Postpartum blues includes an array of psychiatric manifestations occurring in the period of post-partum, due to hormonal imbalance. Knowing in detail will help for quicker diagnosis and better outcomes.
Prepared in December, 2017.
2. Introduction
• Pregnancy causes lot of stress on the mother.
• Various hormones like
– Estrogen
– Progesteron
– hCG
Play important role in causing metabolic changes, which
ultimately lead to psychological illness
Sudden drop in these hormones after removal of
placenta plays great role
• It is common, but may become an emergency.
4. Post-partum blues
• A self-limiting, relatively mild, mood syndrome
• 30-80% of mothers
• 3-10 days after birth; remits by 2 weeks
• Risk factors:
– No certain cause 9idiopathic)
– Primi
– Late leuteal phase dysphoria
– Depression history
– First-degree relative with depression
7. Post-partum Psychosis
• Psychosis or psychotic depression in the post-partum
period
• 2 in 1000 mothers
• Within first 2 weeks to 3 months
• Risk factors:
– Considered as organic disease (hormonal imbalance,
heredity, h/o psychosis, etc..)
– Psycho social causes are secondary
8. Post-partum Psychosis
• Symptoms:
– Prodrome: worsening insomnia, without a crying baby or
physical discomfort, psychomotor agitation
– Confusion
– Memory impairment
– Irritability
– Anxiety
– Intrusive thoughts about harming the infant
– Paranoid and religious delusions
– Auditory hallucinations
– Thought insertion, withdrawal and broadcasting
– Brief periods of elation followed by inexplicable sadness or rage
– Lucid intervals can be seen
9.
10. Post-partum Depression
• An intermediate, prolonged syndrome like
post partum blues
• 5-10% of mothers, who had postpartum blues
• Insidously, with in 3 weeks post-partum
11. Post-partum Depression
• Risk factors
– Hereditary, h/o psychiatric illness
– Psychosocial
• Marital discord
• Stressful life during pregnancy
• Ambivalence about motherhood
• Lower socio economic status
• Isolation from family or friends
14. When to meet a doctor?
• Assess all the pregnant at their first visit to hospital
• Provide counselling regarding stress-free environment and
family support
• Counsel all the mothers, who had history of psychiatric
illness or relatives with psychiatric disorders, and their
family members regarding this disease and its symptoms
• Any undue agitation/ sadness/ insomnia/ fatigue should
not be taken lightly and immediate consultation is needed
• Other suicidal or homicidal tendencies towards the baby or
undue injuries to the baby, when alone with the mother
should bring up a doubt and immediate psychiatrist
consultation is mandatory.
15. Treatment
• Post-partum blues can be managed with re-
assurance and support of the family
• It rarely needs medication
• Other two are ‘psychiatric emergencies’
• Need to be hospitalized immediately