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Post partum problems

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A talk given to general physicians

A talk given to general physicians

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Post partum problems Post partum problems Presentation Transcript

  • Psychiatric disorders in the postpartumperiod
  • Why is this important● Mother – Infant unit● Epigenetic influences● Affect on infants development & unfolding of emotion-behaviour● Mood disorders● Physical illness
  • Postpartum Blues (PPB)● Onset 3-4 days postpartum● Mood swings,insomnia, anxiety● 50-80% women develop● Resolves in 10-14 days max● 1 out 5 women with PPB >> PPD
  • Postpartum Depression (PPD)● Onset in few days to weeks● Pervasive depressive sx● 10-15 % women develop● Associated with past h/o & f/h/o depression● Needs counseling or medications
  • Postpartum Depression● No past h/o >> 10%● Past h/o present >> 25%● Other risk factorsprepartum depressionh/o premenstrual sx earlierhigh stress
  • Postpartum Psychosis (PPP)● Also called puerperal psychosis● Mania, depression, delusions, hallucinationVariable mood, confusion, DSH● Onset like PPD● 0.1% women● Psychiatric Emergency
  • Postpartum Psychosis● Past episode of Bipolar disorder, schizophrenia, past PPPor strong f/h/o PPP● High risk group – prevalence 25-50%● If mother or sister had PPP, nil past h/o – 3%● Medications & IP care
  • Postpartum PsychosisPrevention● All care givers must know about sx● Ideally plan the pregnancy● At risk cases, a review at 8 months● Support systems & psychoeducation● Avoid pregnancy
  • Postpartum Psychosis● 50% chance of recurrence in pregnancies● 50% chance of mood disorder unrelated to pregnancy● Strong association with bipolar disorder
  • Implication on the infant● Childhood emotional dysregulation & risk of CVD Appleton et alJ Epidemiol Community Health. 2013 Jan 15. [Epub ahead of print]● Infants having depressed mother in first 3 months > irritable, less engaged &warm in interactions● Decreased face-to-face interaction, vocalization, smiling, imitation & game-playing >> affects learning skills● Decreased frequency of touch, less affectionate touch, low infant-focussedutterances, >> poor cognitive & linguistic development● “The Still-face Experiment”...maternal attunement, affect-attention modulationby infant● “Existing in the heart & mind of another” & “feeling felt” are critical to infantspsychological development & attachment security