postpartum depression 08.19.2013
TRANSCRIPT
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Triple BoardMorning ReportAllie R. Shapiro MD PGY2
August 19, 2013
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CASE REPORT
A patient you followed in the WBN presentsfor the 2 week well child check. The baby
has surpassed birth weight, his stools havetransitioned, and he is feeding q2-3hours.
On Edinburgh Postnatal Depression Scale
mom scored a 21 with the question aboutself harm or to others being never.
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Postpartum Mood Reactivity
Maternal blues or postpartum moodreactivity is considered a normal
emotional experience in the immediatepostpartum period.
50-80% of women experience transientsymptoms of depressed mood, at timesalternating with elated moods, irritability,increased crying spells, and a sense ofunreality during the first 10 days afterbirth.
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Postpartum Psychosis
Rare (1/1000), serious event that occurswithin 2 weeks postpartum, considered a
psychiatric emergency
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Postpartum Depression
50% of PPD cases are continuations of
depressive episodes that occur during or
before pregnancy New-onset cases of depression during
postpartum period is estimated around 15%
(peak prevalence 10-14 wks post-delivery)
Some studies show that depressive episodesresolve more quickly than a generalized
major depressive episode (really not known)
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Signs and Symptoms Depressed or sad
mood
Anhedonia Irritability
Anxiety
Insomnia
Difficulty
Concentrating Complaints of poor
memory
Crying
Poor appetite
Feelingoverwhelmed
Feeling hopeless orworthless
Thoughts of death(own or childs)
Suicidal Ideation
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At risk Younger maternal age
Lower education
Single marital status Lower SES
Personal or family history of mood disorder
Depression during pregnancy
Psychosocial stress Lack of Social Support
Marital Discord
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Possible effects of maternal
depression on Childrensbehavior
Infant BehavioralProblem
Sleep disruption Feeding/eating
disruption
Temper tantrums
Fussy/Crying
Withdrawn
Delayed CognitiveDevelopment
Lag in developingconcept of objectpermanence
Lower scores on
the McCarthyScale of ChildrensAbilities
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Cont.Impaired SocialDevelopment
Less socialable withstrangers
Less engagementin sharing
No fear of strangers
Insecure AttachmentPatterns
Difficulties withemotions regulation
Difficulties being
comforted
Lack of interest in
age-appropriate
objects
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Effects of Maternal Depression
on Parental Attitudes andBehavior
Guilt/anxiety
Loss of love
Negative attributions
Thoughts of harm
Bizarre beliefs about the baby
Extreme disappointment about the
gender Inflated expectations about the infants
developmental abilities
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Effects on Mother-InfantInteractions
Mother Difficulty enjoying the baby Disinterest or negative
toward the baby Less active interactions Inability or lack of attempt
to sooth the baby Refusal to look at/hold the
baby Hostile expressions toward
the baby
Baby
Decreased eye gazetoward the mother
Less reciprocity in
interactions
More drowsy or fussy
Greater reactivity
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Depression Screening Tools
Edinburgh Postnatal Depression Scale
Postpartum Checklist
Postpartum Depression Screening Scale
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Maximum Score
30 Possible
depression 10 orgreater
Always look atitem 10
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Case Cont.
Your patients mom scored a 21!
What questions do you ask next?
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Questions to ask
How are you feeling about being a newmother?
How are you coping with the additionalstress of a new baby?
Are you able to sleep when the baby issleeping?
Do you have enough energy to do thethings you need to do for yourself, yourbaby, your work?
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Have you been feeling sad or depressedover the past week?
Have you been feeling anxious, worried,or irritable over the past week?
Have you had difficulty concentrating orremembering things?
Do you find yourself crying for no reason? Have you been having thoughts of hurting
yourself? Anyone else? Your baby?
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REMEMBER SIGECAPS
S
I
G
E
C
A
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REMEMBER SIGECAPS
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor agitation/retardation
Suicidal
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Mom says she is not suicidal and is notthinking of harming her baby, but is
feeling very overwhelmed. She begins tocry in the office.
What do you tell her next?
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Resources if really worried
211
Crisis number/evaluation
Try to get mom an appointment withPCP/OBGYN
Most moms dont seen there OB until 6
weeks post partum
Follow up in 1 week
www.postpartum.net
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Repeat Screening Track changes in symptom severity to
determine the need for referral and
intervention Identify women at risk as well as affected
women
Identify women who have suicidal ideations
Provide mothers a nonverbal venue to
express their emotions Provide an opening for discussion of other
sensitive issues.