Perinatal Psychiatric Disorders Overview

Study Notes

Perinatal psychiatric disorders include postpartum blues, postpartum depression, and postpartum psychosis.
Aim to understand definitions, clinical features, differential diagnosis, and treatment options.

Baby blues are mood symptoms occurring in the first 4 to 6 weeks postpartum.
Symptoms include transient emotions, rapid mood changes, tearfulness, irritability, anxiety, insomnia, fatigue, loss of appetite, and feelings of being overwhelmed.
Onset usually occurs after the third postpartum day, peaks by day 5, and typically resolves by day 10 without professional treatment.
Symptoms attributed to hormonal changes, stress of childbirth, and new caregiving responsibilities.
Persistent symptoms beyond 2 weeks warrant evaluation for postpartum depression.

Characterized by depressed mood, anhedonia, suicidal thoughts, feelings of guilt, and insomnia.
Onset typically occurs within 12 weeks post-delivery.
Episodes increase the risk of future major depression.
Risk factors include lack of support, severe psychosocial problems, chronic interpersonal difficulties, history of depression, family history of depression, and history of childhood sexual abuse.

Occurs in approximately 0.1 to 0.2% of postpartum women and is a psychiatric emergency.
Often associated with bipolar disorder or unipolar psychotic depression.
Onset occurs between 2 to 3 weeks, almost always within 8 weeks postpartum.
Prodromal symptoms include fatigue, insomnia, restlessness, and emotional volatility (tearfulness, lability).
Later symptoms may include suspiciousness, confusion, incoherence, irrational statements, and obsessive thoughts about the baby's welfare.
Delusions can involve beliefs about the baby's health (e.g., believing the baby is dead or defective) and may feature grandiose or persecutory themes.
Auditory and visual hallucinations may involve commands to harm the baby or self.
Treatment involves antipsychotic medications, lithium, and sometimes antidepressants, with possible hospitalization for suicidal patients to prevent suicide attempts.