1. Postpartum depression is a serious condition that can occur after childbirth and is distinct from the common "postpartum blues".
2. Risk factors for postpartum depression include hormonal changes during pregnancy and childbirth, a history of depression, lack of social support, anxiety during pregnancy, and stressful life events.
3. Screening for postpartum depression is recommended at the first postnatal obstetric visit using standardized scales, as the condition often goes undetected. Treatment involves psychotherapy such as interpersonal therapy and cognitive behavioral therapy, as well as antidepressant medication if needed.
This is a ppt presentation that I did for an Abnormal Psychology class. This presentation looks into the life of Brooke Shields--celebrity who suffered from PPD
Postpartum depression is a mood disorder that affects up to 20% of new mothers. It can range from mild postpartum blues to more severe postpartum psychosis. Risk factors include a history of mood disorders, lack of social support, stressful life events, and having a child with special needs. Left untreated, postpartum depression can negatively impact the mother's bonding with her infant and the infant's cognitive, social, and emotional development. Screening tools like the Edinburgh Postnatal Depression Scale can help identify at-risk mothers so they can receive appropriate treatment.
Postpartum blues includes an array of psychiatric manifestations occurring in the period of post-partum, due to hormonal imbalance. Knowing in detail will help for quicker diagnosis and better outcomes.
Prepared in December, 2017.
PPD is similar to clinical depression.it is not only prevalent among women but also in men. sufferers are not alone and they can prevent this by talk, talk and talk.
in Malays, we called it meroyan. PPD can be divided into postpartum depression and postpartum psychosis. Only postpartum psychosis need treatment such as combination of anti-psychotic, anti depression and mood stabilizer
This document discusses postpartum depression, including its incidence, risk factors, symptoms, impact, screening and treatment. Some key points:
- Postpartum depression (PPD), occurring in 6.8-16.5% of women, is a type of major depression that can begin within 4 weeks of delivery and last for several months if untreated.
- Risk factors for PPD include a family or personal history of mood disorders, childcare difficulties, marital issues, lack of social support and stressful life events.
- Untreated PPD can negatively impact infant development and the mother-infant relationship. It also increases the risk of maternal mortality from suicide.
- All postpartum women
Although pregnancy has typically been considered a time of emotional well-being, recent studies suggest that up to 20% of women suffer from mood or anxiety disorders during pregnancy. Particularly vulnerable are those women with histories of psychiatric illness who discontinue psychotropic medications during pregnancy.
This is a ppt presentation that I did for an Abnormal Psychology class. This presentation looks into the life of Brooke Shields--celebrity who suffered from PPD
Postpartum depression is a mood disorder that affects up to 20% of new mothers. It can range from mild postpartum blues to more severe postpartum psychosis. Risk factors include a history of mood disorders, lack of social support, stressful life events, and having a child with special needs. Left untreated, postpartum depression can negatively impact the mother's bonding with her infant and the infant's cognitive, social, and emotional development. Screening tools like the Edinburgh Postnatal Depression Scale can help identify at-risk mothers so they can receive appropriate treatment.
Postpartum blues includes an array of psychiatric manifestations occurring in the period of post-partum, due to hormonal imbalance. Knowing in detail will help for quicker diagnosis and better outcomes.
Prepared in December, 2017.
PPD is similar to clinical depression.it is not only prevalent among women but also in men. sufferers are not alone and they can prevent this by talk, talk and talk.
in Malays, we called it meroyan. PPD can be divided into postpartum depression and postpartum psychosis. Only postpartum psychosis need treatment such as combination of anti-psychotic, anti depression and mood stabilizer
This document discusses postpartum depression, including its incidence, risk factors, symptoms, impact, screening and treatment. Some key points:
- Postpartum depression (PPD), occurring in 6.8-16.5% of women, is a type of major depression that can begin within 4 weeks of delivery and last for several months if untreated.
- Risk factors for PPD include a family or personal history of mood disorders, childcare difficulties, marital issues, lack of social support and stressful life events.
- Untreated PPD can negatively impact infant development and the mother-infant relationship. It also increases the risk of maternal mortality from suicide.
- All postpartum women
Although pregnancy has typically been considered a time of emotional well-being, recent studies suggest that up to 20% of women suffer from mood or anxiety disorders during pregnancy. Particularly vulnerable are those women with histories of psychiatric illness who discontinue psychotropic medications during pregnancy.
This document discusses postpartum depression, including its symptoms, causes, risks, and treatment options. Postpartum depression causes new mothers to feel restless, anxious, fatigued and worthless. It can be treated through talk therapy and antidepressant medication. Risk factors include a personal or family history of depression or mental illness, lack of social support, stress, substance abuse, and depression during pregnancy. Untreated postpartum depression can negatively impact both mother and baby's health, development and bonding.
Mental disorders in pregnancy may be under-diagnosed and can seriously impact the health and well-being of the mother and baby. A multi-disciplinary team approach is important for predicting, detecting, and treating mental disorders during pregnancy, which include depression, anxiety disorders, psychoses, bipolar disorder, eating disorders, and others. Psychological therapy is generally preferred over pharmacological therapy during pregnancy and breastfeeding, though medication may be considered for severe cases if benefits outweigh risks. Close monitoring is important for high risk patients to support good mental health outcomes for both mother and child.
This document summarizes common psychiatric disorders that can occur during and after pregnancy, including mood disorders like depression and anxiety disorders. It discusses the symptoms, risk factors, screening tools, and treatment options for conditions such as postpartum depression, postpartum psychosis, bipolar disorder, and substance abuse. Nursing diagnoses and management strategies are also provided.
This document discusses various types of post-partum psychiatry disorders including post-partum depression, post-partum psychosis, post-partum OCD, and post-partum anxiety/panic disorder. It provides definitions, epidemiological data, risk factors, clinical features, differential diagnoses, and management strategies for each disorder. The objectives are to identify the different types, provide epidemiological data, determine risk factors, review clinical features, and learn management approaches.
This document discusses perinatal mental health, which refers to a woman's mental health during pregnancy and the first year after birth. It can include pre-existing mental illnesses, or illnesses that develop during pregnancy or postpartum. Examples provided are postpartum depression, anxiety, OCD, postpartum psychosis, and PTSD. Risk factors are outlined. It is estimated that 20% of women are affected by a perinatal mental illness, with 1 in 10 developing postpartum depression. The impacts on emotional wellbeing, bonding with the baby, and long-term child development are discussed. Support resources are provided at the end.
Postpartum psychological issues can range from mild baby blues to severe postpartum psychosis. Baby blues affects 50% of women and involves mood swings and crying for a week after delivery. Postpartum depression occurs in 10-20% of women, with symptoms like sadness and fatigue lasting over two weeks. Postpartum psychosis is the most severe, affecting 1 in 1000 women, with symptoms like hallucinations and delusions starting within 4 days of delivery. Risk factors include family history of mental illness and lack of social support. Treatment depends on severity but includes counseling, medication, and in severe cases hospitalization.
This document discusses post partum disorders including diagnosis and treatment issues. It describes three main categories of post partum psychiatric states: postpartum blues, postnatal depression, and puerperal psychosis. Postpartum blues is the most common, affecting up to 70% of women, featuring transient anxiety, depression and confusion peaking at days 4-5. Postnatal depression peaks at 4-6 weeks in 10-15% of women, featuring classic depression symptoms. Puerperal psychosis is the most severe, occurring in 1-2 per 1000 births, usually beginning in the first week with features of mania, insomnia, and mood lability endangering mother and baby. Early identification of postnatal
Postpartum psychosis is a severe psychiatric disorder that occurs in some women following childbirth, characterized by symptoms like hallucinations, delusions, mood disturbances, insomnia, and feelings of anxiety. It develops abruptly within the first few weeks after delivery in less than 2 in 1000 deliveries. The cause is unknown but risk factors include genetic predisposition, hormonal changes after birth, personal or family history of mental illness, substance abuse and lack of social support. Rapid hospitalization is needed if the safety of the baby or mother is at risk. Treatment involves medication, counseling and family education. Breastfeeding is contraindicated during treatment due to potential effects of medications in breastmilk.
This document discusses mood disorders during pregnancy and the postpartum period. It covers depression during pregnancy, postpartum blues, postpartum depression, postpartum psychosis, and postpartum obsessive-compulsive disorder. Depression is common during pregnancy, with risks including preterm birth and poor health behaviors. Postpartum blues typically occur within the first 2 weeks after delivery and involve mood swings and crying. Postpartum depression has a later onset and can involve intrusive thoughts, while postpartum psychosis involves confusion and delusions. Risks, symptoms, and treatment options are discussed for each condition.
Postpartum depression (PPD) is a type of critical depressive disorder that affects women in their post delivery. This type of disorder has deleterious effects both on the mother and her child.
Postpartum psychosis is a rare but serious mental condition that occurs after giving birth where new mothers lose touch with reality. It is characterized by hallucinations, delusions, insomnia, and extreme feelings of anxiety. Women with a personal or family history of psychosis, bipolar disorder or schizophrenia are most at risk. Treatment involves immediate medical attention, often antipsychotic medications, to address the symptoms before the new mother hurts herself or her baby.
The document provides information on nursing care of the mother during the postpartum period. Key points include:
- The postpartum period lasts approximately 6 weeks as the body returns to its pre-pregnant state.
- Physiologic changes include uterine involution over 10 days and lochia discharge over 3 weeks. Engorgement may occur between days 3-5.
- Nursing assessments include monitoring vital signs, bleeding, breast engorgement, and bonding with the infant. Interventions focus on preventing infection, reducing pain and fatigue, and promoting breastfeeding and self-care.
Postpartum period is a critical period in the life of a female from the biopsychosocial perspective. There are a number of psychological conditions which have their origin post pregnancy viz postpartum blues, postpartum depression, postpartum psychosis. Given their lack of awareness and relatively common presentation, it is imperative to know more about these conditions.
This document discusses various psychiatric emergencies and their management. It describes conditions like suicidal threats, violence, panic attacks, catatonia, hysteria, transient situational disturbances, delirium tremens, epileptic furor, acute drug-induced movement disorders, and drug toxicity. For each condition, it outlines signs, potential causes, and recommended emergency treatment approaches such as reassurance, sedation, monitoring safety, fluid replacement, and stopping causative medications. The overall goal of management is to stabilize the patient, prevent harm, and address the underlying psychiatric condition.
Eclampsia is a serious condition characterized by seizures during pregnancy that can put the mother and baby's lives at risk. It is caused by preeclampsia, a pregnancy complication defined by high blood pressure and protein in the urine. While the exact cause is unknown, problems with the blood vessels are thought to play a role. Eclampsia occurs in about 1 in 200 women with preeclampsia and can lead to complications for both mother and baby like organ damage, preterm birth, and even death in severe cases. Treatment focuses on controlling blood pressure, stopping seizures, and often requires early delivery of the baby.
The document discusses postpartum mood disorders, including prevalence, risk factors, screening tools, diagnosis, and treatment options. It notes that postpartum mood disorders range from mild and temporary postpartum blues to more severe postpartum depression and postpartum psychosis. Screening tools like the Edinburgh Postnatal Depression Scale can help identify at-risk women. Treatment involves psychosocial therapies and may include antidepressant medication depending on severity. A multidisciplinary approach is important to address biological, psychological and social factors.
Preconception care involves counseling women before pregnancy about nutrition, lifestyle factors, medical conditions, and other issues that could impact a future pregnancy. Components of preconception care include risk assessment, health promotion, medical intervention, and psychosocial intervention. The goals are to improve pregnancy outcomes, have a healthy baby, and support the mother's well-being.
I. Postpartum blues, also known as baby blues, is a transient condition that affects about 80% of new mothers within the first few days or weeks after childbirth.
II. Symptoms can include mood swings, crying, anxiety, irritability, and fatigue.
III. The condition is usually mild and self-limiting, resolving within 10 days without treatment. Support from family and seeking help from healthcare providers if symptoms are severe are recommended for successful management.
The document discusses causes of depression and treatments, including cognitive behavioral therapy. It states that depression likely has multiple causes, including biological factors like genetics and neurotransmitter imbalance, psychological factors like stress and cognitive errors, and social factors like relationships and environment. It notes CBT focuses on correcting negative patterns of thinking to treat depression by addressing depressive rumination, negative automatic thoughts, and negative core beliefs.
Cognitive behavioral therapy (CBT) is an effective treatment for depression that focuses on changing negative patterns of thought and behavior. At the core of CBT is the idea that a person's thoughts directly influence their mood and behavior, rather than external factors. The main goals of CBT are to help patients identify negative automatic thoughts, evaluate if they are valid, and replace them with more balanced perspectives. Therapists use techniques like cognitive restructuring and behavioral activation to help patients develop healthier thought patterns and engage in meaningful activities. CBT is a time-limited, goal-oriented approach involving active participation from patients.
This document discusses postpartum depression, including its symptoms, causes, risks, and treatment options. Postpartum depression causes new mothers to feel restless, anxious, fatigued and worthless. It can be treated through talk therapy and antidepressant medication. Risk factors include a personal or family history of depression or mental illness, lack of social support, stress, substance abuse, and depression during pregnancy. Untreated postpartum depression can negatively impact both mother and baby's health, development and bonding.
Mental disorders in pregnancy may be under-diagnosed and can seriously impact the health and well-being of the mother and baby. A multi-disciplinary team approach is important for predicting, detecting, and treating mental disorders during pregnancy, which include depression, anxiety disorders, psychoses, bipolar disorder, eating disorders, and others. Psychological therapy is generally preferred over pharmacological therapy during pregnancy and breastfeeding, though medication may be considered for severe cases if benefits outweigh risks. Close monitoring is important for high risk patients to support good mental health outcomes for both mother and child.
This document summarizes common psychiatric disorders that can occur during and after pregnancy, including mood disorders like depression and anxiety disorders. It discusses the symptoms, risk factors, screening tools, and treatment options for conditions such as postpartum depression, postpartum psychosis, bipolar disorder, and substance abuse. Nursing diagnoses and management strategies are also provided.
This document discusses various types of post-partum psychiatry disorders including post-partum depression, post-partum psychosis, post-partum OCD, and post-partum anxiety/panic disorder. It provides definitions, epidemiological data, risk factors, clinical features, differential diagnoses, and management strategies for each disorder. The objectives are to identify the different types, provide epidemiological data, determine risk factors, review clinical features, and learn management approaches.
This document discusses perinatal mental health, which refers to a woman's mental health during pregnancy and the first year after birth. It can include pre-existing mental illnesses, or illnesses that develop during pregnancy or postpartum. Examples provided are postpartum depression, anxiety, OCD, postpartum psychosis, and PTSD. Risk factors are outlined. It is estimated that 20% of women are affected by a perinatal mental illness, with 1 in 10 developing postpartum depression. The impacts on emotional wellbeing, bonding with the baby, and long-term child development are discussed. Support resources are provided at the end.
Postpartum psychological issues can range from mild baby blues to severe postpartum psychosis. Baby blues affects 50% of women and involves mood swings and crying for a week after delivery. Postpartum depression occurs in 10-20% of women, with symptoms like sadness and fatigue lasting over two weeks. Postpartum psychosis is the most severe, affecting 1 in 1000 women, with symptoms like hallucinations and delusions starting within 4 days of delivery. Risk factors include family history of mental illness and lack of social support. Treatment depends on severity but includes counseling, medication, and in severe cases hospitalization.
This document discusses post partum disorders including diagnosis and treatment issues. It describes three main categories of post partum psychiatric states: postpartum blues, postnatal depression, and puerperal psychosis. Postpartum blues is the most common, affecting up to 70% of women, featuring transient anxiety, depression and confusion peaking at days 4-5. Postnatal depression peaks at 4-6 weeks in 10-15% of women, featuring classic depression symptoms. Puerperal psychosis is the most severe, occurring in 1-2 per 1000 births, usually beginning in the first week with features of mania, insomnia, and mood lability endangering mother and baby. Early identification of postnatal
Postpartum psychosis is a severe psychiatric disorder that occurs in some women following childbirth, characterized by symptoms like hallucinations, delusions, mood disturbances, insomnia, and feelings of anxiety. It develops abruptly within the first few weeks after delivery in less than 2 in 1000 deliveries. The cause is unknown but risk factors include genetic predisposition, hormonal changes after birth, personal or family history of mental illness, substance abuse and lack of social support. Rapid hospitalization is needed if the safety of the baby or mother is at risk. Treatment involves medication, counseling and family education. Breastfeeding is contraindicated during treatment due to potential effects of medications in breastmilk.
This document discusses mood disorders during pregnancy and the postpartum period. It covers depression during pregnancy, postpartum blues, postpartum depression, postpartum psychosis, and postpartum obsessive-compulsive disorder. Depression is common during pregnancy, with risks including preterm birth and poor health behaviors. Postpartum blues typically occur within the first 2 weeks after delivery and involve mood swings and crying. Postpartum depression has a later onset and can involve intrusive thoughts, while postpartum psychosis involves confusion and delusions. Risks, symptoms, and treatment options are discussed for each condition.
Postpartum depression (PPD) is a type of critical depressive disorder that affects women in their post delivery. This type of disorder has deleterious effects both on the mother and her child.
Postpartum psychosis is a rare but serious mental condition that occurs after giving birth where new mothers lose touch with reality. It is characterized by hallucinations, delusions, insomnia, and extreme feelings of anxiety. Women with a personal or family history of psychosis, bipolar disorder or schizophrenia are most at risk. Treatment involves immediate medical attention, often antipsychotic medications, to address the symptoms before the new mother hurts herself or her baby.
The document provides information on nursing care of the mother during the postpartum period. Key points include:
- The postpartum period lasts approximately 6 weeks as the body returns to its pre-pregnant state.
- Physiologic changes include uterine involution over 10 days and lochia discharge over 3 weeks. Engorgement may occur between days 3-5.
- Nursing assessments include monitoring vital signs, bleeding, breast engorgement, and bonding with the infant. Interventions focus on preventing infection, reducing pain and fatigue, and promoting breastfeeding and self-care.
Postpartum period is a critical period in the life of a female from the biopsychosocial perspective. There are a number of psychological conditions which have their origin post pregnancy viz postpartum blues, postpartum depression, postpartum psychosis. Given their lack of awareness and relatively common presentation, it is imperative to know more about these conditions.
This document discusses various psychiatric emergencies and their management. It describes conditions like suicidal threats, violence, panic attacks, catatonia, hysteria, transient situational disturbances, delirium tremens, epileptic furor, acute drug-induced movement disorders, and drug toxicity. For each condition, it outlines signs, potential causes, and recommended emergency treatment approaches such as reassurance, sedation, monitoring safety, fluid replacement, and stopping causative medications. The overall goal of management is to stabilize the patient, prevent harm, and address the underlying psychiatric condition.
Eclampsia is a serious condition characterized by seizures during pregnancy that can put the mother and baby's lives at risk. It is caused by preeclampsia, a pregnancy complication defined by high blood pressure and protein in the urine. While the exact cause is unknown, problems with the blood vessels are thought to play a role. Eclampsia occurs in about 1 in 200 women with preeclampsia and can lead to complications for both mother and baby like organ damage, preterm birth, and even death in severe cases. Treatment focuses on controlling blood pressure, stopping seizures, and often requires early delivery of the baby.
The document discusses postpartum mood disorders, including prevalence, risk factors, screening tools, diagnosis, and treatment options. It notes that postpartum mood disorders range from mild and temporary postpartum blues to more severe postpartum depression and postpartum psychosis. Screening tools like the Edinburgh Postnatal Depression Scale can help identify at-risk women. Treatment involves psychosocial therapies and may include antidepressant medication depending on severity. A multidisciplinary approach is important to address biological, psychological and social factors.
Preconception care involves counseling women before pregnancy about nutrition, lifestyle factors, medical conditions, and other issues that could impact a future pregnancy. Components of preconception care include risk assessment, health promotion, medical intervention, and psychosocial intervention. The goals are to improve pregnancy outcomes, have a healthy baby, and support the mother's well-being.
I. Postpartum blues, also known as baby blues, is a transient condition that affects about 80% of new mothers within the first few days or weeks after childbirth.
II. Symptoms can include mood swings, crying, anxiety, irritability, and fatigue.
III. The condition is usually mild and self-limiting, resolving within 10 days without treatment. Support from family and seeking help from healthcare providers if symptoms are severe are recommended for successful management.
The document discusses causes of depression and treatments, including cognitive behavioral therapy. It states that depression likely has multiple causes, including biological factors like genetics and neurotransmitter imbalance, psychological factors like stress and cognitive errors, and social factors like relationships and environment. It notes CBT focuses on correcting negative patterns of thinking to treat depression by addressing depressive rumination, negative automatic thoughts, and negative core beliefs.
Cognitive behavioral therapy (CBT) is an effective treatment for depression that focuses on changing negative patterns of thought and behavior. At the core of CBT is the idea that a person's thoughts directly influence their mood and behavior, rather than external factors. The main goals of CBT are to help patients identify negative automatic thoughts, evaluate if they are valid, and replace them with more balanced perspectives. Therapists use techniques like cognitive restructuring and behavioral activation to help patients develop healthier thought patterns and engage in meaningful activities. CBT is a time-limited, goal-oriented approach involving active participation from patients.
Demystifying Postpartum Depression And Anxiety For Moms And DadsSummit Health
This presentation identifies the symptoms of postpartum depression and anxiety that can occur in both mothers and fathers, how to seek support, as well as know when to seek treatment.
- Depression is a serious medical condition that impacts mood and functioning. It affects individuals both physically and mentally.
- Depression results from chemical imbalances in the brain involving neurotransmitters like serotonin, norepinephrine, and dopamine. It can have genetic and environmental causes.
- Treatments include antidepressants which target neurotransmitter levels, therapy, and other options like light therapy or electroconvulsive therapy for severe cases. Left untreated, depression can be dangerous and even life threatening. Screening and treatment from a medical professional are recommended.
Postpartum mood disorders can range from mild baby blues to severe postpartum psychosis. Postpartum psychosis occurs in the first 1-4 weeks after delivery in 0.1-0.2% of births and is associated with hormone shifts. Screening tools like the Edinburgh Postnatal Depression Scale are used to assess levels of depression. Postpartum depression is diagnosed using DSM-IV criteria including 5 symptoms of depression emerging within 4 weeks of delivery. Left untreated, postpartum mood disorders can cause risks like suicide, infanticide, and cognitive impairment. Treatments include medications, psychotherapy, electroconvulsive therapy, and hospitalization.
This document discusses three postpartum psychiatric disorders: postpartum blues, postpartum depression, and postpartum psychosis. Postpartum blues occurs within the first few weeks after delivery and involves mood lability and irritability but does not impair function. Postpartum depression occurs within the first three months and includes depressed mood and feelings of worthlessness that do impair function. Postpartum psychosis has an onset within 72 hours of delivery and is characterized by rapidly shifting mood, delusions, and hallucinations that can instruct harm, severely impairing function. Risk factors include hormonal changes, life stressors, previous psychiatric episodes, depression during pregnancy, and history of mood disorders.
Postpartum depression is a severe form of depression that can develop within the first six months after giving birth. Symptoms include sadness, anxiety, restlessness and in rare cases, postpartum psychosis. It is caused by hormonal changes after childbirth and other contributing factors like stress, lack of sleep, and feelings of loss. About 10-15% of new mothers are affected. Left untreated, it can interfere with mother-child bonding and cause family distress, and increase the risk of behavioral problems in children. Treatment options include counseling, antidepressants, and lifestyle changes.
Cognitive behavioral therapy for depressiontheexpat
The Expat Counsellors provides cognitive behavioral therapy for depression and weight loss counseling. They offer various psychological services including family counseling and support services for expats in Singapore. Their therapists are experienced in working with diverse clients and take a confidential and client-centered approach.
This document provides information on postpartum psychiatric complications. It begins with an introduction to postpartum psychiatric disorders including classification into postpartum blues, depression, and psychosis. It then discusses risk factors, signs and symptoms, and management. Key points include that postpartum depression affects approximately 13% of women, risk factors include a history of depression and complications during pregnancy, and treatment involves counseling, antidepressants, and monitoring for suicidal ideation.
This document discusses different postpartum mood disorders including postpartum blues, postpartum depression, and postpartum psychosis. Postpartum blues typically begins 2-3 days after delivery and resolves within 2 weeks, while postpartum depression symptoms may occur within the first year. Postpartum psychosis is a medical emergency characterized by depression, delusions, and thoughts of harming oneself or the infant. Treatment involves medication, counseling, and in severe cases, hospitalization and ECT.
This document provides an overview of perinatal mental disorders (PMDs), including their epidemiology, etiology, risk factors, clinical features, diagnosis, and treatment. Some key points:
- PMDs refer to mental illnesses that occur during pregnancy or within 1 year postpartum, including depression, anxiety, OCD, and psychosis. Around 1 in 10 women develop postnatal depression.
- Biological and psychosocial factors contribute to etiology. Hormonal changes after birth and stress of motherhood can influence symptoms.
- Risk factors include prior mental illness, complications during birth, and lack of social support.
- Clinical features range from mild baby blues to severe postpartum psych
Postpartum depression is a mood disorder that can occur within the first year after giving birth. Hippocrates first described depression, which he called melancholia. Postpartum depression is triggered by hormonal and psychological changes following childbirth. Symptoms include sadness, anxiety, irritability and reduced concentration. Left untreated, postpartum depression can negatively impact both mother and child. Proper screening and treatment with SSRIs like sertraline can effectively treat postpartum depression while allowing for breastfeeding.
Postpartum psychosis by dr alka & dr apurva mukherjee nagpur m.s. indiaalka mukherjee
Postpartum psychosis is a rare but serious mental health illness that can affect a woman soon after she has a baby.
Many women will experience mild mood changes after having a baby, known as the "baby blues". This is normal and usually only lasts for a few days.
But postpartum psychosis is very different from the "baby blues". It's a serious mental illness and should be treated as a medical emergency.
It's sometimes called puerperal psychosis or postnatal psychosis.
Symptoms of postpartum psychosis
Symptoms usually start suddenly within the first two weeks after giving birth. More rarely, they can develop several weeks after the baby is born.
Symptoms can include:
hallucinations
delusions – thoughts or beliefs that are unlikely to be true
a manic mood – talking and thinking too much or too quickly, feeling "high" or "on top of the world"
a low mood – showing signs of depression, being withdrawn or tearful, lacking energy, having a loss of appetite, anxiety or trouble sleeping
loss of inhibitions
feeling suspicious or fearful
restlessness
feeling very confused
behaving in a way that's out of character
PSYCHOLOGICAL COMPLICATION DURING PREGNANCY.pdfNANCY MAURYA
The document discusses psychological complications that can occur during pregnancy, including maternity blues, postpartum depression, and postpartum psychosis. Maternity blues occurs in about 50% of women 4-5 days after delivery and involves mood lability, tearfulness, anxiety, and sleep/appetite disturbances. Postpartum depression occurs in 10-20% of mothers within the first 4-6 months after delivery and is associated with psychiatric, obstetric, and psychosocial risk factors. Postpartum psychosis is a psychiatric emergency that occurs in 1-2% of women and requires hospitalization due to symptoms like delusions, hallucinations, and disorientation. Prevention focuses on identifying at-risk women through
This document discusses premenstrual changes (PMCs), also known as premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). PMCs are common cyclic affective disorders affecting young and middle-aged women, characterized by mood and physical symptoms in the luteal phase prior to menstruation. Mild symptoms affect 30-80% of women, while severe symptoms affect 3-5%. The exact causes are unclear but likely involve serotonin and hormonal fluctuations. Diagnosis involves tracking symptoms over at least two cycles to identify cyclic patterns. Treatment options range from lifestyle modifications to pharmacotherapy depending on symptom severity.
Psychiatric Complications of Puerperium.pptxSalimKun
Contents:
1. Introduction
2. Epidemiology
3. Risk factor
4. Pathophysiology
5. Clinical features
6. Investigation
7. Management
8. References
-------------------------------------------
1. Introduction
The puerperium is the period of time after childbirth, usually lasting six weeks, during which the mother’s body returns to its pre-pregnant state.
It is a time of physical and emotional adjustment, and some women may experience psychiatric complications such as mood disorders, anxiety disorders, psychosis, or post-traumatic stress disorder.
-----------------------------------
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
Antidepressant medication advice for adultsMichel Newman
This document provides information about antidepressant medication, including how they work, when they are used, potential side effects, and treatment duration. It explains that antidepressants are thought to work by increasing serotonin and norepinephrine in the brain, and are often prescribed alongside therapy for moderate to severe depression and anxiety. Common side effects include nausea, headaches, and sexual difficulties, though some are short-lived. People may need to take antidepressants for different lengths of time, from just 12 months to indefinitely, and stopping medication requires medical supervision.
postpartumdepression is a ver y common disorders-170424094316.pdfDivyaThomas45
This document provides an overview of postnatal depression. It defines postnatal depression as a type of clinical depression that can affect both sexes after childbirth, with symptoms including sadness, low energy, changes in sleeping and eating patterns. Around 1 in 10 women experience postnatal depression within a year of giving birth. Risk factors include a personal or family history of depression, prenatal depression or anxiety, and life stress. Hormonal changes after childbirth as well as lifestyle and relationship factors may contribute to the causes. Screening tools can help diagnose postnatal depression, which has similar diagnostic criteria to other forms of major depression.
Perinatal Depression: When Depression Hits at the Moment of Joy.Dr. Umi Adzlin Silim
The document provides an overview of perinatal depression and efforts to improve perinatal mental health services in Malaysia. It discusses (1) the need to move beyond biological models to recognize psychosocial risk factors for perinatal depression, (2) current lack of specialized perinatal mental health services in Malaysia, and (3) ongoing research efforts like the National Maternal and Child Health Survey and ASPIRE studies to better understand prevalence of perinatal depression in Malaysia and test interventions.
Antidepressants are the second most prescribed medication in the US, with 15 million Americans affected by depression each year. Depression is treated through medications and therapy. Antidepressants work by adjusting neurotransmitter levels in the brain like serotonin, dopamine, and norepinephrine. Common classes include SSRIs, SNRIs, TCAs, and MAOIs. While effective, antidepressants can cause side effects like nausea, insomnia, sexual dysfunction, and increased suicide risk initially. Doctors closely monitor patients to improve treatment outcomes and safety.
This document summarizes information about postpartum depression screening and education in New Jersey. It discusses celebrities and tragic cases that have brought awareness to postpartum depression. Statistics on incidence rates in New Jersey are provided. The document reviews the history of recognizing and diagnosing postpartum mood disorders. It outlines New Jersey's 2006 legislation requiring education and screening for new mothers and includes details on screening tools, potential effects of postpartum mood disorders, risk factors, and types of postpartum mood disorders.
women_2011b.PPT women mental health and educationjayvee73
The document discusses how mental disorders disproportionately affect women of childbearing and childrearing age. Rates of depression and anxiety are higher in women compared to men. These conditions are also influenced by hormonal changes during a woman's life such as puberty, menstruation, pregnancy, postpartum period, and menopause. Effective treatment of mental illness is complicated during these reproductive stages due to risks of medication exposure to a fetus or breastfeeding infant.
BEATING THE BLUES: PRACTICAL SOLUTIONS FOR A COMMON HEALTH PROBLEMSummit Health
Lecture on depression, including information about causes, symptoms, and treatment. Learn to distinguish depression from feeling down. Find out how practical techniques can help improve short-term and long-term blue moods, sadness, and depression.
This document discusses psychiatric disorders in pregnant and lactating women. It provides information on how pregnancy can impact mental health and psychiatric disorders. Key points include how psychiatric disorders and medications can affect pregnancy and the fetus. It emphasizes the importance of screening and predicting mental health issues during pregnancy and postpartum. The document also discusses managing different mental disorders throughout pregnancy, delivery, and lactation.
Evaluation and Treatment of Bipolar and Related Disorders in Children and Ado...Stephen Grcevich, MD
In these lectures presented by Dr. Stephen Grcevich to child and adolescent psychiatry trainees at Akron Children's Hospital in January 2021, the following objectives were addressed:
Identify critical questions challenging our assumptions regarding treatment of bipolar disorder in kids.
Explore diagnostic challenges associated with comorbidity with other common mental health conditions.
Review key literature evaluating effective pharmacotherapy of pediatric bipolar disorder.
Examine available data on non-pharmacologic treatments in kids with bipolar disorder.
Este documento descreve as principais características de três tipos de pneumonias: pneumonia adquirida na comunidade, pneumonia nosocomial e pneumonia associada ao ventilador. Detalha os sinais e sintomas, exames complementares, agentes etiológicos, tratamento e duração da terapêutica para cada tipo de pneumonia.
This document discusses the relationship between sleep and pain. It summarizes research showing that sleep deprivation can increase pain sensitivity in healthy individuals and exacerbate pain in people with chronic pain conditions. However, the direction of this relationship (whether pain also disrupts sleep) remains unclear. The document calls for improved study methodologies to better understand the mechanisms and causal relationships between sleep and pain.
1) Adjuvant therapy refers to additional treatment given after primary treatment like surgery to eradicate micrometastasis and reduce the risk of cancer recurrence.
2) For colon adenocarcinoma, common adjuvant therapy options include chemotherapy regimens like FOLFOX and CapeOX. Clinical trials have shown these regimens improve disease-free and overall survival for stage III colon cancer patients.
3) Side effects of adjuvant chemotherapy include nausea, diarrhea, fatigue and neuropathy, though most symptoms improve after treatment completion. Elderly patients may receive less intensive regimens due to higher risk of side effects.
1) O documento descreve várias lesões potencialmente malignas da mucosa oral, incluindo leucoplasia, eritroplasia, lesões de fumantes, fibrose submucosa, líquen plano e queratose actínica.
2) Essas lesões têm um risco aumentado de progressão para carcinoma pavimento-celular e requerem monitoramento cuidadoso.
3) Fatores como tabagismo, localização e apresentação clínica influenciam o risco e prognóstico de cada lesão.
O documento descreve o carcinoma urotelial da bexiga, incluindo sintomas, fatores de risco, estágios, tipos histológicos, diagnóstico, tratamento e acompanhamento. A hematúria é o sintoma inicial mais comum. O tabagismo é a principal causa. O diagnóstico é feito por cistoscopia e citologia urinária. O tratamento varia de acordo com o estágio e risco, indo de vigilância até cistectomia radical para tumores avançados.
O documento descreve o gene CUX1, que codifica três proteínas (p200, p110 e p75) e atua como um gene supressor de tumor e oncogene. Níveis reduzidos de CUX1 promovem o desenvolvimento do tumor inicial, enquanto um aumento nos níveis de CUX1 promove a progressão do tumor avançado através de mecanismos diferentes. O documento analisa o papel dual deste gene na tumorigênese.
Este documento discute hérnias discais lombares e dor lombar aguda, incluindo anatomia relevante, classificações de hérnias, e abordagens imagiológicas como radiografia, tomografia computadorizada, ressonância magnética e imagiologia por tensor de difusão.
O documento descreve a anatomia das cavidades nasais e seios perinasais, incluindo suas paredes, limites, orifícios e variações anatômicas. Detalha também técnicas de imagem como radiografia, TC e ressonância magnética para avaliação dessas estruturas, assim como aspectos relevantes para a cirurgia endoscópica funcional.
Este documento descreve a doença de Huntington, uma patologia autossómica dominante neurodegenerativa causada por um aumento do número de repetições do aminoácido glutamina na proteína huntingtina. Apresenta os sintomas, idade de aparecimento, mecanismos moleculares e formas de detecção da doença.
This document summarizes the key points of hemocyanin, an oxygen-transport metalloprotein found in some arthropods and mollusks. It contains two copper atoms that reversibly bind to oxygen. The deoxygenated form is colorless and the oxygenated form is blue. It has been crystallized from various species and its basic structural unit is a hexamer of subunits.
Assembly of Preactivation Complex for Urease Maturation in Helicobacter pyloriJoão Augusto Ribeiro
O documento descreve a maturação da urease da bactéria Helicobacter pylori. A urease é ativada por um complexo de quatro proteínas acessórias (UreEFGH) que inserem íons de níquel no seu sítio ativo. O estudo determinou a estrutura do subcomplexo UreF-UreH e como este interage com UreG para formar o complexo de pré-ativação UreG-UreF-UreH, essencial para a maturação da urease.
O documento discute o linfoma, um tipo de câncer que afeta o sistema linfático. Explica o que é o sistema linfático e seus componentes, como os linfócitos B e T. Detalha os tipos principais de linfoma, Hodgkin e não-Hodgkin, suas causas, sintomas e estágios. Descreve métodos de diagnóstico e determinação do estádio, como raio-X, TAC e biópsia. Finalmente, cobre os principais métodos de tratamento como quimioterapia, radioter
O documento descreve o procedimento de injeção intracitoplasmática de espermatozóides (ICSI), que direciona indivíduos com baixa mobilidade ou anomalias nos espermatozóides. Detalha os métodos de recolha dos gâmetas masculinos através de procedimentos como MESA, PESA e TESA para tratamento de azoospermia obstrutiva e não-obstrutiva. Explica também a recolha dos oócitos femininos e o processo da injeção do espermatozóide no óvulo.
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International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
Joker Wigs has been a one-stop-shop for hair products for over 26 years. We provide high-quality hair wigs, hair extensions, hair toppers, hair patch, and more for both men and women.
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
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PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
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Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
Key Areas Covered:
Texting and Email Communication: Understand the compliance requirements for electronic communication.
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Why Attend:
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TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
Comprehensive Rainy Season Advisory: Safety and Preparedness Tips.pdfDr Rachana Gujar
The "Comprehensive Rainy Season Advisory: Safety and Preparedness Tips" offers essential guidance for navigating rainy weather conditions. It covers strategies for staying safe during storms, flood prevention measures, and advice on preparing for inclement weather. This advisory aims to ensure individuals are equipped with the knowledge and resources to handle the challenges of the rainy season effectively, emphasizing safety, preparedness, and resilience.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
5. 1. Biological Factors
Hormonal variations during pregnancy and puerperium
2. Obstetric Factors
C-section
Unplanned pregnancies
POSTPARTUM DEPRESSION
RISK FACTORS
6. 3. Clinical and Psychological Factors
History of previous depression
Prenatal anxiety and/or depression
POSTPARTUM DEPRESSION
RISK FACTORS
7. Stress pré-
natal
Falta de
suporte
social
Falta de
suporte
conjugal
Expectativa/Reali
dade de ser mãe
Exigências
do cuidado
do bebé
Temperamento
do bebé
POSTPARTUM DEPRESSION
RISK FACTORS – SOCIAL AND PSYCHO-SOCIAL FACTORS
POSTPARTUM DEPRESSION
RISK FACTORS – SOCIAL AND PSYCHO-SOCIAL FACTORS
8. Sintomas
• Perda de prazer, energia e motivação
• Ansiedade
• Irritabilidade, agitação
• Alteração dos hábitos alimentares e de sono
• Medo de não ser uma boa mãe – culpa
• Pensamentos em magoar o bebé ou a si própria
9. Trying to mitigate the serious adverse outcomes of PPD already mentioned → EARLY DETECTION!
Screening: at 1st postnatal obstetrical visit (usually 4-6 weeks after delivery), FP or pediatric setting
Most common: EPDS (Edinburgh Postnatal Depression Scale) (Sensitivity 80-82%, Specificity 78-82%)
Other: PDSS (Postpartum Depression Screening Scale) and PHQ-9 (9-item Physician’s Health Questionnaire)
Antepartum: APQ (Antepartum Questionnaire) (Sensitivity 80-82%, Specificity 78-82%)
POSTPARTUM DEPRESSION
SCREENING
10. PPD frequently missed by the primary care team (clinical signs not apparent unless screened for)
DSM-IV Criteria for MDE (Major Depressive Episode) ↔ PPD
Antepartum education on PPD!
Postpartum onset of MDE → 4 weeks after delivery … but… 3 months? ≥1 year?
Differential psychiatric diagnosis: Postpartum Blues (up to 75% of mothers in the 10 days following delivery)
Differential psychiatric diagnosis: Postpartum Psychosis (psychiatric emergency requiring hospitalization)
Differential non-psychiatric diagnosis: Transient hypothyroidism, hyperthyroidism, anemia, infection
POSTPARTUM DEPRESSION
DIAGNOSIS
11. Treatment
1st line therapy: non-pharmacological therapy!
Psychotherapy → IPT (Interpersonal Therapy) and CBT (Cognitive Behavioral Therapy)
IPT – time-limited interpersonally-oriented psychotherapy (depression as a medical illness occurring in a social context)
Effectiveness supported by several studies (O’Hara and colleagues, Clark et al)
CBT – well studied and effective treatment for MDE (modification of distorted patterns of negative thinking
and making behavioral changes that enhance coping and reduce distress)
Several trials assessing CBT alone or with other interventions for the treatment of PPD → support CBT interventions
as helpful in the treatment of PPD (Appleby et al, Misri et al)
12. 1. Postpartum blues: generally self-limited and resolve between 2 weeks and
3 months. Supportive reassurance is sufficient.
2. Postpartum depression:
• psychotherapy
• pharmacotherapy
• diet
3. Postpartum Psychosis, add:
• electroconvulsive therapy
• hospitalization
POSTPARTUM DEPRESSION
TREATMENT OPTIONS
13. • IPT (InterPersonal Therapy): time-limited (12-20 weeks) treatment based on
addressing connection between interpersonal problems and mood.
• CBT (Cognitive Behavior Therapy): to help the depressed patient to
modify negative thinking and to make behavioral changes in order to reduce
distress.
• Non-Directive Counseling: with a health visitor to empathically and
nonjudgementally listen and support.
• Peer and Partner Support: practical and emotional support from partner and
friends are essential to recovery for most women.
POSTPARTUM DEPRESSION
PSYCHOTHERAPY – 1ST LINE TREATMENT
14. • Doses and time are similar to the ones for major depression.
• Must be continued for 6 to 12 months after childbirth.
• If the mother had responded to a specific psychodrug in the past, that
medication must be the first one to consider.
POSTPARTUM DEPRESSION
PHARMACOTHERAPY – 2ND LINE TREATMENT
16. • Transdermal Estrogen
• neural growth
• neurotransmitters activity
• oxidative stress
• Must be avoided if risk of tromboembolism is present
• Progesterone (norethisterone nitrate)
• Very few studies
• No role for synthetic progesterone in treatment
• Increases risk of depression
After childbirth, we assist to a dramatic drop of maternal levels of estrogen and progesterone that
could be the trigger to PPD.
POSTPARTUM DEPRESSION
PHARMACOTHERAPY – HORMONAL THERAPY
17. • Few studies on the effects on infants of exposure to antidepressants
through breast milk.
• Adverse effects include: sleep changes, gastrointestinal problems,
respiratory problems, seizure.
• Mostly resolved by interruption of treatment or breastfeeding
• SSRI (sertraline, fluoxetine) and TCA (nortriptyilne) have the most
data supporting safety during breastfeeding
POSTPARTUM DEPRESSION
PHARMACOTHERAPY – BREASTFEEDING CONSIDERATIONS
18. • Diet
• Ω3 fatty acids (3-4 g/die): depletion during pregnancy to build the fetus’s CNS
• Proteins
• vit. B6
• carbohydrates, caffeine, sugar
• Electroconvulsant therapy (ECT)
- psychotic symptoms
- for non-respondent to antidepressants women
• Hospitalization
- suicide risk
POSTPARTUM DEPRESSION
OTHER TREATMENTS
Editor's Notes
Blues – 50 a 70 por cento de todas as mulheres após o parto. Começa ao 3º/4º dia e termina 2 semanas depois. A mulher sente-se cansada, ansiosa, stressada, solitária.
Depressão pós-parto – pode ter os blues, mas acaba por arrastar-se por mais tempo; pode também aparecer mais tarde do que apenas ¾ dias.
Psicose – raro – mania, pensamentos psicóticos, depressão severa, e outros tipos de problemas. É uma emergência médica.
O declínio rápido nos níveis de hormonas reprodutivas que ocorrem após o parto podem estar na origem da PPD. Depois do nacimento, os níveis de progesterona e estrogénio caem rapidamente, retomando aos níveis da pré-gravidez em 3 dias. Há um aumento da prolactina também.
Stress pré-natal – experiências como a perda de um ente querido, divórcios, perder o emprego, mudar de casa são conhecidas como causadoras de stress e podem desencadear episódios depressivos em indivíduos sem história prévia de depressão (uma vez que as mulheres também passam por momentos de flutuação hormonal)
Suporte Social – receber suporte social através de amigos e familiares durante tempos stressantes é um fator protetor contra a depressão e vários estudos evidenciam uma redução da PPD com tal. O isolamento é mau. Emigrantes!!!
Childbearing – a mãe tende a fazer a maior parte das tarefas de cuidados. Normalmente, a relação entre os pais tende a sofrer e há menos tempo para socializar. Uma relação de apoio com o pai pode ajudar a mitigar o stress de ser mãe.
…
To try to mitigate the serious adverse outcomes of PPD, early detection is key. This might be complicated by the normal physical and emotional demands of new motherhood (changes in energy and appetite, sleep deprivation, concern for wellbeing of the infant)
Experts suggest screening at the 1st postnatal obstetrical visit (usually 4-6 weeks after delivery), or in the family practice or pediatric setting.
Most common screening tool Edinburgh Postnatal Depression Scale (EPDS), initially proposed in 1987, a 10 item self-report that emphasizes emotional and functional factors over somatic symptoms. Values ≥ 10 indicate a possible PPD, and a reasonable cut-off for a positive screen is ≥ 13 (out of a possible 30), with a special note to positive responses to item 10 (suicidal ideation).
Other common screening tools with evidence of validity in the puerperium: Postpartum Depression Screening Scale (PDSS) (http://www.mededppd.org/pdss.asp - 35-item Likert-type response scale consisting of 7 domains: sleeping/eating disturbances, anxiety/insecurity, emotional lability, cognitive impairment, loss of self, guilt/shame, and contemplating harming oneself) and the 9-item Physician’s Health Questionnaire (PHQ-9) (http://patient.info/doctor/patient-health-questionnaire-phq-9 - PHQ-9 is the depression module, which scores each of the nine DSM-IV criteria as "0" (not at all) to "3" (nearly every day). It has been validated for use in primary care. It is not a screening tool for depression but it is used to monitor the severity of depression and response to treatment. However, it can be used to make a tentative diagnosis of depression in at-risk populations).
The Antepartum Questionnaire (APQ) was developed in 1997 and evaluates in 24 questions the past and present-time feelings of the puerperal on a number of subjects. A scoring of ≥ 46 should be considered for psychiatric evaluation and followed closely during the postpartum to detect possible signs of PPD.
PPD frequently missed by the primary care team, because the clinical signs are not apparent unless screened for. This is why assessment at every chance is key!
Because PPD is classified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as a part of the spectrum of major depression the same criteria can be used when screening for PPD
An MDE may be classified as having a postpartum onset if the depressive symptoms begin within the 1st 4 weeks after delivery. But there are studies suggesting that depressive episodes are significantly more common in the 1st 3 months after delivery and an increased vulnerability to psychiatric illness may persist for 1 year or more.
It is important to differentiate PPD from other psychiatric and non-psychiatric diagnosis. The postpartum blues or “baby blues” is a transient mood disturbance that affects up to 75% of new mothers in the 10 days following delivery, and consists of crying, irritability, fatigue, anxiety, and emotional lability. Symptoms are generally mild and self-limited, and do not involve total loss of pleasure or interest, persistent low mood, or suicidal ideation.
On the other extreme, postpartum psychosis is a psychiatric emergency that requires immediate intervention, and is characterized by the rapid onset of severe mood swings, a waxing and waning sensorium, delusions, hallucinations or disorganized behaviors, and a relatively high incidence of suicidal ideation or homicidal ideation toward the infant.
Other non-psychiatric diagnoses might include transient hypothyroidism, which affects 4 to 7% of patients and peaks 4 to 6 months postpartum, thyrotoxicosis, which may present with symptoms suggesting panic disorder, anemia, whose symptoms of fatigue, loss of energy and difficulty sleeping overlap with depression, and infection, whose symptoms of fatigue, loss of energy and mood changes also overlap with depression.
Antepartum education on PPD is also a big factor in diagnosis. New mothers may feel ashamed when they’re not overjoyed with the birth of a new child and may not report symptoms or problems to their doctor.
First line therapy is non-pharmacological therapy! Although relatively few studies have systematically investigated non-pharmacologic treatments for PPD, existing research supports the use of both psychological treatments as well as psychosocial interventions.
Two methods of therapy that have been shown to be beneficial are Interpersonal Therapy (IPT) and short-term cognitive behavioral therapy (CBT).
The IPT is a time-limited and interpersonally-oriented psychotherapy and may be effective for women with mild depression. It addresses the connection between interpersonal problems and mood, which frames depression as a medical illness occurring in a social context. Over the course of the therapy (typically 12–20 weeks), strategies are pursued to assist patients in modifying problematic approaches to relationships and in building better social supports. Several studies have supported the effectiveness of IPT for treating postpartum depression. In one large-scale randomized controlled trial, to give just one example, 120 women with postpartum depression were randomized to receive 12 weekly 1 hour individual sessions of IPT by a trained therapist versus control condition of a wait-list. The women who received IPT had a significant decrease in their depressive symptomatology (measured by Hamilton Depression Rating Scale and Beck Depression Inventory) as compared to the wait-list group, as well as significant improvement in social adjustment scores.
The CBT teaches people to recognize their inaccuracies in thinking and to make behavioral changes that enhance coping and reduce distress. There have been several trials assessing CBT alone or with other interventions for the treatment of PPD. These studies support CBT interventions as helpful in the treatment of PPD, though they do not support an additional benefit to CBT in combination with pharmacotherapy.
IPT: patient and clinician select focus on one of these treatment areas, role transition, role dispute, grief, interpersonal deficits, in order to build better social support. In this case, the treatment areas are more focused on the relationship mother-infant, mother-partner, transition back to work.
NDC: the health visitor is usually a nurse who conducts home visits with pregnant and postpartum women.
The main concern is about the exposure of the infant to the drug through breastmilk (see slide). Another concern is about the mother’s self-perception as a bad mother since she requires medication. The drug must be prescriped by a specialist after careful clinical considerations.
It is important to monitor the infant for any behavioral and physical changes/symptoms, with particular care on sleeping, and feeding patterns, sedation, social interaction, irritability. Plasma levels of the drug do not correlate with the adverse effects, so periodic blood tests are currently not recomended.
Anesthetic agents used in ECT are typically rapidly metabolized, and risk of transmission in breast milk can be minimized by timing breast feeding accordingly.