Problems following Childbirth Flashcards
What is the presumed pathophysiology behind puerperal psychiatric disorders?
After pregnancy there are sudden dramatic changes in hormone levels, which disturb the neurobiochemical pathways in the brain.
Additionally, endoctinde disturbances such as hypopituitarism or puerperal hypothyroidism are common, which also affect mental health.
What is the epidemiology of baby blues?
Affect 50-75% of mothers
What is the course of baby blues?
They affect 50-75% of mothers a few days after the birth and last only days (up to 10).
What are the symptoms of baby blues?
They feel:
- weepy, irritable, and muddled
- their mood seems ‘all over the place’ (labile)
- They may have trouble sleeping (but not early morning wakening)
What symptoms are not part of normal baby blues and warrant further assessment?
- Panic attacks
- Episodes of low mood >2 weeks
- Low self-esteem
- Guilt or hopelessness
- Thoughts of slef-harm/suicide
- Any mood disturbances affecting normal social functioning
- Any biological symptoms (appetite, early wakening)
- Change in affect
How is baby blues managed?
Explanation and reassurance are usually all that are required, although occasionally severe baby blues progress to postnatal depression.
What is the epidemiology of postnatal depression?
Postnatal depression is depression in women during the first year after birth of a child. It is surprisingly common, affecting 10% of mothers.
Women with previous Hx of depression are at even higher risk (20-30%).
What is the risk of recurrence in a subsequent pregnancy for postpartum depression and postpartum psychosis?
For both disorders, the risk of recurrence is 50%.
What is the natural progression of postpartum depression?
It usually start later in the post-natal period, at around 6 weeks. Women should be asked at the 6-week baby check and again at 3-4 months about their mood.
Without treatment, most women will recover within 3-6 months; however, 1 in 10 will remain depressed at 1 year.
What are the risk-factors for postpartum depression?
Risk factors include:
- Previous history of depression
- Previous history of postnatal depression
- Depression durgin pregnancy
- Younger maternal age
- Marital discord
- Poor social support
- Recent adverse life events
What are the specific clinical features of postpartum depression?
In contrast to baby blues and puerperal psychosis, postpartum depression usually presents later, commonly around 6 weeks - so the 6-week postnatal check is an ideal opportunity to detect early postnatal depression.
Clinical features are very similar to Depression, however depressive cognitions are commonly related to the baby. There may be guilt or feeling a failure as a mother.
Recurrent intrusive thoughts about harming the baby can be distressing.
What is the management of postpartum depression?
- Risk assessment as always is important; hospital admission should be considered in severe depression with suicidal or infanticidal ideation. A mother and baby unit (MBU) is optimal under these circumstances, since it allows treatment without separation of mother and child. This enables bonding, staff support with childcare, and risk management.
- Assess safeguarding concerns for other children at home or vulnerable adults in the care of someone with depression.
- Lifestyle advice for all, including local postnatal groups.
For a woman with mild-moderate depressivesymptoms: refer to guided self-help, based on the principles of CBT.
For a woman with moderate-severe depression, or a history of severe depression: refer to community mental health team (CMHT) for high-intensity psychotherapy and consider antidepressant therapy (or in combination). Only offer antidepressant therapy if she has expressed interest, failed to improve on psychotherapy or refused psychotherapy.
TCAs, SSRIs and SNRIs are generally considered safe while breastfeeding, howeverthe baby needs to be monitored for adverse effects.Also support women who do not want to breastfeed.
What is the epidemiology of puerperal psychosis?
Psychosis follows 1 in 500-1000 births and usually occurs in the first fortnight, but peaks during the 5th day.
Describe the clinical picture of puerperal psychosis
Symptoms usually start within the first 2 weeks after giving birth. Onset is rapid, often beginning with insomnia, restlessness and perplexity. Later, psychotic symptoms emerge, settling into one of three patterns:
- Delirium
- Affective (psychotic depression or mania)
- Schizophreniform
Patients can experience delusions, hallucinations, self-neglect, thoughts of self-harm and loss of insight.
Symptoms can fluctuate dramatically and quickly - don’t be misled by temporary symptom-free periods.
Who is at highest risk of puerperal psychosis?
Those at highest risk are those with a personal or family history of puerperal psychosis or BPAD and non-postpartum depressive illnesses. Other risk factors include puerperal infection and obstetric complications and a family history.
