Postnatal depression and psychosis Flashcards
Green
What psychiatric problems are common in puerperium?
‘Third day blues’
Postnatal depression
Puerperal psychosis
What are third day blues?
Temporary emotional lability (50% affected)
Support and reassurance required
How common is PND?
10% (most do not present)
Questionnaires such as Edinburgh postnatal depression scale (EPDS) help identify problem
What increases the risk of PND?
Social/emotional isolation
Previous Hx (associated with depression later in life)
After complicated pregnancy
What other differentials should be considered for a patient with PND?
Postpartum thyroiditis
What symptoms does PND present with?
Tiredness
Guilt
Feelings of worthlessness
How is PND treated?
Social support
Psychotherapy
Antidepressants (SSRIs e.g. fluoxetiene)
If previous Hx of PND, see psychotherapist before delivery, arrange MDT plan for discharge
Urgent referral needed if recent significant change in mental state/symptoms/thoughts of self harm/perceived incompetence as mother/distance from infant
How common is puerperal psychosis?
0.2% mothers affected (1/500 births)
How does puerperal psychosis present?
High suicidal drive Severe depression Mania Schizophrenic symptoms (rare) Exclude psychotic delerium secondary to infection
When does puerperal psychosis present?
50% present by 7d postpartum
90% have presented 3m postpartum
Onset usually sudden and deterioration rapid
Which mothers are more likely to get puerperal psychosis?
Primips with family Hx
How is puerperal psychosis managed?
Referral to community psych team
Major tranquilizers (after exclusion of organic illness
Recovery good, but 10% relapse in future pregnancies
How many patients with puerperal psychosis develop PND?
10% (of these, a third to a half develop severe PND)
