postpartum depression 08.19.2013

7/27/2019 Postpartum Depression 08.19.2013

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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Withdrawn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

P

S


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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.

postpartum depression 08.19.2013

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