DEPRESSION & PSYCHOSIS IN THE POSTPARTUM PERIOD

Dr.Deddy Soestiantoro SpKJ MKes

POSTPARTUM DEPRESSION
*20-40%emotional disturbance/cognitive dysfunction

*Indonesia: 10-30% as postpartum/medical complication

*Baby Blues: -normal state of sadness,dysphoria, frequent tearfulness and clinging dependence,ascribed to rapid changes in hormonal levels, the stress of childbirth,and the awareness of the increased responsibility *Postpartum Depression : -a depressed mood,excessive anxiety and insomnia

ETIOLOGY -multifactorial: -sociocultural factors, -baby and mother conditions, -psychosocial factors, -personality factor, -history of depression/emotional problems, hormonal factor

*1-2 in 1000 deliveries depressed feelings and suicidal ideation,in severe cases may reach psychotic proportions with hallucinations, delusions and thoughts of infanticides

*severe postpartum depression are at high risk for future episode and failure to treat may contribute to long-term,refractory mood disorders *evaluation of depression: HDRS (Hamilton Depression Rating Scale) Score: * 0-6 : normal 7-16 : mild depression 17-23 : moderate 24- > : severe

COMPARISON OF BABY BLUES& POSTPARTUM DEPRESSION

Characteristic

Baby Blues

Postpatum Depression

-Incidence 50%of woman who give birth 10% -Time of onset 3-5days after delivery Within 3-6 months after -Duration Days to weeks Month to years if untreated -Ass. stressors No Yes,esp.lack of support -S.cultural infuences No Strong association -H.of mood disorder No Strong association -Fam.h.of mood dis. No Some association

-Tearfulness -Mood lability -Anhedonia -Sleep disturbance -Suicidal thoughts -Thought of harming the baby -Feeling of guilt,

Yes Yes No Sometimes No Rarely Absent or mild

Yes Often present Often Nearly always Sometimes Often Often present and excessive

Pitts criteria for Postpartum depression: -positive symptoms of depression, -the symptoms begin & developed after birth, -the symptoms never seen before -the symptoms persist more then 2 weeks
DSM IV: -the onset during 4 weeks postpartum periode Kit & Cox: -6 weeks PPDGJ III: -6 weeks

*Syndrome in Fathers (during pregnacies or after the babies are born) affected by many factors: -resposibility, -sexual outlet, -attention, -child as a binding force

Depressive episode -PPDGJ III/ICD X -Main symptoms:-decrease affect/depressed mood -loss of interest/enjoyment -lack of energy -Other symptoms:-reduced attention/concentration -reduced self esteem & self confidence -ideas of guilt and unworthyness -bleak and pessimistic view of the future -ideas of acts of self harm or suicide -disturbed sleep -diminished appetite -The lowered mood varies,often unresponsive to circumtances sometimes there's diurnal variation,severe symptoms maybe shorter than 2 weeks.

Negative effect of Postpartum Depression in Childhood - 3 year olds :conduct disorders - 4 year olds :cognitive deficit - disorders in mother-childs relationship, Treatment should be comprehensive / integrated