Mental Health in Pregnancy and Postpartum Flashcards
What are the baby blues?
A mild, transient mood disturbance experienced by women after childbirth, characterized by emotional lability and low mood.
When do the baby blues typically occur?
Within the first few days postpartum, peaking around day 3–5 and usually resolving by day 10.
What are the common symptoms of the baby blues?
Tearfulness.
Irritability.
Mood swings.
Fatigue.
Feelings of overwhelm.
Anxiety or mild low mood.
The baby blues typically resolves within __________ days postpartum without the need for medical intervention.
10
What causes the baby blues?
Hormonal changes after childbirth, particularly the sudden drop in estrogen and progesterone, combined with the stress and exhaustion of caring for a newborn.
True/False
Q: The baby blues is considered a mental health disorder requiring long-term treatment.
False (it is a transient and normal response to childbirth).
What are the risk factors for experiencing the baby blues?
First-time motherhood.
History of mood disorders.
Stressful delivery or lack of social support.
Sleep deprivation.
What is the management for the baby blues?
Reassurance: It is common and usually resolves without intervention.
Emotional support: Encourage open discussion with family and friends.
Promote rest and self-care.
How can you differentiate the baby blues from postpartum depression?
Baby Blues: Mild, starts within a few days postpartum, resolves by day 10.
Postpartum Depression: More severe, persists beyond 2 weeks, includes significant functional impairment and possibly suicidal thoughts.
Baby blues is a __________ postpartum condition that does not require medical treatment.
Self-limiting
A new mother presents with tearfulness, irritability, and feeling overwhelmed at day 4 postpartum. Symptoms have been mild and started on day 2. What is the most likely diagnosis?
Baby blues.
What are the key takeaways about the baby blues?
It is a normal physiological response to childbirth.
Symptoms are transient and self-limiting.
Emotional support and reassurance are the mainstays of management.
What is obstetric depression?
Depression occurring during pregnancy (antenatal) or after childbirth (postnatal), affecting the emotional and functional well-being of the mother.
What is the prevalence of postnatal depression?
Affects 10-15% of mothers within the first year postpartum.
What are the risk factors for obstetric depression?
History of depression or other mental health disorders.
Lack of social support.
Stressful life events or relationship problems.
Complications during pregnancy or childbirth.
Premature birth or illness in the baby.
What are the symptoms of obstetric depression?
Persistent low mood or sadness.
Loss of interest or anhedonia.
Fatigue and low energy.
Poor concentration or indecisiveness.
Sleep disturbances (insomnia or hypersomnia).
Appetite changes.
Feelings of guilt or worthlessness.
Thoughts of self-harm or suicide.
Obstetric depression is diagnosed when symptoms persist for at least __________ weeks and impact daily functioning.
2
How can you differentiate postnatal depression from the baby blues?
Baby Blues: Mild, transient, resolves by day 10 postpartum.
Postnatal Depression: Persistent symptoms lasting >2 weeks, affecting daily life and bonding with the baby.
What tools are used for screening obstetric depression?
Edinburgh Postnatal Depression Scale (EPDS).
Patient Health Questionnaire (PHQ-9).
True/False
Q: The Edinburgh Postnatal Depression Scale (EPDS) is validated for use during pregnancy and postpartum.
true.
What are the management options for obstetric depression?
Psychological therapies:
Cognitive-behavioral therapy (CBT).
Interpersonal therapy (IPT).
Medication:
Antidepressants (e.g., SSRIs such as sertraline or fluoxetine).
Lifestyle:
Adequate rest, exercise, and nutrition.
Support groups or peer support.
Specialist input if severe or associated with psychosis.
_________ are the first-line pharmacological treatment for obstetric depression, especially during breastfeeding.
SSRIs
What are the potential complications of untreated obstetric depression?
Poor maternal-infant bonding.
Delayed infant development.
Relationship breakdowns.
Risk of self-harm or suicide.
Increased risk of future depressive episodes.
A 30-year-old mother presents 4 weeks postpartum with persistent low mood, tearfulness, and loss of interest in activities. She struggles to bond with her baby and reports insomnia. What is the likely diagnosis, and how should she be managed?
Diagnosis: Postnatal Depression.
Management: Psychological therapies (e.g., CBT) and consider SSRIs if symptoms are moderate to severe.
Why is sertraline considered the preferred SSRI for breastfeeding mothers?
It has a low transfer rate into breast milk and minimal adverse effects on the infant.
How can obstetric depression be prevented?
Early identification of at-risk women.
Regular antenatal mental health screening.
Strengthening social support networks.
Education about normal postnatal emotional changes.
Match the type of depression with its characteristic:
Baby Blues
Postnatal Depression
Postpartum Psychosis
a. Severe mood swings with psychotic features.
b. Mild mood changes resolving within 10 days.
c. Persistent low mood and anhedonia lasting >2 weeks.
1-b, 2-c, 3-a
What is postpartum depression (PPD)?
A depressive disorder occurring within the first year postpartum, characterized by persistent low mood, loss of interest, and functional impairment.
How common is postpartum depression?
Affects approximately 10-15% of mothers.
When does postpartum depression typically begin?
Symptoms can start any time within the first year postpartum, commonly within the first 6 weeks.
List some risk factors for postpartum depression.
History of depression or other mental health disorders.
Lack of social support.
Stressful life events or financial stress.
Complications during pregnancy or delivery.
Premature birth or neonatal illness.
Sleep deprivation.
The peak onset of postpartum depression is typically within the first __________ weeks postpartum.
6
What are the key symptoms of postpartum depression?
Persistent low mood or sadness.
Loss of interest (anhedonia).
Irritability or anger.
Fatigue or low energy.
Sleep disturbances (insomnia or hypersomnia).
Poor appetite or overeating.
Feelings of guilt or worthlessness.
Difficulty bonding with the baby.
Thoughts of self-harm or suicide.
How can you differentiate postpartum depression from baby blues?
Baby Blues: Mild, transient, resolves by day 10 postpartum.
Postpartum Depression: Persistent, lasting >2 weeks, and interferes with functioning.
Which tools are used to screen for postpartum depression?
Edinburgh Postnatal Depression Scale (EPDS).
Patient Health Questionnaire (PHQ-9).
True/False
Q: Postpartum depression always resolves without treatment.
False (it often requires intervention and support).
What are the management options for postpartum depression?
Psychological therapies:
Cognitive-behavioral therapy (CBT).
Interpersonal therapy (IPT).
Pharmacological therapies:
SSRIs (e.g., sertraline, fluoxetine).
Lifestyle changes:
Encourage rest and support from family or friends.
Support groups.
Specialist referral if severe or if psychotic features are present.
A 28-year-old new mother presents 4 weeks postpartum with persistent sadness, poor sleep, and difficulty bonding with her baby. She feels guilty about her parenting abilities and has thoughts of self-harm. What is the likely diagnosis and appropriate management?
Diagnosis: Postpartum Depression.
Management: CBT and consider SSRIs if symptoms are moderate to severe.
The __________ scale is specifically designed to screen for postpartum depression.
Edinburgh Postnatal Depression Scale (EPDS).
What are the complications of untreated postpartum depression?
Poor maternal-infant bonding.
Delayed infant development.
Increased risk of future depressive episodes.
Potential for self-harm or suicide.
What is the prognosis for postpartum depression?
Excellent with appropriate treatment.
Untreated depression can persist for months and impact maternal and infant health.
What is puerperal psychosis?
A rare and severe psychiatric condition that occurs shortly after childbirth, involving psychosis with symptoms like delusions, hallucinations, and disorganized thinking.
How common is puerperal psychosis?
Affects approximately 1-2 per 1,000 births.
When does puerperal psychosis typically occur?
Usually within the first 2 weeks postpartum, but it can present up to 6 weeks postpartum.
What are the risk factors for puerperal psychosis?
Personal or family history of bipolar disorder or psychosis.
First pregnancy.
Traumatic birth or obstetric complications.
Lack of social support.
Previous episode of puerperal psychosis.
Women with a history of __________ are at significantly higher risk of developing puerperal psychosis.
Bipolar disorder
What are the clinical features of puerperal psychosis?
Delusions: Fixed false beliefs, often about the baby.
Hallucinations: Auditory or visual.
Severe mood disturbances: Mania or depression.
Disorganized thoughts and behaviors.
Poor insight and judgment.
Risk of harm to self or baby.
How does puerperal psychosis differ from postnatal depression?
Puerperal psychosis includes psychotic symptoms like delusions and hallucinations.
Postnatal depression is primarily characterized by low mood and anhedonia without psychosis.
What is the basis for diagnosing puerperal psychosis?
Clinical diagnosis based on history and presentation.
Exclude organic causes (e.g., encephalopathy, substance use, or infection).
True/False
Q: Puerperal psychosis is a psychiatric emergency requiring immediate intervention.
true.
What are the management options for puerperal psychosis?
Urgent psychiatric referral: Consider inpatient admission to a mother-and-baby unit.
Pharmacological treatment:
Antipsychotics (e.g., olanzapine).
Mood stabilizers (e.g., lithium).
Antidepressants if depressive symptoms predominate.
Electroconvulsive therapy (ECT): For severe or resistant cases.
Supportive care:
Family support and monitoring.
Ensuring safety of the mother and baby.
A 32-year-old woman presents 10 days postpartum with delusions that her baby is possessed, auditory hallucinations, and severe insomnia. She has a history of bipolar disorder. What is the likely diagnosis, and how should she be managed?
Diagnosis: Puerperal Psychosis.
Management: Urgent psychiatric referral, likely inpatient care, and treatment with antipsychotics or mood stabilizers.
What are the potential complications of untreated puerperal psychosis?
Risk of harm to self or baby.
Long-term psychiatric illness (e.g., bipolar disorder).
Poor maternal-infant bonding.
What is the prognosis for puerperal psychosis?
Good with early diagnosis and treatment.
Most women recover fully but are at risk of recurrence in future pregnancies.
_________ therapy may be used in severe cases of puerperal psychosis that are resistant to medication.
Electroconvulsive (ECT)
