Types of post-partum metal disorders:-

1. Maternity blues
2. Puerperal psychosis
Maternity blues

• Patient will experienced lability of mood

• Symptoms:-
- Irritability
- Muddled thinking
- Tearfulness
• These symptoms reach their peak on 3rd or 4th post-
partum day
• Reassurance that this is common and short-lived must be
given to patient
• Usually no treatment needed
Puerperal psychosis
• Three types of psychosis in post-partum patient
-Delirium
-Affective
-Schizophrenic
• Affective syndromes more common than
schizophrenic
• Psychosis symptoms typically begins 2-3 days after
delivery and nearly always in 1st to 2nd week of post-
partum
• Occurrence : 1 in 500 births
• More common in:-
1. Primiparous women
2. Previous serious major psychiatric disorder
3. Family history of psychiatric disorder
Treatment of Puerperal Psychosis
• Usually same as cases occurring outside puerperium
• Electro Convulsive Therapy (ECT) often the best
treatment for marked or moderate disorder because its
rapid effect enables the mother to resume the care of
the baby
• If the disorder is not severe and mother has no idea to
harm the baby treatment at home would be sufficient
• If the condition is severe and the mother might harm
the child, hospitalization might be needed
• If anti depressant or anti psychotic drugs or lithium to be
given to patient then breast feeding has to be stopped
Other puerperal depressive
disorder
- Prevalence mild/moderate depressive disorder
• 10-15% of recently delivered women
• More common than puerperal psychoses

- Symptoms of depressive disorder:-

• Tiredness
• Irritability
• Anxiety
• May be prominent phobic symptoms
Treatment for puerperal
depression
• Additional help with child care may be needed
• Marital counselling also needed for any marital
problems in looking after the child
• Anti depressant may be prescribed if there is any
sign of biological symptoms of depression
 Menstrual-related disorders
0 Premenstrual syndrome (PMS)
0 Premenstrual dysphoric disorder (PMDD)
 PMS
0 Clinically significant PMS occurs in 20-30% women during the 5 days
before menses in each of the three prior menstrual cycles
0 Characterized by the presence of at least 1 of affective and somatic
symptoms
0 The symptoms are relieved within 4 days of the onset of menses, without
recurrence until at least cycle day 13
0 Symptoms are present in the absence of any pharmacological therapy,
hormone ingestion, or drug or alcohol use
0 Symptoms occur reproducibly during two cycles of prospective recording
0 Patient suffers from identifiable dysfunction in social or economic
performance
0 Affective
0 Depression
0 Angry outburst
0 Irritability
0 Anxiety
0 Confusion
0 Social withdrawal
0 Somatic symptoms
0 Breast tenderness
0 Abdominal bloating
0 Headache
0 Swelling of extremities
 PMDD
0 In the majority of menstrual cycles, at least five symptoms must
be present in the final week before the onset of menses, start to
improve within a few days after the onset of menses, and become
minimal or absent in the week post menses. One or more of the
following must be present:
0 Depressed mood, hopelessness, or self depreciating thoughts
0 Anxiety, tension, feeling keyed up, or on the edge
0 Marked affective lability (mood swings, increase sensitivity to
rejection)
0 Marked irritability or anger or increase interpersonal conflicts
0 One or more of the following must additionally be present, to reach a
total of 5 symptoms from Criterion B
0 Decrease interest in usual activities
0 Subjective difficulty in concentration
0 Lethargy, easy fatigability, or marked lack of energy
0 Marked change in appetite, overeating, or specific food cravings
0 Hypersomnia or insomnia
0 A sense of being overwhelmed or out of control
0 Physical symptoms such as breast tenderness, swelling, joint or
muscle pain, bloating, weight gain
0 The symptoms in A-C must have been met for most menstrual cycle that
occurred in the preceding year.
0 The symptoms are associated with clinically significant distress or
interference with work, school, usual social activities, or relationship
with others
0 The disturbance is not merely an exacerbation of the symptoms of
another disorder, such as MDD, panic disorder, PDD, or personality
disorder
0 Criterion A should be confirmed by prospective daily ratings during at
least 2 symptomatic cycles
0 The symptoms are not attributed to physiological effects of a substance or
another medical condition
 First line treatment
0 Antidepressant: SSRI, SNRI
 Second line
0 Benzodiazepine for luteal phase depression
0 OCP
0 GnRH agonist

0 Other treatments:
0 Diuretics for severe oedema