Psychiatric Morbidity and Correlates in Postpartum Women in a Tertiary Care Hospital

Abstract

Background:A range of psychological disorders occur in women in the postpartum period apart from the traditional blues, postpartum depression and psychosis. These include obsession of infanticide, PTSD, morbid preoccupations regarding child birth and disorders of mother-infant relationships, though they are under emphasized.Methods:it is a cross-sectional study conducted in the tertiary maternity care hospital. A total of 152 study subjects were interviewed on MINI (Mini International Neuropsychiatric Inventory) and GAF (Global Assessment of Functioning) within 2 weeks after delivery.Results:The psychiatric morbidity was seen in 67 (44%) of the study subjects. About 26% of subjects had Depressive disorder NOS. Obsessive harm to the child, Panic disorder, Social phobia were the other disorders identified. There were no cases of Mania, Bipolar disorder, psychosis, post traumatic stress disorder or substance use disorder diagnosed across the sample. The Global Assessment of Functioning (GAF) score averaged 87.8. Statistically significant association was seen to be present between psychiatric illness and number of previous still births and dead children before this delivery (P = 0.045).Conclusions:The study reveals that psychiatric co-morbidity is very common in the postpartum period and can be detected as early as first week after delivery. Social phobia identified as a common association is a new finding and needs further replication. It needs a larger sample with a prospective assessment to generalize the findings of our study.

A community-based cross-sectional study to assess the prevalence of post-partum depression

“…Kumar et al . [ 14 ] reported the prevalence of Depressive disorder NOS (not otherwise specified) as 26% among 152 patients in a tertiary maternity care hospital. Their subjects were interviewed using Mini International Neuropsychiatric Inventory.…”

“…A literature search was done and the range of prevalence of PPD was found to be 11.45–31.4%. [ 8 9 10 11 12 13 14 15 ] Taking prevalence of PPD from past literature to be 20%, at 95% confidence limits, Z = 1.96 and maximum allowable error to be 5% a sample size of 250 (approx.) was calculated, using n = Z 2 P (1-P)/D 2 .…”

Postpartum Psychosis: A Review of Risk Factors, Clinical Picture, Management, Prevention, and Psychosocial Determinants

“…Postpartum psychosis itself is not included in DSM5 or ICD-10 as a disease entity, and the current diagnostic criteria equate PP with other psychoses [ 13 , 27 , 96 , 97 ]. DSM-5 allows the use of the term “with perinatal onset” to characterize mood disorders with psychotic features during pregnancy or within 4 weeks after delivery [ 98 – 100 ]. This specifier cannot be used in patients with schizophrenia and other psychotic disorders, with the exclusion of short-term disorders occurring after childbirth [ 98 ].…”

“…This specifier cannot be used in patients with schizophrenia and other psychotic disorders, with the exclusion of short-term disorders occurring after childbirth [ 98 ]. ICD-10 allows a separate diagnosis only if the patient cannot be diagnosed with another disorder and only within the first 6 weeks after delivery (F.53.0–53.9, Mental and behavioral disorders associated with puerperium, not elsewhere classified) [ 100 , 101 ]. For women suffering from PP, this poses a serious legal problem, as it hampers the ability of women who have committed the crime of infanticide and have been charged with murder to defend themselves in court [ 27 , 96 , 97 , 102 ].…”

Fatores de risco e cuidados à mulher com baby blues

“…Observou-se que o baby blues acomete cerca de 80% das parturientes e pode ser observado no primeiro dia do puerpério por meio da detecção precoce dos fatores de risco. 24,23 Um dos primeiros fatores de risco é a possibilidade de uma disfunção do eixo--hipotalâmico-pituitário-adrenal e das mudanças hormonais de estrogênio e progesterona que ocorrem no período gestacional e puerperal. Essa desregulação hormonal pode ocorrer devido à liberação de cortisol em casos de trauma e estresse antes, durante e após o parto.…”