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PubMed1989

Postnatal depression: what can a health visitor do?

Postnatal depression has been a subject that has provoked interest and research for many years. Marce published a paper in 1858 on puerperal and lactational psychoses, and since then many other writers have pursued different avenues of interest, primary cause, affect and treatment. A great deal of this work over the years has been done by psychiatrists and physicians, principally being interested in the more severe postpartum psychosis, when many of those suffering are admitted to an acute psychiatric hospital. However, as research has continued the less severe forms of postnatal depression and the upsetting effect they have on the patient's family continue to be a source of concern, not only to the professionals themselves, but more importantly, to the mothers who are suffering from this very upsetting problem. Professor Cox stated that he found it ironical that primary care workers regularly visited mothers in the puerperium and only rarely recognized postnatal depression. This led me to believe that we, as health visitors, should set about trying to put this right. As Professor Cox rightly said, it's a sad paradox that considering the medical scrutiny mothers receive over the antenatal and postnatal period, many depressed mothers still are not identified. The author therefore attempts to devise some kind of strategies for health visitors to identify mothers suffering from postnatal depression, and considers whether any links can be found between those suffering from postnatal depression.

Community Health Nursing↗
PubMed1994

Follow-up and family study of postpartum psychoses. Part I: Overview.

A group of 119 patients suffering from a severe psychiatric postpartum disorder who were admitted for the first time in their life to a psychiatric hospital has been investigated. The onset of illness occurred within 3 months following delivery. The patients represented 92% of the total sample fulfilling the inclusion criteria. A follow-up investigation was performed after a mean of 21 years (range 2-35 years). Of the patients 66% had nonpuerperal psychotic episodes in later life. The diagnosis, taking into account the long-term course, was affective psychosis in 57%, schizoaffective psychosis in 18%, schizophreniform psychosis in 12%, brief reactive psychosis in 4% and schizophrenia in 9%. A bipolar psychosis was found in 31%. The relation of unipolar to bipolar psychoses corresponded to that in a control group of affectively ill women without puerperal onset. The frequency of a manic syndrome in bipolar psychoses at the index episode was the same as in nonpuerperal episodes, which does not suggest a mania-provoking pathoplastic effect of the puerperium. The comparison with female nonpuerperal controls matched for age and diagnosis revealed evidence of a better long-term course in the index patients. The risk of a puerperal relapse for further pregnancies was 35%. The global morbidity risk for functional psychoses in first-degree relatives was 11%, with affective psychoses representing the majority of secondary cases (6.8%). The index patients showed a nonsignificant lower morbidity risk in relatives than a control group of psychotically ill women without puerperal onset. The major aetiological factor found for postpartum psychoses is the relation of these disorders to functional psychoses. There is strong evidence that the postpartum period tends to provoke affective psychoses and other nonschizophrenic psychoses, but not, or only to a lesser degree, narrowly defined schizophrenias. The liability to puerperal decompensations suggests some common pathophysiological mechanism, the nature of which remains unknown.

Adolescent↗
PubMed1997

Causes of death among mental patients at Muhimbili Medical Centre, Dar es Salaam.

The clinical notes of the 146 patients who died during a five year period in the psychiatric ward at the Muhimbili Hospital were studied and analysed to identify gender, age, duration of hospital stay, psychiatric diagnosis and primary cause of mortality. There were 99 (67.8%) males and 47 (32.2%) females. The mean age, which could be established in only 105 (71.9%) instances, was 31.1 years. The average hospital stay was 21.6 days. The main psychiatric morbidity consisted of functional psychoses (52.7%), organic psychoses (37.6%), epilepsy (6.2%) and puerperal psychosis (2.1%). Mortality was primarily attributed to infectious diseases in at least half of the cases. Pyrexia of unknown origin was associated with death in 11.0% of cases and the cause of death could not be established in 17.1%. Clinical notes need to be improved and greater efforts made to diagnose and treat concomitant physical illnesses effectively.

Academic Medical Centers↗