Postpartum psychiatry (316/1700)

A 28 yo female who delivered 6 weeks ago feels sad and has no interest to feeding the baby. She has been eating poorly and having difficulty sleeping. She feels weak throughout the day and has stopped taking the baby out of the house. She also says that the baby has evil eyes. What is the most likely diagnosis?
a. Postpartum blues
b. Postpaetum depression
c. Postpurtum psychosis
d. Schizophrenia
e. Psychotic depression

























answer: C

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 late), can present in the context of depression

Treatment: admit to hospital