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Flashcards in postpartum depression Deck (31):
1

Postpartum Psychiatric Disorders

Depression, anxiety, psychosis

2

Common preggo symptoms

“Morning Sickness” - N/V: ^^ estrogen, progesterone, hCG
◦ Reflux: ^^ gastric emptying time, dec. sphincter tone
◦ Constipation: dec. motility, ^^ water absorption

3

more preggo symptoms

◦ Back pain
◦ Constipation
◦ Edema
◦ GERD
◦ Hemorrhoids
◦ Round Ligament Pain
◦ Urinary Frequency
◦ Varicose Veins
◦ Headaches/migraines
◦ Sinusitis
◦ Neck aches
◦ Joint pain (carpal tunnel
syndrome)
◦ Sciatica
◦ Hip pain/ Low back pain
◦ Pubic pain

4

preggo back pain symptoms

Increased lumbar lordosis
Myofascial strains
Paraspinal muscle strain/muscle spasm Lumbar-sacral junction compression

5

preggos on OMM

OMM can be used throughout pregnancy, labor and postpartum
-Always treat patient in the most comfortable position! Usually supine or side-lying is best
-Use patient’s own body weight to help you and help patient to relax
HVLA is a relative contraindication in pregnancy!

6

pregnancy complications

High numbers of visits to prenatal clinic due to medical issues Congenital malformation in the infant

7

postpartum recovery

Estrogen and progesterone levels drop Prolactin and oxytocin stimulate lactation

8

postpartum recovery: Lochia (Postpartum Bleeding):

AKA postpartum period
Vaginal discharge containing blood, mucus and uterine tissue
Typically continues for *4-6 weeks*

9

more postpartum recovery

constipation
varicosities
hairloss
headaches

10

breastfeeding probs

Not enough milk
◦ Engorgement
◦ Clogged milk ducts
◦ Mastitis

11

baby issues

Medical problems
Poor suck/feeding problems
Reflux/gas
Colicky baby

12

Postpartum Blues

Mild depressive symptoms such as dysphoria (sadness, tearfulness, irritability and anxiety
-Insomnia, Decreased concentration
-Develop in *50-75% of women within 2-3 days* of delivery
-Symptoms usually *peak over the next few days* and *resolve within 2 weeks*

13

Postpartum Depression prevalence

8-15%

14

Major Depressive Disorder w/peripartum onset DSM-5 Diagnosis

This specifier can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs DURING PREGNANCY or in the 4 WEEKS FOLLOWING DELIVERY

15

PPD risk factors

*Past history of depression*
-Hx of physical or sexual abuse
-Young age
-Unplanned pregnancy
-Stressful life events (marital conflicts) during the 12 months prior to delivery
-Lack of social/financial support
-Living without a partner
-Intimate partner violence
-Unemployment for either mother or head of household
-High numbers of visits to prenatal clinic
-Congenital malformation in the infant
-Not breastfeeding
-Childcare stressors such as a colicky baby
-Personality traits (high neuroticism and high introversion)
-Positive family history

16

do hormones play a role in PPD?

-Progesterone and estrogen levels drop precipitously postpartum.
-Cortisol, thyroid and other large hormonal shifts also occur.
-However, hormone levels and changes in levels do not correlate with mood symptoms.
*Women who get peripartum depression are more sensitive to hormone fluctuations*

17

Postpartum anxiety disorders: panic disorder

-Intense fear of harm/harming baby,
-Palpitations, hyperventilation, sweating,etc
-Difficulty caring for, leaving baby

18

Postpartum anxiety disorders: OCD

-Intrusive thoughts/images of grievous harm to baby.
-Mother sometimes imagines herself inflicting harm

19

Perinatal Depression and Anxiety: Treatment and Prophylaxis

Stress reduction
Support groups
Psychotherapy: interpersonal, cognitive behavioral, supportive
Medication: SSRIs

20

Postpartum Psychosis prevalence

Postpartum psychosis (0.1% to 0.2%)

IN CONTRAST:
Postpartum blues (50% to 75%)
Postpartum depression (8-15%)

21

Postpartum psychosis

one of the rarest psychiatric disorders
*psychiatric emergency!!*
◦ rapid onset of severe maternal symptoms
◦ potential for a catastrophic outcome, such as infanticide or suicide

22

Postpartum psychosis etiology

◦ Pathogenesis is likely multifactorial
◦ Significant drop in estrogen/progesterone
◦ Estrogen affects the monoaminergic system, particularly serotonin and dopamine.
◦ Hx of bipolar/psychosis
◦ Families with bipolar disorder in which at least one woman had suffered a manic or psychotic episode within 6 weeks postpartum.
◦ Sleep disruption

23

Postpartum psychosis risk factors

-primiparity
-discontinuation of mood stabilizer
-obstetric complications
-perinatal infant mortality
-previos bipolar episodes, psychosis, postpartum psychosis
-fam hx of postpartum psychosis or bipolar disorder
-sleep deprivation
-inc. environmental stress
-lack of partner support

24

postpartum psychosis clinical presentation

◦ acute onset within the *first 2 weeks after delivery in 65% of cases*,
◦ elated, dysphoric, or labile mood,
◦ insomnia, agitation and bizarre behavior
◦ Psychotic symptoms include mood-incongruent delusions with frequent content related to the infant (eg, the infant being harmed), thought broadcasting, ideas of reference, delusions of control, or command hallucinations

25

postpartum psychosis dangers

◦ *4% of women with postpartum psychosis commit infanticide*
◦ *5% commit suicide*
◦ Any mother who presents with a *postpartum mood or psychotic disorder should be asked about thoughts of harming herself or the infant*
◦ The lack of reality testing and disorganized behavior can lead to unsafe and neglecting behaviors even in the absence of clear infanticidal ideation.

26

postpartum psychosis details

-onset: within *2 weeks postpartum* (early as 1 day)
-congnitive: poor concentration, delirium (rule out organic cause)
-behavioral: agitated, hyperactive, emotional distance/coldness
-mood: elated, labile, dysphoric, depressed (less frequent)
-affect: flat/incongruent
-speech: rambling
-sleep: insomnia

27

postpartum psychosis details 2:

-thought content:
`mood-incongruent delusion: thought broadcasting, ideas of reference, infant being harmed/killed, persecutory, jealousy, of being controlled
`mood-congruent delusions of grandiosity
-thought process: disorganized, flight of ideas
-perception: hallucinations: organic (visual, etc) or commanding auditory
-suicide/homicide

28

postpartum psychosis tx

like bipolar!
mood stabilizers
atypical antipsychotics
antidepressants

29

postpartum psychosis tx: mood stabilizers

lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol) and lamotrigine (Lamictal)

30

postpartum psychosis tx: atypical antipsychotics

olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris)

31

postpartum psychosis tx: antidepressants

help manage depression. Usually along with a mood stabilizer or antipsychotic. Antidepressant alone can sometimes trigger a manic episode!