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Obstetrics > Post Partum Depression > Flashcards

Post Partum Depression Flashcards

1
Q

What age group is depression most common?

A

18-59

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2
Q

Rate of major depression during pregnancy

A

9.4-12.7%

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3
Q

Major depression postpartum doubles

A
  1. 1% first 3mo

21. 9% in firth 12mo

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4
Q

Post partum blues

A

Predominant mood: happy

Tearfulness, mood lability, reactivity

Peaks 3-5days after delivery

50-80% of women

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5
Q

Which is not related to environmental stressors or psychiatric hx?

A

Postpartum blues

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6
Q

Hormone withdrawal hypotheses

A

Blues correlates w/ magnitude of drop in estrogen

GABA levels & sensitivity decreases
- progesterone metabolite: allopregnanolone

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7
Q

Oxytocin

A 
Uterine contraction
Milk ejection
Social attachment/bonding
Pair bonding/intimacy
Parental behavior
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8
Q

Disruption of what hormone prevents/decreases maternal behavior?

A

Oxytocin

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9
Q

Some women are vulnerable to mood disorders during hormonal flux regardless of environmental stress

A

Normal high of oxytocin may predispose to depression w/high stress & low social support

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10
Q

Key sxs of major depression

A

At least 1 of the following:

  • depressed most of the day
  • Markedly diminished interest or pleasure in all, almost all activities most of the day, nearly every day
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11
Q

Associated sxs of major depression

A

Four or more of the following:

  • changes in wt/appetite
  • insomnia/hypersonic
  • psychomotor agitation/retardation
  • fatigue/loss of energy
  • feeling worthless or guilty
  • impaired concentration, indecisiveness
  • thoughts of death
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12
Q

Post partum depression

A
  • depressed, despondent and or emotionally numb
  • sleep disturbance, fatigue, irritability
  • loss of appetite
  • poor concentration
  • feelings of inadequacy
  • ego-dystopia thoughts of harming the baby
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13
Q

Difficulty in diagnosing depression during pregnancy

A

Sxs overlap

  • sleep disturbance
  • increased appetite
  • decreased energy
  • changes in concentration

Illnesses w/ similar sxs

  • anemia
  • thyroid dysfxn
  • GDM
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14
Q

Characteristics of post partum depression

A

Starts within 4wks of birth

Peaks 3-6mo

  • related to environmental stressors
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15
Q

Post partum period

A

Up to 1year

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16
Q

Risks of postpartum depression

A
  • previous episodes of depression
  • significant loss or life stress
  • unwanted/unplanned pregnancy
  • prior fetal loss
  • marital conflict
  • socioeconomic Status
  • unexpected birth outcomes
  • low social support
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17
Q

Which is most dangerous?

A

Postpartum psychoses

Onset within 3wks postpartum

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18
Q

Which is composed of a heterogenous group of disorders:

  • bipolar disorder
  • Major depression w/ psychotic features
  • Schizophrenia
  • medical conditions (thyroid/low B12)
  • Drugs (amphetamines, hallucinogens, bromocriptine)
A

Post partum psychoses

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19
Q

Sxs of post partum psychoses

A
  • delusions (baby possessed by demons)
  • insomnia
  • hallucinations (seeing someone else’s face)
  • increased confusion/disorientation
  • rapid mood swings
  • waxing & waning ( normal-crazy-normal)
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20
Q

Factors that contribute to antenatal depression

A

Indirect effects:

  • poor nutrition
  • reduced prenatal care

Poor appetite & wt loss

  • socioeconomic deprivation
  • alcohol & cigarettes

Direct effects
- changes in cortisol & HPA axis development

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21
Q

OB Complications of untreated depression

A

Low birth wt

Premature

Pre-eclampsia

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22
Q

Effects of depression on offspring

A

Cry excessively, inconsolable

Poor growth, high risk of infxn

Difficult temperament, sad, distressed, fear, shy, frustrated- up to 5yo

23
Q

Early consequences for offspring

A 
Bad mom-baby relationship
Cortisol elevation (mom & baby)

Failure to thrive

Physical injury/death

Sometimes none

24
Q

Late consequences on offspring

A

Depression

Reduced cognitive abilities

More school problems

Role reversal

Behavioral disturbance, including conduct disorder

25
Q

Effects of maternal stress & anxiety

A

Low GA

Low birth weight

Low APGAR scores

Altered fetal hemodynamics & mvt

Changes in cortisol up to age 10

26
Q

Effects on relationships

A

Altered roles within couple,extended family

Impaired communication
Psychiatric sxs in partner

Alternate caregiver patterns are difficult to change later

27
Q

Increases suicide risk

A
  • unwanted pregnancy, esp if couldn’t get abortion
  • abandoned by partner during pregnancy
  • prior pregnancy loss/death of children
28
Q

Infanticide

A

Often Self report

A part of suicide attempt

No anger toward baby - don’t want to abandon/burden others

No hx of child abuse usually

Greater risk w/ psychotic sxs

29
Q

Thoughts of harming baby: Low risk

A

No delusions/hallucinations of harming baby

Taken steps to protect baby

Ego-dystopia thoughts- obsessive/scare her

30
Q

High risk

A

Delusional beliefs about baby

Thoughts of harming baby are ego-syntonic*

  • thinks thoughts are reasonable
  • tempted to act

History of violence

Labile mood/impulsive behavior

31
Q

Infants of depressed moms are at high risk for developing

A

Insecure attachment

32
Q

Attachment theory

A

Secure: child sees caretaker as loving & responsive & her/himself worthy of love

Insecure: child sees caretaker as unresponsive (rejecting) & her/himself unworthy of love

33
Q

Child w/ insecure attachment @ risk for

A

Mood disorders

Delayed cognition

Behavior disorders

34
Q

What does the infant bring to the table?

A
  • readiness to interact socially w/ others
  • unique individual characteristics & temperament
  • inherent drive to master things
  • Resilience
35
Q

What does the parent bring to the table?

A
  • capacity to recognize & respond to the infant’s emotional signals
  • current mental & physical status
  • social support network
  • Hx of being in other relationships
36
Q

Edinburgh Postnatal Depression Scale (EPDS)

A

10 item self-report questionnaire

37
Q

Advantages to EPDS

A

*specifically designed for peripartum use

Easy to score

Well validated during pregnancy & postpartum & cross culturally

In 20 languages

38
Q

Disadvantages of EPDS

A

Not linked to DSM IV diagnostic criteria

Cannot be used for assessment or tracking treatment

39
Q

What is the max score for the EPDS?

A

30

40
Q

What is the most important item of the EPDS?

A

Item #10

Suicidal thoughts

41
Q

PHQ9

A

9 item self-reported questionnaire

42
Q

Advantages of PHQ9

A
  • Can use to assess & track treatment response
  • Items & scores linked to DSM IV depression criteria
  • Easy to score
43
Q

Disadvantages of PHQ9

A
  • Not designed for peri-partum use

- not as well validated peripartum

44
Q

What is a positive PHQ9 score ?

A

5 out of 27

45
Q

PHQ9 Depression severity

A

0-5: does not meet criteria for major depression

5-9: mild depression

10-14: moderate depression

15-19: moderately severe depression

20-27: severe depression

46
Q

What should be the initial treatment response?

A

Score drops 5 or more from baseline after 4 wks

47
Q

What is an adequate treatment response?

A

50% decrease after 8wks of treatment (2mo)

48
Q

What is remission?

A

Score <5 post treatment

49
Q

When should you refer?

A

When response in primary care setting is inadequate

50
Q

What is the best validated screening tool for peripartum populations?

A

EPDS

51
Q

What is the best validated screening tools for tracking response to treatment?

A

PHQ9

52
Q

Other screening tools for perinatal depression

A

Beck Depression Inventory

Center for Epidemiologic Studies

Postpartum Depression Screening Scale

53
Q

Protective influences of social support

A

Greater satisfaction in marriage

Better mom-baby interaction

Decreased incidence of PPD

Increased rate of maternal education completion

Less alcohol & drug use

Higher rates of infant immunization (on time)

Fewer accidental injuries

Less child abuse

54
Q

Examples of Self care

A

Social support

Sleep

Breaks from baby

Enjoyable, replenishing activities

Nutrition: iron, calcium, folate, EFA (essential fatty acids)

Aerobic exercise

Break isolation: friends, partner, other moms

Take time for yourself

Protect your energy

Obstetrics (6 decks)

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