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562 sEctiON iii Psychiatry ` Psychiatry—Pathology Psychiatry ` Psychiatry—Pathology

Peripartum mood Onset during or shortly after pregnancy or within 4 weeks of delivery.  risk with history of mood
disturbances disorders.
Maternal 50–85% incidence rate. Characterized by depressed affect, tearfulness, and fatigue starting 2–3
(postpartum) blues days after delivery. Usually resolves within 2 weeks. Treatment: supportive. Follow up to assess for
possible MDD with peripartum onset.
MDD with peripartum 10–15% incidence rate. Formerly called postpartum depression. Meets MDD criteria with onset no
onset later than 1 year after delivery. Treatment: CBT and SSRIs are first line.
Postpartum psychosis 0.1–0.2% incidence rate. Characterized by mood-congruent delusions, hallucinations, and thoughts
of harming the baby or self. Risk factors include first pregnancy, family history, bipolar disorder,
psychotic disorder, recent medication change. Treatment: hospitalization and initiation of atypical
antipsychotic; if insufficient, ECT may be used.

Grief The five stages of grief per the Kübler-Ross model are denial, anger, bargaining, depression, and
acceptance (may occur in any order). Other normal grief symptoms include shock, guilt, sadness,
anxiety, yearning, and somatic symptoms that usually occur in waves. Simple hallucinations of
the deceased person are common (eg, hearing the deceased speaking). Any thoughts of dying are
limited to joining the deceased (vs complicated grief). Duration varies widely; usually resolves
within 6–12 months.
Persistent complex bereavement disorder involves obsessive preoccupation with the deceased and
causes functional impairment, lasting at least 12 months (6 months in children). Can also meet
criteria for major depressive episode.

Electroconvulsive Rapid-acting method to treat refractory depression, depression with psychotic symptoms, catatonia,
therapy and acute suicidality. Induces tonic-clonic seizure under anesthesia and neuromuscular blockade.
Adverse effects include disorientation, headache, partial anterograde/retrograde amnesia usually
resolving in 6 months. No absolute contraindications. Safe in pregnant and elderly individuals.

Risk factors for suicide Sex (male) SAD PERSONS are more likely to complete
completion Age (young adult or elderly) suicide.
Depression Most common method in US is firearms; access
Previous attempt (highest risk factor) to guns  risk of suicide completion.
Ethanol or drug use Women try more often; men complete more
Rational thinking loss (psychosis) often.
Sickness (medical illness) Other risk factors include recent psychiatric
Organized plan hospitalization and family history of completed
No spouse or other social support suicide.
Stated future intent

Anxiety disorders Inappropriate experiences of fear/worry and their physical manifestations incongruent with the
magnitude of the stressors. Symptoms are not attributable to another psychiatric disorder, medical
condition (eg, hyperthyroidism), or substance abuse. Includes panic disorder, phobias, generalized
anxiety disorder, and selective mutism.

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