Psychiatric Disorders in Pregnancy – Obstetrics | Lecturio

Psychiatric Disorders in Pregnancy – Obstetrics | Lecturio


[Music] now we’ll talk about psychiatric disorders in pregnancy so there are three psychiatric disorders that we see in pregnancy postpartum blues postpartum depression and postpartum psychosis let’s take the time to explore each of these so postpartum blues it occurs in about 50 to 80 percent of pregnancies so it’s very common the symptoms are guilt crying feeling overwhelmed and the onset is usually anywhere between birth to two weeks after delivery the treatment spontaneous it resolves on its own so you just reassure mom if she has these symptoms next is postpartum depression now there are risk factors for postpartum depression you need to be aware of these so that when you see your patients during pregnancy you also make them aware that if these symptoms start to happen associate with postpartum depression they should seek your care so if a patient has a history of postpartum depression or depression in general they’re at increased risk for developing postpartum depression if they have poor social support if the baby has health problems or if there’s another baby that they’re taking care of another child they’re taking care of that has health problems they are at increased risk for developing postpartum depression if they have difficulty with breastfeeding if we remember from the breastfeeding lecture breastfeeding is one of the things that protects us against postpartum depression so if there’s difficulty with breastfeeding this can be a risk factor and also for families or moms that have financial difficulties they’re at increased risk for developing postpartum depression as well so with postpartum depression it occurs in approximately fifteen to twenty-five percent of pregnancies now that rate may actually be a bit higher because sometimes we’re not so great at diagnosing it speaking of diagnosis there is a way to diagnose postpartum depression it is called the edinburgh post natal depression scale this scale is administered to up to from two weeks up to a year after delivery it is a self-administered questionnaire where patients are able to assess how well they are coping with their new state of being a mom it’s very good at determining who has postpartum depression so what are the symptoms inability to cope if they have disinterest in themselves disinterest in their child disinterest in their normal activities that patient may have postpartum depression onset of symptoms can be anywhere from two weeks up to a year after the birth of their child the treatment is psychotherapy and SSRIs so the literature shows that doing psychotherapy works well doing medication works well but the two working together works the best now postpartum psychosis this is very rare we see this in less than 1% of pregnancies symptoms are the same as typical psychosis meaning patients may experience visual or auditory hallucinations the onset of symptoms can be anywhere from two weeks up to a year after delivery now the treatment for psychosis because it is a more severe form of a psychiatric disorder are to start antipsychotics under the care of psychiatrists this is not typically a diagnosis that obstetricians will take care of now let’s review that again epidemiology for postpartum blues 50 to 80 percent of pregnancies symptoms guilt crying being overwhelmed onset two weeks and it resolves spontaneously postpartum depression 15 to 25 percent of pregnancies symptoms being inability to cope did centrist in self or child onset being 2 weeks up to a year after delivery treatment psychotherapy and SSRIs postpartum psychosis occurs in less than 1% of pregnancies symptoms are visual and auditory hallucinations onset of symptoms 2 weeks up to a year after delivery and treatment antipsychotics under the care of psychiatrist of note in any of these situations if a patient is complaining of homicidal or suicidal ideation that patient needs to be referred to the emergency room for immediate hospitalization so let’s take a case this is a nineteen year old gravity’ one para one female that presents to your office two weeks after an emergency c-section for evaluation of her incision you notice that she appears unkempt and seized seems just interested in her infant upon further questioning she reports separating from her partner and has poor family support she reports crying all the time and she is having difficulty coping the next best step in managing this patient is a reassurance be began a selective serotonin reuptake inhibitor or an SSRI C hospitalization under the care of a psychiatrist d reevaluate symptoms in two weeks to determine if they have resolved what do you think the answer is the answer is B we want to begin a selective serotonin reuptake inhibitor let’s break down this question now she’s presenting two weeks after her c-section okay so that lets us think that now the symptoms are starting two weeks after delivery she seems unkempt and disinterested in her child which means she’s also disinterested in herself and she has separated from her partner and has poor family support she’s crying all the time and having difficulty coping these are all symptoms and all risk factors for postpartum depression so a is incorrect reassurance is only used for postpartum blues C is incorrect because we use this if suicidal ideation homicidal ideation is present or psychosis and D yes we may want to reevaluate the symptoms in two weeks but the patient needs therapy now so the answer is B start a selective serotonin reuptake inhibitor [Music]

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