Perinatal Mental Health Flashcards
What is postpartum/puerperal psychosis?
Severe mental illness
Develops acutely in postnatal period
Psychiatric emergency
Psychotic features present
Close link with bipolar
When is the risk of postpartum psychosis greatest?
In first few weeks following childbirth
What are the risk factors for postpartum psychosis?
History of mental illness and hospitalisation
Family history
First degree relative with bipolar
Pasty history of bipolar or postpartum psychosis
What are possible contributing factors to postpartum psychosis?
Manifestation of underlying bipolar disorder possibly
Sleep deprivation, hormonal changes, stress, genetic influences
What is the presentation of postpartum psychosis?
Typically within first postnatal month
Depressive in nature - Withdrawal Confusion Loss of competence Distraction Catatonia
Manic - elation, lability, agitation, rambling
Delusions
Hallucinations
Odd beliefs about the baby
What are the differentials of postpartum psychosis?
Major depression with psychosis
Schizophrenia
Bipolar disorder with postpartum onset
Organic causes Stroke Electrolyte imbalances Hypoglycaemia/hyper Thyroid/parathyroid B12, folate, thiamine Sepsis
Investigations to confirm diagnosis, bloods, CT/MRI rule out organic causes
What is the management of postpartum psychosis?
Urgent assessment, referral, admission ideally to mother and baby unit
Pharmacological for psychosis - antipsychotic, mood stabilisers
Choice of medication must take breast feeding into account, do not give clozapine
Can consider ECT
Supportive psychotherapy
What is postnatal depression?
Development of a depressive illness following childbirth and may form part of a bipolar, or unipolar illness
Onset of depressive episode within four weeks of childbirth
What are the risk factors for postnatal depression?
Previous hx mental illness
Psychological disturbance during pregnancy
Poor social support and relationship with partner
Baby blues
Recent major life events
Unplanned pregnancy Unemployment Not breastfeeding Antenatal stress Substance misuse Neonatal illness
What is the presentation of postnatal depression?
Low mood, anhedonia, anxiety, disturbed sleep
Loss of appetite, poor concentration, low self-esteem, loss of libido
Remember some symptoms can be normal in early postnatal period
What should be asked about postnatal depression at booking and postnatal checks?
Often been bothered by feeling down, depressed or hopeless
Bothered by having little interest or pleasure in doing things
Feeling nervous, anxious or on edge
Not been able to stop or control worrying
How should a patient be assessed for mental health problems postnatal?
Past history, family history Physical well being Alcohol and drug misuse Woman's attitude to and experience of pregnancy Mother-baby relationship Relationships, social isolation Domestic violence
What is the management of postnatal depression?
Empowerment, remove stigma, allow role in treatment
Communication
Family support
Consider self-help if mild, consider antidepressant moderate
If severe - consider
High intensity psychological intervention - CBT and interpersonal psychotherapy over 9-12 week period
Antidepressant treatment if risks understood, psychological therapies declined or not worked
What is postpartum blues?
Very common self-limited condition
Not as severe as depression
Symptoms start within a few days after childbirth
What are the signs and symptoms of postpartum blues?
Tearfulness Mood swings Irritability Anxiety Questioning ability Difficulty making choices
