Perinatal psychiatry

Question 1

What 3 main conditions should you consider when evaluting a woman’s pyschological symtoms who has just given birth?

Answer 1

• Postnatal blues
• Postnatal depression
• Puerperal psychosis

Question 2

Symptoms of post natal blues?

Answer 2

Typical sx:

• emotional lability
• tearfulness
• mild anxiety
• irritability

Sx generally mild and not pervasive

Question 3

How common is postnatal blues?

When does it occur?

How long does it last?

Answer 3

• Common occurrence in postpartum period, 50-80%
• Most frequently present about Day 5 but usually present between Day 3 to 10
• The Blues generally last 48 hours and no specific treatment is required

Question 4

What causes postnatal blues?

Answer 4

Attributed to hormonal changes in combination with physical and emotional exhaustion

Question 5

What are risk factors for postnatal depression?

Answer 5

• If woman has suffered previous severe depressive illness or PND illness, risk of developing a further illness following this delivery is around 50%
• Depression history
• Psychiatric disorders
• Traumatic birth/pregnancy

Question 6

When does postnatal depression occur?

Answer 6

• Peak onset b/w 2-4w postpartum
• secondary peak around 3m postpartum

Question 7

How long does it take to recover from postnatal depression?

Answer 7

• With prompt and appropriate treatment 2/3 of illnesses will resolve within 2-3m
• Without treatment, it can take 6m or longer to recover

Question 8

How is puerperal psychosis characterised?

Answer 8

Sudden onset of:

• behavioural disturbances
• hallucinations
• delusions
• fear
• perplexity

Question 9

What does puerperal psychosis occur?

Answer 9

• 50% present by day 7
• 75% present by day 16
• 95% present by day 90

Question 10

What is the risk of post-partum pychosis if the patient has Bipolar Disorder or previous postpartum psychosis

Answer 10

50%

(99% of postpartum psychoses are either bipolar or schizoaffective disorder)