Perinatal Psychiatric Disorders PDF

Perinatal psychiatric disorders Dr. Noor Ali Hasan M.B.Ch.B., F.A.C.M.(Psych) Objectives 1.To define perinatal psychiatric disorders. 2.To know the clinical features. 3.To determine the differential diagnosis. 4.To know how to treat. Three main psychiatric disorders affecting women in the p...

Perinatal psychiatric disorders Dr. Noor Ali Hasan M.B.Ch.B., F.A.C.M.(Psych) Objectives 1.To define perinatal psychiatric disorders. 2.To know the clinical features. 3.To determine the differential diagnosis. 4.To know how to treat. Three main psychiatric disorders affecting women in the peripartum period: 1. postpartum blues. 2. Postpartum depression 3. Postpartum psychosis Postpartum blues (Baby blues) ✓ Baby blues is the most common constellation of mood symptoms experienced by women in the immediate postpartum period (4 to 6 weeks following delivery). ✓Baby blues, include transient symptoms and rapid mood shifts, including tearfulness, irritability, anxiety, insomnia, lack of energy, loss of appetite, and the general experience of feeling overwhelmed— particularly with regard to newborn caregiving tasks ✓Onset typically occurs after the third postpartum day, after the mother has left the hospital after delivery. Symptoms typically peak by day 5 and spontaneously resolve by day 10 postpartum. ✓ These feelings, have been ascribed to rapid changes in women’s hormonal levels, the stress of childbirth, and the awareness of the increased responsibility that motherhood brings. ✓No professional treatment is required other than education and support for the new mother. ✓ No conclusive evidence indicates that “baby blues” will lead to a subsequent episode of depression but if the symptoms persist longer than 2 weeks, evaluation is indicated for postpartum depression. Postpartum depression Characterized by a depressed mood, anhedonia, suicidal thoughts, thoughts of harming the baby, feeling of guilt, insomnia. The onset is generally within 12 weeks after delivery. Several studies do indicate that an episode of postpartum depression increases the risk of lifetime episodes of major depression. ❖ Risk factors ✓ Lack of support. ✓ Severe psychosocial problems. ✓ Chronic interpersonal difficulties. ✓ History of depression. ✓ Family history of depression ✓ Childhood sexual abuse Postpartum Psychosis (puerperal psychosis) ✓Postpartum psychosis is rare, affecting approximately 0.1 to 0.2% of postpartum women. ✓ Postpartum psychosis is commonly associated with the diagnosis of bipolar disorder and unipolar psychotic depression later. ✓ Postpartum psychosis is a psychiatric emergency because of the potential risk for infanticide or suicide and therefore imminent referral to a psychiatrist, hospitalization, or initiation of antipsychotic medication is indicated. ✓ The mean time to onset is within 2 to 3 weeks and almost always within 8 weeks of delivery. Clinical features: ✓Prodromal symptoms as fatigue, insomnia, and restlessness, episodes of tearfulness and emotional lability. ✓Later, suspiciousness, confusion, incoherence, irrational statements, and obsessive concerns about the baby’s health and welfare may be present. ✓Delusional material may involve the idea that the baby is dead or defective, persecutory or grandiose delusion. ✓ Auditory hallucinations may involve voices telling the patient to kill the baby or herself, also visual hallucination. ✓ Patients may deny the birth and express thoughts of being unmarried, virginal, persecuted, or perverse. ✓Complaints regarding the inability to move, stand, or walk are also common ✓Antipsychotic medications and lithium , often in combination with an antidepressant, are the treatments of choice. ✓Suicidal patients may require transfer to a psychiatric unit to help prevent a suicide attempt.