depression & psychosis in the postpartum period

DEPRESSION & PSYCHOSISIN THE POSTPARTUM PERIODDr. Firmansyah B SpOG (K)

POSTPARTUM DEPRESSION *20-40%emotional disturbance/cognitive dysfunction *Indonesia: 10-30% as postpartum/medical complication *Baby Blues: -normal state of sadness,dysphoria, frequent tearfulness and clinging dependence,ascribed to rapid changes in hormonal levels, the stress of childbirth,and the awareness of the increased responsibility *Postpartum Depression : -a depressed mood,excessive anxiety and insomnia

ETIOLOGY -multifactorial: -sociocultural factors, -baby and mother conditions, -psychosocial factors, -personality factor, -history of depression/emotional problems, hormonal factor

*1-2 in 1000 deliveries depressed feelings and suicidal ideation,in severe cases may reach psychotic proportions with hallucinations, delusions and thoughts of infanticides *severe postpartum depression are at high risk for future episode and failure to treat may contribute to long-term,refractory mood disorders *evaluation of depression: HDRS (Hamilton Depression Rating Scale) Score: * 0-6 : normal 7-16 : mild depression 17-23 : moderate 24- > : severe

COMPARISON OF BABY BLUES& POSTPARTUM DEPRESSION

Characteristic Baby Blues Postpatum Depression

-Incidence 50%of woman who give birth 10%-Time of onset 3-5days after delivery Within 3-6 months after-Duration Days to weeks Month to years if untreated-Ass. stressors No Yes,esp.lack of support-S.cultural infuences No Strong association-H.of mood disorder No Strong association-Fam.h.of mood dis. No Some association-Tearfulness Yes Yes-Mood lability Yes Often present-Anhedonia No Often-Sleep disturbance Sometimes Nearly always-Suicidal thoughts No Sometimes-Thought of harm- Rarely Often ing the baby -Feeling of guilt, Absent or mild Often present and excessive

Pitts criteria for Postpartum depression: -positive symptoms of depression, -the symptoms begin & developed after birth, -the symptoms never seen before -the symptoms persist more then 2 weeks

DSM IV: -the onset during 4 weeks postpartum periode

Kit & Cox: -6 weeks

PPDGJ III: -6 weeks

*Syndrome in Fathers

(during pregnacies or after the babies are born) affected by many factors: -resposibility, -sexual outlet, -attention, -child as a binding force

Depressive episode -PPDGJ III/ICD X -Main symptoms:-decrease affect/depressed mood -loss of interest/enjoyment -lack of energy -Other symptoms:-reduced attention/concentration -reduced self esteem & self confidence -ideas of guilt and unworthyness -bleak and pessimistic view of the future -ideas of acts of self harm or suicide -disturbed sleep -diminished appetite

-The lowered mood varies,often unresponsive to circumtances sometimes there's diurnal variation,severe symptoms maybe shorter than 2 weeks.

Negative effect of Postpartum Depression in Childhood - 3 year olds :conduct disorders - 4 year olds :cognitive deficit - disorders in mother-childs relationship,

Treatment should be comprehensive / integrated

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