The majority of postpartum psychotic episodes are characterized by which of the following presentations?
B. It is well known that postpartum psychosis is often an episode of bipolar manic illness. A small minority have schizophreniform presentation or organic, delirious presentation. Another episode of relapse occurs in the same year in nearly 70% and risk during subsequent pregnancy is greater than 50%. In delirious presentations, ruling out organic cause, such as postpartum pituitary apoplexy, is very important.
Which of the following fi gures represent the correct estimate of the incidence of postpartum psychosis?
A. Postpartum psychosis affects 1 to 2 per 1000 childbirths. Initially, it was claimed that the incidence was higher in the West but, currently, comparable rates have been obtained worldwide. In contrast, postpartum depression affects 10 to 15% of all mothers, while postpartum blues affects 50 to 70% of mothers.
Which of the following postpartum disorders is correctly matched with its time of onset?
C. Time of onset of symptoms is an important clue in postpartum illnesses, especially to aid diagnosis during early presentation. Postpartum blues typically start 3 to 5 days after delivery; postpartum psychosis is also of acute onset and can develop between 2 weeks and 2 months after delivery; postpartum depression can occur anytime between 2 months and 1 year after childbirth, most commonly in the third month.
Which of the following principle has guided the organization of disorders in ICD-10 Chapter V?
A. Jasperian hierarchy refers to the principle that, in psychiatric practice, some diagnoses when made preclude using another diagnostic label even if a second diagnosis could account for a constellation of symptoms. For example when a diagnosis of major depression is made, symptoms of generalized anxiety are included in the description of depression itself; a separate diagnosis of generalized anxiety disorder need not be entertained. Similarly, depressive symptoms can be present during an acute psychotic episode of schizophrenia – they need not always indicate a separate diagnosis of depression. The hierarchy is maintained in ICD-10, to some extent, in the way the various chapters of ICD are organized. Organic disorders trump a diagnosis of psychotic disorders, which in turn are more or less equally considered with affective disorders. Affective disorders trump neuroses, which in turn trump personality disorders. DSM has abandoned this hierarchy to a large extent, though the principle is retained. Different modes of onset or degrees of disability will not yield differing diagnosis. Treatment response cannot be considered as a principle for organization of ICD-10 Chapter V.
In ICD-10 schizoaffective disorder is included in the same chapter as which of the following disorders?
A. Schizoaffective disorder is a diagnosis that lies between schizophrenia and affective disorder. It is placed together with schizophrenia in section F20–29. ICD-10 stipulates that schizophrenic and affective symptoms must be simultaneously present and both must be equally prominent. In DSM-IV the concept of a continuum between psychosis and affective illness is better highlighted. According to DSM-IV: (1) both schizophrenia and affective disorder categories must be met simultaneously; (2) a period of psychosis (2 weeks) without prominent affective symptoms must be present; and (3) the mood disturbance must be present for a substantial period during active (psychotic) and residual periods. Note that in postschizophrenic depression (classified under schizophrenia in ICD-10) the psychotic symptoms must not be prominent (but residual) when a depressive episode is present, and depression must be within 12 months of the most recent psychotic episode. Schizophreniform disorder is a diagnosis used when schizophrenia does not fulfill the duration criteria in DSM-IV (<6 months). This diagnosis is not included in ICD-10.
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