Post partum depression and ppt Flashcards
outcome!!
risk factors of PPD
maria called them predictors. the ones with !!! were highlighted in class. I removed ones with overlap
• Risk factos:
- hx of depression,
- troubled childhood,
- low self-esteem,
- stress in home or at work,
- lack of effective support,
- differing expectations bet partners,
- or disappointment in kid (eg boy instead of girl-if baby is cog challenged)
Hx of substance abuse
Unstable relationships, lack of partner!!!!!!!!!!!!!!!!!!
Traumatic experience of birth
Perfectionist or obsessive/compulsive personality traits!!!!!!!!!!!!!
Breastfeeding challenge!!!!!!!!!!!!!!!!!!
is it normal to feel a little sad after birth?
• Most women have some immed feelings of sadness aka postpartal blues after childbirth (1-10 days postpartum)
outcome!!
why might a woman naturally feel a little sad?
• Most likely this is d/t hormonal shifts (dec estrogen, progesterone, and gonatotropin-releasing hormone and the anticlimactic feeling after birth.
what % of women feel sad beyond the 1-10 days of postpartal blues
is this figure accurate? why?
up to 10%- 20% of women, esp those disappointed w baby or w poor support the postpartal blues can ontinu beyond the immed postpartal period (up to 1yr) or reflect a more serious problem. They become postpartum depression (PPD)
this condition is underreported because mnay feel that they “should” be happy during this time. It may be as high as 50%
outcome!!
how can PPD affect the family
• Can interfere w breastfeeding, child care, and returning to a career
• Depression and inability to bond is postpartal complication with far reaching implications, can affect future health of whole family
-also dec ST memory
outcome!!
what are s/s of PPD
• Women and men may notice
extreme fatigue,
inability to stop crying,
in anxiety about their health or their infants,
insecurity (unwilling to make decisions or be left alone), psychosomatic symptoms (N, V, diarrhea),
and either depressive or extreme mood flucturations
who else can get PPD
fathers
• When using the Edinburgh PPD scale they found 5.2% of fathers with PPD
is it easy to predict PPD?
What can be used to help with this?
what is important about dx ppd?
- Difficult to predit who will dev PPD as childbirth elicits diff reactions
- Depression scales are avail but conscientious observation and discussion can reveal symptoms as well
imp to catch it early!
what might be nec if pt has PPD
• Woman may need counselling and antidepressant therapy
how to prevent PPD
- Balanced program of nutrition, exercise, sleep
- Easy to prpe meals, sleep when baby sleeping, walk daily w baby
- Share feelings w support person
- Take time ea day to do something for yourself
- Don’t try to be perfect and let unimportant things go for another day
- Don’t let yourself be isolated by baby care. Keep in touch w friends
which is more common ppd vs postpartal blues
s/s of PPD vs ppb
nursing role and therapy for woman with PPD
incidence PBb=70% PPD=10-20%
s/s PB=Sadness and tears
s/s PPD=Anxiety, feeling of loss, sadness
PPD=Counselling and drug therapy
PPD=Refer to counseling (id also say education)
t or f both PB and PPD have hormonal changes and stress as part of cause
t
when can perinatal mood disorders occur
can occur during preg as well, mostly postpartum
As I said earlier the outcomes relate more to PPD than PPP but her slides covered it and she taught it so i guess we have to know
what is postpartal psychosis.
why does it occur
psychosis in postpartal period
-it isnt a response to the physical act of childbearing but to the crisis of childbearing…many women (1/500) have mental illness, most PPP had preceding mental illness. They pregancny can set off their mental illness or some other stressful event like death in family
how might pp psychosis woman appear
she is exceptionally sad
she might be delusional, hallucinating eg the baby is talking to me, denying she was pregnant when baby is brought to her
she has delusions/hallucinations of harming self or babe
is it beneficial to orient woman to reality
not really, this might be threatening and her sensorium might be too disturbed to understand what youre talking aout
what interventions/nursing care must be prioritized for woman w pp psychosis
-refer to psychiatric counseling
-may need antipsychotic meds
-dont leave woman alone (risk of self harm) HIGH RISK OF SUICIDE
-dont leave woman alone with baby (risk of infanticide!!!)
Maria says sleep is priority as lack of sleep sets off mental illness. This is esp true if woman is bipolar as their sleep patterns are off to begin with
pp psychosis incidence
1-2%
possible etiology of pp psychosis
women with hx of what should be carefully screened for psychosis
-possible hormonal changes
-fam hx of bipolar disorder
Always check for psychotic symptoms in women with history of unipolar or bi-polar illness
50% of women who live with bi-polar illness are susceptible for a manic episode following delivery if bi-polar illness is not well-controlled before delivery
what is a surprising way that the woman might present with psychosis
she might be highly highly functional. eg you enter the room and everything is hyperorganized, she has full face of makeup, is being controlling
outcome!!
long term effects of PPD or PPP
Biological
Delayed cognitive and language development
Psychological
Insecure attachment and emotional impairment
Behavioral issues
Effects on child-if untreated they have delayed language and cog dev, may never attach to mom which can impair attachment to others too
Well mother=well baby
Disinterest in baby Anxiety about feeding, baby care Tears (?baby blues) Difficulty with coping, difficulty with decision making Early signs of psychosis, mania
outcome!!
precipitating factors of perinatal mood disorder
Hormones
Sleep deprivation
Euphoria of birth experience can trigger manic episode in the context of bi-polar illness
50% of women who live with bi-polar illness are susceptible for a manic episode following delivery if bi-polar illness is not well-controlled before delivery
this occurs in vaginal birth d/t release of hormones/endorphins. doesnt really occur w epidural
outcome!!
s/s of perinatal mood disorder
Feeling unhappy Crying for long periods of time following the regular “baby blues” period Social withdrawal Anger at partner Anger at infant Thoughts of wanting to harm infant Thoughts of wanting to harm self Inability to sleep, wanting to sleep all the time
outcome!
what assessment findings might occur with bipolar mania or hypomania
Heightened mood-euphoria, irritability, lability
Gregariousness, intrusiveness, increased telephone time, careless spending, increased goal directed activities
Decreased need for sleep
Decreased need for food
Increased energy
Hypersexuality
what is a helpful acronym that can be applied to guide care in all mood disorders
N-utrition
U-nderstanding
R-est (Sleep hygiene)
S-pirituality
E-xercise
t or f it is too dangerous to use meds during pregnancy and lactation if woman has mental health troubles?
No treatment is NOT an option!
Exposure to illness or exposure to medications?
Not everyone requires medications, but medical assessment is paramount
Always a difficult conversation since women worry about the effects of medications on unborn child, or implications of lactation
Medications may prevent depressive or manic episodes which can have dire consequences for women and their infants
meds for unipolar depression
Unipolar depression: SSRI’s and Benzodiazepines can be used in pregnancy and lactation
meds for bipolar
Bipolar illness: Mood stabilizers (eg: Lithium)
meds for postpartum psychosis
post-partum psychosis: Anti-psychotics AKA neuroleptics (eg: haloperidol, loxapine, seroquel, olanzapine)
breastfeeding and meds?
Some women will choose not to breastfeed because of concerns with medications
