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Flashcards in postpartum mood disorders Deck (24):
1

Lifetime of postpartum mood disorders for women?

- 20-25%

2

Diff post partum mood disorders?

- postpartum blues
- depression
- psychosis (most serious)
- anxiety disorder

3

How common is the postpartum blues? Time course?

- 50-85% new mothers: most common in 1st pregnancy
- time course:
begins w/in 48 hrs delivery
peaks: 3-5 days
lasts around 2 weeks
- etiology unknown, just having to cope with a new child is a stressor
- one of the reasons why women experience the blues and depression is b/c estrogen, progesterone, and cortisol plummet about 48 hrs after birth

4

RFs of postpartum blues?

- hx of depression
- depressive sxs during pregnancy
- family hx of depression
- premenstrual or OCP assoc mood changes
- stress around child care
- psychosocial impairment in areas of work, relationships, and leisure activities

5

Sxs of postpartum blues?

- mood lability
- tearfulness
- sadness or elation that is out of proportion
- anxiety
- irritability
- insomnia
- decreased concentration

6

Tx of postpartum blues?

- supportive with reassurance to the woman and her family
- allowing the woman to have enough rest
- perhaps getting someone to take care of the infant at night
- generally resolves on its own
- careful monitoring for the development of postpartum depression

7

How common is postpartum psychosis? Why is this so dangerous?

- 1-2/1000 postpartum women
- usual onset w/in 2 weeks of delivery
- women are more likely to experience psychosis following childbirth then at any other time in their lives
- women with PPP are more likely to commit suicide or infanticide - MEDICAL EMEREGENCY

8

Pathogenesis of PPP?

- complete etiology isn't known
- research suggests hormonal and genetic factors
- rapid hormonal changes following childbirth may play a role as a trigger
- currently thought of as a manifestation of bipolar

9

RFs for PPP?

- 1st pregnancy
- hx of bipolar
- hx of puerperal psychosis
- family hx of puerperal psychosis
- recent d/c of lithium or other mood stabilizers

10

Sxs of PPP?

- delusions
- hallucinations (visual, auditory, or olfactory)
- thought disorganization
- severe insomnia
- suicidal ideation
- homicidial ideation
- aggression
- agitation
- impulsivity

11

Tx of PPP?

- usually acute hospitalization
- antipsychotics
- therapy
- electoconvulsive therapy if pharm unsuccesful
- TRUE medical EMERGENCY!

12

What are the diff postpartum anxiety disorders?

- OCD: obessions and compulsions
- panic disorder
- generalized anxiety disorder
- PTSD

13

How common is PPD? RFs?

- 12-15% women
- 10-26% men
RFs:
- marital conflict
- stressful life events, lack of social support for pregnancy
- lack of emoional and financial support of partner
- living w/o a partner
- unplanned pregnancy, previous miscarriage
- having contemplated terminating the pregnacny
- poor relationship with one's own mother
- high number of visits to prenatal clinic
- congenitally malformed child
- personal hx of bipolar

14

Sxs of PPD?

- irritability and anger
- sig anxiety often wtih panic attacks
- feelings of inadequacy and of being a failure as a mother
- feelings of guilt
- feelings of hopelessness or despair
- feeling of being overwhelmed or unable to care for baby
- not bonding to baby, further exacerbates feelings of shame and guilt
- typical: insomnia, wt changes, decreased libido, decreased energy levels
- often can lead to women suffering in silence

15

PPD screening?

- edinburgh postnatal depression scale (EPDS)
- postpartum depression screening scale
- BECK depression inventory
- screen with general ?s:
how is your mood?
how have you been feeling?

16

What medical causes should you rule out first b/f dx PPD?

- anemia
- diabetes
- thyroid disorders- thru preg -
1-3 mo hyperactive
3-4 mo hypoactive
7-8 mo stabilization
postpartum thyroiditis

17

6 stages of PPD?

- denial
- anger
- bargaining
- depression
- acceptance
- PTSD (worried that PPD will return)

18

Sxs of men's PPD?

- increaed anger and conflict towards others
- increased use of alcohol or other drugs
- frustration or irritability
- violent behavior
- losing wt w/o trying
- isolation from family and friends
- being easily stressed
- impulsiveness and taking risks, like reckless driving or extramarital sex
- feeling discouraged
- increases in complaints about physical probs
- ongoing physical sxs, like HAs, digestive probs or pain
- problems with concentration, and motivation
- loss of interest in work, hobbies and sex
- working constantly
- frustration or irritability
- misuse of Rx meds
- increased concerns about productivity and fxning at school or work
- fatigue
- experiencing conflict b/t how you think you should be as a man and how you actually are
- thoughts of suicide

19

PPD tx?

- psychotherapy:
interpersonal - marital strain, role transitions
- CBT:
changing negative cog. distortions
aids in developing coping behaviors
- group therapy

20

What should be considered when using meds for PPD?

- breastfeeding - weigh risk vs benefit
- drug transfer -
protein binding
lipid solubility
MW of drug
half life
- eval of infant

21

Tx for PPD?

- TCAs: elavil, pamelor, silenor
- SSRIs: zoloft and paxil are preferred (can still breastfeed)
- SNRI: cymbalta
- bupropion - concerning
- benzos: serax, xanax - don't use in preg (x) or lactation
- hypnotics: sonata, ambien, lunesta
* some of these you can't breastfeed while taking

- optional: Electroconvulsive therapy

22

duration, Sxs and tx of postpartum blues?

- 2-3 days, resolves w/in 10 days
- sxs: tearfulness, fatigue, depressed affect, irritability
- tx: reassurance, watchful waiting, 20% will develop PPD w/in 1 yr

23

duration, sxs, and tx of PPD?

- 2 wks to 12 months
- sxs: depressed affect, anxiety, sxs worse at night, poor concentration, decreased libido
- tx: antidepressant meds, psychotherapy

24

duration, sxs, and tx of PPP?

- variable - tpyically days to 4-6 wks postpartum
- sxs: delusions, confusion, sleep disturbances, unusual behavior, emotional lability
- tx: antipsychotic meds, antidepressants, possible inpt hospitalization