Mental health articles

OF mental health care and mentally ill

Postnatal Anxiety and Depression

Incidence

Postnatal mood disorders are commonly described as falling into three main categories: the ‘blues’, postnatal depression, and postpartum psychosis, with rates of 50–80%, 10–15%, and 0.2% respectively. A range of postnatal anxiety disorders have been described, including generalised anxiety, phobias, obsessive compulsive disorder and posttraumatic stress disorder (Brockington, Macdonald,& Wainscott,2006a; Rogal et al, 2007).Comorbidity is common, with Brockington et al. (2006a) reporting that 27% of women diagnosed with postnatal depression had two or more comorbid disorders.

The ‘Blues’

The ‘blues’, common enough to be regarded as probably normative, are medically significant only in drawing attention to the likelihood of actual illness ensuing if the symptoms persist or are severe (Henshaw, Foreman,& Cox, 2004).

Puerperal Psychoses

At the other end of the spectrum, postpartum psychosis (affective or  schizoaffective) constitutes a psychiatric emergency. Illness is often florid, acute, with onset in the first three weeks postpartum if not prior to the birth, and carries a high risk for the survival of mother and infant. Others may have to assist with care of the infant, and breastfeeding is often difficult to sustain, so lithium, other mood stabilisers, antipsychotic medication and electroconvulsive therapy (ECT)can be used in the usual way. Hospital admission, preferably to a dedicated mother–baby unit, is often necessary (see Chapter 15). With postpartum psychosis a recurrence rate of 50% to 90% is expected with subsequent pregnancies, while some women will also experience episodes at nonpregnant times (Viguera, Cohen, Nonacs, & Baldessarina, 2005).

Postnatal Depression

Postpartum depression (PND), minor or major without psychotic symptoms, may have an insidious onset over the early weeks and months, with the usual features of depressive disorder recognisable if an effort is made to identify them — for example, low mood, anhedonia, inability to concentrate, forgetfulness, low energy, insomnia, loss of interest and appetite, and thoughts of death (self and others). Irritable mood may be a prominent feature. This constellation, allied with extreme fatigue and the additional responsibilities for a new baby, can create difficulties in all the woman’s close relationships and in her capacity to care for her baby. Timely identification of any problems and appropriate intervention are thus critical to the wellbeing of the whole family. Previous studies of women admitted to a residential unit to address persistent ‘mothercraft’ problems reported that some 40% scored above the threshold for likely major depressive disorder, and a more recent study (Phillips, Sharpe,& Matthey, 2007) confirmed that there are high levels of psychiatric morbidity (depressive and anxiety disorders with a high level of  comorbidity) among such clients. The authors emphasised the need for multifaceted interventions to address psychological issues for both mother and infant. Women with depression are not a homogenous group and it is important to note that not all parents experiencing anxiety and depression show impaired parenting skills, and that not all suboptimal care-giving is linked with parental mental illness (Brockington, Aucamp,& Fraser, 2006b).

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