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Post - Partum Disorder

  1. One percent of all females going through postpartum period go through post partum psychiatric disorders.
  2. Postnatal depression (puerperal depression or postpartum depression) occurs within 1 year of delivery in about 10% of women who deliver. Patients present with depression of varied intensity.
  3. The most important feature is that many of the psychopathology is related to the newborn.
  4. Postnatal blues (maternal blues or baby blues) occurs in about 50% of women who deliver, around the 3rd day, characterized by emotional distress of mild to moderate intensity.
  5. It is mostly brief and self –limiting; hence, no specific therapeutic intervention is necessary
  6. Duration usually After 3rd Day – 4 Weeks. If Psychiatric symptoms are found within first 72 hrs of delivery it usually indicates organi-city
  7. Most commonly the presentation includes mixture of depressive. Manic and psychotic symptoms also called as Affective symptoms.
  8. Onset of psychiatric symptoms 6 weeks postpartum indicates most commonly towards abnormal thyroid function test.
Management =
  1. Mainstay of T/t is pharmacotherapy ie an antidepressant ± cognitive therapy
  2. SSRI (specific serotonin reuptake inhibitor) viz Fluoxetine, Sertraline, Paroxetine, Fluvoxamine & citalopram.
  3. Tricyclic antidepressant like amitriptyline or imipramine but use is limited by the side effects especially anticholinergic side effects, cardiac side effects and ortho static hypotension.
Suicide and depression
  1. Depression is the most common cause of suicide. Suicide is common when depression is severe.
  2. Risk factors for suicide in depressed patients include advanced age (> 40 years), male sex, living alone (unmarried, divorced or widowed), chronic medical illness, psychotic symptoms (psychotic depression, previous suicidal attempt, social isolation and family history of depression.
  3. As the presence of psychotic symptoms, i.e., psychotic depression is a risk factor for suicide the following type of depression have suicidal risk: -
    1. Endogenous Vs reactive (neurotic) : - Psychotic symptoms occur in endogenous depression but not in reactive (neurotic) depression. Therefore, suicidal risk is common in endogenous depression.
    2. Old age (involutional) vs childhood depression: - As the psychotic symptoms occur later in life, suicidal risk is more common in involutional depression.
Suicidal risk common: - Endogenous depression, psychotic depression, involutional (old age) depression.

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