Psychiatric problems of the puerperium

Question 1

Third day blues

Answer 1

Temporary emotional lability
50% women
Support and reassurance

Question 2

Postnatal depression

Answer 2

10% women, but most don’t present
More common on women who are emotionally or socially isolated, have a previous history or after pregnancy complications
Postpartum thyroiditis should be considered
Questionnaires (eg Edinburgh Postnatal Depression Scale, EPDS) are helpful
Tiredness, guilt, feelings of worthlessness
Social support, psychotherapy and antidepressants
Frequently recurs and associated with depression later in life

Question 3

Suicide

Answer 3

Major cause of death postpartum
Most women have history of depressive, bipolar or other psychiatric disorder (record at booking visit)
In general, psychiatric drugs should be continued in pregnancy, but this decision should be made preconceptually. SSRIs (eg fluoxetine) preferred.
Women with a history of psychiatric illness should see a psychiatrist before delivery and a MDT plan for postnatal discharge arranged

Question 4

Puerperal psychosis

Answer 4

0.2% women
Abrupt onset of psychotic symptoms, usually around the fourth day
More common in primigravid women with a family history
Psychiatric admission and major tranquilisers after exclusion of organic illness
Usually full recovery, some develop mental illness in later life
10% relapse following subsequent pregnancy