True regarding postpartum psychosis:
Correct Answer: Usually occurs on 2 week postpartum
Description: Ans: C (Usually occurs within 2 week postpartum) Ref: Dutta Obstetrics. 6th edition, Pg 444 and Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th editionExplanation:Postpartum Psychological DisordersPsychiatric disorders after childbirth in females have a spectrum of presentation.They are:1. Postpartum blues2. Postpartum depression3. Postpartum psychosis.Postpartum Blues fsvn. maternity blues/ baby blues}It is a common, transient and self-limiting condition.Observed 4-5 days after delivery.Lasts a few days to 2 - 3 weeks.Occurs at the height of hormonal changes.Seen in 50% of postpartum women.Manifestations are:o Labile moodo Depressiono Anxietyo Fearful nesso Insomniao Helplessnesso Negative feelings towards infant.Can progress to post-partum depression.Treatment: Reassurance and psychological support of family members.Contrast to this, baby pinks" is a condition where women experience elated mood. It is rare but serves as a risk factor for postpartum psychosis.Postpartum Depression (postnatal depression)it is an uncommon disorder characterised by symptoms of major depression.Occurs usually within 2 weeks after childbirth.Lasts more than 2 weeksNeglect of self and baby is a real threat.Seen in 10 - 20% of mothers.It is more gradual in onset over the first 4-6 months following delivery or abortion.Changes in hypothalamo-pituitary-adrenal axis.Clinical features:o Loss of energyo Loss of appetiteo Insomniao Social withrdrawaio Irritiabilityo Suicidal tendenciesRisk of recurrence is 50 - 100% in subsequent pregnancies.Treatment: Fluoxetine is effective.It is insidious or acute in onset and warrants treatment as earfy as possible.SSRIs and psychotherapy both found to be useful.Risk factors are:o Family historyo Past history of depressiono Premenstrual dysphoric disorder o Unwanted pregnancy.Postpartum Psychosis (Puerperal psychosis)It is a rare but severe condition.It is characterised by abrupt or acute onset of either.o Polymorphic or persistent changes in mood (elation or depression).o Behaviour {agitation or catatonia),o Psychotic symptoms (hallucinations, delusions),It occurs within 2 weeks of childbirth.Risk factors:o Primi-gravidao Female babieso Babies with congenital defectsECT is highly effective method of treatment.SSRIs and antipsychotics also useful.Ruling out organic cause is must (like cortical vein thrombosis).Course is relatively fair but NOT GOOD.Recurrence is a real possibility but NOT A RULE.Recurrence may be in another childbirth or an independent episode {if so. usually a bipolar illness).Melancholic filicide is infanticide after childbirth is usually due to profound postpartum depression or psychosis.
Category:
Psychiatry
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