Postpartum MH Flashcards
What is postnatal depression?
development of a depressive illness following childbirth (within 1y)
Epidemiology of postnatal depression
~10% women
6 Risk factors for postnatal depression
Hx MH problems.
Psychological disturbance during pregnancy.
Poor social support.
Poor relationship with partner.
Baby blues.
Recent major life events.
Give 6 symptoms of postnatal depression
Low mood.
Loss of enjoyment + pleasure.
Low energy levels.
Difficulty bonding with baby
Withdrawal from social contacts
Thoughts of harming baby
What tool can be used to screen for pregnancy/ postnatal depression?
Edinburgh postnatal depression scale
indicates how the mother has felt over the previous week
>13 indicates depressive illness
What is management for sub-threshold depressive symptoms, or mild depression postnatally?
Self-guided help
What is management for women with a history of severe depression presenting with depressive symptoms?
TCA or SSRI
What is the management for moderate or severe postnatal depression?
High-intensity psychological intervention (e.g. CBT)
TCA, SSRI or (S)NRI if preference for meds/ declines psychological intervention
If severe: admit to mother + baby unit
What SSRIs should be used in the postnatal period?
Sertraline
Paroxetine
Which SSRIs should be avoided in the postnatal period?
Fluoxetine (due to long half life)
What are baby blues?
Emotional lability, low mood, tearfulness + anxiety
Occurs within 2w of birth
Often recover promptly
What is management of baby blues?
Reassurance + support
Epidemiology of baby blues
60-70% women
More common in primips
What is puerperal psychosis?
Psychosis often with mania +/or depressive Sx manifesting within days to 2-3w of birth
What causes puerperal psychosis?
May be linked to hormonal changes, causing chemical imbalances in brain
What is the risk of recurrence of puerperal psychosis?
1 in 2
(50%)
Give 3 symptoms of puerperal psychosis
Severe mood swings
Hallucinations
Delusions e.g. baby is possessed
Epidemiology of puerperal psychosis
0.1%
(1 in 1000)
Give 4 risk factors for puerperal psychosis
Hx of puerperal psychosis
Type I Bipolar disorder
Schizoaffective disorder
FH puerperal psychosis
What is management of puerperal psychosis?
Admit to mother + baby unit
Benzos for agitation (Lorzaepam)
Antipsychotics: Olanzapine (Lithium if NOT breastfeeding)
Referral to Children + Families Social Service
What is the prognosis of puerperal psychosis?
Most recover in 6-12w
What is the management for a woman taking Lithium for Bipolar disorder who has become pregnant?
Stop Lithium gradually over 4w
Switch to an antipsychotic- Haloperidol, Risperidone
Are antipsychotics safe in pregnancy?
Antipsychotics are safe in pregnancy (except clozapine)
What are the risks of taking Lithium during pregnancy and postpartum?
Ebstein’s anomaly
Lithium highly expressed in breast milk
What monitoring is required for bipolar women during pregnancy?
More frequent- every 4w
Weekly from 36w
What are pregnant women with bipolar disorder at higher risk of?
Puerperal psychosis
Postnatal depression
Relapse
