12.1b Postpartum Mood Disorders

Question 1

Postpartum Mood Disorders

Answer 1

• Preexisting conditions of mood are likely to worsen during postpartum
• 85% of mothers experience mild depression “Baby Blues”

Characterized by

• Mood swings
• Sadness/Anxiety
• Crying
• Difficulty Sleeping
• Loss of Appetite
• Treatment is not needed and usually resolves in a few days

Question 2

Postpartum Depression

Answer 2

• Change from heightened estrogen and progesterone to much lower after birth may be a cause of PPD.
• Can also be caused by poor nutrition
• Low folate causes poor response of antidepressant medication
• History of PPD puts someone at severe risk for PPD again

Question 3

PPD Risk Factors

Answer 3

• Young Age
• Unintended Pregnancy
• History of premenstrual dysphoria (feeling of uselessness before menstruation)
• Family history
• Unmarried
• Lack of Social Support
• Socioeconomic Status
• Low Education
• Substance Abuse
• Low Self-Esteem
• Severe psychosocial problems
• Complications in Pregnancy

Question 4

PPD Screening

Answer 4

• Highly treatable if caught early

ASSESSMENT TOOLS
- Edinburgh Postnatal Depression Screen (EPDS) 
(Patient response to 10 statements) 
- Postpartum Depression Screening Scale (PDSS) 
1. Sleeping/Eating Disturbances
2. Anxiety/Insecurity
3. Emotional Liability
4. Mental Confusion
5. Loss of Self
6. Guilt or Shame
7. Suicidal Thoughts

Question 5

Patient Health Questionnaire Tool

Answer 5

• If “Yes” is an answer to either question, screen is positive

1. Over the past 2 weeks have you felt depressed or hopeless
2. Over the past 2 weeks have you felt little pleasure in doing things

Question 6

Paternal PPD

Answer 6

• BEST PREDICTOR IS PARTNER WITH PPD

Other Risks

• History of Depression
• Younger than 25
• Low Socioeconomic Class
• Unmarried
• Inadequate Support
• Family/Social Stressors

Question 7

Signs of PPD

Answer 7

• Fatigue
• Frustration
• Anger/Irritability
• Indecisiveness
• Withdrawal from social situations
• Alcohol/Drugs
• Marital Conflict
• Partner Violence
• Somatic Symptoms

Question 8

PPD

Answer 8

• More serious and persistent than Postpartum Blues.
• Lasts longer than 2 weeks
• Intense fear/anger/anxiety/despondency
• Feelings of incompetency towards parenthood

Question 9

Post Partum Major Depression

Answer 9

• Loss of appetite or weird food cravings
• Binges with abnormal appetite
• Weight Gain
• Sleep Disturbances
• Irritability
• Detachment from Newborn
• Guilt and shame can cause women to have obsessive thoughts of harming their baby.

Question 10

Nursing Inteventions

Answer 10

• Education on signs of PPD and PPB is incredibly important

Question 11

Blues

Answer 11

• Sad, anxious and overwhelmed

- Crying, loss of appetite, difficulty sleeping

Question 12

Depression

Answer 12

• Same signs as blues but lasts longer (sad, anxious, overwhelmed)
• Maybe thoughts of harming themselves or baby
• Also may not have interest in the baby

Question 13

Psychosis

Answer 13

• Seeing or hearing things that are not there
• Feeling of confusion
• Rapid mood swings
• May try to hurt themselves or their baby

Question 14

WHEN TO CALL HCP

Answer 14

• Blues lasts longer than 2 weeks
• Depression gets worse
• Difficulty preforming tasks at home/work
• Inability to care for self or baby
• Thoughts of harming baby

Question 15

Postpartum Psychosis

Answer 15

• Most severe mood disorder postpartum
• Can be due to major depression and often associated with bipolar disorder (maniac-depressive)

SYMPTOMS

• Mania
• Depression
• Elevated energy, cognition, and mood
• One or more depressive episodes

Question 16

Postpartum Psychosis

Answer 16

• Rapid onset of bizarre behavior
• Auditory/Visual Hallucinations
• Paranoid or Delusional
• Delirium/Disorientation
• Extreme deficits in judgement with high levels of anxiety

Question 17

Postpartum Psychosis Complaints

Answer 17

• Fatigue, Insomnia, Restlessness
• Episodes of tearful emotional liability
• Suspiciousness
• Confusion, Incoherent, Irrational Statements
• Obsessive concerns with baby health/welfare
• Hallucinations, Delusions
• Disinterest in Infant

Question 18

PP Psychosis Management

Answer 18

• Inpatient psychiatric care
• Antipsychotics
• Mood stabilizers
• Benzodiazepines
• Antidepressants
• BEFORE DISCHARGE EDUCATE PATIENT/PARTNER ABOUT SIGNS OF PPB, PPD, PPS AND WHEN TO SEEK HELP

Question 19

DIAGNOSIS

Question 20

Potential Injury to Woman/Newborn

Answer 20

• Educate signs and symptoms of PPD
• Contact HCP of behaviors of depression such as crying
• Develop plan for maternal/infant supervision

Question 21

Impaired Family Function due to PPD

Answer 21

• Allow mom/partner to verbalize concerns
• Educate PPD to family
• Identify coping mechanisms that have worked during past crisis

Question 22

Inadequate Parenting due to PPD

Answer 22

• Observe maternal/infant interactions

- Encourage mother to have as much contact as possible with newborn

Question 23

Safety Concerns

Answer 23

• Ask mom if she has thoughts of hurting herself or her baby

Measure seriousness of a suicidal plan with the below

1. Method
2. Availability
3. Specificity
4. Lethality

• Suicidal women with PP Psychosis who are unwilling to seek treatment may require legal action to hospitalize her and separate her from infant.

Question 24

Psychotropic Medications and Lactation

Answer 24

• Avoid breastfeeding during peak levels of medication

SSRI - Only small amounts pass through milk
Benzodiazepines/Mood Stabilizers/Antipsychotics - No long term effects of breastfeeding
Lithium - Safe

Question 25

Anxiety Disorders

Answer 25

• Panic disorders
• Generalized anxiety
• PTSD
• Agoraphobia

Question 26

Anxiety/Stress Assocations

Answer 26

• Miscarriage
• Preterm Birth
• Preeclampsia
• Birth complications

Question 27

Panic Disorders

Answer 27

• Associated with panic attacks
• Rapid onset of intense fear (peaks at 10 minutes)

Psychological Symptoms (At Least 4)

• Palpations
• Sweating
• SOB
• Choking
• Nausea
• Abdominal Discomfort
• Dizziness
• Numbness/Tingling
• Chills
• Hot Flashes

Cognitive Symptoms
- Fear of going crazy, dying, or losing control

Question 28

Anxiety Disorders

Answer 28

• Excessive worrying or inability to let go
• Feeling keyed up
• Restlessness/Inability to Relax
• Difficulty Concentrating
• Distress about making decisions
• Obsessions over things that are out of proportion

Question 29

Anxiety Disorder Physical Symptoms

Answer 29

• Muscle Tension
• Irritability
• Restlessness
• Insomnia
• Fatigue
• Headache
• Nausea
• Diarrhea
• IBS
• DIAGNOSIS REQUIRES SIGNIFICANT IMPAIRMENT TO FUNCTION AND INTRUSIVE ANXIETY FOR AT LEAST 6 MONTHS AFFECTING MULTIPLE DOMAINS (FINANCE, WORK, HEALTH)

Question 30

PTSD

Answer 30

• Caused by serious injury or actual/threat of death/sexual violence

SYMPTOMS

• Re-experiencing Traumatic Events
• Persistent avoidance of stimuli
• Numbing
• Difficulty Sleeping
• Irritability
• Angry Outbursts
• Difficulty Concentrating
• Hypervigilance
• Exaggerated Startle Response Lasting At Least a Month

If pregnancy was out of rape, birth can trigger memories of being out of control and she may lose contact with reality

STATEMENTS OF REASSURMENT

• You are having an examination to make sure the baby is okay
• You are in labor, I am your nurse, You are in a hospital, I will check you frequently, You are safe here

Question 31

Strategies to Reduce Stress

Answer 31

• Empowerment through education
• Sensory Intervention (Music Therapy, Aromatherapy)
• Medication
• Behavior Interventions (Breathing, Progressive Muscle Relaxation, Guided Imagery)

Cognitive Strategies

• Encouragement of Self Talk
• Questioning Negative Thoughts