Red flag presentations

Urgent referral to a specialist perinatal mental health team for women who report:

• Recent significant change in mental state or emergence of new symptoms
• New thoughts or acts of violent self harm
• New and persistent expressions of incompetency as a mother or estrangement from their baby

Screening for mental health issues

Booking appointment

• History of mental health problems, previous treatment, family history
• Identify risk factors: young, single, domestic issues, lack support, substance abuse, unplanned/unwanted pregnancy, pre-existing mental health problem

Puerperal affective disorders

Baby blues

• Brief episodes of emotional lability, irritability and tearfulness arising in about 50% of women 2-3 days postpartum and resolving spontaneously in a few days
• Managed with support and reassurance

Puerperal psychosis

• Over 80% of cases are an affective psychosis and the onset is usually within the first 2 weeks following delivery
• Disorientation and confusion are often noted
• Severely depressed patients may have delusional ideas that the child is deformed, evil or otherwise affected in some way, and such false ideas may lead to either attempts to kill the child or attempts at suicide
• Emergency - needs admission to specialised mother-baby unit
  • Antidepressants, antipsychotics, mood stabilisers and ECT

Postnatal depression

• Non-psychotic postnatal depressive disorders occur during the first postpartum year in 10% of mothers, especially in the first 3 months, with a higher prevalence in developing countries