Term
| Chronic pelvic pain is most often caused by... |
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Definition
| endometriosis and pelvic adhesions |
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Term
| Unexplained pelvic pain is often associated with... |
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Definition
| depression, somatic symptoms, substance abuse sexual dysfunction (physical and sexual abuse) |
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Term
| How should you treat patients with unexplained pelvic pain? |
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Definition
| multidisciplinary, individualized treatment to address somatic, social and psychological influences |
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Term
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Definition
| chronic burning, stinging or pain of the vulva in the absence of objective clinical or laboratory findings |
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Term
| What are the two types of vulvodynia? |
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Definition
| vulvar vestibulitis, dysesthetic vulvodynia |
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Term
| What is vulvar vestibulitis? |
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Definition
| restricted burning and pain of the vestibule solicited by touch |
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Term
| What is dyesthetic vulvodynia? |
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Definition
| pain not restricted to the vestibule which may occur with or without touch or pressure |
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Term
| What is the etiology of vulvodynia? |
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Definition
| unknown, possibly neuropathic |
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Term
| How do you treat vulvodynia? |
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Definition
| SNRIs may be helpful (no controlled trials) |
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Term
| Vulvodynia is often comorbid with... |
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Definition
| depression, fibromyalgia, and interstitial cystitis |
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Term
| What are typical situations in which denial of pregnancy occur? |
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Definition
| schizophrenic patients, older patients attributing amenorrhea to menopause, younger passive patients in strict families without much knowledge about reproduction |
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Term
| What is the frequency of pregnancy denials? |
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Definition
|
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Term
| What is the term for hysterical pregnancy? |
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Definition
|
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Term
| What physical symptoms can occur in false pregnancy? |
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Definition
| may stop menstruating, have a distended abdomen, even lactate, etc. |
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Term
| T/F Pseudocyesis has been reported in men. |
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Definition
|
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Term
| Is the incidence of pseudocyesis increasing or decreasing? |
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Definition
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Term
| T/F Pregnancy protects against depression. |
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Definition
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Term
| What percent of pregnant women have depressive symptoms? |
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Definition
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Term
| What percent of pregnant patients have full MDE? |
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Definition
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Term
| What are the risk factors for MDE? |
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Definition
| previous MDE, marital discord, lower socioeconomic status, unwanted pregnancy |
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Term
| In what ways does maternal depression adversely affect the developing fetus? |
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Definition
| preterm birth, lower birth weight, smaller head circumference, lower apgar scores |
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Term
| What non-pharmacologic managment can be used to treat depression during pregnancy? |
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Definition
| psychotherapy and electroconvulsive shock therapy |
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Term
| When do maternity blues start? |
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Definition
|
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Term
| What are the prevalence of maternity blues? |
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Definition
|
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Term
| What percent of patients with maternity blue progress to MDE? |
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Definition
|
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Term
| What causes maternity blues? |
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Definition
| probably related to changes in progesterone levels and will subside |
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Term
| At what time post partum are patients at highest risk for psychiatric illness? |
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Definition
| first 3 months postpartum |
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Term
| What is the prevalence of postpartum depression? |
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Definition
|
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Term
| What are the risk factors for postpartum depression? |
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Definition
| younger and older age, history of depression, lack of support, unemployment, hormonal factors not consistently related |
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Term
| Postpartum depression can be secondary to _______ in a small subset of patients. |
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Definition
| postpartum autoimmune thyroiditis |
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Term
| How can you decrease the exposure of a breast feeding infant to mom's SSRIs? |
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Definition
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Term
| What is the prevalence of postpartum psychosis? |
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Definition
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Term
| What are the characteristics of postpartum psychosis? |
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Definition
| extreme agitation, confusion, sleeplessness, hallucinations, delusions |
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Term
| What is the typical onset of postpartum psychosis? |
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Definition
| sudden onset, usually between day 3 and 14 postpartum |
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Term
| Why do some mothers with pospartum psychosis commit infanticide or suicide? |
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Definition
| infanticide often in response to command hallucination and/or suicidal urges and desire not to leave child behind |
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Term
| T/F Most antidepressants are relatively safe in pregnancy. |
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Definition
| true; although areas of concern exist, particularly some evidence of higher risk of preterm birth, neonatal adaptation difficulties, and congenital cardiac malformations |
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Term
| Which SSRI has a warning for heart malformations? |
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Definition
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Term
| What are the teratogenic effects of lithium? |
|
Definition
| ebstein's anomaly, no neurobehavioral differences, most common toxic effects "floppy baby" syndrome in neonate |
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Term
| What are the lithium levels of cord blood? |
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Definition
| equivalent to maternal blood |
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Term
| What are the teratogenic effects of valproate? |
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Definition
| neural tube defects, neurobehavioral: mental retardation suggested in "fetal valproate syndrome" but not definitive; neonatal toxicity (liver toxicity and withdrawal symptoms such as irritability and feeding difficulties and abnormal tone) |
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Term
| What are the rates of neural tube defects with valproate use? |
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Definition
| 5-9%; dose related in use 17 to 30 days postconception |
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Term
| What is the concentration of valproate in cord blood? |
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Definition
| two times higher in cord serum than in maternal serum |
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Term
| What are the teratogenic effects of carbamazepine? |
|
Definition
| craniofacial defects (11%), neural tube defects (0.5-1%); no neurobehavioral dysfunctions detected; 2 case reports of transient hepatic toxicity |
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Term
| What are the cord blood levels of carbamazepine? |
|
Definition
| fetal serum levels are 50-80% of maternal levels |
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Term
| What are the teratogenic effects of lamotrigine? |
|
Definition
| major defects identified in patients on monotherapy (2%); similar to general population; US pregnancy registry shows increased risk of cleft lip or palate; no neurobehavioral delays noted |
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Term
| What are the cord levels of lamotrigine? |
|
Definition
| metabolism by glucuronidation immature in fetus and neonate leading to only a 25% decrease relative to cord blood |
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Term
| Taking antipsychotics increases the rate of congenital malformations by what compared to women not taking antipsychotics? |
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Definition
| psychotic women, whether they are taking drugs or not, have rates of malformation twice that of the normal population |
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Term
| What are the effects of antipsychotics during fetal development in newborns? |
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Definition
| withdrawal and EPS possible in infant, no neurobehavioral defects noted |
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Term
| What are the specific malformation and perinatal complications that can occur with antipsychotics? |
|
Definition
| possible increase in cardiovascular defects and nearly double the risk of gestationl diabetes |
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Term
| What are the psychological symptoms of menopause? |
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Definition
| irritability, mood swings, depressed mood, forgetfulness, low sex interest, sleep difficulties |
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