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4: Y4 - Obstetrics [13] > [54] Post-Natal Depression > Flashcards

[54] Post-Natal Depression Flashcards

1
Q

What is postnatal depression defined as?

A

Non-psychotic illness occurring during the first postnatal year

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2
Q

What should the term ‘postnatal depression’ not be used as?

A

An umbrella term for all mental health problems following delivery

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3
Q

What are the different scenarios in which post-natal depression can occur?

A
  • De novo
  • Recurrence of depressive condition occurring prior to pregnancy
  • Part of wider problem, e.g. bipolar disorder
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4
Q

How does the overall prevalence of PND compare to depression at other times?

A

Probably not significantly more common in the post-natal period than other times

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5
Q

What is the prevalence of PND in the developed world?

A

10-15%

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6
Q

What % of women with PND symptoms seek or obtain medical advice?

A

As few as 15%

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7
Q

What are the strongest risk factors for PND?

A
  • Previous history of mental health problems
  • Psychological disturbance during pregnancy
  • Poor social support
  • Poor relationship with partner
  • Baby blues
  • Recent major life events
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8
Q

What are the less strong risk factors for PND?

A
  • Unplanned pregnancy
  • Unemployment
  • Not breast-feeding
  • Antenatal parental stress
  • Antenatal thyroid dysfunction
  • Longer time to conception
  • Depression in father of child
  • Having 2 or more children
  • Current, or history of, substance misuse
  • Neonatal low birth weight or illness, stillbirth, or SIDS
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9
Q

What are the weakest risk factors for PND?

A
  • Obstetric complications
  • History of abuse
  • Low family income
  • Lower occupational status
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10
Q

How does PND present?

A

Same as depression in other circumstances, including;

  • Low mood
  • Low enjoyment and pleasure
  • Anxiety
  • Disturbed sleep
  • Loss of appetite
  • Poor concentration
  • Low self-esteem
  • Low energy levels
  • Loss of libido
  • Thoughts of death/suicidal thoughts
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11
Q

What needs to be considering when a patient presents with symptoms of PND?

A

Some of these symptoms can be normal in the early post-natal period, e.g. sleep disturbance, tiredness, anxiety about the baby

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12
Q

What should HCPs be aware of regarding the symptoms of PND?

A

Women may be unwilling to disclose symptoms of depression and other mental health problems

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13
Q

Why might new mothers be unwilling to disclose symptoms of depression and other mental health problems?

A
  • Fear or stigma
  • Fear the baby may be taken into care
  • Concern they will be perceived as a poor mother
  • Problems with alcohol or substance dependence
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14
Q

What can screening questions for PND be asked?

A

At booking at postnatal checks

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15
Q

What screening questions for PND can be asked at screening and postnatal checks?

A
  • During the past month, have you often felt bothered by feeling down, depressed, or hopeless?
  • During the past month, have you often been bothered by having little interest or pleasure in doing things?
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16
Q

What should be done if the answer to the screening questions for PND is yes, or if there is clinical suspicion?

A

Further assessment is required

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17
Q

What can be used to help the assessment of a woman who answers yes to the screening questions for PND, or there is clinical concern?

A

Formal assessment tool, e.g. Edinburgh Postnatal Depression Scale

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18
Q

What are the general principles of the management of PND?

A
  • Empowerment
  • Communication
  • Wider family environment
19
Q

What is involved in empowerment in PND?

A
  • Involve women in decisions about their care
  • Reassure that postnatal depression is not uncommon
  • Be optimistic about its resolution
20
Q

What should be done if a mother with PND lacks capacity?

A

Follow Department of Health guidelines and code of practice accompanying the Mental Capacity Act

21
Q

What communication is important in PND?

A
  • The woman, her relatives, and carers should be given information in a form that is culturally appropriate
  • Communication between all HCP involved is vital for integrated care
22
Q

What needs to be considered in PND regarding the wider family environment?

A

Consider needs of other children, dependent adults, and the effect the illness may have on the relationships with partners

23
Q

What always needs to be considered in the management of PND?

A

Welfare of the baby

24
Q

What should the choice of treatment in PND be decided based on?

A
  • Efficacy
  • Previous response to treatment
  • Incidence of side effects
  • Likely compliance
  • Patient preference
  • Safety during breastfeeding
25
Q

How should mild to moderate PND be managed?

A

Consider facilitated self-help strategies

26
Q

How should mild to moderate depression be managed when there is a history of severe depression?

A

Consider anti-depressant

27
Q

What are the management options for moderate to severe PND?

A
  • High intensity psychological intervention
  • Antidepressant treatment
  • Combination of psychological therapy and antidepressants
28
Q

Give an example of a high intensity psychological intervention

A

CBT

29
Q

When should antidepressants be used in mild to moderate PND?

A
  • Risks are understood and accepted
  • Woman declines psychological therapy
  • Psychological therapies have failed
30
Q

How should severe PND with thoughts of suicide or harming the baby be managed?

A
  • Immediate referral for urgent psychiatric assessment

- Child protection procedures may need to be invoked

31
Q

Can antidepressants be used in breastfeeding women?

A

Evidence remains unclear about role and safety of antidepressants in breast-feeding women, and so decisions have to be made on an individual basis

32
Q

What do the NICE guidelines say about antidepressants and breastfeeding?

A

Women should be encouraged to breastfeed, unless they are taking;

  • Lithium
  • Sodium valproate
  • Carbamazepine
  • Clozapine
33
Q

How does the threshold for pharmacological therapy in the treatment of depression vary in pregnancy compared to other times?

A

It is higher

34
Q

Describe the course of PND

A

Widely variable, and will depend on predisposing factors and response to treatment

35
Q

By when do most cases of PND resolve?

A

3-6 months

36
Q

What proportion of women will have symptoms of PND after 6 months?

A

1/4

37
Q

What is untreated PND associated with?

A

Adverse effects on the infant

38
Q

What adverse effects on the infant are associated with untreated PND?

A

Short-term and long-term poor cognitive, emotional, social, and behavioural development

39
Q

When are the adverse effects of PND on the infant seen?

A

When the mother is unable to engage actively with the infant

40
Q

What does NICE recommend for the prevention of PND?

A

Women are proactively screened for mental health problems, and high-risk patients identified

41
Q

When should HCPs screen for depression and anxiety?

A
  • Booking

- Postnatally at 4-6 weeks and 3-4 months

42
Q

What questions should be asked to screen for depression and anxiety?

A
  • Past or present severe mental illness
  • Previous treatment by psychiatrist/specialist mental health team, including inpatient care
  • Family history of severe perinatal mental illness in first-degree relative
43
Q

What past or previous severe mental illness should be asked about when screening for PND?

A
  • Schizophrenia
  • Bipolar disorder
  • Psychosis in postnatal period
  • Severe depression
44
Q

What should done when a woman is identified as high risk of developing severe depression, or with a history of severe mental illness?

A

Referral to secondary care mental health services

4: Y4 - Obstetrics [13] (61 decks)

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