suffering from lack of sleep. She also has thought of harming her little baby. What is the most
appropriate management for this pt?
a. ECT
b. CBT
c. IV haloperidol
d. Paroxethine
e. Amitryptiline
answer: B Post partum depression, cbt and ssri's are a valid option, however CBT is the first line option
NICE
a TCA, SSRI or (S)NRI if the woman understands the risks associated with the medication and the mental health problem in pregnancy and the postnatal period and:
she has expressed a preference for medication or
she declines psychological interventions or
her symptoms have not responded to psychological interventions
POSTPARTUM BLUES
• 85% of new mothers, onset day 3-10; extension of the
“normal” hormonal changes and
adjustment to a new baby
• self-limited, should resolve by 2 wk
• manifested by mood lability, depressed affect,
increased sensitivity to criticism, tearfulness,
fatigue, irritability,
poor concentration/despondency
Treatment: reassurance
POSTPARTUM
DEPRESSION
• definition: major depression occurring in a woman
within 6 mo of childbirth
• epidemiology: 10-20%, risk of recurrence 50%
• risk factors
1. personal
or family history of depression (including PPD)
2. prenatal
depression or anxiety
3. stressful
life situation
4. poor
support system
5. unwanted
pregnancy
6. colicky
or sick infant
• clinical features: suspect if the “blues” last beyond 2
wk, or if the symptoms in the first two
weeks are severe (e.g. extreme
disinterest in the baby, suicidal or homicidal/infanticidal
ideation)
• assessment: Edinburgh Postnatal
Depression Scale or other
• treatment: antidepressants, CBT, ECT if refractory
• prognosis: interferes with bonding and attachment
between mother and baby so it can have
long-term effects
POSTPARTUM
PSYCHOSIS
• definition: onset of psychotic
symptoms (severe mood swings: up and down, delusions, hallucinations) within first
month postpartum, can present in the context of depression
Treatment: admit to hospital
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