risk of recurrence following first episode=30% to 50% with each subsequent pregnancy
50% - 80% chance of developing another episode at any point, usually within bipolar spectrum
Risk factors for PP
Known case of Bipolar Mood disorder
personal or family history of PP
Screen at-risk population and offer treatment prophylaxis before delivery to avoid illness
Symptoms to recognize
mood swings
confusion
strange beliefs
hallucinations
especially in the first 2–4 weeks postchildbirth
Red flags
Confusion
threats to harm herself or others
difficulty caring for her children
poor self-care
Clinical Features
Mania or depression, mixed mood + psychosis or non affective psychosis (<10%) Confusion
Disorganized behaviour
Obsessive thoughts, delusions, hallucinations -
may be in relation to the infant, delusions may be
mood incongruent
Notable perplexity
Marked fluctuations in intensity of symptoms
Suicidality, homicidality - "altruistic homicide"
Always enquire re thoughts of harm to self and/or
infant/other children
Screening tools
Depression - EPDS
Mania / Hypomania - MDQ
In infected, medically ill patients, cytokine-driven sickness behavior, psychological reaction, delirium, and medication side effects must be differentiated
aminoglycoside with broad antimicrobial activity, is commonly used in both obstetrics and gynecology
Are used for Respiratory infection and UTI in non-pregnant women. Cat D drug near term
Used as part of anti-tuberculous treamtent. Well documented s/e. .case report
used for treatment of sepsis along with other antibiotics
CNS side effects of levofloxacin like headache, dizziness, restlessness, tremor, insomnia, hallucinations, convulsions, anxiety and depression are well documenteds..case report
used for treatment of sepsis along with other antibiotics
used for Rx of Herpes Simplex Virus infection, Genital Herpes
May be used for treatment of hepatitis C virus infection or melanoma. Induces depressive symptoms in up to 58% of patients
Neurologic, rheumatologic, GI, respiratory, oncologic illnesses. Symptoms may vary from subtle anxiety/depression to full-blown affective and psychotic syndromes. Dose-dependent
Dopamine agonist. Used for the prevention of breast engorgment.
Benzodiazepines ? reports and small studies report association with depression and even suicide. Associated with higher doses and lower anxiety
Classic signs and symtpoms of sympathomimetic toxidrome hyperactivity, mydriasis (dilated pupil), hypertension, tachycardia, hyperthermia, may also ppt psychosis and seizures.
Anti-Asthamatic.
Used in spinal anaesthesia to prevent low BP and as an anti-asthamatic.
Decongestant used to relieve stuffy nose.
mad as a hatter (Psychosis), hot as hell (Hyperthermia), red as a beat (flushed skin), dry as a bone (dry mouth and urinary retention), and blind as a bat (dilated pupils)
antihistamine used to relieve symptoms of allergy, hay fever, and the common cold.
Opioid agonist used for analgesia. Obstetric analgesia is also an indication. case report
Same as cocaine, both may have a chronic phase as well
Agitation, autonomic instability, insomnia, seizures, and delirium tremens
Head and face edema, Headache, Visual distrubance, Excessive wt gain, Increased BP.
pre-eclampsia,
eclampsia
Careful medical history, with history of severe headache, preeclampsia during pregnancy, unilateral weakness, new onset sensory deficits, seizurelike behaviors; check blood pressure; consider head CT or MRI; consult neurologist urgently
Ischemic stroke (arterial or venous) secondary to preeclampsia or eclampsia, severe hemorrhage during delivery more
Hemorrhagic stroke secondary to uncontrolled hypertension, arteriovenous malformation, aneurysm, disseminated intravascular coagulation more
90% are women, more common in Asians and blacks. Photosensitivity, discoid or malar rash, oral ulcers; fatigue, weight loss, fevers; arthralgias and arthritis; pleuritis, pericarditis; renal disease; anemia, leucopenia. more
Lupus cerebritis likely to occur in post partum period
Acute or subacute mood/behavioral changes, short-term memory problems, complex-partial seizures, cognitive dysfunction. Also hyperthermia, somnolence, and endocrine abnormalities. Most common associated malignancies ? lung (small cell carcinoma; SCC), testicular, breast, ovarian, thymoma, Hodgkin lymphoma. Or there may be no malignancy [i.e. non-neoplastic]. more, case report - LE presenting as PP
Hyponatremia - Serum Na less than 124 - Nausea, Vomiting, Headache, Lethargy. Serum Na less than 120 - Confusion, Ataxia, Seizures, Coma. more
Hypernatremia - Nausea, Vomiting, Anorexia, Lethargy, Hyperreflexia, Seizures. more
Likely in a patient rxed with Mag Sulf. First sign - loss of tendon reflexes. other early signs flushing, feeling of warmth, double vision, somnolence, slurred speech, weakness and hypotension. Later symmptoms muscular paralysis and respiratory depression. magnesium sulfate, hypermagnesemia
Neurologic symptoms - Dizziness, Visual disturbance, Confusion, Loss of consciousness, Convulsions, Syncope. more
Polyuria, polydipsia, polyphagia, Abdo pain, Nausea, Vomiting, Fatigue. more
Fatigue, Anorexia, Nausea or Vomiting, Weight gain, Edema, Confusion (uremic encephalopathy). more
Early - day night reversal, sleepiness, confusion, personlaity change, flapping tremor.
Later - fetor hepaticus, stupor, seizure, coma. more
The time frame for postpartum (painless/lymphocytic) thyroiditis, which is characterized by transient hyper- and hypothyroid phases, may overlap with that for postpartum depression,although there is no established causal relationship between the 2 conditions.
Weakness, fatigue, somnolence, cold intolerance, weight gain, constipation, hair loss, hoarseness, stiffness, muscle aches, bradycardia, facial puffiness, slowed speech. more
Symptoms include nervousness, anxiety, irritability, sweating, fatigue, heat intolerance, weight loss, muscle weakness. Signs include arrhythmias, e.g. atrial fibrillation, myxedema, proptosis. more
Paresthesias, muscle cramps, carpopedal spasm, rarely facial grimacing, severe ? tetany and seizures. more
Postpartum pituitary infarction. Inability to lacate may be one of the first symptoms. case report
Common with certain anticonvulsants (e.g. valproic acid), elderly, alcoholics, eating disorders, malnourished. Symptoms include cognitive dysfunction. Signs ? megaloblastic anemia. more
Megaloblastic anemia, myelopathy (subacute combined degeneration), dementia, delirium, peripheral neuropathy. Occurs in pernicious anemia, chronic peptic ulcer disease, after gastrectomy or gastric bypass, alcohol dependence, irritable bowel disorder, eating disorders, malnourished. more
Global confusion, ataxia, opthalmoplegia, tremor, nephropathy. Hyperemesis Gravidarum is a risk factor in pregnant female. more
Abdominal pain, peripheral neuropathy, and mental disturbances. Seizures, autonomic instability, dehydration, electrolyte disturbances, dermatologic changes also may occur. Physical symptoms occur in attacks, but psychological ones may persist. case report