Postpartum Depression- EXAM 1

Question 1

How many women suffer from ppd

Answer 1

1 in 7, 13%
approximately 1/2 are undiagnosed and untreated

Question 2

What are the risks for mother who refuse treatment

Answer 2

Poor maternal infant bonding: no response to infant cues and may neglect self or infant
Slowed infant development: decreased cognitive skills and language and risk for long term child behavioral problem
Risk for suicide/infantcide: may think baby is better off in heaven with mom then this “cruel” world

Question 3

PPD risk factors

Answer 3

Biological: depression or anxiety in pregnancy
family history
Young age at delivery
Hormonal: sensitivity to hormonal changes, sleep deprivation, receiving birth control within 48 hours of delivery
Psychosocial: lack of support, partner violence, unhappiness, dramatic life ev ents, being a new parent stress, disatisfaction with self

Question 4

Prevention stratagies: Antepartum

Answer 4

identify at risk group
Brochures about depression and treatments
Provide mentors to at risk mothers

Question 5

Prevention stratagies: secondary prevention

Answer 5

screenings
Educating women with history of ppd for lower risk of reoccurrence

Question 6

Prevention stratagies: Future

Answer 6

Perform more research on recommendation for medication

Question 7

Baby blues diagnosis

Answer 7

normal experience
Affects 50%-85% of mothers
Symptoms last up to 2 weeks postpartum; resolves spontaneously
S:mood swings, anxiety, sadness, crying, feeling overwhelmed, reduced concentration, appetite problems, trouble sleeping
NOT suicidal
Reassurance and education can treat

Question 8

PPD diagnosis

Answer 8

Normal, can happen but needs to be treated
Affects 13% of mother
Symptoms can begin immediately and up to a year postpartum
S: early recognition or fatigue, depressed mood, severe mood swings, excessive crying, intense irritability and anger, severe anxiety, difficulty bonding with baby, insomnia or sleeping too much, decreased interest in activities once enjoyed, feeling of guilt or inadequacy, thought of harming self, no appetite
Symptoms if untreated can last months or longer
Treatment: can be treated as outpatient, lower with psychotropic meds, ECT

Question 9

PPP diagnosis

Answer 9

Rare disorder; EMERGENCY
Affects 0.1% to 0.2% of mothers
RF: 1st delivery, prior history or depression or bipolar
Symptoms begin within the first 3 months of postpartum
S:depressed mood, confusion, disorientation, obsessive thoughts about baby, hallucinations, delusion, sleep disturbances, paranoia, attempts to harm self or baby
S&S are more severe snd require immediate treatment
Treatment: often psychiatric hospitalization, lithium anti psychosis or ECT in combo with psychotherapy, removal or infant and social support

Question 10

EPDS

Answer 10

screen for depressive symptoms
10 question scale
ranges from 0 to 30

Question 11

Antidepressants: SSRI
Not recommended for pregnancy and lactation

Answer 11

Sertraline or Paroxetine
Preg: Paroxetine not recommended during pregnancy bc it increases risk of persistent pulmonary hypertension when taken after 20 weeks gestation
Lac: Citalopram & Fluoxetine, present in high levels
Fluxotine- risk of crossing into breast and increasing crying and decreasing sleep, GI distress and irritability

Question 12

cyclics
Not recommended for pregnancy and lactation

Answer 12

Present in breast mill at low levels
Preg: clomipramie, linked to cardiovascular defects
Lac: not reported, push to use nortiptyline and desipramine

Question 13

SNRI
Not recommended for pregnancy and lactation`

Answer 13

Venlafaxine, passes into breast milk in low levels
Preg: has elevated associations with multiple defects
Lac: none reported, push to use

Question 14

What SSRI resulted in highest risk of specific birth defects

Answer 14

Paroxetine and fluoxetine

Question 15

What drug was associated with increased risk of diaphragmatic hernia

Answer 15

Bupropion