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DOI: 10.1055/s-2003-43419
Postpartale psychische Störungen - ein unterschätztes Problem in der Geburtshilfe
Psychic disturbances in the postpartum period: An increasing problem?Publication History
Eingereicht: 23.6.2003
Angenommen nach Überarbeitung: 22.8.2003
Publication Date:
05 November 2003 (online)
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Zusammenfassung
Die postpartalen psychischen Störungen lassen sich im Wesentlichen drei Gruppen zuordnen: Dem so genannten „Baby Blues”, der Wochenbettdepression und der Wochenbettpsychose. Der etwa 3 - 5 Tage nach Entbindung auftretende Baby Blues kommt nach 50 - 70 % aller Geburten vor und klingt nach etwa einer Woche ohne weitere Therapie meist folgenlos ab. Allerdings entwickeln 20 - 30 % dieser Frauen im weiteren Wochenbettverlauf eine Depression, weshalb bei über 2 Wochen post partum persistierenden Bluessymptomen eine genauere Exploration hinsichtlich einer Depression zu empfehlen ist. Wochenbettdepressionen betreffen 10 - 15 % aller Entbundenen; sie treten meist mehrere Wochen bis Monate nach Entbindung in Form einer depressiven Verstimmung mit Schlafstörungen, Ängstlichkeit, Antriebsmangel, Interessenverlust und Schuldgefühlen bis hin zu Selbstmordgedanken auf. Um sie nicht als Babyblues fehlzudeuten, sind gezielte Fragen nach der Stimmungslage der jungen Mutter bei der Untersuchung 6 Wochen post partum, ggfs. unter Anwendung der Edinburgh-Skala zu empfehlen. Patientinnen mit bekannten Risikofaktoren für die Entwicklung einer Wochenbettdepression (Z.n. Wochenbettdepression oder Wochenbettpsychose, depressive Erkrankung, Angsterkrankung, bipolare Erkrankung) bedürfen einer engmaschigen Überwachung und ggfs. einer prophylaktischen Behandlung in Kooperation mit dem Psychiater. Leichtere Formen der Wochenbettdepression sind ambulant mit psychotherapeutischen und soziotherapeutischen Maßnahmen meist gut zu behandeln. Bei schwereren Verläufen sind Antidepressiva (selektive Serotoninwiederaufnahmehemmer (SSRI) oder bestimmte Trizyklika) indiziert. Postpartale Angst- und Zwangsstörungen sprechen gut auf Psychotherapie an; bei Angsterkrankungen werden außerdem Benzodiazepine, bei Zwangserkrankungen SSRI empfohlen. Wochenbettpsychosen (ca. 0,1 - 0,2 %) treten vermehrt bei bekannter bipolarer oder schizoaffektiver Störung bzw. bei Z.n. Wochenbettpsychose auf. Sie müssen vor allem wegen der Gefahr des erweiterten Suizids stationär behandelt werden; idealerweise erfolgt dies in interdisziplinären Mutter-Kind-Einheiten.
Abstract
Postpartum psychic disorders can be mainly divided into 3 groups: The so-called postpartum blues, the postpartum depression and the postpartum psychosis. The postpartum blues occurs 3 - 5 days postpartum in 50 - 70 % of deliveries mostly disappearing after one week without specific therapy. However, 20 - 30 % of patients will develop a depression in their further postpartum course so that a thorough evaluation concerning depression is warranted, if blues symptoms persist more than 2 weeks. Postpartum depression can be found in 10 - 15 % of deliveries and mostly occurs several weeks or months after delivery with symptoms of depressive mood, sleeping disorders, anxiety, loss of interest and accord and feelings of guilt up to suicidal ideas. In order not to misinterpret them as postpartum blues specific questions concerning the mood of the young mother during the postpartum examination - if necessary using the Edinburgh scale - are recommended. In patients with known risk factors for a postpartum depression (i. e. postpartum depression or psychosis in previous pregnancies, depression disorder, anxiety disorder, bipolar illness), a thorough survey is mandatory and - if necessary - a prophylactic treatment in cooperation with the psychiatrist.
Less severe forms of postpartum depression can mostly be treated with psychotherapy and sociotherapy on an outpatient basis. In more severe cases, antidepressant drugs (selective serotonin reuptake inhibitors, SSRIs or some tricyclic drugs) are indicated. Postpartum anxiety and compulsive disorders respond well to psychotherapy; besides in anxiety disorders benzodiazepines are recommended, in compulsive disorders SSRIs. Postpartum psychoses (about 0.1 - 0.2 %) most often occur in bipolar or schizoaffective disorders or after postpartum psychosis. They require a hopitalization mainly because of the danger of suicide and homicide toward the newborn; ideally this is performed in mother-child-units.
Schlüsselwörter
Babyblues - Wochenbettdepression - Wochenbettpsychose
Key words
Postpartum blues - postpartum depression - postpartum psychosis
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Dr. med. Birgit Kemp
Universitätsfrauenklinik Aachen
Pauwelsstr. 30
52074 Aachen
Phone: 0241/8088400
Fax: 0241/8082476
Email: Dr.Kemp@t-online.de