SDR 23-24 Psychiatry of the mother Flashcards
What is the stage 1 task?
Acceptance
What are the characteristics of Psychological Stage 1 of Pregnancy?
Lasts from first learning of pregnancy to the first ultrasound (performed at 6-8 weeks). Characterized by memory impairments, ambivalence, fear of miscarriage.
What are the characteristics of Psychological Stage 2 of Pregnancy?
Lasts from the first ultrasound to the point of viability. Involves sharing the news and realization that life exists within. It is a time of relative peace and fulfillment.
What is the stage 2 task?
Recognition of fetus as separate from self
What are the characteristics of Psychological Stage 3 of Pregnancy?
Lasts from point of viability (week 24-26) to birth. It is characterized by nesting behavior and fear about the birth process & baby’s health.
What is the stage 3 task?
Attachment
What are the four general situations that a patient might be referred to mental health services?
- New psychiatric illness while pregnant (e.g. onset of panic attacks), 2. discovery of pregnancy while taking psychotropic meds (e.g. depressed women that are taking Zoloft to manage it), 3. history of psychiatric illness with plans to become pregnant - this is the ideal scenario (e.g. women with bipolar disorder that has been on lifelong meds would visit to weigh the risks and benefits of staying medication versus untreated bipolar disorder) 4. history of psychiatric illness (e.g. a woman who has had three episodes of depression that all occured around major events)
When do psychiatric disorders most often arise?
Between ages of 18-45, which roughly corresponds to the reproductive years.
What poor birth outcomes have been linked to psychiatric disorders in pregnancy?
Pre-eclampsia, low birth weight, preterm labor, fetal distress
What percent of women exhibit clinically significant symptoms of depression during pregnancy? Major depressive disorders?
20% exhibit clinically significant symptoms; 10-15% experience major depressive disorder.
Why is it difficult to diagnose depression during pregnancy?
Many symptoms of depression can be considered normal effects of pregnancy, e.g. insomnia, low energy, lack of concentration, appetite changes, moodiness
What is the biggest risk factor for depression during pregnancy?
A prior history of depression
What is the strongest risk factor for postpartum depression?
Antenatal depression (3x risk)
What are risk factors for depression during pregnancy?
A prior history of depression, young age, marital conflict, low spousal/social support, more previous children, termination of previous pregnancy, early parental bereavement, excessive ambivalence about pregnancy
What behavior during pregnancy is characteristic of untreated depression?
Poor self-care, substance abuse, suicide, non-compliance with prenatal care
What might be the long-term outcomes for child from untreated depression?
Elevated cortisol levels, poor adaption to stress, increased risk for anxiety/depression/behavioral disorders increased risk for medical problems
Bipolar diorder
Mood disorder in which the person experiences depression, followed by mania, hypomania, and/or mixed states. Left untreated, it is severely disabling.
Though to be based on biological conditions in the brain which may cause the chemical imbalance in serotonin and norepinephrine levels.
What percent of women with a history of bipolar disorder have postpartum relapse?
70% - very high risk of relapse
True of false: modest levels of anxiety are common during pregnancy
True. High levels of anxiety during pregnancy, however, are a strong predictor of high levels of anxiety after delivery.
What physiological changes that are normal during pregnancy may contribute to increased anxiety/panic?
During pregnancy, heart rate, blood volume, ventilation rate, GFR all increase.
What might occur in women with eating disorders during pregnancy/delivery?
Fetal complicaitons, C-section, postpartum depression
What percent of women have a depressive relapse after discontinuing medications during pregnancy? With continued medication use?
68% after discontinuing medication; 28% relapsed with continued medication use - may be due to underdosing, as drugs are metabolized more rapidly during pregnancy.
True of false: physicians often use antidepressants, some benzodiazepines, and sleep aids in pregnancy
True
What is the Gerber Myth?
The unrealistic and idealistic image of motherhood that may contribute to a mother’s disappointment
What is the biggest predictor of PPD?
Major depressive disorder (MDD)
True or false: no women with PPD experiences initial stages of motherhood as she had fantasized
True
What factors contribute to PPD?
Unrealistic expectations, hormonal changes, sleep deprivation, single biggest identity transition for women, possible difficulties in pregnancy or birth, possible predisposition for depression (MDD)
What are the postpartum blues
Common, benign transitory mild symptoms occurring in the first 10 days. More pronounced than normal daily mood fluctuations. Most recover within two weeks. No pharmacologic or psychosocial interventions needed unless it continues past two weeks or escalates to a more severe level.
What are symptoms of postpartum blues?
Weeping, emotional lability, sad mood, irritability, lack of affection, hostility towards husband, feelings of unreality.
True or False: baby blues are a psychological disorder.
False - Baby blues are NOT a psychological disorder; it is completely separate from PPD. May begin day 3 or 4 (when baby first comes home) and peaks around day 4 or 5 (when mother is alone with baby at home)
When does PPD usually begin?
1-6 months after delivery.
What may bring on diagnosis of PPD?
There is no DSM criteria for PPD - a woman may be diagnosed with PPD after a major depressive episode within 4 weeks postpartum
What is prevalence of PPD?
12-14% or 1/9 women
What are symptoms of PPD?
tearfulness, despondency, emotional lability, excessive guilt, excessive worry about the baby’s well-being & sees self as bad/inadequate mother, poor concentration & memory, ego dystonic thoughts
What are ego dystonic thoughts?
Distress associated with the thought of harming the baby, occurs in the context of loving the child and keeping him/her safe. The mother is very anxious that she may lose control over herself and do something she does not want to do. This is an extreme form of anxiety. Ex: drowning the baby while giving him/her a bath
What are the risk factors for PPD?
history of mood disturbances/depression; low family income/occupational status; poor marital relationship/social support; co-existence of excessive life stress
What are treatment options for PPD?
SSRIs and psychosocial interventions.
True or false: breastfeeding is safe while on SSRIs
True
What is the prevalence of postpartum psychosis?
2/1000 new moms
What is the highest period of risk for PPP?
First month. Note: new moms are usually asymptomatic for the first 2-3 days postpartum, and since follow up appointment is usually 6 weeks after birth, many women suffering from PPP are left untreated.
What is the most common presentation of PPP?
Affective disorder
What is the hallmark red flag of PPP?
Sleeplessness
What are the symptoms of PPP?
sleeplessness, impairment in reality testing, delusions, hallucinations, tearfulness, psychomotor retardation, excessive guilt/worthlessness, appetite disturbances,
What is major difference between PPD mom and PPP mom?
In contrast to the PPD mother, thoughts of hurting the baby do NOT create distress for the PPP mother
What is the risk of a woman with bipolar disorder developing PPP?
50%. Note - first degree relative with bipolar disorder also increases the risk
What percent of women with schizophrenia develop PPP?
24%
How do you treat PPP?
PPP is a psychiatric emergency. The patient MUST be admitted. Pharmacological treatment comes first: antidepressants, mood stabilizers, and antipsychotic agents. Psychosocial interventions once psychotic symptoms remit. 95% of adequately treated women improve within 2-3 months
What are non-pharmacological treatment interventions?
Involve ways to manage anxiety. Elimination of caffeine, nicotine and alcohol to allow new mom to get adequate sleep. Support groups, light therapy, or marital therapy to reduce stress. Myth debunking in therapy.
What is IPT?
Interpersonal Psychotherapy - short term and supportive, focusing on interactions between people and development of psychiatric symptoms. Process of recovery from PPD involves healing from unrealized fantasies and developing a strong support network and close bond with the baby.
What is cognitive behavioral therapy?
Short term, structured treatment that involves collaborative relationships. Uses a series of interventions that focus on educating patients on the importance of self-care. Negative thoughts are viewed as “hypotheses” that can be questioned and then proved inaccurate. These hypotheses are replaced with more balanced thoughts.
What is engrossment?
New father’s total absorption with the presence of the newborn in his life. It is the transformation of a man’s identity into a father. Validation of masculinity.
