Psychiatry- Perinatal and Postnatal Flashcards
What is baby blues
Distressing but NORMAL feeling experienced by 50-80% of mothers
Presentation of baby blues
• Onset 3-5 days post-natal (within first 10)
• Lasts <2 weeks:
◦ Any more would be post-partum depression
• Emotional lability: mood all over the place
• Irritability
• Insomnia
• Weepiness
• Fatigue
Management of baby blues
1) Reassurance:
• Often self-resolves without treatment within 2 weeks of birth
What is post-natal depression
Prolonged low mood within first year of birth
Risk factors for post-natal depression
RISK FACTORS:
• Domestic violence
• Younger age
• Childhood trauma
• Lack of social support
• Higher levels of oxytocin mid pregnancy associated with early PND
(Common)
Time of presentation of post-natal depression
• Most present 6-8 weeks postpartum
◦ Onset can be from pregnancy to 1 year post-natal
Screening test for post-natal depression
• Edinburgh Postnatal Depression Scale
Presentation of post-natal depression
• Core symptoms (>2 weeks):
• Low mood
• Anhedonia
• Low energy
• Poor sleep
• Poor appetite
• Weight loss
• Poor concentration
• Guilt
• Reduced self-confidence
• Poor self-care
• Agitation or retardation
• Suicidal/self-harm thoughts
Management of mild post-natal depression
• Advise about local social support:
◦ Local children’s centres
◦ Mother and baby groups
◦ Health visitor
• Follow-up
Management of moderate post-natal depression
• CBT
• Consider SSRIs:
• Sertraline or Paroxetine can be used during breastfeeding
Management of severe post-natal depression
• Consider admission to mother and baby unit
What is post-natal psychosis
Psychiatric emergency characterised by psychotic symptoms in post-natal period
Risk factors for post-natal psychosis
RISK FACTORS:
• Childbirth
• Bipolar disorder 1 or schizoaffective disorder
• Family history
• Parity (usually first birth)
• Domestic abuse or childhood trauma
Time of presentation of post-natal psychosis
• Most present 2 weeks post-natal (but can present up to 1 year post-natal)
Presentation of post-natal psychosis
• Anxiety:
‣ Can be first presentation
‣ Also staring blankly, not sleeping, off behaviour
• Mania
• Paranoid psychosis
• Perplexity
• Severe mood swings
• Disordered perception: Auditory hallucinations
Investigations for postnatal psychosis
• Screen for obstetric complications to rule out organic causes of confusion
Management of post-natal psychosis
• Mental State Examination
• Admission to Mother and Baby Unit:
◦ If risk to baby or others is too high, admit to psychiatric intensive care unit
• Urgent treatment with antipsychotics
◦ Rapid tranquilisation with Benzodiazepines may be needed for agitation
◦ Olanzapine or Quetiapine are safe for breastfeeding
• Collateral history + Social services referral
