postpartum depression Flashcards
Postpartum Psychiatric Disorders
Depression, anxiety, psychosis
Common preggo symptoms
“Morning Sickness” - N/V: ^^ estrogen, progesterone, hCG
◦ Reflux: ^^ gastric emptying time, dec. sphincter tone
◦ Constipation: dec. motility, ^^ water absorption
more preggo symptoms
◦ Back pain ◦ Constipation ◦ Edema ◦ GERD ◦ Hemorrhoids ◦ Round Ligament Pain ◦ Urinary Frequency ◦ Varicose Veins ◦ Headaches/migraines ◦ Sinusitis ◦ Neck aches ◦ Joint pain (carpal tunnel syndrome) ◦ Sciatica ◦ Hip pain/ Low back pain ◦ Pubic pain
preggo back pain symptoms
Increased lumbar lordosis
Myofascial strains
Paraspinal muscle strain/muscle spasm Lumbar-sacral junction compression
preggos on OMM
OMM can be used throughout pregnancy, labor and postpartum
-Always treat patient in the most comfortable position! Usually supine or side-lying is best
-Use patient’s own body weight to help you and help patient to relax
HVLA is a relative contraindication in pregnancy!
pregnancy complications
High numbers of visits to prenatal clinic due to medical issues Congenital malformation in the infant
postpartum recovery
Estrogen and progesterone levels drop Prolactin and oxytocin stimulate lactation
postpartum recovery: Lochia (Postpartum Bleeding):
AKA postpartum period
Vaginal discharge containing blood, mucus and uterine tissue
Typically continues for 4-6 weeks
more postpartum recovery
constipation
varicosities
hairloss
headaches
breastfeeding probs
Not enough milk
◦ Engorgement
◦ Clogged milk ducts
◦ Mastitis
baby issues
Medical problems
Poor suck/feeding problems
Reflux/gas
Colicky baby
Postpartum Blues
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
- Symptoms usually peak over the next few days and resolve within 2 weeks
Postpartum Depression prevalence
8-15%
Major Depressive Disorder w/peripartum onset DSM-5 Diagnosis
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
PPD risk factors
- Past history of depression*
- Hx of physical or sexual abuse
- Young age
- Unplanned pregnancy
- Stressful life events (marital conflicts) during the 12 months prior to delivery
- Lack of social/financial support
- Living without a partner
- Intimate partner violence
- Unemployment for either mother or head of household
- High numbers of visits to prenatal clinic
- Congenital malformation in the infant
- Not breastfeeding
- Childcare stressors such as a colicky baby
- Personality traits (high neuroticism and high introversion)
- Positive family history
do hormones play a role in PPD?
- Progesterone and estrogen levels drop precipitously postpartum.
- Cortisol, thyroid and other large hormonal shifts also occur.
- However, hormone levels and changes in levels do not correlate with mood symptoms.
- Women who get peripartum depression are more sensitive to hormone fluctuations*
Postpartum anxiety disorders: panic disorder
- Intense fear of harm/harming baby,
- Palpitations, hyperventilation, sweating,etc
- Difficulty caring for, leaving baby
Postpartum anxiety disorders: OCD
- Intrusive thoughts/images of grievous harm to baby.
- Mother sometimes imagines herself inflicting harm
Perinatal Depression and Anxiety: Treatment and Prophylaxis
Stress reduction
Support groups
Psychotherapy: interpersonal, cognitive behavioral, supportive
Medication: SSRIs
Postpartum Psychosis prevalence
Postpartum psychosis (0.1% to 0.2%)
IN CONTRAST: Postpartum blues (50% to 75%) Postpartum depression (8-15%)
Postpartum psychosis
one of the rarest psychiatric disorders
psychiatric emergency!!
◦ rapid onset of severe maternal symptoms
◦ potential for a catastrophic outcome, such as infanticide or suicide
Postpartum psychosis etiology
◦ Pathogenesis is likely multifactorial
◦ Significant drop in estrogen/progesterone
◦ Estrogen affects the monoaminergic system, particularly serotonin and dopamine.
◦ Hx of bipolar/psychosis
◦ Families with bipolar disorder in which at least one woman had suffered a manic or psychotic episode within 6 weeks postpartum.
◦ Sleep disruption
Postpartum psychosis risk factors
- primiparity
- discontinuation of mood stabilizer
- obstetric complications
- perinatal infant mortality
- previos bipolar episodes, psychosis, postpartum psychosis
- fam hx of postpartum psychosis or bipolar disorder
- sleep deprivation
- inc. environmental stress
- lack of partner support
postpartum psychosis clinical presentation
◦ 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
postpartum psychosis dangers
◦ 4% of women with postpartum psychosis commit infanticide
◦ 5% commit suicide
◦ Any mother who presents with a postpartum mood or psychotic disorder should be asked about 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.
postpartum psychosis details
- onset: within 2 weeks postpartum (early as 1 day)
- congnitive: poor concentration, delirium (rule out organic cause)
- behavioral: agitated, hyperactive, emotional distance/coldness
- mood: elated, labile, dysphoric, depressed (less frequent)
- affect: flat/incongruent
- speech: rambling
- sleep: insomnia
postpartum psychosis details 2:
-thought content: mood-incongruent delusion: thought broadcasting, ideas of reference, infant being harmed/killed, persecutory, jealousy, of being controlled
mood-congruent delusions of grandiosity
-thought process: disorganized, flight of ideas
-perception: hallucinations: organic (visual, etc) or commanding auditory
-suicide/homicide
postpartum psychosis tx
like bipolar!
mood stabilizers
atypical antipsychotics
antidepressants
postpartum psychosis tx: mood stabilizers
lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol) and lamotrigine (Lamictal)
postpartum psychosis tx: atypical antipsychotics
olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris)
postpartum psychosis tx: antidepressants
help manage depression. Usually along with a mood stabilizer or antipsychotic. Antidepressant alone can sometimes trigger a manic episode!
