Postnatal Mood Problems Flashcards
+ve feelings in puerperium
- Satisfaction
- Increased closeness to her partner
- Increased closeness to her own mother
- Gradual ‘falling in love’ with baby
- Feeling of protectiveness towards baby
- Changes in relationship with martial partner: now ‘mother and father’, not just ‘husband and wife’
-ve feelings in puerperium
- dissatisfaction, disappointment or distress over delivery process
- anxiety about baby
- rejection or ambivalence about baby
- jealousy about baby being centre of attention
- fears of harming baby
- physical discomfort and anxiety about physical change during birth
- overwhelming responsibility
- resentment at loss of freedom
- reactivation of poor relationship with own mother, leading to anxiety about repetition through generations
When do postnatal blues typically occur? How common is it?
- Postnatal blues typically occur between fourth and tenth days of puerperium
- It occurs in 50-70% of women and affects primiparous and multiparous women equally
- It is so common that it is regarded as normal
- Self-limiting condition
- Usually lasts 24-48 hours
- May resolve faster with protected sleep and rest
What are proposed hormonal factors of postnatal blues?
Combination of psychosocial factors and hormonal factors
Hormonal factors:
- Studies show E + P were higher in women with postnatal blues, but level of cortisol was similar
- Prolactin was higher in women with postnatal blues and may correlate with anxiety and depression
What are the psychosocial factors of postnatal blues?
- anxiety in pregnancy
- experiencing pregnancy as unpleasant
- fear of childbirth and pre-existing anxious or pessimistic personality
Based on NICE guideline, when should a woman be assessed for PND?
What is postnatal depression? When does it commonly occur?
What is postpartum psychosis? How common is it? When does it usually present? What is there a risk of?
What are pre-existing mental health problems which may occur / relapse after childbirth?
What is the leading cause of maternal deaths overall? What are the common methods?
History taking for postnatal mood problems
Depression screening questions (Whooely questions)
- During the past month, have you often been bothered by feeling down, depressed or hopeless?
- During the past month, have you often been bothered by having little interest or pleasure in doing things?
- Is this something with which you would like help?
What screening methods is used for postnatal depression?
Edinburgh Postnatal Depression Scale
- Ten-item, self-rated questionnaire that has been used extensively for the detection of postpartum depression
- Most commonly used cut-off score of >12 has an overally PPV of 57% and NPV of 99%
What are some red flags in history taking?
- “Signs of warning of impending dangers of disaster”
- Psychosis & suicide
- Recent or rapidly changing significant alterations in mental state
- Emergence of new Sx, which can include psychotic Sx (delusions, hallucinations) or severe anxiety in relation to her infant’s (and/or other children’s) welfare
- Psychotic Sx that involve the infant
- Thoughts of violents self-harm or suicide
- Acts of violent self-harm or suicide
- New/persistent/nonreassurable ideas and expression of these ideas, where the woman believes she is incompetent/inadeqate as a mother or feels estranged from her infant
- Pervasive guilt and hopelessness
- Deterioration in function as a consequence of symptoms, e.g. self-care, care of the infant, avoidance of the infant
- Not eating
- Severe insomnia
- Psychomotor retardation
For suicidal assessment, what must we assess?
- Any suicidal thoughts “wanting to die”, “not wanting to wake up” or “wanting to end it all”
- For long periods or may just be fleeting
- Any action plan
Counselling of women diagnosed with postnatal blues
- A lot of women have emotional changes
- Hormonal changes + environemntal changes + physical changes = easy to have PND or low mood
- There are PND nurses + psychiatrists
- See husband as well to inform him of the condition (ask for consent first for this)
Screening for PND should be performed prior to patients’ postnatal discharge
