POSTPARTUM PSYCHOSIS Flashcards
Baby blues
- Incidence
- Prognosis
- Diagnosis confirm
- 70 % postnatal women
- complete recovery/self lmiting
- diagnosis by time as rapid improvement
Baby blues
starts which day
symptoms
- 3rd to 5th day , may be upto 2 weeks, but improvement
- Feeling of anxiety, loss of concentration , inadequace
depression
10% women postnatally
psychological disease prevalence depends overall
- positive family HX
- Positive personal HX
- taking medications
postnatal blues VS postnatal depression
NOT in same woman
puerperial psychosis prevalence
- 2/1000, 0.5 %
- incidence increase if past hX of puerperial psychosis then 50 %
- HX of bipolar disorder then 25 %
puerperial psychosis diagnosis
delusions, hallucinations, someone talking evil things, suicidal ideation, homicide
symptoms common to depression and psychosis
lack of concentration, labile moods
Baby blues MX
family support reassurance friends improve by time then discharge
depression MX
- admission to hospital
- psychological counselling
- group therapy
- antidepressant after psychological counselling
p. psychosis MX
- First step separate the baby,
- Admit to mental health unit, in labour ward
- psychological counselling
- referral consultation by psychiatrist (obs last step)
- antipsychotic medicine by psychiatrist (OBs can prescribe antidepressant)
psychological disorders medicine
antidepressant
antipsychotics
mood stabilizers
antidepressant
- TCA: impiramine, amytryptyline
- SSRI: fluxetine, paroxetine
SSRI in pregnancy
paroxetine contraindicated in pregnancy and breast feeding
In pregnancy what anti-depressant more suitable in pregnancy
SSRI:
- TCA more teratogenic
- toxicity threshold, safety margin is limited
During lactation what antidepressant
TCA superior b/c excretion in breast milk less than SSRI.
SSRI in large amount almost 1/4 th
Antipsychotics
- Typical anti psychotics: Haloperidol, chloropromazine
- New generation: olanzapine
olanzapine
gestational diabetes
OGTT regularly when receiving.
olanzapine depot
a
Antipsychotic medications: phenothaizine, chloropromazine, - Seeking infertility then what hormone important to check
- hyperprolactinemia
CBT indication
1 - mild depressive illness
2 - generalized anxiety disorder
3 - CBT is only treatment in post- trauma stress disorder
4 - Only treatment in eating diorder
mode stablizer
lithium carbonate (most important) carmazapine (not used these days)
lithium carbonate
- strong mode stablizer, 50% within 1 mont
- 50% severe rebound and detrioration
- regularly taking preconception should continue,
- so follow up levels, every 4 weeks, all through pregnancy, from 36 weeks weekly until delivery.
- stopped in labour
- measure 12 hours post delivery
- start ASAP
- ebstein cardiac anomaly
Sertraline , ssri
class 3 FDA
