Baby blues, Post Partum Depression, Puerperal psychosis

Question 1

Definition

Answer 1

Low mood in the postnatal period:
- Baby blues is seen in the majority of women in the first week or so after birth
- Postnatal depression is seen in about one in ten women, with a peak around 3 months after birth
- Puerperal psychosis is seen in about one in a thousand women, starting a few weeks after birth

Question 2

Baby blues presentation

Answer 2

Affects 50% of women in the week after birth, especially first time mothers.
Presents with:
- Mood swings
- Low mood
- Anxiety
- Irritability
- Tearfulness

Question 3

Causes of baby blues

Answer 3

• Significant hormonal changes
• Recovery from birth
• Fatigue and sleep deprivation
• The responsibility of caring for the neonate
• Establishing feeding
• All the other changes and events around this time.

Question 4

Baby blues treatment

Answer 4

Symptoms are usually mild, only last a few days and resolve within two weeks of delivery. No treatment is required

Question 5

Postnatal depression symptoms

Answer 5

Postnatal depression is similar to depression that occurs outside of pregnancy, with the classic triad of:
- Low mood
- Anhedonia (lack of pleasure in activities)
- Low energy
Typically affects around 3 months after birth.

Question 6

Postnatal depression treatment

Answer 6

• Symptoms should last at least two weeks before postnatal depression is diagnosed.
• Treatment is similar to depression at other times:
  = Mild cases may be managed with additional support, self-help and follow up with their GP.
  = Moderate cases may be managed with antidepressant medications (e.g. SSRIs) and cognitive behavioural therapy.
  = Severe cases may need input from specialist psychiatry services, and rarely inpatient care on the mother and baby unit.

Question 7

Diagnostic criteria

Answer 7

The Edinburgh postnatal depression scale:
- Used to assess how the mother has felt over the past week, as a screening tool for postnatal depression.
- Ten questions, with a total score out of 30 points.
- 10 or more suggests postnatal depression.

Question 8

Puerperal psychosis

Answer 8

Rare but severe illness that typically has an onset between two or three weeks after delivery.
Women experience full psychotic symptoms:
- Delusions
- Hallucinations
- Depression
- Mania
- Confusion
- Thought disorder

Question 9

Puerperal psychosis treatment

Answer 9

• Admission to the mother and baby unit
• Cognitive behavioural therapy
• Medications
  = antidepressants,
  = antipsychotics or mood stabilisers)
  = Electroconvulsive therapy (ECT)

Question 10

Mother and baby unit

Answer 10

• Specialist unit for pregnant women and women that have given birth in the past 12 months.
• Designed so mother and baby can remain together and continue to bond.
• Mothers supported to continue caring for their baby while they get specialist treatment.

Question 11

Preparation during pregnancy

Answer 11

Women with existing mental health concerns before/during pregnancy referred to perinatal mental health services for advice and specialist input:
- psychiatric medications (SSRIs, antipsychotics, lithium)
- followed up closely from midwifes and health visitors post birth.

Question 12

Risk of taking SSRIs during pregnancy

Answer 12

• Neonatal abstinence syndrome (AKA neonatal adaptation syndrome).
• Presents in the first few days after birth
• Sx:
  = irritability
  = poor feeding.
• Neonates are monitored for this after delivery.
  = Supportive management is usually all that is required.