post partum psychiatry

Post-partum Psychiatry

AL-Saleh, Yassin ,M. college of medicine, KSU.

Objectives

To Identify the different types of post-partum psychiatry .

To give an epidemiological data.To determine the risk factors

associated with different types.To review the clinical feature of

each type.To learn how to manage each

disorder.

Introduction

The importance of post-partum period.

Post-partum psychiatry :

1- Post-partum depression.

2- Post-partum psychosis.

3- Post-partum OCD.

4- Postpartum anxiety/panic disorder.

1 -Post-partum depression. (definition)Postpartum depression is a major

depressive episode with an onset in the first four weeks following childbirth.

Postpartum depression Vs postpartum blues (baby blue).

Baby blue last for two weeks after delivery.

Why it is called baby blue?

1 -Post-partum depression. (epidemiology)10-15% of new mothers develop

postpartum depression.Only 10% seek for help.CAUSES:

Unknown. (biological factor, genetic , hormonal, life stresses)

1 -Post-partum depression. (Risk factors)Personal history of depression Family history of depression Unplanned pregnancy Poor support from partner Single parent Depression during pregnancy Complications during pregnancy Pre-term birth Poor social support

1 -Post-partum depression. (symptoms)Lack of interest or pleasure in

activities. Lack of appetite or pleasure in eating .Sleep disruption .Fatigue or lack of motivation. Feelings of guilt or worthlessness .Poor concentration .Persistent anxiety ↑.Thoughts of death or suicide ↓.

1 -Post-partum depression. (differential diagnosis)puerperal psychosis.postpartum

hypothyroidism.anaemia.

1- Post-partum depression. (management)Multifactorial.Reassurance.Psychoeducation.Psychotherapy.pharmacologic treatment.Acupuncture, herb, dietary

supplements, massage and relaxation techniques.

1 -Post-partum deperession. (management)

Level of depression

Treatment

Mild to moderate psychotherapy, cognitive therapy

Moderate to severe

Serotonin re-uptake inhibitors (Fluoxetine, Sertraline, Paroxetine)

Tricyclic antidepressants (Imipramine, Nortriptyline, and others)

New generation antidepressants (Venlafaxine, Buproprion, and others)

Mild to severeCombined psychotherapy and antidepressant

medications

Severe depression Electroconvulsive therapy

2 -Postpartum psychosis

about 0. 1-0.2% of new mothers.condition is defined as an atypical

psychosis which may begin within the first six months of delivery.

Presenting symptoms include severe insomnia, agitation and restlessness, hallucinations, paranoia and delusions focused on the baby. Homicidal and suicidal thought are not uncommon.

Consider as a medical emergency.

3-Postpartum obsessive compulsive disorderCondition characterized by many of

the typical symptoms of OCD, however the obsessions and the compulsion are more focused on the baby and the patient's new role and responsibilities of being a mother.

4-Postpartum anxiety/panic disordercondition which characterized by

symptoms of intense anxiety or panic and may involve many somatic symptoms such:

cardiac palpitations, tachycardia, tachypnea, dyspnea, hot or cold flashes, chest pain, abdominal pain, dizziness, tremor and feelings of doom and helplessness.

ConclusionWomen should be followed during

post partum period, especially if they have a history of depression or depressive symptoms during pregnancy.

Treatment should be multifactorial, including consideration of psychosocial as well as pharmacologic options.

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