Postpartum Psychiatric Disorders

The postpartum (PP) period is a common time for the emergence or exacerbation of psychiatric disorders. Postpartum blues, PP depression, and PP psychosis are 3 of the most common psychiatric disorders experienced in the PP period. Although both genders are affected, PP is more common in women. Postpartum blues and PP depression affect up to 80% and 25% of women, respectively. Postpartum psychosis is less common but can be more serious. Unfortunately, perinatal mental illness is largely underdiagnosed and undertreated. Diagnosis is clinical, and management typically involves psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy and antidepressants. Antipsychotics are used in the management of PP psychosis.

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Overview

Definitions

  • Postpartum (PP) blues: mild depressive symptoms that are transient and self-limiting in the perinatal period
  • PP depression: depressive symptoms beginning within the 1st 12 months following childbirth and lasting for at least 2 weeks
  • PP psychosis: a psychiatric manifestation with abrupt onset after delivery that is characterized by psychotic symptoms

Classification

The American Psychiatric Association (APA)’s Diagnostic and Statistical Manual 5th Edition (DSM-V) currently:

  • Does not classify PP psychiatric disorders as distinct entities
  • Allows providers to use the “with peripartum onset” specifier with the following diagnoses: 
    • Adjustment disorder Adjustment disorder Adjustment disorder is a psychological response to an identifiable stressor. The condition by emotional or behavioral symptoms that develop within 3 months of exposure, and do not last more than 6 months. Adjustment Disorder with depressed mood 
    • Depressive disorder not otherwise specified
    • Major depressive disorder Major depressive disorder Major depressive disorder (MDD), commonly called depression, is a unipolar mood disorder characterized by persistent low mood and loss of interest in association with somatic symptoms for a duration of ≥ 2 weeks. Major depressive disorder has the highest lifetime prevalence among all psychiatric disorders. Major Depressive Disorder
    • Brief psychotic disorder Brief psychotic disorder Brief psychotic disorder is the presence of 1 or more psychotic symptoms lasting more than 1 day and less than 1 month. An episode is often stress-related with a sudden onset, and the patient fully returns to baseline functioning after an episode. Brief Psychotic Disorder
    • Major depressive, manic, or mixed episode in bipolar I or II disorders

According to the DSM-V, to use the “with peripartum onset” modifier, the onset of symptoms must occur during pregnancy Pregnancy Pregnancy is the time period between fertilization of an oocyte and delivery of a fetus approximately 9 months later. The 1st sign of pregnancy is typically a missed menstrual period, after which, pregnancy should be confirmed clinically based on a positive β-hCG test (typically a qualitative urine test) and pelvic ultrasound. Pregnancy: Diagnosis, Maternal Physiology, and Routine Care or within 4 weeks PP (rather than within 1 year, which is commonly considered in clinical practice).

Epidemiology

  • Prevalence:
    • PP blues: very common, up to 80% of pregnancies
    • PP depression: often underdiagnosed, approximately 10%–25% of pregnancies 
    • PP psychosis: rare, < 1–2 per 1000 births
  • Gender: primarily occur in women
  • Age: more common in women < 25 years of age

Risk factors

  • Young age (< 25 years)
  • Poor social support
  • Difficulties with breastfeeding Breastfeeding Breastfeeding is often the primary source of nutrition for the newborn. During pregnancy, hormonal stimulation causes the number and size of mammary glands in the breast to significantly increase. After delivery, prolactin stimulates milk production, while oxytocin stimulates milk expulsion through the lactiferous ducts, where it is sucked out through the nipple by the infant. Breastfeeding
  • Cesarean sections, traumatic birth experience, or other perinatal complications
  • Women with infants having health problems and/or with infants admitted to the NICU
  • History of psychotic illnesses (especially anxiety and depression)
  • Family history of psychiatric illnesses
  • Previous episode of PP psychiatric disorder
  • Stressful life events (during pregnancy Pregnancy Pregnancy is the time period between fertilization of an oocyte and delivery of a fetus approximately 9 months later. The 1st sign of pregnancy is typically a missed menstrual period, after which, pregnancy should be confirmed clinically based on a positive β-hCG test (typically a qualitative urine test) and pelvic ultrasound. Pregnancy: Diagnosis, Maternal Physiology, and Routine Care and near delivery)
  • Childcare stress (e.g., inconsolable crying infant)
  • History of sexual abuse Sexual Abuse Sexual abuse and assault are major public health problems that affect many people from all walks of life, including people of all ages and genders, but it is more prevalent in women and girls, with reports of up to 1 in 3 experiencing sexual assault at some time in their life. Sexual Abuse
  • Financial difficulties

Pathophysiology

The exact mechanisms are unclear and often multifactorial. 

  • Estrogen can affect the monoaminergic system (serotonin and dopamine) → changes in estrogen influence affective and psychotic symptoms
  • Drastic changes in hormone levels are thought to be major contributing factors in PP psychiatric disorders: early PP period is characterized by a marked ↓ in both estrogen and progesterone
  • Genetic factors may contribute.

Screening tools

There are a number of validated screening questionnaires that can help identify patients with or at risk for PP psychiatric disorders. Some of the most common questionnaires include:

  • Edinburgh Postnatal Depression Scale (EPDS): 
    • Used to assess patients for PP depression specifically (as opposed to major depressive disorder in general)
    • Self-reported 10-item questionnaire
    • Includes anxiety symptoms, which are a prominent feature in perinatal mood disorders
    • Excludes constitutional symptoms (e.g., changes in sleeping patterns) that are common in the PP period
    • An EPDS score > 11 indicates a risk for PP depression.
  • PP Depression Screening Scale (PDSS): 
    • Self-reported 35-item questionnaire 
    • High sensitivity and specificity
  • Patient Health Questionnaire-9 
    • Used to assess depression severity and monitor effects of treatment (though not specific for PP depression)
    • Self-reported 9-item questionnaire
    • Includes constitutional symptoms → reduces specificity in PPD

Postpartum Blues

Clinical presentation

  • Symptoms may include:
    • Feeling guilty and/or overwhelmed (especially about being a mother)
    • Crying, sadness
    • Rapid changes in mood and irritability
    • Anxiety 
    • Poor concentration
    • Eating too much or too little
    • Insomnia Insomnia Insomnia is a sleep disorder characterized by difficulty in the initiation, maintenance, and consolidation of sleep, leading to impairment of function. Patients may exhibit symptoms such as difficulty falling asleep, disrupted sleep, trouble going back to sleep, early awakenings, and feeling tired upon waking. Insomnia or frequent awakenings at night
  • Symptoms are mild and do not interfere with activities of daily living.
  • Onset of symptoms: within a couple of days after birth 
  • Duration of symptoms: lasting up to and no more than 2 weeks
  • Does not meet the criteria for major depressive disorder

Management

  • Resolves spontaneously
  • Provide reassurance. 
  • Encourage self-care.

Postpartum Depression

Clinical presentation

  • Symptoms may include:
    • Disinterest in self, in child, and in normal activities
    • Feeling isolated, unwanted, or worthless
    • Feeling a sense of shame or guilt about parenting skills
    • ↑ Anger outbursts
    • Suicidal ideation or frequent thoughts of death
  • Symptoms are more severe and patients have an inability to cope.
  • Onset of symptoms: 
    • American College of Obstetrics and Gynecology (ACOG): 2 weeks to 1 year after delivery 
    • APA: within 4 weeks of delivery
    • WHO: within 6 weeks of delivery
  • Duration of symptoms: > 2 weeks

Diagnosis

Postpartum depression is a clinical diagnosis. The following information may assist in establishing the diagnosis:

  • Screening questionnaires (e.g., EPDS, PDSS, or Patient Health Questionnaire-9) 
  • DSM-V criteria for major depressive disorder with peripartum onset:
    • Patients must meet at least 5 out of 9 symptoms for > 2 weeks.
    • Depressed mood or anhedonia (reduced pleasure from previously enjoyable habits) must be among the patient’s symptoms.
    • Symptoms include:
      • Depressed mood, almost everyday
      • Anhedonia
      • Appetite/weight changes (↓ or ↑)
      • Sleep disturbances (↓ or ↑)
      • Psychomotor agitation or retardation (patient is anxious and moves a lot, or barely moves)
      • Loss of energy/fatigue
      • Feeling worthless or excessively guilty
      • Trouble concentrating
      • Suicidal ideation and/or attempts
    • Symptoms cause a significant decline in function in social and occupational/school settings.
    • The patient does not have a history of:
      • Other psychiatric disorders (especially bipolar disorder Bipolar disorder Bipolar disorder is a highly recurrent psychiatric illness characterized by periods of manic/hypomanic features (distractibility, impulsivity, increased activity, decreased sleep, talkativeness, grandiosity, flight of ideas) with or without depressive symptoms. Bipolar Disorder)
      • Substance use 
      • Medical conditions such as hypothyroidism Hypothyroidism Hypothyroidism is a condition characterized by a deficiency of thyroid hormones. Iodine deficiency is the most common cause worldwide, but Hashimoto's disease (autoimmune thyroiditis) is the leading cause in non-iodine-deficient regions. Hypothyroidism, nutritional deficiency, and cerebrovascular disease, which cause depressive mood
    • Limitations of the DSM-V criteria:
      • Many symptoms, especially weight changes and sleep Sleep Sleep is a reversible phase of diminished responsiveness, motor activity, and metabolism. This process is a complex and dynamic phenomenon, occurring in 4-5 cycles a night, and generally divided into non-rapid eye movement (NREM) sleep and REM sleep stages. Physiology of Sleep disturbances, are common and frequently unrelated to depression in the PP period.
      • Restricts the diagnosis to symptoms beginning within 4 weeks of delivery → may lead to underdiagnosis
  • Laboratory studies:
    • If patients do have a history of medical conditions known to cause depressive symptoms, tests should be ordered to assess status.
    • Should be ordered if patients have other findings consistent with these conditions (e.g., new-onset constipation Constipation Constipation is common and may be due to a variety of causes. Constipation is generally defined as bowel movement frequency < 3 times per week. Patients who are constipated often strain to pass hard stools. The condition is classified as primary (also known as idiopathic or functional constipation) or secondary, and as acute or chronic. Constipation and goiter Goiter A goiter is a chronic enlargement of the thyroid gland due to nonneoplastic growth occurring in the setting of hypothyroidism, hyperthyroidism, or euthyroidism. Morphologically, thyroid enlargement can be diffuse (smooth consistency) or nodular (uninodular or multinodular). Goiter, which are suggestive of hypothyroidism Hypothyroidism Hypothyroidism is a condition characterized by a deficiency of thyroid hormones. Iodine deficiency is the most common cause worldwide, but Hashimoto's disease (autoimmune thyroiditis) is the leading cause in non-iodine-deficient regions. Hypothyroidism)

Management

  • Psychotherapy:
    • Cognitive-behavioral therapy 
    • Family-centered therapy
    • Nondirective counseling
  • Antidepressants: Weigh risks against benefits for breastfeeding Breastfeeding Breastfeeding is often the primary source of nutrition for the newborn. During pregnancy, hormonal stimulation causes the number and size of mammary glands in the breast to significantly increase. After delivery, prolactin stimulates milk production, while oxytocin stimulates milk expulsion through the lactiferous ducts, where it is sucked out through the nipple by the infant. Breastfeeding mothers.
    • Selective serotonin reuptake inhibitors Serotonin Reuptake Inhibitors Antidepressants encompass several drug classes and are used to treat individuals with depression, anxiety, and psychiatric conditions, as well as those with chronic pain and symptoms of menopause. Antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and many other drugs in a class of their own. Serotonin Reuptake Inhibitors and Similar Antidepressant Medications (SSRIs): 1st line, best studied
    • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • A combination of psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy and SSRIs is most effective.
  • Electroconvulsive therapy (ECT) can also be considered (no risk to infant).
  • Most women recover within 6–12 months.

Complications

  • Risk of impaired maternal-child bonding → risk of behavioral problems and/or developmental delay in the infant
  • ↑ Risk of developing major depressive disorder later in life
  • Suicide Suicide Suicide is one of the leading causes of death worldwide. Patients with chronic medical conditions or psychiatric disorders are at increased risk of suicidal ideation, attempt, and/or completion. The patient assessment of suicide risk is very important as it may help to prevent a serious suicide attempt, which may result in death. Suicide (preventable with adequate treatment)
  • Infanticide

Postpartum Psychosis

Clinical presentation

Symptoms are similar to those of non-obstetric psychosis. The presenting symptoms are often severe, interfere with daily activities, and require hospitalization.

  • Symptoms may include:
    • Visual or auditory hallucinations
    • Paranoia, confusion, or delusions (especially regarding issues of parenthood) 
    • Mood symptoms (e.g., mania, depression, or both)
    • Disorganized speech
    • Disorganized or catatonic behavior
    • Obsession with caring for the infant 
    • Severe insomnia or frequent awakenings at night
    • Irritability, anxiety, hyperactivity, and psychomotor agitation 
    • Homicidal or violent thoughts related to the infant
    • Suicidal ideation or attempts
  • Onset: few days to 1 year after delivery (most commonly 2 weeks after delivery)
  • More common in patients with bipolar disorder Bipolar disorder Bipolar disorder is a highly recurrent psychiatric illness characterized by periods of manic/hypomanic features (distractibility, impulsivity, increased activity, decreased sleep, talkativeness, grandiosity, flight of ideas) with or without depressive symptoms. Bipolar Disorder or other psychiatric disorders characterized by psychosis (e.g., schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia)

Etiology and diagnosis

According to the DSM-V, PP psychosis is not recognized as a distinct disorder. Instead, PP is classified as a primary psychiatric disorder and given the modifier “with peripartum onset” if symptoms begin within 4 weeks of delivery. 

  • Most common associated psychiatric disorders:
    • Bipolar disorder
    • Schizoaffective disorder Schizoaffective disorder Schizoaffective disorder is a mental disorder that is marked by 2 components: a psychotic component (hallucinations or delusions) and a mood component (mania or depression). Patients must therefore meet the diagnostic criteria for both major mood disorder and schizophrenia. Schizoaffective Disorder
    • Schizophrenia
    • Major depression with psychotic features
    • Substance abuse disorder
    • Psychosis due to general medical conditions
    • Brief psychotic disorder Brief psychotic disorder Brief psychotic disorder is the presence of 1 or more psychotic symptoms lasting more than 1 day and less than 1 month. An episode is often stress-related with a sudden onset, and the patient fully returns to baseline functioning after an episode. Brief Psychotic Disorder
  • Other potential causes of psychosis: (work-up based on presentation)
    • Illicit drug use
    • Infectious diseases (e.g., mastitis Mastitis Mastitis is inflammation of the breast tissue with or without infection. The most common form of mastitis is associated with lactation in the first few weeks after birth. Non-lactational mastitis includes periductal mastitis and idiopathic granulomatous mastitis (IGM). Mastitis, endometritis Endometritis Endometritis is an inflammation of the endometrium, the inner layer of the uterus. The most common subtype is postpartum endometritis, resulting from the ascension of normal vaginal flora to the previously aseptic uterus. Endometritis)
    • Metabolic encephalopathy
    • Endocrine dysfunction
    • CNS events
  • Laboratory studies to evaluate other potential causes:
    • Urine drug screen
    • CBC: Leukocytosis may indicate infectious diseases.
    • CMP: Abnormal electrolytes Electrolytes Electrolytes are mineral salts that dissolve in water and dissociate into charged particles called ions, which can be either be positively (cations) or negatively (anions) charged. Electrolytes are distributed in the extracellular and intracellular compartments in different concentrations. Electrolytes are essential for various basic life-sustaining functions. Electrolytes may suggest metabolic encephalopathy.
    • Thyroid studies: may suggest hypothyroidism Hypothyroidism Hypothyroidism is a condition characterized by a deficiency of thyroid hormones. Iodine deficiency is the most common cause worldwide, but Hashimoto's disease (autoimmune thyroiditis) is the leading cause in non-iodine-deficient regions. Hypothyroidism

Management

Postpartum psychosis is considered a psychiatric emergency.

  • Hospitalization:
    • Especially if there is homicidal or suicidal ideation
    • The patient should be under the care of a psychiatrist (not an obstetrician).
  • Medical therapy:
    • Antipsychotics 
    • May be combined with antidepressants or mood stabilizers depending on the symptoms
  • Psychotherapy:
    • Generally only useful after the initial crisis 
    • Family-centered therapy can provide support for recovery.
  • ECT can be used to reduce depressive symptoms.

Complications

  • Temporary disruption to the maternal-infant bond → risk of behavioral problems and/or developmental delay in the infant
  • Suicide Suicide Suicide is one of the leading causes of death worldwide. Patients with chronic medical conditions or psychiatric disorders are at increased risk of suicidal ideation, attempt, and/or completion. The patient assessment of suicide risk is very important as it may help to prevent a serious suicide attempt, which may result in death. Suicide and/or homicide (preventable with adequate treatment)

Summary

Table: Summary of PP psychiatric diseases
PP blues PP depression PP psychosis
Epidemiology 50%–80% of pregnancies 10%–25% of pregnancies < 1% of pregnancies
Common symptoms Guilt, crying, feeling of being overwhelmed Inability to cope, disinterest in self, disinterest in infant Visual or auditory hallucinations
Onset Birth to 2 weeks PP 2 weeks to 1 year after delivery Days to 1 year after delivery
Treatment Resolves spontaneously Psychotherapy, antidepressants Antipsychotics
Differential diagnoses
  • PP depression
  • Major depressive disorder Major depressive disorder Major depressive disorder (MDD), commonly called depression, is a unipolar mood disorder characterized by persistent low mood and loss of interest in association with somatic symptoms for a duration of ≥ 2 weeks. Major depressive disorder has the highest lifetime prevalence among all psychiatric disorders. Major Depressive Disorder
  • Seasonal affective disorder
  • Acute stress disorder Acute stress disorder Acute stress disorder describes stress reactions displayed after an individual has experienced a traumatic event. Symptoms last more than 3 days but less than 1 month and include re-experiencing the event as flashbacks or nightmares, avoidance of reminders of the event, irritability, hyperarousal, and poor memory and concentration. Acute Stress Disorder
  • Dysthymia
  • PP blues
  • PP psychosis
  • Major depressive disorder Major depressive disorder Major depressive disorder (MDD), commonly called depression, is a unipolar mood disorder characterized by persistent low mood and loss of interest in association with somatic symptoms for a duration of ≥ 2 weeks. Major depressive disorder has the highest lifetime prevalence among all psychiatric disorders. Major Depressive Disorder
  • Bipolar disorder
  • Dysthymia
  • Seasonal affective disorder
  • Acute stress disorder Acute stress disorder Acute stress disorder describes stress reactions displayed after an individual has experienced a traumatic event. Symptoms last more than 3 days but less than 1 month and include re-experiencing the event as flashbacks or nightmares, avoidance of reminders of the event, irritability, hyperarousal, and poor memory and concentration. Acute Stress Disorder
  • Hypothyroidism
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview
  • PP blues
  • PP depression
  • Acute psychosis
  • Schizophrenia
  • Delirium Delirium Delirium is a medical condition characterized by acute disturbances in attention and awareness. Symptoms may fluctuate during the course of a day and involve memory deficits and disorientation. Delirium
  • Bipolar disorder
  • Seasonal affective disorder
  • Acute stress disorder Acute stress disorder Acute stress disorder describes stress reactions displayed after an individual has experienced a traumatic event. Symptoms last more than 3 days but less than 1 month and include re-experiencing the event as flashbacks or nightmares, avoidance of reminders of the event, irritability, hyperarousal, and poor memory and concentration. Acute Stress Disorder
PP: postpartum

Differential Diagnosis

  • Acute stress disorder Acute stress disorder Acute stress disorder describes stress reactions displayed after an individual has experienced a traumatic event. Symptoms last more than 3 days but less than 1 month and include re-experiencing the event as flashbacks or nightmares, avoidance of reminders of the event, irritability, hyperarousal, and poor memory and concentration. Acute Stress Disorder: presents after an individual has experienced a life-threatening event. Symptoms last > 3 days and < 1 month and involve re-experiencing the event as flashbacks or nightmares, avoidance of reminders of the event, irritability, hyperarousal, and poor memory and concentration. Management uses cognitive behavioral therapy and medications including anxiolytics. 
  • Major depressive disorder Major depressive disorder Major depressive disorder (MDD), commonly called depression, is a unipolar mood disorder characterized by persistent low mood and loss of interest in association with somatic symptoms for a duration of ≥ 2 weeks. Major depressive disorder has the highest lifetime prevalence among all psychiatric disorders. Major Depressive Disorder: a unipolar mood disorder characterized by persistent low mood and loss of interest, in association with somatic symptoms for at least a 2-week duration. Major depressive disorder Major depressive disorder Major depressive disorder (MDD), commonly called depression, is a unipolar mood disorder characterized by persistent low mood and loss of interest in association with somatic symptoms for a duration of ≥ 2 weeks. Major depressive disorder has the highest lifetime prevalence among all psychiatric disorders. Major Depressive Disorder has the highest lifetime prevalence among all psychiatric disorders. Biological, psychosocial, and genetic factors contribute to depression. Treatment modalities include pharmacotherapy, psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy, and neuromodulation, such as ECT. Suicide Suicide Suicide is one of the leading causes of death worldwide. Patients with chronic medical conditions or psychiatric disorders are at increased risk of suicidal ideation, attempt, and/or completion. The patient assessment of suicide risk is very important as it may help to prevent a serious suicide attempt, which may result in death. Suicide is the leading cause of mortality in major depressive disorder.
  • Bipolar disorder: a recurrent psychiatric illness characterized by periods of manic and hypomanic features. Manic features include distractibility, impulsivity, increased activity, decreased sleep Sleep Sleep is a reversible phase of diminished responsiveness, motor activity, and metabolism. This process is a complex and dynamic phenomenon, occurring in 4-5 cycles a night, and generally divided into non-rapid eye movement (NREM) sleep and REM sleep stages. Physiology of Sleep, talkativeness, grandiosity, and flight of ideas. These features may present with or without depressive symptoms. Management of bipolar disorder Bipolar disorder Bipolar disorder is a highly recurrent psychiatric illness characterized by periods of manic/hypomanic features (distractibility, impulsivity, increased activity, decreased sleep, talkativeness, grandiosity, flight of ideas) with or without depressive symptoms. Bipolar Disorder varies based on the presenting features, but usually involves pharmacotherapy with mood stabilizers. 
  • Schizophrenia: a chronic psychiatric disorder characterized by the presence of psychotic symptoms such as delusions and hallucinations. The signs and symptoms of schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia include both positive symptoms (delusions, hallucinations, disorganized speech, and behavior) and negative symptoms (flat affect, avolition, anhedonia, poor attention, and alogia). Management includes antipsychotics in conjunction with behavioral therapy.
  • Brief psychotic disorder Brief psychotic disorder Brief psychotic disorder is the presence of 1 or more psychotic symptoms lasting more than 1 day and less than 1 month. An episode is often stress-related with a sudden onset, and the patient fully returns to baseline functioning after an episode. Brief Psychotic Disorder: defined as the presence of 1 or more psychotic symptoms lasting more than a day and less than a month. Brief psychotic disorder Brief psychotic disorder Brief psychotic disorder is the presence of 1 or more psychotic symptoms lasting more than 1 day and less than 1 month. An episode is often stress-related with a sudden onset, and the patient fully returns to baseline functioning after an episode. Brief Psychotic Disorder usually has a sudden onset and is often stress related. The diagnosis is clinical and management includes a brief course of 2nd-generation antipsychotics for 1–3 months along with education on the condition and reassurance, and potentially, psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy
  • Delusional disorder Delusional disorder In delusional disorder, the patient suffers from 1 or more delusions for a duration of 1 month or more, without any other psychotic symptoms or behavioral changes and no decline in functioning abilities. Delusional Disorder: a condition in which the patient suffers from 1 or more delusions for a duration of 1 month or longer, without any other psychotic symptoms or behavioral changes and without a decline in the ability to function. Diagnosis is clinical, and the 1st-line treatment is with antipsychotic Antipsychotic Antipsychotics, also called neuroleptics, are used to treat psychotic disorders and alleviate agitation, mania, and aggression. Antipsychotics are notable for their use in treating schizophrenia and bipolar disorder and are divided into 1st-generation antipsychotics (FGAs) and atypical or 2nd-generation antipsychotics. First-Generation Antipsychotics medications provided within the context of a trusting therapeutic relationship. Psychotherapy based on support and education may be helpful.
  • Schizoaffective disorder Schizoaffective disorder Schizoaffective disorder is a mental disorder that is marked by 2 components: a psychotic component (hallucinations or delusions) and a mood component (mania or depression). Patients must therefore meet the diagnostic criteria for both major mood disorder and schizophrenia. Schizoaffective Disorder: a psychiatric disorder that includes both a psychotic component and a mood component. The diagnosis is clinical and management consists of both pharmacotherapy and psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy similar to that used for schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia and mood disorders.

References

  1. Gavin, N., Gaynes, B.N., et al. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstet Gynecol. 106, 1071–1083.
  2. Katherine, L. Wisner, Eydie, L. Moses-Kolko, and Dorothy K.Y. Sit. (2010). Postpartum depression: A disorder in search of a definition. Arch Women’s Ment Health. 13(1), 37–40.
  3. O’Hara, M.W., McCabe J.E. (2013). Postpartum depression: Current status and future directions. Annu Rev Clin Psychol. 9, 379-407.
  4. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing, Washington, DC2013: 186–187.
  5. Howard, L.M., Molyneaux. E., Dennis, C.L., Rochat, T., Stein, A., Milgrom, J. (2014). Non-psychotic mental disorders in the perinatal period. Lancet. 384(9956), 1775–1788.
  6. The American College of Obstetrics and Gynecology Committee on Obstetrics. (2018). Committee Opinion No. 757: Screening for Perinatal Depression. Retrieved May 7, 2021, from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression 
  7. Viguera, A. (2021). Postpartum unipolar major depression: Epidemiology, clinical features, assessment, and diagnosis. In Solomon, D. (Ed.), UpToDate. Retrieved May 7, 2021, from https://www.uptodate.com/contents/postpartum-unipolar-major-depression-epidemiology-clinical-features-assessment-and-diagnosis 
  8. Payne, J. (2018). Postpartum psychosis: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. In Friedman, M. (Ed.), UpToDate. Retrieved May 7, 2021, from https://www.uptodate.com/contents/postpartum-psychosis-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis 

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