POSTPARTUM PSYCHIATRIC DISORDER

Prepared by : Nur Liyana binti ABD Malek1117398

Supervisor : Dr Kartini

OUTLINE◦ Baby blues◦ Postpartum Depression◦ Postpartum Psychosis

Baby bluesDefinition : 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

Rx: no biological treatment needed, only educational and support

Last several days, if lasting more than 2 week, consider Post partum depression

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

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

lactation

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

◦ Etiology : 1. secondary to underlying mental illness (eg : schizophrenia, bipolar disorder)2. Sudden changes of hormonal level after parturition3. Psychodynamic conflict about motherhood

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

Differential diagnosis :1. Post partum blues2. Substance –induce mood disorder : anaesthetic medication3. Psychotic disorder resulting from a general medical condition (rule out infection,

hypothyroidism, encephalopathy associated with toxaemia of pregnancy and pre eclampsia

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

appropriate treatment

◦ Treatment

1. Via bio psychosocial and spiritual approach2. Admit the patient (psychiatric emergency)3. Carry investigations to rule out GMC, and take for baseline4. After confirm the diagnosis, asses the patient whether breastfeeding or not5. As breastfeeding is contraindication for biological treatment

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

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

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