Post Partum Psychiatric Disorders Lecture Powerpoint

Question 1

Post partum psychiatric syndromes must have onset within ___ weeks of delivery, even if they aren’t recognized for 3-4 months

Answer 1

4 weeks

Question 2

2 distninct postpartum psychiatric syndromes

Answer 2

Post partum psychosis

Post partum depression

Question 3

Postpartum depression

Answer 3

Similar to other major and minor depressions, symptoms must be present most of day for 2 weeks, develops in 10-15% of women post delivery, incidence is slightly higher than the usual 6 month prevalence for depression in general population

Question 4

Patients with a history of mood disorder and previous post partum depression have a ___ chance of new onset post partum depression after delivery

Answer 4

very high

Question 5

Post partum blues (50-80% of women)

Answer 5

Usually onset day 4 post delivery and resolved by day 10, transient state of tearfulness, anxiety, irritation, and restlessness, does not interfere with ability to care for newborn and requires only supportive treatment, but if lasting longer than 2 weeks suggests postpartum depression

Question 6

Risk factors of postpartum depression (12)

Answer 6

• under 20
• unmarried
• comes form large family
• received poor parental support and attention
• low self esteem
• hyperemesis gravidarum
• lack of extended family
• pre/eclampsia
• history of infertility
• 1st baby
• previous history of family or personal mood disorders
• perinatal death

Question 7

Clinical presentation for postpartum depression

Answer 7

• Depressed mood
• lack of pleasure or interest
• sleep disturbance (insomnia or hypersonmia)
• weight loss
• feelings of worthlessness
• thoughts of death and suicide
• ANY type of depression screen can detect this cause it is so similar

Question 8

Postpartum depression and feelings about the infant (3)

Answer 8

• ambivalent or neg feelings toward the infant
• may have intrusive and unpleasant fears or thoughts about harming infant but rarely actually do
• often interfere with ability to care for newborn and self

Question 9

Postpartum psychosis

Answer 9

Dramatic onset emerging early and intensely, resembles rapidly evolving manic episode with symptoms of restlessness, insomnia, irritability, rapidly shifting depression or elated mood, disorganized behavior, delusional beliefs regarding infant or auditory hallucinations that instruct to harm self or child, HIGH risk for infanticide or suicide

Question 10

Edinburgh postnatal depression scale

Answer 10

Indicated for all mothers during post partum period, too often dismissed as normal and may persist for months before initiation of therapy, screening during pregnancy can help identify at risk population, a score greater than 12 indicating further workup or positive answer to question 10 about suicide ideation

Question 11

Postpartum depression symptom treatment options (6)

Answer 11

• non pharm support groups or individual or group therapy for mild to moderate symptoms
• SSRI first line for severe
• SNRI second
• tricyclic antidepressants for sleep disturbance
• short course lorazepam or clonazepam in severe anxiety
• electroconvulsive therapy

Question 12

Treatment of puerperal psychosis (2)

Answer 12

• immediate inpatient care
• lithium

-HIGH risk of suicide or infanticide

Question 13

Post partum depression drugs classes that are relatively safe to use while breastfeeding (2)

Answer 13

• TCA

- SSRI