Antenatal and postnatal mental health

Question 1

when does postnatal psychosis occur?

Answer 1

usually within the 1st few weeks following birth

Question 2

women at high risk of postnatal psychosis?

Answer 2

previous history of postpartum psychosis
PMH of bipolar
FH of postpartum psychosis or bipolar

Question 3

symptoms of postpartum psychosis?

Answer 3

hallucinations
delusions
change in behaviour
loss of inhibitions
very high or low in mood
severe confusion
agitation
racing thoughts
withdrawn
difficulty sleeping or not wanting to sleep

Question 4

who gets the baby blues?

Answer 4

very common
more than 50% of new mothers
usually starts 3-4 days after birth, and resolves by 10 days

Question 5

features of baby blues?

Answer 5

mood swings
bursting into tears
feeling low and anxious
over reacting to things

no treatment needed

Question 6

who gets post-natal depression?

Answer 6

around 10-15% of women after birth
symptoms of depression-low mood, lack of energy, anhedonia, lack of appetite, weight loss, early morning wakening, lack motivation, feelings of hopelessness/helplessness.
symptoms present for at least 2 weeks, often start within 1 or 2 months of giving birth
can last many months
most get better without any tment in 3-6mnths
require good support from friends and family, exercise, use of self help books
treatment may be given with counselling, CBT or medication

Question 7

who gets postpartum psychosis?

Answer 7

0.1% of women after having a baby

Question 8

management of postpartum psychosis?

Answer 8

• admission required, ideally to a specialist mother and baby unit
• pharmacological tment-antipsychotic and/or mood stabilising drug, note toxic effects if breastfeeding-lithium toxicity, clozapine associated with agranulocytosis, valproate assoc. with risk of haematological disorders in newborn.
• education and supportive therapy, may be r/f to children and families social services-can be assessed for support and ensure safe plan for baby if mum too unwell to care for them.
• may be role for supportive psychotherapy during and after recovery.