Post-natal Psych

Question 1

When is post natal depression seen?

Answer 1

1/10 suffer in the year after birth ~1 month pp
RF:
Personal or FHx of PND / depression
Younger maternal age
Recent life events
Marital discord
Poor social support

Question 2

What are the hallmarks of post natal depression?

Answer 2

Similar to normal depression: anergia, anhedonia, low mood
Marked: fatigue, irritability, anxiety
Depressive cognitions related to baby!!: guilt/ feeling a failure
Recurrent intrusive thoughts: about harming the baby

Question 3

How is post natal depression managed?

Answer 3

As for general depression
Take care in prescribing antidepressants in those breastfeeding
Sertraline, paroxetine
Low dose amitriptyline probably safe

Question 4

When should hospital admission be considered in post natal depression?

Answer 4

Severe depression with suicidal or infanticidal ideation

Mother and baby unit is optimal, allowing treatment without separation
Enables bonding, staff support and risk management
Early effective treatment essential as it can affect the baby’s attachment, their development and personality

Question 5

When is puerperal psychosis seen?

Answer 5

1/500-1000 - 0.2%
In fortnight after childbirth
Highest risk: personal or fhx of puerperal psychosis/BPAD
Other RF:
Puerperal infection, obstetric complications

Question 6

How does puerperal psychosis present?

Answer 6

Rapid onset
Insomnia, restlessness, perplexity?
Later psychotic sx: delerium/affective/schizophreniform
Symptoms can fluctuate dramatically and quickly

Question 7

What organic causes should be excluded in apparent puerperal psychosis?

Answer 7

Delerium

Substance misuse: intoxication/ withdrawal

Question 8

How is postnatal psychosis managed?

Answer 8

Depending on presentation:
Antipsychotics, antidepressants, lithium
Possibly benzos to control agitation
Admission to mother and baby unit!
20% risk of recurrence

Question 9

What is the prognosis in postnatal psychosis?

Answer 9

Most recover in 6-12 weeks

Overall risk recurrence= 1/3

Question 10

What are ‘the Blues’?

Answer 10

3-7 days of:
Irritability, tearfulness, lability and difficulty sleeping
Seen in 50-75%, more in primips
Explain and reassure
Health visitor support

Question 11

What is the Edinburgh PND scale?

Answer 11

10 item questionnaire /30
>13 = depressive illness
90% sensitivity + specificity