Suggestions to improve the nomenclature of postpartum psychiatric disorders: A personal view
The treatment of psychiatric illness after childbearing suffers from lack of a terminology which reflects the characteristics of syndromes which should be identified. Unique qualities of these syndromes provide therapeutic indications which are likely to be neglected when patients are classified without regard to the event of parturition. Three categories of severe postpartum illness should be distinguished. Puerperal psychosis begins early in the puerperium and is characterized by agitation, confusion, extremes of mood, hallucinations, delusions, rapid changeability of symptoms and often violence. Severe postpartum depression is a syndrome which begins insidiously after the third week postpartum. It is characterized by depression of mood and feelings of exhaustion, incompetence and failure. Suicide is a dangerous hazard. Postpartum psychotic depression combines characteristics of the other two syndromes. Its depressive features may be only partly disabling, but the dull, depressive mood is interrupted occasionally and unpredictably by acute episodes of psychotic symptoms and behavior. Suicide and infanticide are hazards. Lesser syndromes are maternity blues and postnatal depression. The former is an episode of tearfulness and dysphoria which occurs early in the puerperium. The latter is a mild to moderate depression, sometimes with marked personality changes. Postnatal depression follows 10% of births.
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