Maternal mental health Flashcards
how do you manage depression in pregnancy?
- specialist mental health services referral if severely depressed or risk of self harm or suicide, evidence of self neglect, psychotic symptoms, manic features or behaviour, previous definite or possible diagnosis of bipolar disorder
- medication may be given if benefit outweighs risk
what are baby blues? and when is it seen?
- baby blues are seen within 0-2 weeks (commonly 3-7 days after) where mother in anxious, tearful and irritable
- 60-70% of women affected
- more in Primips
how can you differentiate it for PND?
PND is within first year where the low mood is persistent, with other signs of depression
how is baby blues managed?
- solves spontaneously
- reassure and support
- health visitor key role
how do you investigate PND?
Edinburgh postnatal depression scale
- 10 questions with maximum score of 30
- indicates how mother felt over previous week
- > 13 indicated ‘depressive illness of varying severity’
- sensitivity and specificity >90%
self harm screened
what is postnatal depression?
- persistent low mood, with other core features like anhedonia, and lethargy seen upto a year after giving birth
- typically peaks at 3m
- the symptoms may interfere with daily functioning and parenting
- affects 10% of women
what is the pathophysiology of PND?
- biological: hormone, alterations to melatonin, genes
- psychological: history of mood disorders, neuroticism features, traumatic birth experience, motherhood not meeting expectations
- social: lack of social support, relationship issues, life stressors, low socioeconomic
what are some risk factors for PND?
- low socioeconomic status
- history of mental health disorders
- lack of social support
- preterm birth
- unplanned
- substance misuse
- FHx
how does PND present?
- persistent lowering of mood and reduced enjoyment or interest
- lowering energy
- biological sx: poor appetite, sleep
- distinguish between disrupted sleep from infants sleep cycle and other causes
- concerns related to bonding, caring for baby, harming oneself or baby
what are some differentials for PND?
baby blues
Postpartum psychosis
adjustment disorders
GAD
what are the investigations of PND?
- Edinburgh postnatal depression scale
- detailed psych history
- RISK ASSESSMENT
- physical examination
- bloods - FBC, B12, folate, TFT
how is PND managed?
- first line CBT, IPT
- medications: abx paroxetine, sertraline
- severe: specialist mental health services and consider mother and baby unit if evidence of neglect, FHx
what is puerperal psychosis?
- typically occurs within the first two weeks postpartum, characterised by symptoms including paranoia, delusions, hallucinations, mania, depression, and confusion
- 1-2 per 1000 childbirths
- combined genetic susceptibility, hormonal changes, psychosocial stressors
what are some risk factors for puerperal psychosis?
- prior history of severe mental illnesses such as schizophrenia or bipolar affective disorder
- family history of postpartum psychosis
- previous episode of postpartum psychosis
how does puerperal psychosis present?
paranoia
delusions - capgras
hallucinations
manic episodes
depressive episodes
confusion
