Post Partum Psychological disorders

Although pregnancy and childbirth are usually joyous times, for some women the experience is followed by significant emotional distress. Approximately 25% of women with previous postpartum mental disease have a recurrence after their next pregnancy. One-third of women with psychiatric illness during the postpartum period have a history of psychiatric disease.

The exact cause of most of the postpartum emotional changes is unknown, although suggested causes include changing hormone levels (as is seen with premenstrual changes), difficulty adjusting to a new lifestyle, and the stresses of parenthood.

Depression after childbirth has largely been divided into three categories:

1. Postpartum Blues
2. Postpartum Depression (ppd)
3. Postpartum Psychosis

Postpartum Blues

This transient state of heightened emotional reactivity can develop in 50-80% of women.

Onset is 2-14 days after childbirth, with peak being at about the 4th day and duration of less than 2 weeks.

Symptoms include:

• Mild insomnia
• Tearfulness
• Fatigue
• Poor concentration
• Depressed affect(emotion)

Treatment:

Blues generally require no intervention. Rest and social support contribute significantly to remission. However, postpartum blues do constitute a significant risk factor for subsequent depression during the postpartum period- in 20%

Postpartum Depression

Any depression developing within 12 months following childbirth is considered to have postpartum onset. About 10-15% of postpartum women suffer from this.

Average duration is 3-14 months

To be diagnosed with ppd, one must exhibit 5 or more of the following symptoms, including one of the first 2, for most of the past 2 weeks:

• Depressed mood- tearfulness, hopelessness, feeling empty inside with or without severe anxiety
• Loss of pleasure in either all or almost all of daily activities
• Appetite and weight changes- usually a decrease in appetite and weight, but sometimes the opposite
• Sleep problems-trouble sleeping even when the baby is sleeping
• Noticeable change in how you walk and talk- restlessness but sometimes sluggishness
• Extreme fatigue or loss of energy
• Feelings of worthlessness or guilt with no reasonable cause
• Difficulty concentrating and making decisions
• Thoughts about death or suicide. Some women with ppd have fleeting, frightening thoughts of harming their babies. These thoughts tend to be fearful thoughts, rather than urges to harm

Treatment consists of :

• Antidepressant pharmacotherapy -The first line agent right now is Selective-serotonin reuptake inhibitors (SSRIs), although caution is necessary in breast feeding mothers.
• Psychotherapy- Cognitive-behavioral therapy and group therapy have had the most significant effects.
• Support groups nationwide

Postpartum Psychosis

This severe condition is most likely to affect women with bipolar disorder or a history of postpartum psychosis. Affects less than 2% of postpartum women

Symptoms, which usually develop during the first 3 postpartum weeks (as soon as 1 to 2 days after childbirth), include:

• 
  Feeling removed from your baby, other people, and your surroundings (depersonalization).
• 
  Disturbed sleep, even when your baby is sleeping.
• 
  Extremely confused and disorganized thinking, increasing your risk of harming yourself, your baby, or another person.
• 
  Drastically changing moods and bizarre behavior.
• 
  Extreme agitation or restlessness.
• 
  Unusual hallucinations*, often involving sight, smell, hearing, or touch.
• 
  Delusional* thinking that isn't based in reality.

Postpartum psychosis is considered an emergency requiring immediate medical treatment (Antipsychotic pharmacotherapy and antidepressants). If you have any psychotic symptoms, seek emergency help immediately. Until you tell your doctor and get treatment, you are at high risk of suddenly harming yourself or your baby.

*A hallucination is a perception of something that is not really there.

A hallucination can involve any of the senses: hearing, sight, smell, taste, or touch.
The most common hallucinations are seeing (visual) and hearing (auditory) things. For example, the person may hear voices or see an object that other people do not see.
Other types of hallucinations include tasting (gustatory), smelling (olfactory), or feeling (tactile) something that is not there.
Treatment for hallucinations depends on the cause.

*Delusions are firmly held but false beliefs. The most common delusion people have is that someone is trying to steal from them.