Master the board step 3

Psychiatry
Postpartum Depression
Postpartum Blues or
“Baby Blues”
Postpartum Depression
Postpartum Psychosis
Onset After any birth Usually after 2nd birth Usually after 1st birth
Mother’s emotions
toward baby
Cares about baby
Many have thoughts about
hurting the baby
Many have thoughts about
hurting the baby
Symptoms Mild depressive Severe depressive Look for psychotic symptoms
along with severe depressive
symptoms
Treatment
Self-limited; no treatment
necessary
Antidepressants
Mood stabilizers or
antipsychotics and
antidepressants
TIP: Avoid medications if patient
is breastfeeding; instead choose
electroconvulsive therapy (ECT).
Suicide and Suicidal Ideation
Management of the Suicidal Patient
Ask about risk factors:
• History of suicide threats and attempts is the most
important predictor of suicide
• Family history of suicide
• Perceived hopelessness (demoralization)
• Schizophrenia/borderline or antisocial PD
• Drug use, especially alcohol
• Males/age > 65
• Socially isolated/recently divorced or widowed
• Chronic physical illness
• Low job satisfaction or unemployment
Emergency Assessment
• Take all suicide threats seriously
• Detain and hospitalize (usually a couple of weeks)
• Never transport patient to emergency department
without medically trained personnel accompanying
patient
• Do not identify with the patient
• Do not leave patient unsupervised
• Treatment of choice = psychotherapy + antidepressant
medications (SSRIs are first choice)
• For acute, severe risk of self-harm, treatment of choice
is electroconvulsive therapy (ECT)
Indications for Electroconvulsive Therapy (ECT)
··
Major depressive episodes that are unresponsive to medications
··
High risk for immediate suicide
··
Contraindications to using antidepressant medications
··
Good response to ECT in the past
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