Postpartum Depression Flashcards by Brittany Long

3 etiologies of PP depression?

physiologic- fall of hormones PP, fatigue
emotional- post event let down
cultural- isolation from former life, less attractive PP, “super mom syndrome”

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risk factors for PP depression?

previous PPD
FHx of PPD
Hx of depression
ambivalence about PG
unhappy primary relationship
complications of labor/PP/negative birth experience
early mother-child separation
Hx of PMS
hypothyroidism
recent loss or move
isolation (lack of support network)
perfectionism
dissatisfaction w/self (eating disorder)
unresolved SAB/TAB
young age 
multiparity

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what % of women will experience transient “baby blues” w/in first 2 wks following delivery?

50-80%

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what % of women experience PP psychosis w/in first 4 wks following delivery?

0.1 - 0.2%

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what % of women experience major depression during PG?

9.4-12.7%

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what % of women have major depressive episodes in 3 mos PP?

21.9%

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what % of women may not believe they had pPD?

1/3

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which group of moms are esp at high risk for PPD?

primips

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what makes up the spectrum of PPD?

transient PP blues (“baby blues”)
PPD
PP psychosis (medical emergency)

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4 types of PPD?

baby blues
adjustment disorder of PP period
major depression in PP period
PP psychosis

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~ what % experience baby blues? onset? duration? etiology?

~70% experience 
onset: 3-5 d PP
severity: mild to moderate
present in all cultures studied
appears unrelated to environmental stressors

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definition of “blues”?

heightened reactivity not necessarily clinical depression
mood swings
occurs 3-5 d after birth
self-limiting
if occurs, at increased risk for PPD

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physical sxs of baby blues?

lack of sleep
low E
loss of appetite
food cravings
fatigue after sleep

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mental sxs of baby blues?

anxiety
worry
lack of confidence
sad 
overwhelmed
mixed with joy and calm

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behavior sxs of baby blues?

worrying for no reason
excitable
oversensitive
irritable
impatient
restless

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adjustment d/o of PP period occurs in what %? how does it manifest?

occurs in ~20% of birthing mothers
manifests as excessive difficulties adjusting to motherhood
not as severe in PPD

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duration of adjustment d/o? what can it lead to?

can resolve w/o tx over time, but can cause ongoing difficulties for mom
can develop into PPD if more severe and untreated
responds well to short term psychotherapy

what % have PPD start after 6 wks? after weaning? at return of menstruation? when starting oral contraceptive?

6 wks PP: 40%
weaning: 20%
menstruation: 16%
oral contraceptives: 14%

how does PPD manifest?

sxs of depression, often marked anxiety/agitation and obsessions about harm coming to the baby
can develop gradually or abruptly after birth

incidence of PPD? onset? duration?

~10% experience

onset: 6 wk- 1 yr
duration: wks to months
sxs: baby blues + others

physical sxs of PPD?

changes in appetite
H/A
numbness and tingling
chest pn
palpitations
hyperventilation
decreased libido
insomnia 
hypersomnia

mental sxs of PPD?

despair
feelings of inadequacy
hopelessness
inability to cope
hyperconcern
poor memory/concentration
loss of usual interests
suicidal ideation, fantasies
repetitive fears, thoughts or images 
guilt 
emotional numbness

behavioral sxs of PPD?

extreme or unusual behavior
panic
anxiety
hostility/easily angered
anger towards family/baby
phobias/fears
antisocial behavior
lack of grooming
exaggerated high or low moods
frequent sadness or crying
over concern for baby

sxs frequently seen in PPD?

marked agitation and anxiety
mother cannot sleep even when baby is sleeping
obsession and compulsions about the baby

PP obsessions?

commonly focused on infant thoughts (obsessions) about hurting the infant: dropping, drowning, stabbing, putting in oven or microwave, sexually abusing infant, thoughts someone will steal or harm the infant

PP compulsions?

``` commonly follow the obsessions as an attempt to alleviate the thought: avoid holding baby by staircases avoid bathing infant hide knives avoid kitchen area avoid changing diapers or bathing infant avoid leaving the house ```

are PP mother's at risk for harming their baby?

no- very low risk of actually harming their baby, more at risk of hurting themselves

incidence of PP psychosis? onset? severity? duration? RFs? ssxs?

``` 0.1- 0.3% usu w/in 1st 3 wks PP severe duration varies RFs: hx of bipolar affective d/o or psychosis, Fhx of psychosis, having first child sxs: all other sxs plus more ```

how to tx PP psychosis?

MEDICAL EMERGENCY | need to refer out for hospitalization most likely

sxs of PP psychosis?

delusions: false beliefs, often of a religious nature and very frequently involving the infant perceptual distortions: hearing or seeing things which are not present often feelings of excessive well being or importance

physical sxs of PP psychosis?

refusal to eat excessive E compulsive activity inability to sleep

mental sxs of PP psychosis?

``` extreme confusion loss of memory hallucinations delusions agitation suidical ```

behavior sxs of PP psychosis?

``` suspicious paranoia irrational preoccupation w/trivia aversion to baby violent suicidal ```

management of PP psychosis?

``` prevention listening reassurance rest nutrition exercise breastfeeding referral to support group/counseling naturopathic meds allopathic meds ```

supportive tx options we can provide?

supplements/homeopathics counseling, individual and/or group support groups pharmacological intervention

how to prevent PP psychosis?

``` La Leche League play group mom's group friends and family PP doula educate the family! ```

dx of PPD?

edinburgh PN depression scale 10 question self-report, max 30 points women who report depressive sxs w/o suicidal ideation or major fxnal impairment are re-evaluated w/in 1 mo to determine state of depression

what is the edinburgh PN depression scale?

``` designed for home or outpatient use 10 questions can be completed in approx 5 mins reviews feelings the previous 7 d scored 0-3 depending on sx severity depending on study, cut off is 14 ```

knowing referral sources that utilize what 4 things is especially important to know?

do they accept Medicaid? do they utilize a sliding fee? will they develop a payment plan? do they offer free counseling?

how can exercise help?

home based exercise programs result in improvement of depression better scores on screening depression scales decreased fatigue

drug of choice for PPD while breastfeeding?

SSRIs when prescribing look into half-life, effect on libido and wt usu give in those who haven't had PPD before

4 steps of recovery process of PPD?

initial: still depressed, reassurance needed transition: few good days, but also still some bad days middle: more good days than bad, as she becomes assertive can see increased arguments with partner, encourage patience final: coping, knows who she is again