Postpartum_Mental_Health_Problems_Flashcards

Question 1

What range of mental health problems can occur postpartum?

Answer 1

Postpartum mental health problems range from the ‘baby-blues’ to puerperal psychosis.

Question 2

What tool may be used to screen for postpartum depression?

Answer 2

The Edinburgh Postnatal Depression Scale may be used to screen for depression.

Question 3

What is the Edinburgh Postnatal Depression Scale?

Answer 3

A 10-item questionnaire with a maximum score of 30, indicating how the mother has felt over the previous week. A score > 13 indicates a ‘depressive illness of varying severity’. It has sensitivity and specificity > 90% and includes a question about self-harm.

Question 4

How common are the ‘baby-blues’?

Answer 4

Seen in around 60-70% of women.

Question 5

When are the ‘baby-blues’ typically seen?

Answer 5

Typically seen 3-7 days following birth and is more common in primips.

Question 6

What are the characteristic symptoms of the ‘baby-blues’?

Answer 6

Mothers are characteristically anxious, tearful and irritable.

Question 7

How common is postnatal depression?

Answer 7

Affects around 10% of women.

Question 8

When does postnatal depression typically start and peak?

Answer 8

Most cases start within a month and typically peaks at 3 months.

Question 9

What are the features of postnatal depression?

Answer 9

Features are similar to depression seen in other circumstances.

Question 10

How common is puerperal psychosis?

Answer 10

Affects approximately 0.2% of women.

Question 11

When does puerperal psychosis typically onset?

Answer 11

Onset usually within the first 2-3 weeks following birth.

Question 12

What are the features of puerperal psychosis?

Answer 12

Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations).

Question 13

What is the management for the ‘baby-blues’?

Answer 13

Reassurance and support, the health visitor has a key role.

Question 14

What is the management for postnatal depression?

Answer 14

As with the baby blues, reassurance and support are important. Cognitive behavioural therapy may be beneficial. Certain SSRIs such as sertraline and paroxetine* may be used if symptoms are severe**.

Question 15

What is the management for puerperal psychosis?

Answer 15

Admission to hospital is usually required, ideally in a Mother & Baby Unit. There is around a 25-50% risk of recurrence following future pregnancies.

Question 16

Why is paroxetine recommended for postnatal depression?

Answer 16

Paroxetine is recommended by SIGN because of the low milk/plasma ratio.

Question 17

Why should fluoxetine be avoided for postnatal depression?

Answer 17

Fluoxetine is best avoided due to a long half-life.

Question 18

summarise

Answer 18

Postpartum mental health problems

Postpartum mental health problems range from the ‘baby-blues’ to puerperal psychosis.

The Edinburgh Postnatal Depression Scale may be used to screen for depression:
10-item questionnaire, with a maximum score of 30
indicates how the mother has felt over the previous week
score > 13 indicates a ‘depressive illness of varying severity’
sensitivity and specificity > 90%
includes a question about self-harm

‘Baby-blues’ Postnatal depression Puerperal psychosis
Seen in around 60-70% of women

Typically seen 3-7 days following birth and is more common in primips

Mothers are characteristically anxious, tearful and irritable Affects around 10% of women

Most cases start within a month and typically peaks at 3 months

Features are similar to depression seen in other circumstances

Affects approximately 0.2% of women

Onset usually within the first 2-3 weeks following birth

Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations)
Reassurance and support, the health visitor has a key role As with the baby blues reassurance and support are important

NICE CKS state ‘Most women with the baby blues will not require specific treatment other than reassurance’

Cognitive behavioural therapy may be beneficial. Certain SSRIs such as sertraline and paroxetine* may be used if symptoms are severe** - whilst they are secreted in breast milk it is not thought to be harmful to the infant Admission to hospital is usually required, ideally in a Mother & Baby Unit

There is around a 25-50% risk of recurrence following future pregnancies

*paroxetine is recommended by SIGN because of the low milk/plasma ratio
**fluoxetine is best avoided due to a long half-life

Question 19

A 35-year-old woman comes to see you, her GP, because she feels tearful and low since the birth of her son 1 month ago and she isn’t sleeping well. She says she thinks the baby hates her and feels they aren’t bonding, though she is still breast feeding. She has a good family network, including the baby’s father and has never suffered with depression in the past. She does not feel suicidal and has not been abusing any substances, you do not feel the baby is at risk. What is the most appropriate management?

Refer to social services
Antidepressant therapy
Cognitive behavioural therapy (CBT)
Mindfulness
Prescribe zopiclone

Answer 19

Cognitive behavioural therapy (CBT)

The National Institute for Health and Care Excellence recommends that for women without previous history of severe depression, the first line treatment for moderate to severe depression in pregnancy or the post-natal period should be a high intensity psychological intervention (such as CBT).

If this is refused, or symptoms do not improve, then an antidepressant should be used. NICE suggests a selective serotonin re-uptake inhibitor (SSRI) or tricyclic antidepressant (TCA). Mindfulness may be useful for women with persistent subclinical depressive symptoms. You would only need to involve social services if you felt that someone in the household may be at risk. According to the British National Formulary (BNF) zopiclone should be avoided whilst breast feeding as it is present in breast milk.

Question 20

A woman who gave birth 6 weeks ago presents to her local GP surgery with her husband. She describes ‘crying all the time’ and ‘not bonding’ with her baby. Which one of the following screening tools is it most appropriate to detect postnatal depression?

Hamilton Depression Rating Scale
Patient Health Questionnaire-2
Beck Depression Inventory
Patient Health Questionnaire-9
Edinburgh Scale

Answer 20

The Edinburgh Scale is a screening tool for postnatal depression

The most appropriate screening tool to detect postnatal depression in this case is the Edinburgh Scale. The Edinburgh Postnatal Depression Scale (EPDS) is specifically designed to assess postnatal depression in women who have recently given birth. It is a 10-item self-report questionnaire that has been validated for use in the postpartum period and is widely used in primary care settings. The EPDS can help identify women at risk of developing postnatal depression, allowing for early intervention and support.

The Hamilton Depression Rating Scale is a clinician-rated scale that measures the severity of depressive symptoms. Although it can be used to assess depression in various populations, it is not specific to the postpartum period and may not accurately capture the unique aspects of postnatal depression.

The Patient Health Questionnaire-2 (PHQ-2) is a brief screening tool that consists of only two questions, focusing on depressed mood and anhedonia. While it can be useful as an initial assessment for depression, it lacks specificity for postnatal depression and does not provide a comprehensive evaluation of symptoms.

The Beck Depression Inventory (BDI) is another self-report questionnaire that evaluates depressive symptoms across various domains. However, like the Hamilton Depression Rating Scale, it is not tailored specifically to assess postnatal depression and may not be as sensitive or accurate as the EPDS in detecting this condition.

Lastly, the Patient Health Questionnaire-9 (PHQ-9) is a widely used self-report measure for assessing depressive symptoms but, again, it lacks specificity for postnatal depression. Although it can be helpful in identifying general depressive symptoms, it might not capture all relevant aspects of postnatal depression experienced by new mothers.