E. Arrange urgent admission – Explanation
The mother may be suffering from puerperal psychosis and needs urgent admission to allow
psychiatric evaluation
Post-partum mental health problems
Post-partum mental health problems range from the ‘baby-blues’ to puerperal psychosis
| ‘Baby-blues’ | Postnatal depression | Puerperal psychosis |
| Seen in around 60-70% of WomenTypically seen 3-7 days following birth and is more common in primipsMothers are characteristically anxious, tearful and irritable |
Affects around 10% of women
Most cases start within a month and typically Features are similar to depression seen in |
Affects approximately 0.2% of women Onset usually within the first 2-3 weeks following birthFeatures include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations) |
| Reassurance and support, the health visitor has a key role |
As with the baby blues reassurance and support are important Cognitive behavioural therapy may be beneficial. Certain SSRIs such as sertraline and paroxetine* may be used if symptoms are severe** – whilst they are secreted in breast milk it is not thought to be harmful to the infant |
Admission to hospital is usually required There is around a 20% risk of recurrence following future pregnancies*paroxetine is recommended by SIGN because of the low milk/plasma ratio |
*paroxetine is recommended by SIGN because of the low milk/plasma ratio
**fluoxetine is best avoided due to a long half-life
