10 - PRE- PERI- & POST-NATAL DEPRESSION

Question 1

Peri-natal depression def

Answer 1

• More common than previously believed
• Misconceptions: ”baby blues”, “typical hormonal changes”…
• 50 to 80% of postnatal depression cases start in antenatal period
• Significant financial impact: $5.7B in US, around £8B in UK
• Not a part of conventional screening in pregnancy
• In US, less than 15% of “mothers to be” receive adequate treatment
• Social stigma supports “don’t ask, don’t tell” culture

Question 2

PND: impact for mother

Answer 2

• Maternal suicide accounts for about 20% of postpartum deaths
• Increased incidence of preterm delivery & perinatal complications
• 35 to 50% reoccurrence risk in subsequent pregnancy
• 1 to 7% of mothers experiencing PND develop PTSD

Question 3

Major depressive disorder, description

Answer 3

• Most common & most impairing depressive disorder, often not perceived by others
• Presence of sad, empty or irritable mood, accompanied by somatic and/or cognitive changes (specific symptoms)
• Specific symptoms: depressed mood, anhedonia, nutrition problems, sleep problems, psychomotor agitation/retardation, fatigue, excessive/inappropriate guilt, attention deficits, suicide ideation/plan/attempt
• Recurrent episodes of at least 2 weeks with remission phases in-btw
• Affects functional capacities

Question 4

Anxiety disorders / GAD: description

Answer 4

• Excessive, irritational, non-adapted or persisting fear & anxiety and related psychological & somatic disturbances & symptoms
• Panic attacks common manifestation of anxiety disorders
• Different triggers for each disorder
• Fear: response to real or perceived imminent threat; autonomic arousal, fight or flight, escape behaviors
• Anxiety: anticipation of future threat, muscle tension, vigilance, avoidance behavior
• Affects executive functions: altered attention, memory, self control
• Lead to physical symptoms related to agitation that can lead to severe damage to own body & to social interaction, affecting all ADLs

Question 5

Post traumatic stress disorder: description

Answer 5

• Reactions following exposure to one or more traumatic events
• Manifestation/symptoms vary but most common ones are re-living traumatic situation or sensorimotor
  symptoms of it ; panic attacks ; anhedonia ; dissociative states ; recurrent, involuntary & intrusive memories of event
• Manifestations occur following triggers
• Avoidance of triggers, thoughts & memories related to event(s) - Amnesia of event(s) can be present
• Impact on attention & memory

Question 6

Obsessive compulsive disorder: description

Answer 6

• Great variation of affection levels
• Repetition of idea or action, that must compulsively be executed
• If it can’t be reproduced : signs of panic attack, accompanied by somatic symptoms
  —> Nature of motor behavior: from harmless actions, to aggressive / harmful behavior
  —> Tendency to present acerbic (meticulous) behavior

Question 7

PND: impact for child

Answer 7

• Increased risk of social, behavioral & cognitive dysfunction, detectable as early as 6 months
• Antenatal anxiety (ANA) associated with poor cognitive- emotional development in newborns
• PND mothers – children are 4.7% more likely to experience MDD before 16y

+ SCHEMA

Question 8

Physiological changes contributing to PND

Answer 8

• Stress-related disorders = major component of PND
• Genetics & previous MH history
• Higher activation of the HPA axis as typical adaptation during pregnancy
• Prenatal maternal DA levels negatively relate to PND occurrence & positively relate to neonatal DA & SE
  levels, which in turn positively relate to neonate’s inhibitory control & response inhibition

+ IMAGE

Question 9

Emotional & environmental factors contributing to PND

Answer 9

• Previous medical history:
• MH issues
• Miscarriages
• Adverse experiences:
• Violence
• Abuse
• Incarceration
• Lack of social support
• Unintended pregnancy
• Poor quality interpersonal relationships

Question 10

Screening for PND: prenatal

Answer 10

• Changes in sleep pattern
• Signs of sleep deprivation
• Changes in appetite
• Fatigue
• Irritability
• Feeling overwhelmed for longer periods
• Lack of enjoyment in previously enjoyed activities
• Feelings of hopelessness
• Disinterest in social connections
• Decreased interest in sexual activity
• Ideation on self harm, harming baby, or other

Question 11

Screening for PND: postnatal

Answer 11

• Any of the previous, plus:
• Difficult or traumatic pregnancy and/or birth
• Depression and/or anxiety during pregnancy
• Premature birth
• Baby needing NICU care
• Difficulties with breastfeeding

Question 12

Screening period

Answer 12

Schema

Question 13

Physiotherapy management

Answer 13

• Support creation of new paradigms
• Recognizing signs
• Educating about seeking help
• Disrupting social prejudice
• Encouraging engagement in physical activity to reduce impact of PND