Postnatal depression Flashcards Preview

Obstetrics and Gynaecology > Postnatal depression > Flashcards

Flashcards in Postnatal depression Deck (15):
1

Definition

Depression illness following childbirth (usually within 6 month), can be part of bipolar or unipolar

2

Epidemiology

Prevalence 7-19%

3

Etiology

1. Psychosocial: stressors, finance, violence, low employment
2. Psychiatric illness: antenatal history of depression/anxiety increases risk 3-5 times
3. Personality disorder: high neuroticism, low self esteem
4. Genetic factors
5. Sleep disturbance
6. Complications of pregnancy and birth
7. Young maternal age->mothers

4

Pathophysiology

Not exactly known
May be vulnerable to specific pueperal trigger
No major difference in hormone profile->may have abnormal sensitivity to normal physiological changes during pregnancy

5

Reducing the risk of postnatal depression

Professional home visits by nurses and midwives
Interpersonal psychotherapy
CBT
Edinburgh PNDS at 6 weeks

6

Clinical features

Depressed mood
Anhedonia
Decreased energy or increased fatiguability
Suicidal ideation
Loss of confidence/self esteem
Unreasonable feelings of self reproach or excess guilt
Poor concentration
Sleep, appetite, weight, obsessive thoughts

7

Risk factors

History of depression/anxiety
Recent stressful life events
Discontinuation of psychopharmacological therapies
Sleep deprivation
Genetic susceptibility
Violence

8

Investigations

1. Whooley questions
a. The questions are: "During the past month, have you often been bothered by feeling down, depressed, or hopeless?" and "During the past month, have you often been bothered by having little interest or pleasure in doing things?"
b. If the answer to either of these questions is positive, a third question is recommended: "Is this something with which you would like help?"
c. The 3 questions have a positive predictive value of 32% and a negative predictive value of 99% for major depression.
2. EPNDS

9

How does PND differ from minor mood disturbance/baby blues

1. mother typically presents with mood swings ranging from elation to sadness, insomnia, tearfulness, crying spells, irritability, anxiety, and decreased concentration.
2. Symptoms develop within 2 to 3 days postnatal, peak on the fifth day, and resolve within 2 weeks.

10

Assessing self harm/harm to baby

1. Whether feels life is not worth living
2. Ever thought of harming baby
3. Impaired bonding, lack feeling of attachment, sense of numbness
Does not increase risk of following through
4. Obsessive, intrusive and aggressive thoughts
5. Suicidal thoughts
6. Plan
7. Lethality
8. Means
9. Risk and protective factors
10. Mental state
11. History of suicidal behaviour
12. Family history
13. Substance use
14. Strengths and supports

11

History

1. Symptoms
2. Suicide/homicide risk
3. Mania/hypomania
4. Complete psychiatric history

12

Management

1. Self help, counselling, CBT, interpersonal therapy
2. Antidepressants->sertraline or paroxetine

13

Follow up

1. Reviewed regularly
2. In pharM & breast feeding->adverse effects + in premature/young/ill->monitor infant for ++sedation, irritability, changes in sleep, feeding and growth
3. Develop a trusting relationship->thoughts, concerns, expectations
4. Discuss risk of recurrence

14

Complications

1. Impaired bonding
2. Neglect of the baby or infanticide
3. Suicide
4. Bipolar

15

Prognosis

1. Usually last for 3-6 months
2. Higher risk of recurrence
3. Depends on the the persistence of the adverse circumstances
4. Early-onset depression (within the first 6-8 weeks), severe depression, and depression with bipolar or psychotic symptoms suggest the presence of a specific puerperal trigger,