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OB > Postpartum depression > Flashcards

Postpartum depression Flashcards

1
Q

postpartum “blues”

A 
tearfulness, lability, reactivity
predom. mood: happiness
peaks 3-5 days after delivery
unrelated to environmental stressors/ psychiatric hx
present in 50-80% of women
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2
Q

hormone withdrawal hypothesis: estrogen

A

receptors concentrated in the brain

“blues” correlate w/ magnitude of drop

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3
Q

homone withdrawal hypotheses: progesterone metabolite (allopregnanolone)

A

GABA agonists; CNS GABA levels & sensitivity may decrease during pregnancy as an adaptation
the reduced brain GABA may recover more slowly in women w/ “blues”

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4
Q

oxytocin peripheral effects include?

A

uterine contraction

milk ejection

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5
Q

oxytocin general info

A

receptors concentrated in brain
new receptors are induced by estrogen during pregnancy
disruption prevents/ decreases maternal behavior

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6
Q

oxytocin in pregnancy

A

social attachment/bonding
pair-bonding/ intimacy
parental behavior

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7
Q

a subset of women may be vulnerable to mood d/o’s at times of hormonal flux, such as?

A

premenstrual, postpartum, perimenopausal

regardless of environmental stress

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8
Q

the nml heightened emotional responsiveness caused by__________may predispose to depression in the context of high stress & low social support

A

oxytocin

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9
Q

major depression key sx’s

A

at least 1 of following, for 2 wks

  • depressed mood most of the day, nearly every day
  • diminished interest or pleasure in all
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10
Q

major depression associated sx’s

A

changes in wt & appetite

  • insomnia/ hypersomnia
  • psychomotor agitation or retardation
  • fatigue or loss of energy
  • feeling worthless/guilty
  • impaired concentration, indecisiveness
  • thoughts of death
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11
Q

clinical features of postpartum depression

A 
depressed, despondent &/or emotionally numb
sleep disturbance, fatigue, irritability
loss of appetite
poor concentration
feelings of inadequacy
ego-dystonic thoughts of harming baby
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12
Q

confounds in dx depression during pregnancy- overlapping sx’s

A

sleep disturbance
increased appetite
decreased energy
changes in concentration

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13
Q

confounds in dx depression during pregnancy: illness w/ similar sx’s

A

anemia
thyroid dysfunction
GDM

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14
Q

characteristics of postpartum depression

A
  • begins w/in 4 wks of birth
  • clinical presentation peaks 3-6 mo after delivery
  • postpartum period considered up to 1 yr
  • related to environmental stressors
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15
Q

regardless of culture, the risks of postpartum depression are similar

A 
previous episodes of depression
significant loss of life stress
unwanted/unplanned pregnancy
prior fetal loss
unexpected birth outcomes
marital confict
socioeconomic status
low social support
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16
Q

postpartum psychoses heterogeneous group of d/o’s

A 
bipolar d/o
major depression w/ psychotic features
schizophrenia spectrum d/o's
medical conditions
drugs (amphetamines, hallucinogens, bromocriptine)
17
Q

postpartum psychoses onset

A

usually w/in 3 wks of postpartum

18
Q

postpartum psychoses: sx’s

A 
delusions
hallucinations
insomnia
confusion/disorientation
rapid mood swings
waxing & waning
19
Q

factors that that may contribute to risks associated w/ antenatal depression

A

rindirect effects: reduced prenatal care, less optimal nutrition
poor appetite & wt loss: socioeconomic deprivation, increased use of cigarettes & alcohol
direct effects: changes in cortisol & HPA axis development

20
Q

effects of untreated depression on OB complications

A

low birth wt
premature birth
pre-eclampsia

21
Q

effects of antenatal depression on offspring

A

newborns cry excessively & are more inconsolable
babies (up to age 1) have poorer growth & increased risk of infxn
children (up to age 5) have more difficult temperaments, more distress, sadness, fear, shyness, frustration

22
Q

early consequences of untreated postpartum depression for offspring

A 
sometimes none
distrubed mother-infant relationship
cortisol elevation (baby & mother)
FTT
physical injury/ death
23
Q

later consequences of prolonged maternal depression for offspring

A

depression
behavioral disturbance, including conduct d/o
reduced cognitive abilities
more school problems (truancy, dropping out)
role reversal

24
Q

effects of maternal stress & anxiety during pregnancy

A 
altered fetal hemodynamics & mvnt
lower gestational age
lower infant birth wt
lower apgar scores
enduring changes in cortisol measures in offspring- so far observed up to age 10
25
Q

potential effects of postpartum depression on relationships

A 
altered roles w/in the couple
altered roles w/in extended family
establishing alt. caregiver patterns that become difficult to change later
impaired communication
psychiatric sx's in partner
26
Q

risk of suicide from untreated major depression during pregnancy

A

overall risk may be greater than in non-pregnant women
risk may be increased when: pregnancy is unwanted, esp. when wanted abortion but couldn’t obtain; partner abandoned woman during pregnancy; woman has had prior pregnancy loss &/or death of CH

27
Q

infanticide d/t postpartum depression

A

rare; greater risk w/ psychotic sx’s
rarely has hx of abusing CH
most often part of a suicide attempt
no anger toward baby; wish not to abandon baby &/or not to burden others w/ baby
rarely attempt to conceal; often self-report

28
Q

thoughts of harming baby: low risk

A 
common in non-psychotic PPD
mother doesn't want to harm baby
thoughts are ego-dystonic
mother takes steps to protect baby
mother has no delusions/hallucinations related to harming baby
29
Q

ego-dystonic thoughts

A

obsessive in nature & odd/frightening to mother

30
Q

thoughts of harming baby: high risk

A

mom has delusional beliefs about baby
thoughts of harming baby are ego-syntonic
mom has hx of violence
mom has labile mood &/or impulsive behavior

31
Q

ego-syntonic thoughts

A

mother thinks they are reasonable &/or feels tempted to act on them

32
Q

potential effects on mother-infant relationship

A

brain & CNS development: interplay bet. genes & experiences, early interactions directly affect how the brain is “wired”, HPA axis-stress response sx impact
Attachment: infants of depresed mothers are at high risk for developing an insecure attachment relational problems bet. infants & their ?
caegivers are connected to early social, emotional, & behavioral problems for CH

OB (13 decks)

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