ch. 31 mental health disorders Flashcards
perinatal mood disorders (PMDs)
a set of disorders that can occur anytime during pregnancy as well as in the first year postpartum:
- depression (PPD)
- bipolar disorder
- postpartum psychosis
1) emerges during the childbearing period requires a thorough medical and family history, review of systems, and complete physical examination
2) suicide among leading causes of death among new mothers; pregnancy and postbirth period are considered risky times of depressive symptoms
perinantal mood disorders (PMDs) implications, diagnosis
1) implications:
- one of the most common medical complications during pregnancy and the postpartum period
- depression during pregnancy is a major risk factor for postpartum depression (PPD), which is associated with several negative effects on child development (abuse, nonengaging/stimulating, can affect learning)
2) diagnosis:
- r/o thyroid abnormalities and anemia first
- s/sx of major depression
- edinburgh postnatal depression SCALE: accurately identifies depression in pregnant and postpartum women
perinatal mood disorders: care mgmt
1) care mgmt:
- usually a combination of antidepressants and cognitive behavioral therapy (CBT) or interpersonal psychotherapy (IPT)
2) antidepressant medications:
- in the US, use of antidepressants has become increasingly common over the last 30 years
- 4 groups of common antidepressants: SSRI (zoloft, lexapro), SNRI (effexor), TCA (lamictal), MAOI (don’t use during pregnancy to treat depression))
perinatal mood disorders (PMDs)mnursing intervention
- educate women about depression as an illness and the plan of care, including medications
- discuss alternative treatments, and respect her choice if she refuses medications
- maintain a caring, helpful relationship
anxiety disorders (diagnosis)
1) GAD:
- characterized by excessive/pervasive worrying
- restlessness
- inability to relax
- difficulty concentrating
- distress about making decisions
- obsession over things that are out of proportion to the impact of the event
2) panic disorder, ocd, disturbing intrusive thoughts are repetitive/unacceptable/unwanted, ptsd (most prevalent in women who have experienced severe complications in pregnancy or childbirth)
anxiety disorders (care mgmt, medications)
1) care mgmt:
- psychotherapy: many different approaches
- psychotherapy and pharmacotherapy are frequently used in combination
2) medications:
- antidepressants (SSRIs/SNRIs), are often used to treat anxiety disorders.
- anxiolytics such as benzos (valium), alprazolam (xanax) may be used for short term anxiety
- best psychotropic meds for breatfeeding women are those with the greatest documentation of prior use, few or no metabolites, and fewer side effects
anxiety disorders (nursing intervention)
- empowerment through education
- sensory interventions (aromatherapy, music therapy, popsicles, jelo)
- medication
- behavioral interventions
- cognitive strategies
special considerations for meds during pregnancy: the benefits of breastfeeding and the potential risks must be carefully considered before using mood stabilizers (do cross placenta)
postpartum mood disorders (postpartum depression)
- experienced by 9-24% of women during the postpartum period
- cause: biologic, psychologic, situational, multifactoral
- risk factors: hx. depression, previous PPD
- poor nutrition
- complications of pregnancy and birth increase the risk for PPD
postpartum mood disorders (postpartum blues)
lasts for about 2-3 weeks postpartum
paternal post partum depression
- 8-10% men experience
- best predictor: having a partner with PPD
- not routinely screen for PPD
PPD without psychotic features
- often referred to simply as PPD
- sx: fatigue, sleep, appetite disturbances, irritability, feelings of detachment toward the newborn, characterized by major depressive episodes (MDEs)
- care mgmt: doesn’t peak until 2-3 weeks postpartum
PPD with psychotic features
- affects approximately 1/2 per 1000 births during 1st month PP
- commonly associated with: bipolar disorder (increased risk psychosis)
- sx: hearing voices, delusional
- medical mgmt: may need inpatient psychiatric care
postpartum mood disorders: interprofessional care mgmt
- most widely used and validated screening tools
1) edinburgh postnatal depression scales (EPDS)
2) perinatal anxiety screening scale, generalized anxiety disorder scale
3) patient health questionnaire
nursing considerations:
- mild sx. may need only support and counseling
- psychotherapy may be needed for moderate to severe symptoms, meds may also be used
- aerobic exercise has been shown to reduce postpartum depressive symptoms
- resolve sleep deprivation and restore circadian rhythm
- enlisting social support is key to recovery from PPD
postpartum depression safety conderns
- risk of suicide
- attachment behaviors with infant (neglect)
perinatal substance use disorder
1) chemical dependency is a chronic, relapsing, and progressive disease
- warning signs of abuse
2) women make up about 30% of substance use addicted population, and many of them are in their reproductive years, illicit drug use occurs among pregnant women
- rates of use were higher in the first and second trimesters of pregnancy than in the third
tip:
- universal drug screen use in pregnant women recommended
