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Post partum presentation

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  • 1. Post-PartumMood DisordersCassandra HuangAll Saints University School of MedicineFor Dr. Daniel B Martinez, Psychiatry Core Rotation
  • 2. Puerperal Psychosis• Occurs in the first 1-4 weeks after delivery, withhighest incidence in the first 2 weeks• 50-75% of childbirths are associated with baby blues• 10-13% of childbirths are associated with depression• 0.1-0.2% of childbirths are associated with psychosis• Suspected to coincide with sudden hormone shiftsafter delivery• Screening tests and level of depression rated viaEdinburgh Postnatal Depression Scale andPostpartum Depression Screening Scale• Psychosis is often suspected to be the initialpresentation of bipolar disorder
  • 3. DSM-IV criterion:Major Depressive Episodew/Post- Partum Onset specifier• Onset of major depressive episode within 4 wks of delivery• 5 of more of the following within the same 2 weeks includingdepressed mood and/or anhedonia:• change in weight or appetite• Insomnia or hypersomnia• Psychomotor agitation or retardation• Fatigue, loss of energy• Feelings of worthlessness, guilt• Decreased ability to concentrate or indecisiveness• Recurrent thoughts of death, suicidal ideation• Clinically significant distress or impairment in social or occupationalfunctioning• Symptoms are not drug induced or due to another underlying generalmedical condition
  • 4. Signs and Symptoms• Psychosis with or without thought insertion• Cognitive impairment• Disorganized behaviour• Restlessness• Sleep disturbance• Irritability• Depressed or elated mood, delirium or mania• Delusions and hallucinations• High risk of suicide and/or infanticide• Anxiety and panic attacks• Spontaneous crying
  • 5. Risk Factors• History of depression or another mooddisorder: 30%• Family history of depression, bipolar orschizoaffective disorder, or schizophrenia• History of post-partum depression followingprevious deliveries: 50-62%• Marital instability• Lack of social support• Adverse life events
  • 6. Therapies and Treatment• Antimanic drugs (lithium, valproic acid)• Atypical antipsychotics (olanzapine)• Antidepressants (SSRI, TCAs)• Estrogen prophylaxis*• Electroconvulsive therapy• Psychotherapy• Hospitalization• Additional help with the baby
  • 7. References• American Psychiatric Association. “Diagnostic andStatistical Manual of Mental Disorders DSM-IV TR (TextRevision)”. Arlington, VA: American PsychiatricAssociation; 2000• Sit, Dorothy, Rothschild, Anthony J., and Katherine L.Wisner. “A Review of Postpartum Psychosis”. NationalInstitute of Health; 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109493/• Sharma, Verinder and Vivien K. Burt. “DSM-V: modifyingthe postpartum-onset specifier to include hypomania”.National Institute of Health; 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3032179/