Postnatal depression and Puerperal psychosis Flashcards
What is postnatal depression?
Depression arising in months following childbirth.
What is the aetiology of postnatal depression?
Psychosocial factors play largest role. Biological theories on sudden drop of P+O.
What is the epidemiology of postnatal depression?
15% mothers, usually within 3 months of birth.
What may you find in the history and exam of postnatal depression?
May develop insiduously over weeks or exacerbation of baby blues.
Sleep/energy/enjoyment/libido changes. Cognitive features: guilt, self loathing, anger.
O/E depressive features, obsessional thoughts, harming the baby thoughts.
What investigations of postnatal depression?
As for depression.
What is the management of postnatal depression?
Assess risk to mother and child. Mild do not require intervention.
Moderate depresson can be managed at home but can need admission to mom and baby unit.
MDT care, screening for depression inclusion at 6wk baby check. ?antidepressant meds.
What are the complications and prognosis of postnatal depression?
Harm to baby and mother
Attachment difficlties for baby.
Marital/relationship problems. Maternal suicide or infanticide.
Insecure attachment at 18 months.
10% mat have course for >6 months if untreated. .
What is Puerperal psychosis?
Psychotic disorder arising after childbirth.
What is the aetiology of Puerperal psychosis?
Strong asociation with bipolar affective disorder (>genetic predisposition)
What is the epidemiology of Puerperal psychosis?
Associated with past Hx, bipolar, FHx, primigravida. 1/500 births.
What may you find in the history and exam of Puerperal psychosis?
Usually within 1 month of delivery but may be in first few days. Rapid fluctuations of mood and abrupt onset of disturbed behavior.
Marked restlessness and fear. Mixture of manic and depressive features. Delusions and hallucinaitons may be based around baby or auditory hallucinatory commands. Perplexed but not cognitively impaired.
What investigations of Puerperal psychosis?
Rule out delirium due to infection.
What is the management of Puerperal psychosis?
Assess risk for mother and child.
Admit (with or without MHA) mother and baby unit. Medicate as appropriate (AD, MS, AP). ECT if medication has failed. Supportive psychotherapy.
What are the complications and prognosis of Puerperal psychosis?
Harm, neglect of child, infanticide, suicide. Lack of bonding and attachment disorders.
Most settle in 6wk and fully recover by 6m. Recurrence rate is 50% for subsequent normal psychosis, 25% for subsequent puerperal psychosis.
