an emotional responses of the mother during the postpartum period with depression being a central feature of these responses

may exhibit the mild, transitory blues, a deeper incapacitating depression or severe depression with psychotic aspects

PHYSIOLOGICAL FACTORS

no evidence makes this link conclusively hormonal etiology play an important role physiologic changes could trigger depressive reaction in women with predisposition or risk factor

PSYCHOSOCIAL STRESSOR
more important than physiologic factors in causation of affective depression

life situation is important factor in postpartum depression

lack of feelings of competence also appear significant in postpartum depression

puerperal psychosis
incidence 0.45 per 1000 deliveries cycloid (bipolar/manic-depressive) psychosis are majority of postpartum psychosis the proportion of schizophrenias is small, and the risk of first psychiatric admission due to schizophrenic psychosis is not increased after childbirth

the big question mark is

whether the biologic stress associated with the hormonal changes

or
the psychological stress associated with the social and psychological changes after delivery

is crucial for the outbreak of psychosis

SOCIODEMOGRAPHIC FACTORS
age and marital status

PSYCHOSOCIAL STRESSOR
obstetrics complication twin birth caesarean section preterm delivery history of a previous psychosis

FAMILIAL MORBIDITY
still inconclusive familial factors may play a role in susceptibility to puerperal trigger significance evidence that variation at the variable number tandem repeats polymorphism in intron 2 of the serotonin transporter gene influences susceptibility to puerperal psychosis
(Coley et al, Lancet 2000, 356; 1490-1)

ACUTE TREATMENT
antipsychotics thymoleptics anxiolytics ablactation is recommended during antipsychotics treatment The use of estrogen in the treatment of postpartum psychosis show a surprising result, but still deserves further study

PROPHYLAXIS
the use of mood stabilizer, especially with lithium, could be beneficial

eight-fold relative risk of postpartal relapse for women with history of bipolar disorders without prophylaxis
unfortunately administering mood stabilizer during pregnancy is impossible because of highly teratogenic effect

the prognosis is basically favorable with regard to both the remission of symptoms and social and occupational functioning
in the majority of cases, postpartum psychosis take a recurrent course, and the recurrence-rate are between 35% - 69% the suicide risk vary between 1,4% and 10,9% with average of 4% what is the EBM says ???

a psychiatric epidemiological study of postpartum chinese women

( Lee TSD, Yip SKA, Chiu FKH et al, Am J Psychiatri 2001; 158: 220-6)

previous study suggested that postpartum depression is absent in chine because of the enriched postpartum social network provided by the family

present study show that postpartum depression is common in contemporary hong kong women

divorce, family violence, job insecurity, child and sexual abuse, juvenile pregnancy, deterioration in network solidarity and drug and alcohol addiction probably play a potential role