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CSI > postpartum depression > Flashcards

postpartum depression Flashcards

1
Q

Postpartum Psychiatric Disorders

A

Depression, anxiety, psychosis

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2
Q

Common preggo symptoms

A

“Morning Sickness” - N/V: ^^ estrogen, progesterone, hCG
◦ Reflux: ^^ gastric emptying time, dec. sphincter tone
◦ Constipation: dec. motility, ^^ water absorption

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3
Q

more preggo symptoms

A 
◦ 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
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4
Q

preggo back pain symptoms

A

Increased lumbar lordosis
Myofascial strains
Paraspinal muscle strain/muscle spasm Lumbar-sacral junction compression

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5
Q

preggos on OMM

A

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!

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6
Q

pregnancy complications

A

High numbers of visits to prenatal clinic due to medical issues Congenital malformation in the infant

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7
Q

postpartum recovery

A

Estrogen and progesterone levels drop Prolactin and oxytocin stimulate lactation

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8
Q

postpartum recovery: Lochia (Postpartum Bleeding):

A

AKA postpartum period
Vaginal discharge containing blood, mucus and uterine tissue
Typically continues for 4-6 weeks

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9
Q

more postpartum recovery

A

constipation
varicosities
hairloss
headaches

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10
Q

breastfeeding probs

A

Not enough milk
◦ Engorgement
◦ Clogged milk ducts
◦ Mastitis

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11
Q

baby issues

A

Medical problems
Poor suck/feeding problems
Reflux/gas
Colicky baby

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12
Q

Postpartum Blues

A

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
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13
Q

Postpartum Depression prevalence

A

8-15%

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14
Q

Major Depressive Disorder w/peripartum onset DSM-5 Diagnosis

A

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

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15
Q

PPD risk factors

A
  • 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
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16
Q

do hormones play a role in PPD?

A
  • 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*
17
Q

Postpartum anxiety disorders: panic disorder

A
  • Intense fear of harm/harming baby,
  • Palpitations, hyperventilation, sweating,etc
  • Difficulty caring for, leaving baby
18
Q

Postpartum anxiety disorders: OCD

A
  • Intrusive thoughts/images of grievous harm to baby.

- Mother sometimes imagines herself inflicting harm

19
Q

Perinatal Depression and Anxiety: Treatment and Prophylaxis

A

Stress reduction
Support groups
Psychotherapy: interpersonal, cognitive behavioral, supportive
Medication: SSRIs

20
Q

Postpartum Psychosis prevalence

A

Postpartum psychosis (0.1% to 0.2%)

IN CONTRAST: 
Postpartum blues (50% to 75%)
Postpartum depression (8-15%)
21
Q

Postpartum psychosis

A

one of the rarest psychiatric disorders
psychiatric emergency!!
◦ rapid onset of severe maternal symptoms
◦ potential for a catastrophic outcome, such as infanticide or suicide

22
Q

Postpartum psychosis etiology

A

◦ 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

23
Q

Postpartum psychosis risk factors

A
  • 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
24
Q

postpartum psychosis clinical presentation

A

◦ 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

25
Q

postpartum psychosis dangers

A

◦ 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.

26
Q

postpartum psychosis details

A
  • 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
27
Q

postpartum psychosis details 2:

A

-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

28
Q

postpartum psychosis tx

A

like bipolar!
mood stabilizers
atypical antipsychotics
antidepressants

29
Q

postpartum psychosis tx: mood stabilizers

A

lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol) and lamotrigine (Lamictal)

30
Q

postpartum psychosis tx: atypical antipsychotics

A

olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris)

31
Q

postpartum psychosis tx: antidepressants

A

help manage depression. Usually along with a mood stabilizer or antipsychotic. Antidepressant alone can sometimes trigger a manic episode!

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