Postpartum Psychiatric Illnesses

October 27, 2011

Postpartum "Blues":occurs in 50-80%, onset usually between day 3 and day 14 postpartum, symptoms may persist from several days to a few weeks.

Postpartum "Blues"

-occurs in 50-80%
-onset usually between day 3 and day 14 postpartum
-symptoms may persist from several days to a few weeks

Symptoms:

  • mood instability
  • weepiness
  • sadness
  • anxiety
  • lack of concentration/inability to carry out activities of daily living
  • feelings of dependency

Etiology:

  • rapid hormonal changes
  • physical and emotional stress of birthing
  • physical discomforts
  • emotional letdown after pregnancy and birth
  • awareness and anxiety about increased responsibility
  • fatigue and sleep deprivation
  • disappointments-about the birth, spousal support, nursing, the baby, etc.

Postpartum Depression
-occurs in 8-15%, 20% of those with postpartum blues develop depression
-onset is usually insidious although it can be rapid, and can occur any time in the first year
-may last from 3 to 14 months, most recover within 1 year

Symptoms:

  • excessive worry or fatigue
  • sad mood, feelings of guilt, loss of interest, phobias
  • sleep problems (often can't sleep)
  • physical symptoms or complaints in excess of or without physical cause
  • marked fear of criticism of mothering skills
  • excessive concern about baby's health or well-being
  • infant's failure to thrive
  • loss of focus and concentration (may miss appointments)
  • loss of interest or pleasure
  • appetite changes-poor appetite or weight gain

Risk factors:

  • 50-80% risk if previous postpartum depression
  • depression or anxiety during pregnancy
  • past psychiatric disorder (especially depression) or family history of depression
  • presence of anti-thyroid antibodies
  • marital conflict, single parenthood, irritable infant

Postpartum Obsessive-Compulsive Disorder
-3%-5% of new mothers may develop obsessive symptoms

Symptoms:

  • intrusive repetitive and persistent thoughts or mental pictures
  • thoughts often are about hurting or killing the baby
  • tremendous sense of horror and disgust about these thoughts (ego alien)
  • thoughts may be accompanied by behaviors to reduce the anxiety (hiding knives)

Risk factors:

  • history of Obsessive-Compulsive Disorder
  • negative feelings resulting from unrealistic expectations

Postpartum Panic Disorder
-may occur in up to 10% of postpartum women

Symptoms:

  • episodes of extreme anxiety
  • shortness of breath, chest pain, sensations of choking or smothering, dizziness
  • hot or cold flashes, trembling, palpitations
  • may experience restlessness, agitation, or irritability
  • during attack may fear she is going crazy, dying, or losing control
  • panic attack may awaken from sleep
  • often no identifiable trigger for panic
  • excessive or obsessive worry or fears

Risk factors:

  • previous history of anxiety or panic disorder
  • thyroid dysfunction

Postpartum Psychosis
-occurs in 1-2/1000, this disorder has a 5% suicide and 4% infanticide rate
REQUIRES IMMEDIATE HOSPITALIZATION

Symptoms:

  • begins about 3 days postpartum
  • fatigue
  • tearfulness
  • mood instability
  • confusion, suspiciousness, and obsessive concern about baby
  • delusional thinking (infant death, denial of birth, need to kill baby)


Risk factors:

  • history of psychosis or bipolar disorder
  • family history of mental illness
  • difficult labor
  • possible other factors include: first child, perinatal death, advanced maternal age, premature delivery, low birth weight, unmarried mother

References:

REFERENCES

Dunnewold, Ann, Evaluation and Treatment of Postpartum Emotional Disorders

Professional Resource Press, Sarasota, Florida, 1997

Knops, GG. Postpartum mood disorders: a startling contrast to the joy of birth. Postgraduate Medicine 1983;93(3):103-116.

Stowe ZN, Nemeroff CB. Women at risk for postpartum-onset major depression.

Am J Obstet Gynecol 1995;173(2):639-644.