Post-Partum Depression

Question 1

Postpartum Psychiatric Disorders

Answer 1

• Postpartum Depression
• Postpartum Anxiety
• Postpartum Psychosis

Question 2

Morning sickness is from

Answer 2

increased estrogen, progesterone and hCG

Question 3

Reflux during pregnancy is from

Answer 3

increased gastric emptying time and decreased sphincter tone

Question 4

Constipation during pregnancy is from

Answer 4

decreased motility, increased water absorption

Question 5

Reasons for pregnancy back pain

Answer 5

• Increased lumbar lordosis
• Myofascial strains
• Paraspinal muscle strain/muscle spasm
• Lumbar-sacral junction compression

Question 6

Hormone levels after birth

Answer 6

• Estrogen and progesterone levels drop

- Prolactin and oxytocin stimulate lactation

Question 7

Lochia

Answer 7

• Post partum bleeding
• Vaginal discharge containing blood, mucus and uterine tissue
• usually happens for 4-6 weeks

Question 8

Postpartum recovery

Answer 8

• caring for tears/episiotomy wounds
• lochia
• postpartum depression
• constipation and hemorrhoids
• breast problems
• diastas recti (post partum belly pooch- wait for dr to give okay to exercise)
• uterine problems (kegels)

Question 9

Postpartum Blues

Answer 9

-aka baby blues
-a transient condition
-Mild depressive symptoms such as dysphoria (sadness,
tearfulness, irritability and anxiety
-insomnia
-decreased concentration
-Develop in 50-75% of women within 2-3 days of delivery

Question 10

During Postpartum Blues, symptoms usually peak ______ and resolve _______

Answer 10

peak over the next few days (within 2-3 days of deliver) and resolve within 2 weeks

Question 11

Major Depressive Disorder with Permpartum Onset

Answer 11

This specifier can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.

Question 12

Do hormones play a role in peripartum depression?

Answer 12

• hormone levels and changes in levels DO NOT correlate with mood symptoms
• Progesterone and estrogen levels drop postpartum. Cortisol, thyroid and other large hormonal shifts also occur.
• Women who get peripartum depression are more sensitive to hormone fluctuations

Question 13

Postpartum anxiety disorders include

Answer 13

Panic Disorder (intense fear of harm/harming any, palpitations, hyperventilation, sweating, difficulty caring for baby, leaving baby)

OCD (intrusive thoughts, images of grievous harm to baby, mother sometimes images herself inflicting harm)

Question 14

Perinatal depression/anxiety treatment

Answer 14

• decrease stress
• support groups
• psychotherapy (interpersonal, cognitive behavioral, supportive)
• SSRIs

Question 15

Postpartum Psychosis

Answer 15

• one of rarest psych disorders
• PSYCHIATRIC EMERGENCY
• rapid onset of severe maternal symptoms
• potential for a catastrophic outcome, such as infanticide or suicide

Question 16

Etiology of Postpartum Psychosis

Answer 16

• multifactorial
• significant drop in estrogen/progesterone (estrogen affects the monoaminergic system especially serotonin and dopamine)
• hx if bipolar/psychosis
• families with bipolar in which at least 1 woman had a manic or psychotic episode within 6 weeks of having a baby
• sleep disruption
• lack of partner support

Question 17

Clinical presentation of Postpartum Psychosis

Answer 17

• acute onset within the first 2 weeks after delivery in 65% of cases
• elated, dysphoric, or labile mood
• insomnia, agitation and bizarre behavior
• Psychotic symptoms include mood-incongruent delusions with frequent content related to the infant (eg, the infant being harmed), thought broadcasting, ideas of reference, delusions of control, or command hallucinations.

Question 18

4% of women with postpartum psychosis commit _______ and 5% commit _________

Answer 18

4%- infanticide

5%- suicide

Question 19

Any mother who presents with a postpartum mood or psychotic disorder should be asked about __________

Answer 19

thoughts of harming herself or the infant

-The lack of reality testing and disorganized behavior can lead to unsafe and neglecting behaviors even in the absence of clear infanticidal ideation

Question 20

Treatment for Postpartum Psychosis

Answer 20

1. Mood stabilizers: lithium, valproic acid, divalproex sodium, carbamazepine and lamotrigine
2. Atypical Antipsychotics: olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone, or asenapine
3. Antidepressants: help manage depression. Usually along with a mood stabilizer or antipsychotic. Antidepressant along can sometimes trigger a manic episode.