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Features which distinguish postpartum disorders
Symptoms of organicity
Changeability of symptoms
Timing and progression of symptoms blues, psychosis
Increase in incidence with previous episode
Excellent prognosis
Epidemiological studies
12 months after delivery is the greatest risk of psychiatric illness in a woman's life for postpartum depression
25-fold increase in the risk of a psychotic illness in the 30 days
Biological changes
Estrogen and progesterone reach highest during pregnancy
Precipitous fall after parturition
Unsubstantiated studies have shown decreased incidence with estrogen or post partum progesterone treatment
1. No major mood disturbances
2. More mood disturbances in primiparas
3. Significant correlations:
Increased irritability with higher postpartum blues estrogen levels
Increased depressive symptoms with greater drop
Increased sleep disturbance with lower estrogen
Depressive symptoms
1. Stressful life events during pregnancy
2. Depressive symptoms during pregnancy
3. Total breast feeding
4. Lower levels of stress during delivery
depression related to:
1. Previous depressive episodes
2. 1st degree relative with depression
3. Perception of support
4. Marital problems
Number of child care-related stressors
C. Other psychosocial aspects
1. Changes in body image
2. View of role as a woman and a mother
3. Fear of losing her identity
4. Financial and housing issues Older primiparas
6. Impaired parental relationships
IV. NOMENCLATURE
A. Post-partum psychosis
B. Post partum depression
C. blues
V. Psychosis
A. Incidence and course
1. 1-2 per 1,000
2. 1st 6 weeks
3. 3-20 days is highest risk period
4. Lasts for a few days to months
5. 80% recover in 1 year
6. 30-50% recurrence
7. High incidence of future affective diagnosis
B. Risk factors
1. Previous history of affective disorder
2. Family history of affective disorders
3. Previous psychosis
4. 1st pregnancy
5. C-section
6. Perinatal death
C. Characteristics
1. Agitation
2. Confusion
3. Extremes of mood
4. Hallucinations
5. Delusions
6. Bizarre behavior
7. Violence
D. Hazards
1. Signs and symptoms subject rapid change
2. Impulsivity
3. Violence to self or others
4. Infanticide
5. Misinterpret remission as real improvement E. Suspect organic etiology
F. Management