Week 3: Postnatal depression and peurperal psychosis Flashcards
What is baby blues?
Recognised since 1850’s Occurs during early postnatal period Incidence - Estimates range from 30-80% (Handley et al, 1980) Onset usually within 10 days of birth Culminates between days 3-5 Usually only lasts a few days Some studies have linked blues with later postnatal depression and psychosis
What is baby blues characterised by?
Mood swings
Anxiety
Irritability
Tearfulness
What are the suggested causes of baby blues?
Hormonal mechanism –Inability of body to adjust to rapid fall in oestrogen & progesterone within first 24hrs of delivery –Thyroid hormone levels can also fall following delivery resulting in depression, tiredness, sleeping difficulties, weight gain, poor concentration) Elevated morning cortisol on day of symptoms Central tryptophan unavailability –Serotonin synthesis in brain dependent on availability of trytophan (essential dietary amino acid)–also increased cyclic adenosine monophosphate and cortisol
What are predisposing factors of baby blues?
Previous menstrual cycle dysfunction- heightened hormonal response or stress Racial/ethnic factors Unplanned pregnancy Non acceptance of motherhood role Ways of coping with major life events Low social support networks Marital or relationship problems Anxiety Sleep disturbance in the perinatal period
What is the role of the midwife in relation to baby blues?
Warn all women of likelihood of suffering from baby blues Monitor severity On going monitoring of further symptoms Support for partners Referral to health visitors Referral to multidisciplinary team Support
What are the small, low, moderate and strong risk factors for developing perinatal depression?
Strong to moderate: Depression or anxiety during pregnancy Past history of mental disorder Life events Lack of (or perceived lack of) social support Moderate: Neuroticism (one of the Big Five higher-order personality traits in the study of psychology. Individuals who score high on neuroticism are more likely to have low moods) Difficult marital relationship during pregnancy Low: Obstetric factors Socioeconomic status Small: Parity or number of children Educational level Length of relationship with partner Gender of the child (in Western societies)
What are possible long term consequences of perinatal depression?
Infant and childhood cognitive, emotional and behavioural problems Depression in adolescents Poor infant growth Increased risk of sudden infant death syndrome
Possible screening questions?
Q1. During the past month, have you often been bothered by feeling down, depressed or hopeless? Q2. During the past month, have you often been bothered by having little or no interest or pleasure in doing things? Q3. During the past month, have you been feeling nervous, anxious or on edge? Q4. During the past month, have you not been able to stop or control worrying?
Screening instruments?
Screening Instruments (see NICE 2014: 1.5.3) Edinburgh Postnatal Depression Scale (EPDS) Postpartum Depression Screening Scale (PDSS) Bromley Postnatal Depression Scale (BPDS)
On assessment what norms of the postnatal period is it important to take into account?
Sleep Appetite Activity levels Libido Suicidal ideation Presence of psychotic symptoms
How can we reduce stigma?
Advise all women at the beginning of any meeting, particularly a booking or first appointment, that you ask all women all the same questions. Do not use euphemisms, outdated or pejorative terms to describe mental health problems: ‘trouble with your nerves’, ‘high maintenance’, ‘nervy’, ‘crazy’ etc.
How can we encourage honesty, reducing anxiety?
Ask women how they would like you to document the information they have given you. •Explain what information you need to share with other members of the team, who and why. •Reassure women that if you felt that you needed to share any information they gave you with other teams, such as social work or mental health, that you would discuss this with them firs
Identifying Needs: OARS
Open questions: –encourages woman to tell you more •How does that affect you? •What are the signs for you that you are becoming unwell? Affirmation:–Ensure that the woman feels you have acknowledged and understand her situation •That must be very difficult •You have been through a tough time Reflection:–Ensure the woman feels you have understood what she has said and allow her to correct your understanding if required •You feel very low at the moment •You’ve been worrying about…. Summarise: •You have been feeling increasingly anxious and could do with some additional help? •You feel you are doing well at the moment and don’t need further help at the moment
What psychological interventions can be used in management?
Psychological Interventions: –HV based non-directive counselling sessions for mild to moderate depression –HV trained in Cognitive Behavioural Counselling intervention –Interpersonal therapy –Group treatment (includes education, support and CBT
What psychological therapies are there?
Psychological therapies such as cognitive behavioural therapy (CBT) or Interpersonal Therapy (IPT) are the first choice of treatment for antenatal depression and anxiety
A study by Field et al (2013) found that for those women who did yoga and had social support, there was a reduction in cortisol levels, ultimately having a positive effect on anxiety and depression
What is the Stepped Care Model?
- Overarching model of primary care for individuals with mental health issues (NICE, 2011)
- Recommends the relevant intensity of treatment for the level of distress and impact on functioning women
- Treatment should be monitored systematically and can be changed if proved ineffective
