DEPRESSION & PSYCHOSIS

IN THE POSTPARTUM PERIOD

Dr. Firmansyah B SpOG (K)

POSTPARTUM DEPRESSION
*20-40%emotional disturbance/cognitive dysfunction
*Indonesia: 10-30% as postpartum/medical complication
*Baby Blues:
-normal state of sadness,dysphoria, frequent
tearfulness and clinging dependence,ascribed
to rapid changes in hormonal levels, the stress
of childbirth,and the awareness of the increased
responsibility
*Postpartum Depression :
-a depressed mood,excessive anxiety and insomnia

ETIOLOGY
-multifactorial:
-sociocultural factors,
-baby and mother conditions,
-psychosocial factors,
-personality factor,
-history of depression/emotional problems,
hormonal factor

*1-2 in 1000 deliveries depressed feelings and

suicidal ideation,in severe cases may reach
psychotic proportions with hallucinations,
delusions and thoughts of infanticides
*severe postpartum depression are at high risk
for future episode and failure to treat may
contribute to long-term,refractory mood disorders
*evaluation of depression:
HDRS (Hamilton Depression Rating Scale)
Score: * 0-6 : normal
7-16 : mild depression
17-23 : moderate 24- > : severe

COMPARISON OF BABY BLUES& POSTPARTUM DEPRESSION

Characteristic

Baby Blues

Postpatum Depression

-Incidence
50%of woman who give birth
10%
-Time of onset
3-5days after delivery
Within 3-6 months after
-Duration
Days to weeks
Month to years if untreated
-Ass. stressors
No
Yes,esp.lack of support
-S.cultural infuences
No
Strong association
-H.of mood disorder
No
Strong association
-Fam.h.of mood dis.
No
Some association

-Tearfulness
-Mood lability
-Anhedonia
-Sleep disturbance
-Suicidal thoughts
-Thought of harming the baby
-Feeling of guilt,

Yes
Yes
No
Sometimes
No
Rarely
Absent or mild

Yes
Often present
Often
Nearly always
Sometimes
Often
Often present and excessive

Pitts criteria for Postpartum depression:

-positive symptoms of depression,
-the symptoms begin & developed after birth,
-the symptoms never seen before
-the symptoms persist more then 2 weeks
DSM IV:
-the onset during 4 weeks postpartum periode
Kit & Cox: -6 weeks
PPDGJ III: -6 weeks

*Syndrome in Fathers
(during pregnacies or after the babies are born)
affected by many factors:
-resposibility,
-sexual outlet,
-attention,
-child as a binding force

Depressive episode -PPDGJ III/ICD X

-Main symptoms:-decrease affect/depressed mood
-loss of interest/enjoyment
-lack of energy
-Other symptoms:-reduced attention/concentration
-reduced self esteem & self confidence
-ideas of guilt and unworthyness
-bleak and pessimistic view of the future
-ideas of acts of self harm or suicide
-disturbed sleep
-diminished appetite
-The lowered mood varies,often unresponsive to
circumtances sometimes there's diurnal variation,severe
symptoms maybe shorter than 2 weeks.

Negative effect of Postpartum Depression in Childhood

- 3 year olds :conduct disorders
- 4 year olds :cognitive deficit
- disorders in mother-childs relationship,
Treatment should be comprehensive / integrated