in Malays, we called it meroyan. PPD can be divided into postpartum depression and postpartum psychosis. Only postpartum psychosis need treatment such as combination of anti-psychotic, anti depression and mood stabilizer

1. POSTPARTUM
PSYCHIATRIC
DISORDERPrepared by : Nur Liyana binti ABD Malek
1117398
Supervisor : Dr Kartini

2. OUTLINE
◦ Baby blues
◦ Postpartum Depression
◦ Postpartum Psychosis

3. Baby blues
Definition : a transient mood disturbance characterized by mood lability, sadness, dysphoria,
subjective confusion and tearfulness.
Etiology : rapid changes in woman’s hormonal level, stress of childbirth and the awareness of
increase in responsibility that motherhood bring

5. Rx: no biological treatment needed, only educational and
support
Last several days, if lasting more than 2 week, consider Post
partum depression

6. Postpartum Depression
◦ Definition: severe depression beginning within 4 weeks of giving
birth.
◦ Predispose factor: underlying mood or psychiatric disorder
◦ Symptoms : depressed mood, excessive anxiety, insomnia, change
in weight

7. ◦ Risk of lifetime episodes of major depression
◦ Treatment : not well studied, risk of transmitting anti depressant drug during lactation

9. Postpartum Psychosis
◦ Definition: syndrome occurring after childbirth and characterized by severe depression and
delusions.
◦ Epidemiology : occur in 1 -2 in deliveries per 1000. mostly primigravida

10. ◦ Etiology :
1. secondary to underlying mental illness (eg : schizophrenia, bipolar disorder)
2. Sudden changes of hormonal level after parturition
3. Psychodynamic conflict about motherhood

11. ◦ Symptoms : (occur at day 2 and day 3 postpartum)
Initial : insomnia, restlessness, emotional lability
Later: confusion, irrationality, delusions and obsessive concerns about the infant, ideation of
suicide or infanticide

12. Differential diagnosis :
1. Post partum blues
2. Substance –induce mood disorder : anaesthetic medication
3. Psychotic disorder resulting from a general medical condition (rule out infection,
hypothyroidism, encephalopathy associated with toxaemia of pregnancy and pre eclampsia

13. ◦ Course : untreated case -> risk of infanticide, suicide or both
◦ Prognosis: good if -> supportive family network, good premorbid personality, appropriate
treatment

14. ◦ Treatment
1. Via bio psychosocial and spiritual approach
2. Admit the patient (psychiatric emergency)
3. Carry investigations to rule out GMC, and take for baseline
4. After confirm the diagnosis, asses the patient whether breastfeeding or not
5. As breastfeeding is contraindication for biological treatment

15. biological psychosocial spiritual
 antipsychotic +
mood stabilizer +
anti depressant
 If breastfeaading:
contraindication to
drug
• Close monitoring
• Psycoeducation
• Family therapy
• Encourage patient to
be closed to Allah by
performing solat, zikir
and reciting Al-Quran

16. TAKE HOME MESSAGES
◦ Postpartum psychiatric disorder is important
◦ highly susceptible to person with underlying mental illness
◦ Postpartum psychosis is a psychiatric emergency

17. References:
◦ Kaplan & sadock’s Concise Textbook of Clinical Psychiatry
◦ Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry