Female-specific psychiatric disorders

Question 1

Why are they actually not female-specific?

Answer 1

While they refer to disorders of pregnancy/post-partum period, many aspects of these psychiatric disorders can be found in new fathers.

Question 2

What are the baby blues?

Answer 2

Up to 50% of women in days after birth: mood swings, sadness, appetite loss, sleep problems. Symptoms not severe and disappear in a short time without medication.

Question 3

What is postpartum depression?

Answer 3

o Affects 10-40% of women, with onset up to 1 year after birth.
o Symptoms more severe and prolonged than for baby blues, and require treatment.
o Symptoms may also include loss of interest in baby and thoughts of harming baby/oneself.
o Risk factors include personal/family history of depression, exposure to stressful life events, lack of support, young age.
o Genetic risks (porcine and rodent models).

Question 4

Postpartum/puerperal psychosis frequency and symptoms.

Answer 4

o Affects 1-2 in every 1000 women, with onset usually within 2 weeks of birth.
o Symptoms extremely severe (one of the most severe recognised psychiatric disorder).
 Hallucinations and delusions (often infant-oriented, e.g., infant is the antichrist).
 Mood swings (from depression to mania)
 Confused thinking, cognitive disorganisation.
 Suicidal and infanticidal ideation.

Question 5

Why is it likely that puerperal psychosis has a biological basis?

Answer 5

 Rapid onset and proximity to childbirth.
 Dissociable from social and cultural factors.
 High relapse rate.

Question 6

What are the risk factors for pp?

Answer 6

 Previous history of bipolar disorder or schizoaffective disorder.
 Primiparity (those having their first child are most at risk, potentially a biological root, but may be an ascertainment bias; those who’ve had PP will be more closely monitored during subsequent births)
 Increased age.
 Stressful events in the puerperium.
 Maternal sleep problems.
 Rapid changes in circulating steroid hormone (oestrogen) levels- as soon as the placenta is ejected, massive reduction of circulating steroid hormones.
 Thyroid dysfunction, e.g. in those with autoimmune disorders affecting the thyroid.
 Preeclampsia, i.e. increased blood pressure during pregnancy.

Question 7

What are the treatment options for PP, why are drugs problematic?

Answer 7

 Antipsychotics, antidepressants, mood stabilising drugs.
• NB with pharmacological approaches: some are teratogens that can cause mutations. Others can be passed on through breast milks.
 Cognitive behavioural approaches.