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now we'll talk about psychiatric
disorders in pregnancy so there are
three psychiatric disorders that we see
in pregnancy postpartum blues postpartum
depression and postpartum psychosis
let's take the time to explore each of
these so postpartum blues it occurs in
about 50 to 80 percent of pregnancies so
it's very common the symptoms are guilt
crying feeling overwhelmed and the onset
is usually anywhere between birth to two
weeks after delivery the treatment
spontaneous it resolves on its own so
you just reassure mom if she has these
symptoms
next is postpartum depression now there
are risk factors for postpartum
depression you need to be aware of these
so that when you see your patients
during pregnancy you also make them
aware that if these symptoms start to
happen
associate with postpartum depression
they should seek your care so if a
patient has a history of postpartum
depression or depression in general
they're at increased risk for developing
postpartum depression if they have poor
social support if the baby has health
problems or if there's another baby that
they're taking care of another child
they're taking care of that has health
problems they are at increased risk for
developing postpartum depression if they
have difficulty with breastfeeding if we
remember from the breastfeeding lecture
breastfeeding is one of the things that
protects us against postpartum
depression so if there's difficulty with
breastfeeding this can be a risk factor
and also for families or moms that have
financial difficulties they're at
increased risk for developing postpartum
depression as well so with postpartum
depression it occurs in approximately
fifteen to twenty-five percent of
pregnancies now that rate may actually
be a bit higher because sometimes we're
not so great at diagnosing it
speaking of diagnosis there is a way to
diagnose postpartum depression it is
called the edinburgh post natal
depression scale this scale is
administered to up to from two weeks up
to a year after delivery
it is a self-administered questionnaire
where patients are able to assess how
well they are coping with their new
state of being a mom it's very good at
determining who has postpartum
depression so what are the symptoms
inability to cope if they have
disinterest in themselves disinterest in
their child disinterest in their normal
activities that patient may have
postpartum depression onset of symptoms
can be anywhere from two weeks up to a
year after the birth of their child
the treatment is psychotherapy and SSRIs
so the literature shows that doing
psychotherapy works well doing
medication works well but the two
working together works the best
now postpartum psychosis this is very
rare we see this in less than 1% of
pregnancies symptoms are the same as
typical psychosis meaning patients may
experience visual or auditory
hallucinations the onset of symptoms can
be anywhere from two weeks up to a year
after delivery now the treatment for
psychosis because it is a more severe
form of a psychiatric disorder are to
start antipsychotics under the care of
psychiatrists this is not typically a
diagnosis that obstetricians will take
care of now let's review that again
epidemiology for postpartum blues 50 to
80 percent of pregnancies symptoms guilt
crying being overwhelmed onset two weeks
and it resolves spontaneously postpartum
depression 15 to 25 percent of
pregnancies symptoms being inability to
cope did centrist in self or child onset
being 2 weeks up to a year after
delivery treatment psychotherapy and
SSRIs postpartum psychosis occurs in
less than 1% of pregnancies symptoms are
visual and auditory hallucinations onset
of symptoms 2 weeks up to a year after
delivery and treatment antipsychotics
under the care of psychiatrist of note
in any of these situations if a
patient is complaining of homicidal or
suicidal ideation that patient needs to
be referred to the emergency room for
immediate hospitalization so let's take
a case this is a nineteen year old
gravity' one para one female that
presents to your office two weeks after
an emergency c-section for evaluation of
her incision you notice that she appears
unkempt and seized seems just interested
in her infant upon further questioning
she reports separating from her partner
and has poor family support she reports
crying all the time
and she is having difficulty coping the
next best step in managing this patient
is a reassurance be began a selective
serotonin reuptake inhibitor or an SSRI
C hospitalization under the care of a
psychiatrist d reevaluate symptoms in
two weeks to determine if they have
resolved what do you think the answer is
the answer is B we want to begin a
selective serotonin reuptake inhibitor
let's break down this question now she's
presenting two weeks after her c-section
okay so that lets us think that now the
symptoms are starting two weeks after
delivery
she seems unkempt and disinterested in
her child which means she's also
disinterested in herself and she has
separated from her partner and has poor
family support she's crying all the time
and having difficulty coping these are
all symptoms and all risk factors for
postpartum depression so a is incorrect
reassurance is only used for postpartum
blues C is incorrect because we use this
if suicidal ideation homicidal ideation
is present or psychosis and D yes we may
want to reevaluate the symptoms in two
weeks but the patient needs therapy now
so the answer is B start a selective
serotonin reuptake inhibitor
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