00:01
Now we'll talk about psychiatric
disorders in pregnancy.
00:04
So there are three psychiatric
disorders
that we see in pregnancy.
00:09
Postpartum Blues,
Postpartum Depression
and Postpartum Psychosis.
00:13
Let's take the time to
explore each of these.
00:17
So postpartum blues.
00:18
It occurs in about 50 to 80% of
pregnancies so it's very common.
00:23
The symptoms are guilt,
crying, feeling overwhelmed.
00:28
And the onset is usually
anywhere between birth to
2 weeks after delivery.
00:32
The treatment spontaneous.
00:36
It resolves on it's own.
00:37
So you just reassure mom
if she has these symptoms.
00:40
Next is postpartum depression.
00:46
Now there are risk factors
for postpartum depression.
00:49
You need to be aware
of these so that
when you see our patients
during pregnancy,
you also make them aware
that if the symptoms
start to happen associated
with postpartum depression,
they should seek your care.
01:01
So if the patient has a history
of postpartum depression
or depression in general,
they are at increased risk
for developing postpartum
depression.
01:09
If they have poor
social support.
01:13
If the baby has health
or there's another baby that
they're taking care of
or another child
that they are taking care of
that has health problems,
they are at increased risk for
developing postpartum depression.
01:23
If they have difficulty
with breastfeeding.
01:26
If we remember from
the breastfeeding lecture,
breastfeeding is one of
the things that protects us
against postpartum depression.
01:33
So if there's difficulty
with breastfeeding
this can be a risk factor.
01:36
And also for families or
moms that have financial
difficulties.
01:42
They are increased risk for
developing postpartum depression
as well.
01:45
So with postpartum depression it
occurs in approximately 15 to 25%
of pregnancies.
01:52
Now the rate may
actually be a bit higher.
01:54
Because sometimes when we
are not great at diagnosing it.
01:57
Speaking of diagnosis, there
is a way to diagnose postpartum
depression.
02:02
It is called the Edinburgh Postnatal
Depression Scale.
02:05
This scale is administered
from 2 weeks up to a year
after delivery.
02:10
It's a self administered
questionnaire where patients are
able to access how well they are
coping with their new state
of being a mom.
02:19
It's very good in determining
who has postpartum depression.
02:24
So what are those symptoms,
inability to cope.
02:26
If they have disinterest
in them self,
disinterest in their child,
disinterest in their normal
activities.
02:32
That patient may have
postpartum depression.
02:34
Onset of symptoms can be
anywhere from 2 weeks up to
a year after the birth
of their child.
02:41
The treatment is
psychotherapy and SSRI's.
02:45
So the literature shows that
doing psychotherapy works well.
02:49
Doing medication works well.
02:51
But the two working
together, works the best.
02:56
Now postpartum psychosis.
03:00
This is very rare.
03:03
We see this in less
than 1% of pregnancies.
03:06
Symptoms are the same
as typical psychosis.
03:09
Meaning patients may
experience visual or auditory
hallucinations.
03:14
The onset of symptoms can be
anywhere from 2 weeks up to
a year after the delivery.
03:20
Now the treatment for psychosis
is, because it is a more severe
form of psychiatric disorder re
to start anti-psychotics under
the care of psychiatrist.
03:30
This is not typically diagnosis
obstetricians will take care of.
03:37
Now, let's review that again.
03:38
Epidemiology for postpartum
blues 50 to 80% of pregnancies.
03:43
Symptoms guilt, crying,
being overwhelmed.
03:47
Onset 2 weeks and it
resolves spontaneously.
03:50
Postpartum depression.
03:52
15 to 25% of pregnancies.
03:55
Symptoms inability to cope,
disinterest for self or child.
03:59
Onset being 2 weeks up
to year after delivery.
04:02
Treatment psychotherapy
and SSRI's.
04:05
Postpartum psychosis, occurs
then less than 1% of pregnancies.
04:09
Symptoms are visual and
auditory hallucinations.
04:12
Onset of symptoms, 2 weeks
up to a year after delivery.
04:16
And treatment anti-psychotics
under the care of psychiatrist.
04:20
Of note, in any of these
situations if the patient is
complaining of homicidal
or suicidal ideation,
that patient needs to be
referred to the emergency room
for immediate hospitalization.
04:34
So let's take a case.
04:35
This is a 19 year old gravida 1
para 1 female that presents
to your office 2 weeks after
an emergency C-section
for evaluation of her incision.
04:47
You notice that she appears
unkempt and she seems
disinterested in her infant.
04:53
Upon further questioning,
she reports separating from
her partner and has poor
family support.
05:00
She reports crying all
the time
and she's having difficulty
coping.
05:04
The next best step in
managing this patient is .
05:07
A. Reassurance.
05:09
B. Begin a Selective Serotonin
Reuptake Inhibitor or an SSRI.
05:15
C. Hospitalization under
the care of a psychiatrist.
05:18
D. Re-evaluate symptoms in 2 weeks
to determine if they have
resolved.
05:24
What do you think
the answer is?
The answer is B.
05:28
We want to begin a Selective
Serotonin Reuptake Inhibitor.
05:31
Let's breakdown this question.
05:34
Now, she's presenting two
weeks after her C-section.
05:38
Okay, let's just think so now
the symptoms are starting
2 weeks after delivery.
05:42
She seems unkempt
and disinterested in her child
which means she's also
disinterested in herself
and she has separated her partner
and has poor family support.
05:52
She's crying all the time and
have been difficulty coping.
05:56
These are all symptoms
and all risk factors for
postpartum depression.
06:01
So A is incorrect.
06:03
Reassurance is only use
for postpartum blues.
06:06
C is incorrect because we
use this if suicidal ideation,
homicidal ideation is present
or psychosis.
06:13
And D yes we may want to
re-evaluate the symptoms in 2 weeks
but the patient needs therapy now.
06:20
So the answer is B.
06:21
Start a Selective Serotonin
Reuptake Inhibitor.