Postpartum blues vs depression vs psychosis

postpartum blues vs depression vs psychosis explained well 2024

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Introduction

Postpartum blues vs depression vs psychosis

Although delivering a baby is typically a happy event, many postpartum women develop depressive symptoms. These symptoms may manifest as the postpartum blues, which consist of mild depressive symptoms that are generally self-limited, but may be a risk factor for more severe syndromes of major depression.

Why do postpartum psychiatric illnessed like blues, depression and psychosis occur?

Though clear pathophysiology is not understiiod it is hypothesized that it is due to the fact that during pregnancy hormones like estrogen are high in boody and suddent withdrawl or reduction in the level in blood leads to mood change and all the symptoms of the blues, depression or psychosis.

This is also attributable to the psychihatric status of the person before getting pregnany any family and genetic predisposition as well.

Read: Abortion laws in Nepal

Risk factors for postpartum psychiatric disorders

Risk factors — Factors that are associated with the postpartum blues include the following:

1. Not breastfeeding
2. Stress around child care
   
3. Psychosocial impairment
   
4. Family history of depression
   
5. History of:
• Postpartum depression
• Premenstrual mood changes
• Oral contraceptive use that is associated with mood changes
• Depressive syndromes predating pregnancy
• Antepartum depressive symptoms
• Caesarian section

Blues▶

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During the puerperium, mild, transient depressive symptoms such as dysphoria, insomnia, emotional lability, and decreased concentration occur in many women.

Postpartum blues is generally benign but may indicate future possibility of more severe psychiatric illness so careful watch mut be given immidiately and in the future as well .

✅Depressed. fatique. tearfulness, mood swings 30-70%
✅Starts 2-3 days >delivery, Resolves- within 10 days, No thoughts of harming baby
✅Rx - Support and follow up

Postpartum depression▶

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The diagnostic criteria for postpartum major depression are the same criteria that are used to diagnose nonpuerperal major depression.

Depresses. Anxiety 10-15%

✅Starts within 12 weeks from delivery & persists > 2 weeks
✅Thoughts of harming +-
✅Rx - CBT & SSRIs

Postpartum Psychosis▶

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Postpartum psychosis (or puerperal psychosis) is most often seen in patients that have been or will be diagnosed with bipolar disorder but can also occur in women with a major depression with psychosis, schizophrenia, or schizoaffective disorder. A subset of women experience isolated postpartum psychosis that does not progress to mood or psychotic episodes outside the postpartum time period [1].

The clinical picture of postpartum psychosis includes rapid onset of psychotic symptoms including hallucinations and delusions, bizarre behavior, confusion, and disorganization that may appear to be delirium. Postpartum psychosis constitutes a medical emergency and generally requires rapid intervention and hospitalization, as well as a comprehensive medical evaluation and psychiatric management.

Psychosis is a disturbance in an individual’s perception of reality. Psychosis can be manifested through one or more of the following:

1. Delusions – Fixed, false, idiosyncratic beliefs that are not culturally based.
2. Hallucinations – Sensory experiences without physical sensory stimulation including tactile, visual, auditory, gustatory, and olfactory sensations.
3. Thought disorganization.
4. Disorganized behavior.

✅Delusions, hallucinations 0.1-0.2%
✅Thoughts of harming or self +
✅Rx - Hospitalisation, Atypical antipsychotics