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postpartum mood disorders Flashcards

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1
Q

Lifetime of postpartum mood disorders for women?

A
  • 20-25%
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2
Q

Diff post partum mood disorders?

A
  • postpartum blues
  • depression
  • psychosis (most serious)
  • anxiety disorder
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3
Q

How common is the postpartum blues? Time course?

A
  • 50-85% new mothers: most common in 1st pregnancy
  • time course:
    begins w/in 48 hrs delivery
    peaks: 3-5 days
    lasts around 2 weeks
  • etiology unknown, just having to cope with a new child is a stressor
  • one of the reasons why women experience the blues and depression is b/c estrogen, progesterone, and cortisol plummet about 48 hrs after birth
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4
Q

RFs of postpartum blues?

A
  • hx of depression
  • depressive sxs during pregnancy
  • family hx of depression
  • premenstrual or OCP assoc mood changes
  • stress around child care
  • psychosocial impairment in areas of work, relationships, and leisure activities
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5
Q

Sxs of postpartum blues?

A
  • mood lability
  • tearfulness
  • sadness or elation that is out of proportion
  • anxiety
  • irritability
  • insomnia
  • decreased concentration
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6
Q

Tx of postpartum blues?

A
  • supportive with reassurance to the woman and her family
  • allowing the woman to have enough rest
  • perhaps getting someone to take care of the infant at night
  • generally resolves on its own
  • careful monitoring for the development of postpartum depression
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7
Q

How common is postpartum psychosis? Why is this so dangerous?

A
  • 1-2/1000 postpartum women
  • usual onset w/in 2 weeks of delivery
  • women are more likely to experience psychosis following childbirth then at any other time in their lives
  • women with PPP are more likely to commit suicide or infanticide - MEDICAL EMEREGENCY
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8
Q

Pathogenesis of PPP?

A
  • complete etiology isn’t known
  • research suggests hormonal and genetic factors
  • rapid hormonal changes following childbirth may play a role as a trigger
  • currently thought of as a manifestation of bipolar
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9
Q

RFs for PPP?

A
  • 1st pregnancy
  • hx of bipolar
  • hx of puerperal psychosis
  • family hx of puerperal psychosis
  • recent d/c of lithium or other mood stabilizers
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10
Q

Sxs of PPP?

A
  • delusions
  • hallucinations (visual, auditory, or olfactory)
  • thought disorganization
  • severe insomnia
  • suicidal ideation
  • homicidial ideation
  • aggression
  • agitation
  • impulsivity
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11
Q

Tx of PPP?

A
  • usually acute hospitalization
  • antipsychotics
  • therapy
  • electoconvulsive therapy if pharm unsuccesful
  • TRUE medical EMERGENCY!
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12
Q

What are the diff postpartum anxiety disorders?

A
  • OCD: obessions and compulsions
  • panic disorder
  • generalized anxiety disorder
  • PTSD
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13
Q

How common is PPD? RFs?

A
  • 12-15% women
  • 10-26% men
    RFs:
  • marital conflict
  • stressful life events, lack of social support for pregnancy
  • lack of emoional and financial support of partner
  • living w/o a partner
  • unplanned pregnancy, previous miscarriage
  • having contemplated terminating the pregnacny
  • poor relationship with one’s own mother
  • high number of visits to prenatal clinic
  • congenitally malformed child
  • personal hx of bipolar
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14
Q

Sxs of PPD?

A
  • irritability and anger
  • sig anxiety often wtih panic attacks
  • feelings of inadequacy and of being a failure as a mother
  • feelings of guilt
  • feelings of hopelessness or despair
  • feeling of being overwhelmed or unable to care for baby
  • not bonding to baby, further exacerbates feelings of shame and guilt
  • typical: insomnia, wt changes, decreased libido, decreased energy levels
  • often can lead to women suffering in silence
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15
Q

PPD screening?

A
  • edinburgh postnatal depression scale (EPDS)
  • postpartum depression screening scale
  • BECK depression inventory
  • screen with general ?s:
    how is your mood?
    how have you been feeling?
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16
Q

What medical causes should you rule out first b/f dx PPD?

A
  • anemia
  • diabetes
  • thyroid disorders- thru preg -
    1-3 mo hyperactive
    3-4 mo hypoactive
    7-8 mo stabilization
    postpartum thyroiditis
17
Q

6 stages of PPD?

A
  • denial
  • anger
  • bargaining
  • depression
  • acceptance
  • PTSD (worried that PPD will return)
18
Q

Sxs of men’s PPD?

A
  • increaed anger and conflict towards others
  • increased use of alcohol or other drugs
  • frustration or irritability
  • violent behavior
  • losing wt w/o trying
  • isolation from family and friends
  • being easily stressed
  • impulsiveness and taking risks, like reckless driving or extramarital sex
  • feeling discouraged
  • increases in complaints about physical probs
  • ongoing physical sxs, like HAs, digestive probs or pain
  • problems with concentration, and motivation
  • loss of interest in work, hobbies and sex
  • working constantly
  • frustration or irritability
  • misuse of Rx meds
  • increased concerns about productivity and fxning at school or work
  • fatigue
  • experiencing conflict b/t how you think you should be as a man and how you actually are
  • thoughts of suicide
19
Q

PPD tx?

A 
- psychotherapy: 
interpersonal - marital strain, role transitions
- CBT: 
changing negative cog. distortions
aids in developing coping behaviors
- group therapy
20
Q

What should be considered when using meds for PPD?

A
  • breastfeeding - weigh risk vs benefit
  • drug transfer -
    protein binding
    lipid solubility
    MW of drug
    half life
  • eval of infant
21
Q

Tx for PPD?

A
  • TCAs: elavil, pamelor, silenor
  • SSRIs: zoloft and paxil are preferred (can still breastfeed)
  • SNRI: cymbalta
  • bupropion - concerning
  • benzos: serax, xanax - don’t use in preg (x) or lactation
  • hypnotics: sonata, ambien, lunesta
  • some of these you can’t breastfeed while taking
  • optional: Electroconvulsive therapy
22
Q

duration, Sxs and tx of postpartum blues?

A
  • 2-3 days, resolves w/in 10 days
  • sxs: tearfulness, fatigue, depressed affect, irritability
  • tx: reassurance, watchful waiting, 20% will develop PPD w/in 1 yr
23
Q

duration, sxs, and tx of PPD?

A
  • 2 wks to 12 months
  • sxs: depressed affect, anxiety, sxs worse at night, poor concentration, decreased libido
  • tx: antidepressant meds, psychotherapy
24
Q

duration, sxs, and tx of PPP?

A
  • variable - tpyically days to 4-6 wks postpartum
  • sxs: delusions, confusion, sleep disturbances, unusual behavior, emotional lability
  • tx: antipsychotic meds, antidepressants, possible inpt hospitalization

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