Problems Following Childbirth Flashcards
What are three main mental health disorders that occur after childbirth?
Baby blues
Postnatal depression
Puerperal psychosis
Define baby blues
A distressing but normal disorder that occurs a few days after birth (50-70% of mothers)
Give some symptoms of baby blues
Weepy
Irritable
Labile mood
Sleep disturbance
What is the management for baby blues?
Explanation and reassurance is all that is required
Define postnatal depression (ICD-10/DSM-5)
Same definition for depressive disorder, but commencing from 6 weeks post partum (can last up to 1 year)
Depressive episode (ICD-10):
The patient has a lowering of mood, reduction of energy,
and decrease in activity
DSM-5: onset starts in pregnancy or up to 4 weeks post partum
Give some bio-psycho-social risk factors for PND
Biological
- Personal/family history of PND or depression
- Younger maternal age
- Birth complication
Psychological
- Sleep deprivation
- Violence by partner during pregnancy
Social
- Recent life events (especially stressful)
- Marital discord
- Poor social support (partner, family, friends etc.)
Give some presenting symptoms of PND
Typical depressive symptoms, focus on cognitive symptoms:
- Low mood
- Low energy (anergia)
- Anhedonia
- Loss of confidence/self-esteem
- Guilt (e.g not feeling like a good enough mother)
- Suicidal ideation
- Self-harm, neglect, mistreatment of child (uncommon)
Physical symptoms (can also be natural post partum)
- Irritability
- Anxiety
- Insomnia
- Lack of appetite
Give some investigations for PND
RISK ASSESSMENT
- Edinburgh postnatal depression scale (Score>12)
- Mood Disorder questionnaire
- TFTs
- FBC
- Urine drug screen
- Brain CT or MRI
Outline a management plan for PND
As for depression usually
Mild-moderate
- Self guided help
- CBT
Moderate/severe
- Referral to specialist perinatal mental health service
- CBT
- Antidepressants (TCAs/SSRI/SNRI). Primary = sertraline, 2nd line = paroxetine
Be wary of breastfeeding, low dose TCAs are most safe, sertraline is also safe, avoid lithium
- If psychological therapy needed: refer to community mental health team –> followed up ideally 1 month later, and then no longer than 3 months afterward
Social:
- Encourage social engagement (family, friends)
- Support groups: e.g PANDAS
Where may be the mother/baby be admitted and when would this be used for PND?
- MBU: mother and baby unit
- If severe, suicidal, infanticidal ideation
Allows treatment without separation of mother and child (want to avoid separation wherever possible)
Which community team might you consider getting involved, especially if mother is currently pregnant and has a high risk of PND?
Enhanced health visitor service:
- Regular check ups from health visitor
- Will continue up to 2yrs postnatally
- Provides support for baby care
- Will get involved earlier (during pregnancy)
During a consultation, what points are important to mention/explain to a mother with PND?
Diagnosis, concerns, treatment (psych and biological), prognosis, referrals/admissions
- Explain diagnosis (occurs in 1 in 10, likely due to hormonal changes)
- Address any concerns and reassure (e.g feeling like a bad mother)
- Explain psychological treatment (CBT)
- Explain pharmacological treatment and breastfeeding (e.g sertraline is safe during breastfeeding)
- Explain prognosis (most will recover within a month)
- Explain follow up: postnatal community mental health team
Define puerperal psychosis
Psychosis that occurs usually within 2 weeks after birth
Give some risk factors for puerperal psychosis
- Personal/family history of PP or BPAD
- Puerperal infection
- Obstetric complications
Outline the presenting symptoms and pattern of onset during puerperal psychosis
Rapid onset, beginning with:
- Insomnia
- Restlessness
- Perplexity
Later, psychotic symptoms emerge: - Delirium - Affective (psychotic depression or mania) - Schizophreniform (like schizophrenia) Mainly hallucinations and/or delusions
Symptoms can fluctuate, so there may be temporary symptom free periods
