Post-Partum Mental Health Problems

Question 1

What can be used to screen for postnatal depression?

Answer 1

The Edinburgh Postnatal Depression Scale

Question 2

Tell me about the Edinburgh Postnatal Depression Scale

Answer 2

1. 10 iten questionnaire with a maximum score of 30
2. Indicates how the mother has felt over the previous week.
3. Score >13 indicates a ‘depressive illness of varying severity.
4. Sensitive and specifity are >90%
5. Includes questions about self harm.

Question 3

Tell me about the Baby blues and how you manage it?

Answer 3

1. Seen in 60-70% of women.
2. Seen 3-7 days following birth.
3. More common in primips.
4. Treatment - reassurance and support. Health visitor has a key role in supporting the mother.

Question 4

Tell me about postnatal depression?

Answer 4

1. Affects 10% of women.
2. Most cases start within a month and typically peaks at 3 months.
3. Treatment
   
   • Reassurance and support.
   • Cognitive behavioural therapy.
   • If severe sertraline and paroxetine may be useful.
     
     • Secreted in breast milk but not thought to be harmful. Paroxetine in particular has a low milk/plasma ratio.
     • Avoid fluoxetine due to long half life.

Question 5

Tell me about Puerpal Psychosis.

Answer 5

1. Affects ~ 0.2% of women.
2. Onset usually within the first 2-3 weeks after birth.
3. Features include severe swings in mood (similar to bipolar depression) and disodered perception. (e.g. auditory hallucinations)
4. Treatment - admission to hospital is usually required.
5. Prognosis- There is around 20% risk of recurrence in future pregnancies.