Exam 3: Postpartum Affective/Mood Disorders

Question 1

Postpartum Blues “Baby Blues”

Answer 1

Transient period of rapid cycling mood symptoms, usually occurs in the first 10 days after delivery - emotional lability

Self-limiting and usually resolves within 10-14 days without formal treatment other than reassurance and validation

Mild depressive symptoms, may be manifested by anorexia, tearfulness, difficulty sleeping and sadness

No medications required; Follow up important

Question 2

Postpartum depression (PPD)

Answer 2

Form of clinical depression

Occurs in ~20% of adult birth parents and ~60% of adolescent birth parents

Slow onset, usually occurs 2-4 weeks after birth and becomes evident in first 6 weeks, may persist for a minimum of 6 months

Needs to be treated, is a clinical condition and will not get better on its own

Question 3

PPD risk factors

Answer 3

History of depression
Family history
First pregnancy
Chronic stressors
IPV, substance use
Low self-esteem
<25 years old
Anger or ambivalence towards pregnancy
Multifetal pregnancy
Lack of social support

Question 4

Signs and symptoms of PPD

Answer 4

Restless
Worthless
Guilty
Hopeless
Moody
Sad
Overwhelmed
Loss of enjoyment
Low energy
Loss of libido

Question 5

Postpartum psychosis

Answer 5

EMERGENCY psychiatric condition

Rare: 1:1000 live births

As early as 48 hours after birth but will become evident within 3 months

Sleep disturbances, fatigue, depression, hypomania, hallucinations

May lead to suicide or infanticide; Requires immediate help and psychiatric consult

Question 6

Risk factors for postpartum psychosis

Answer 6

Personal or family history of major psychiatric illness

Previous episode of postpartum psychosis

Question 6

What screening assessment is used for PPD and what score most likely indicates PPD?

Answer 6

Edinburgh Postnatal Depression Scale; 12

Question 7

Nursing interventions for postpartum affective/mood disorders

Answer 7

Provide teaching regarding signs of depression and importance of seeking help
Caring
Promote interaction between birth parent and newborn
Discuss available resources
Provide suggestions for how family can help
Provide forum for expressing feelings

Question 8

Postpartum depression treatment

Answer 8

Psychotherapy

Medications SSRIs, Tricyclic Antidepressant, Amitriptyline

Hospitalization

Question 9

Postpartum psychosis treatment

Answer 9

Hospitalization
Psychotherapy
Medications SSRI, TCS, Antimanics, Lithium