Baby blues, post natal depression, puerperal psychosis

Question 1

What are the definitions and RF of Baby blues, post natal depression, puerperal psychosis

Answer 1

Baby blues- mild, self limiting low mood postnatal (50% of new mothers)
Postpartum depression (PPD)- pervasive low mood in postnatal period (10% new mums)
Puerperal pyschosis - acute psychotic illness in postnatal (0.1% new mums)

RF-
BPAD- for psychosis
Past psych Hx, previous PPD, Psychosis
Primigravidy (baby blues)
antenatal/delivery complications
Social isolation
Antipsychotic use (esp risperidone)

Question 2

Sx of Baby blues, post natal depression, puerperal psychosis

Answer 2

Blue - onset 3-5 days, last 14d MAX
Insomnia, fatigue, tearful/labile, anxiety, irritable, impaired focus
if >14d, its PPD

PPD –>2W Baby blues- with anergia, anhedonia, low mood, etc
onset up to 1y post pregnancy -recover fast

Puerperal Psychosis- 80% have BPAD/schizo
delusions, hallucinations, self harm, -PSYCHOTIC
Onset 2-3 days PostPartum -> recover 6-12w
tend to be in 3 patterns-
delirium
affective (like psychotic depression)
Schizophreniform

Question 3

Ix of Baby blues, post natal depression, puerperal psychosis

Answer 3

mainly clinical + clinical aids - 
MSE
Depression rating scales -
screening q
Edinburgh post natal depression scale
Safety net with RISK aSSESSMENT - for self, baby, delusions, etc

Question 4

Mx of Baby blues, post natal depression, puerperal psychosis

Answer 4

Blue - reasurance and support -self limiting
PPD- treat as normal depression, approach as severity - breast feeding safe (SERTRALLINE, Paroxetine)

Psychosis - inpatient admission via psych team - follow psychosis Mx

Question 5

Complications and prognosis of Baby blues, post natal depression, puerperal psychosis

Answer 5

complications- poor emotional attachement to child, suicude, long term psych issues, Infanticide

prog- 30% depression reccurence
20% psychosis reccurence