A talk given to general physicians

1. Psychiatric disorders in the postpartum
period

2. Why is this important
● Mother – Infant unit
● Epigenetic influences
● Affect on infant's development & unfolding of emotion-
behaviour
● Mood disorders
● Physical illness

3. Postpartum Blues (PPB)
● Onset 3-4 days postpartum
● Mood swings,insomnia, anxiety
● 50-80% women develop
● Resolves in 10-14 days max
● 1 out 5 women with PPB >> PPD

4. Postpartum Depression (PPD)
● Onset in few days to weeks
● Pervasive depressive sx
● 10-15 % women develop
● Associated with past h/o & f/h/o depression
● Needs counseling or medications

5. Postpartum Depression
● No past h/o >> 10%
● Past h/o present >> 25%
● Other risk factors
prepartum depression
h/o premenstrual sx earlier
high stress

6. Postpartum Psychosis (PPP)
● Also called puerperal psychosis
● Mania, depression, delusions, hallucination
Variable mood, confusion, DSH
● Onset like PPD
● 0.1% women
● Psychiatric Emergency

7. Postpartum Psychosis
● Past episode of Bipolar disorder, schizophrenia, past PPP
or strong f/h/o PPP
● High risk group – prevalence 25-50%
● If mother or sister had PPP, nil past h/o – 3%
● Medications & IP care

8. Postpartum Psychosis
Prevention
● All care givers must know about sx
● Ideally plan the pregnancy
● At risk cases, a review at 8 months
● Support systems & psychoeducation
● Avoid pregnancy

9. Postpartum Psychosis
● 50% chance of recurrence in pregnancies
● 50% chance of mood disorder unrelated to pregnancy
● Strong association with bipolar disorder

10. Implication on the infant
● Childhood emotional dysregulation & risk of CVD Appleton et al
J Epidemiol Community Health. 2013 Jan 15. [Epub ahead of print]
● Infants having depressed mother in first 3 months > irritable, less engaged &
warm in interactions
● Decreased face-to-face interaction, vocalization, smiling, imitation & game-
playing >> affects learning skills
● Decreased frequency of touch, less affectionate touch, low infant-focussed
utterances, >> poor cognitive & linguistic development
● “The Still-face Experiment”...maternal attunement, affect-attention modulation
by infant
● “Existing in the heart & mind of another” & “feeling felt” are critical to infant's
psychological development & attachment security