Postpartum

psychiatric
disorders
 Etiology
• Biological changes
Decreased levels of estrogen and progesterone
• Psychosocial factors
• Risk factors associated with postpartum disorders
- Primigravida
- unmarried mother
- cesarean sections or other perinatal or natal complication
- past history of psychotic illness
- especially past history of anxiety and depression
- family history of psychiatric illness
- especially mother and sister having postpartum disorder
- previous episode of postpartum disorder

2
 1. Postpartum blues

2. Postpartum 3. Postpartum
depression psychosis
 Introduction
• Postpartum blues:
- Onset during the first few weeks after delivery.

- Characterized by mood lability, tearfulness,

anxiety or irritability.

- Function not impaired.

*If symptoms of depression persist for longer than two weeks, the patient should be
evaluated to rule out a more serious disorder.
• Postpartum depression
- Onset is over the first two to three postpartum months but
may occur at any point after delivery.

- The symptoms include depressed mood, anhedonia,

feelings of guilt, feelings of worthlessness or incompetence,
fatigue, sleep disturbance, change in appetite, poor
concentration and suicidal thoughts.

- Function impaired.
 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
 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 ↓.
 differential diagnosis

• puerperal psychosis.
• postpartum hypothyroidism.
• anaemia.
 management
• Multifactorial.
• Reassurance.
• Psychoeducation.
• Psychotherapy.
• pharmacologic treatment.
• Acupuncture, herb, dietary supplements,
massage and relaxation techniques.
 management
Level of
Treatment
depression

Mild to moderate psychotherapy, cognitive therapy

 Serotonin re-uptake inhibitors (Fluoxetine,

Sertraline, Paroxetine)
Moderate to
 Tricyclic antidepressants (Imipramine,
severe
Nortriptyline, and others)
 New generation antidepressants (Venlafaxine,
Buproprion, and others)
Combined psychotherapy and antidepressant
Mild to severe
medications

Severe depression Electroconvulsive therapy

• Postpartum psychosis
- Onset of symptoms as early as the first 48 to 72 hours after delivery.

- The earliest signs are restlessness, irritability and insomnia in addition

to a rapidly shifting depressed or elevated mood, disorientation or
confusion and disorganized behaviour.

- Delusion are common and often about the infant.

- Auditory hallucinations that instruct the mother to harm herself or her

infant may also occur.

- Function impaired.