Flashcards in Post-natal Psych Deck (11)
When is post natal depression seen?
1/10 suffer in the year after birth ~1 month pp
Personal or FHx of PND / depression
Younger maternal age
Recent life events
Poor social support
What are the hallmarks of post natal depression?
Similar to normal depression: anergia, anhedonia, low mood
Marked: fatigue, irritability, anxiety
Depressive cognitions related to baby!!: guilt/ feeling a failure
Recurrent intrusive thoughts: about harming the baby
How is post natal depression managed?
As for general depression
Take care in prescribing antidepressants in those breastfeeding
Low dose amitriptyline probably safe
When should hospital admission be considered in post natal depression?
Severe depression with suicidal or infanticidal ideation
Mother and baby unit is optimal, allowing treatment without separation
Enables bonding, staff support and risk management
Early effective treatment essential as it can affect the baby's attachment, their development and personality
When is puerperal psychosis seen?
1/500-1000 - 0.2%
In fortnight after childbirth
Highest risk: personal or fhx of puerperal psychosis/BPAD
Puerperal infection, obstetric complications
How does puerperal psychosis present?
Insomnia, restlessness, perplexity?
Later psychotic sx: delerium/affective/schizophreniform
Symptoms can fluctuate dramatically and quickly
What organic causes should be excluded in apparent puerperal psychosis?
Substance misuse: intoxication/ withdrawal
How is postnatal psychosis managed?
Depending on presentation:
Antipsychotics, antidepressants, lithium
Possibly benzos to control agitation
Admission to mother and baby unit!
20% risk of recurrence
What is the prognosis in postnatal psychosis?
Most recover in 6-12 weeks
Overall risk recurrence= 1/3
What are 'the Blues'?
3-7 days of:
Irritability, tearfulness, lability and difficulty sleeping
Seen in 50-75%, more in primips
Explain and reassure
Health visitor support