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Post-Partum
Mood Disorders
Cassandra Huang
All Saints University School of Medicine
For Dr. Daniel B Martinez, Psychiatry Core Rotation
Puerperal Psychosis
• Occurs in the first 1-4 weeks after delivery, with
highest 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 shifts
after delivery
• Screening tests and level of depression rated via
Edinburgh Postnatal Depression Scale and
Postpartum Depression Screening Scale
• Psychosis is often suspected to be the initial
presentation of bipolar disorder
DSM-IV criterion:
Major Depressive Episode
w/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 including
depressed 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 occupational
functioning
• Symptoms are not drug induced or due to another underlying general
medical condition
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
Risk Factors
• History of depression or another mood
disorder: 30%
• Family history of depression, bipolar or
schizoaffective disorder, or schizophrenia
• History of post-partum depression following
previous deliveries: 50-62%
• Marital instability
• Lack of social support
• Adverse life events
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
References
• American Psychiatric Association. “Diagnostic and
Statistical Manual of Mental Disorders DSM-IV TR (Text
Revision)”. Arlington, VA: American Psychiatric
Association; 2000
• Sit, Dorothy, Rothschild, Anthony J., and Katherine L.
Wisner. “A Review of Postpartum Psychosis”. National
Institute of Health; 2011. http://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3109493/
• Sharma, Verinder and Vivien K. Burt. “DSM-V: modifying
the postpartum-onset specifier to include hypomania”.
National Institute of Health; 2011. http://www.ncbi.nlm.
nih.gov/pmc/articles/PMC3032179/

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Post partum presentation

  • 1. Post-Partum Mood Disorders Cassandra Huang All Saints University School of Medicine For Dr. Daniel B Martinez, Psychiatry Core Rotation
  • 2. Puerperal Psychosis • Occurs in the first 1-4 weeks after delivery, with highest 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 shifts after delivery • Screening tests and level of depression rated via Edinburgh Postnatal Depression Scale and Postpartum Depression Screening Scale • Psychosis is often suspected to be the initial presentation of bipolar disorder
  • 3. DSM-IV criterion: Major Depressive Episode w/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 including depressed 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 occupational functioning • Symptoms are not drug induced or due to another underlying general medical 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 mood disorder: 30% • Family history of depression, bipolar or schizoaffective disorder, or schizophrenia • History of post-partum depression following previous 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 and Statistical Manual of Mental Disorders DSM-IV TR (Text Revision)”. Arlington, VA: American Psychiatric Association; 2000 • Sit, Dorothy, Rothschild, Anthony J., and Katherine L. Wisner. “A Review of Postpartum Psychosis”. National Institute of Health; 2011. http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3109493/ • Sharma, Verinder and Vivien K. Burt. “DSM-V: modifying the postpartum-onset specifier to include hypomania”. National Institute of Health; 2011. http://www.ncbi.nlm. nih.gov/pmc/articles/PMC3032179/