancet, 2014.PMID 25455250
- [10]Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB New parents and mental disorders: a population-based register study JAMA, 2006.PMID 17148723
- [11]Yonkers KA, Forray A, Smith MV Maternal Antidepressant Use and Pregnancy Outcomes JAMA, 2017.PMID 28810017
- [12]Bergink V, Burgerhout KM, Koorengevel KM, Kamperman AM, Hoogendijk WJ, Lambregtse-van den Berg MP, et al. Treatment of psychosis and mania in the postpartum period Am J Psychiatry, 2015.PMID 25640930
- [13]UK ECT Review Group Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis Lancet, 2003.PMID 12642045
- [14]Patorno E, Huybrechts KF, Hernandez-Diaz S Lithium Use in Pregnancy and the Risk of Cardiac Malformations N Engl J Med, 2017.PMID 28854098
- [15]Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants Am J Psychiatry, 2004.PMID 15169695
- [16]Galbally M, Sved-Williams A, Kristianopulos D, Mercuri K, Brown P, Buist A Comparison of public mother-baby psychiatric units in Australia: similarities, strengths and recommendations Australas Psychiatry, 2019.PMID 30407072
- [17]Gao SY, Wu QJ, Sun C, Zhang TN, Shen ZQ, Liu CX, et al. Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births BMC Med, 2018.PMID 30415641
- [18]Howard LM, Khalifeh H Perinatal mental health: a review of progress and challenges World Psychiatry, 2020.PMID 32931106