Post partum depression and ppt

Question 1

outcome!!
risk factors of PPD
maria called them predictors. the ones with !!! were highlighted in class. I removed ones with overlap

Answer 1

• Risk factos:

• hx of depression,
• troubled childhood,
• low self-esteem,
• stress in home or at work,
• lack of effective support,
• differing expectations bet partners,
• or disappointment in kid (eg boy instead of girl-if baby is cog challenged)

Hx of substance abuse
Unstable relationships, lack of partner!!!!!!!!!!!!!!!!!!
Traumatic experience of birth
Perfectionist or obsessive/compulsive personality traits!!!!!!!!!!!!!
Breastfeeding challenge!!!!!!!!!!!!!!!!!!

Question 2

is it normal to feel a little sad after birth?

Answer 2

• Most women have some immed feelings of sadness aka postpartal blues after childbirth (1-10 days postpartum)

Question 3

outcome!!

why might a woman naturally feel a little sad?

Answer 3

• Most likely this is d/t hormonal shifts (dec estrogen, progesterone, and gonatotropin-releasing hormone and the anticlimactic feeling after birth.

Question 4

what % of women feel sad beyond the 1-10 days of postpartal blues

is this figure accurate? why?

Answer 4

up to 10%- 20% of women, esp those disappointed w baby or w poor support the postpartal blues can ontinu beyond the immed postpartal period (up to 1yr) or reflect a more serious problem. They become postpartum depression (PPD)

this condition is underreported because mnay feel that they “should” be happy during this time. It may be as high as 50%

Question 5

outcome!!

how can PPD affect the family

Answer 5

• Can interfere w breastfeeding, child care, and returning to a career
• Depression and inability to bond is postpartal complication with far reaching implications, can affect future health of whole family
-also dec ST memory

Question 6

outcome!!

what are s/s of PPD

Answer 6

• Women and men may notice
extreme fatigue,
inability to stop crying,
in anxiety about their health or their infants,
insecurity (unwilling to make decisions or be left alone), psychosomatic symptoms (N, V, diarrhea),
and either depressive or extreme mood flucturations

Question 7

who else can get PPD

Answer 7

fathers

• When using the Edinburgh PPD scale they found 5.2% of fathers with PPD

Question 8

is it easy to predict PPD?
What can be used to help with this?

what is important about dx ppd?

Answer 8

• Difficult to predit who will dev PPD as childbirth elicits diff reactions
• Depression scales are avail but conscientious observation and discussion can reveal symptoms as well

imp to catch it early!

Question 9

what might be nec if pt has PPD

Answer 9

• Woman may need counselling and antidepressant therapy

Question 10

how to prevent PPD

Answer 10

• Balanced program of nutrition, exercise, sleep
• Easy to prpe meals, sleep when baby sleeping, walk daily w baby
• Share feelings w support person
• Take time ea day to do something for yourself
• Don’t try to be perfect and let unimportant things go for another day
• Don’t let yourself be isolated by baby care. Keep in touch w friends

Question 11

which is more common ppd vs postpartal blues

s/s of PPD vs ppb

nursing role and therapy for woman with PPD

Answer 11

incidence PBb=70% PPD=10-20%

s/s PB=Sadness and tears
s/s PPD=Anxiety, feeling of loss, sadness

PPD=Counselling and drug therapy

PPD=Refer to counseling (id also say education)

Question 12

t or f both PB and PPD have hormonal changes and stress as part of cause

Answer 12

t

Question 13

when can perinatal mood disorders occur

Answer 13

can occur during preg as well, mostly postpartum

Question 14

As I said earlier the outcomes relate more to PPD than PPP but her slides covered it and she taught it so i guess we have to know

what is postpartal psychosis.

why does it occur

Answer 14

psychosis in postpartal period

-it isnt a response to the physical act of childbearing but to the crisis of childbearing…many women (1/500) have mental illness, most PPP had preceding mental illness. They pregancny can set off their mental illness or some other stressful event like death in family

Question 15

how might pp psychosis woman appear

Answer 15

she is exceptionally sad
she might be delusional, hallucinating eg the baby is talking to me, denying she was pregnant when baby is brought to her

she has delusions/hallucinations of harming self or babe

Question 16

is it beneficial to orient woman to reality

Answer 16

not really, this might be threatening and her sensorium might be too disturbed to understand what youre talking aout

Question 17

what interventions/nursing care must be prioritized for woman w pp psychosis

Answer 17

-refer to psychiatric counseling
-may need antipsychotic meds
-dont leave woman alone (risk of self harm) HIGH RISK OF SUICIDE
-dont leave woman alone with baby (risk of infanticide!!!)
Maria says sleep is priority as lack of sleep sets off mental illness. This is esp true if woman is bipolar as their sleep patterns are off to begin with

Question 18

pp psychosis incidence

Answer 18

1-2%

Question 19

possible etiology of pp psychosis

women with hx of what should be carefully screened for psychosis

Answer 19

-possible hormonal changes
-fam hx of bipolar disorder
Always check for psychotic symptoms in women with history of unipolar or bi-polar illness
50% of women who live with bi-polar illness are susceptible for a manic episode following delivery if bi-polar illness is not well-controlled before delivery

Question 20

what is a surprising way that the woman might present with psychosis

Answer 20

she might be highly highly functional. eg you enter the room and everything is hyperorganized, she has full face of makeup, is being controlling

Question 21

outcome!!

long term effects of PPD or PPP

Answer 21

Biological
Delayed cognitive and language development

Psychological
Insecure attachment and emotional impairment

Behavioral issues

Effects on child-if untreated they have delayed language and cog dev, may never attach to mom which can impair attachment to others too
Well mother=well baby

Disinterest in baby
Anxiety about feeding, baby care
Tears (?baby blues)
Difficulty with coping, difficulty with decision making
Early signs of psychosis, mania

Question 22

outcome!!

precipitating factors of perinatal mood disorder

Answer 22

Hormones
Sleep deprivation
Euphoria of birth experience can trigger manic episode in the context of bi-polar illness
50% of women who live with bi-polar illness are susceptible for a manic episode following delivery if bi-polar illness is not well-controlled before delivery

this occurs in vaginal birth d/t release of hormones/endorphins. doesnt really occur w epidural

Question 23

outcome!!

s/s of perinatal mood disorder

Answer 23

Feeling unhappy
Crying for long periods of time following the regular “baby blues” period
Social withdrawal
Anger at partner
Anger at infant
Thoughts of wanting to harm infant
Thoughts of wanting to harm self
Inability to sleep, wanting to sleep all the time

Question 24

outcome!

what assessment findings might occur with bipolar mania or hypomania

Answer 24

Heightened mood-euphoria, irritability, lability
Gregariousness, intrusiveness, increased telephone time, careless spending, increased goal directed activities
Decreased need for sleep
Decreased need for food
Increased energy
Hypersexuality

Question 25

what is a helpful acronym that can be applied to guide care in all mood disorders

Answer 25

N-utrition

U-nderstanding

R-est (Sleep hygiene)

S-pirituality

E-xercise

Question 26

t or f it is too dangerous to use meds during pregnancy and lactation if woman has mental health troubles?

Answer 26

No treatment is NOT an option!
Exposure to illness or exposure to medications?
Not everyone requires medications, but medical assessment is paramount

Always a difficult conversation since women worry about the effects of medications on unborn child, or implications of lactation
Medications may prevent depressive or manic episodes which can have dire consequences for women and their infants

Question 27

meds for unipolar depression

Answer 27

Unipolar depression: SSRI’s and Benzodiazepines can be used in pregnancy and lactation

Question 28

meds for bipolar

Answer 28

Bipolar illness: Mood stabilizers (eg: Lithium)

Question 29

meds for postpartum psychosis

Answer 29

post-partum psychosis: Anti-psychotics AKA neuroleptics (eg: haloperidol, loxapine, seroquel, olanzapine)

Question 30

breastfeeding and meds?

Answer 30

Some women will choose not to breastfeed because of concerns with medications