Postnatal depression

Question 1

Definition

Answer 1

Depression illness following childbirth (usually within 6 month), can be part of bipolar or unipolar

Question 2

Epidemiology

Answer 2

Prevalence 7-19%

Question 3

Etiology

Answer 3

1. Psychosocial: stressors, finance, violence, low employment
2. Psychiatric illness: antenatal history of depression/anxiety increases risk 3-5 times
3. Personality disorder: high neuroticism, low self esteem
4. Genetic factors
5. Sleep disturbance
6. Complications of pregnancy and birth
7. Young maternal age->mothers

Question 4

Pathophysiology

Answer 4

Not exactly known
May be vulnerable to specific pueperal trigger
No major difference in hormone profile->may have abnormal sensitivity to normal physiological changes during pregnancy

Question 5

Reducing the risk of postnatal depression

Answer 5

Professional home visits by nurses and midwives
Interpersonal psychotherapy
CBT
Edinburgh PNDS at 6 weeks

Question 6

Clinical features

Answer 6

Depressed mood
Anhedonia
Decreased energy or increased fatiguability
Suicidal ideation
Loss of confidence/self esteem
Unreasonable feelings of self reproach or excess guilt
Poor concentration
Sleep, appetite, weight, obsessive thoughts

Question 7

Risk factors

Answer 7

History of depression/anxiety
Recent stressful life events
Discontinuation of psychopharmacological therapies
Sleep deprivation
Genetic susceptibility
Violence

Question 8

Investigations

Answer 8

1. Whooley questions
   a. The questions are: “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and “During the past month, have you often been bothered by having little interest or pleasure in doing things?”
   b. If the answer to either of these questions is positive, a third question is recommended: “Is this something with which you would like help?”
   c. The 3 questions have a positive predictive value of 32% and a negative predictive value of 99% for major depression.
2. EPNDS

Question 9

How does PND differ from minor mood disturbance/baby blues

Answer 9

1. mother typically presents with mood swings ranging from elation to sadness, insomnia, tearfulness, crying spells, irritability, anxiety, and decreased concentration.
2. Symptoms develop within 2 to 3 days postnatal, peak on the fifth day, and resolve within 2 weeks.

Question 10

Assessing self harm/harm to baby

Answer 10

1. Whether feels life is not worth living
2. Ever thought of harming baby
3. Impaired bonding, lack feeling of attachment, sense of numbness
   Does not increase risk of following through
4. Obsessive, intrusive and aggressive thoughts
5. Suicidal thoughts
6. Plan
7. Lethality
8. Means
9. Risk and protective factors
10. Mental state
11. History of suicidal behaviour
12. Family history
13. Substance use
14. Strengths and supports

Question 11

History

Answer 11

1. Symptoms
2. Suicide/homicide risk
3. Mania/hypomania
4. Complete psychiatric history

Question 12

Management

Answer 12

1. Self help, counselling, CBT, interpersonal therapy

2. Antidepressants->sertraline or paroxetine

Question 13

Follow up

Answer 13

1. Reviewed regularly
2. In pharM & breast feeding->adverse effects + in premature/young/ill->monitor infant for ++sedation, irritability, changes in sleep, feeding and growth
3. Develop a trusting relationship->thoughts, concerns, expectations
4. Discuss risk of recurrence

Question 14

Complications

Answer 14

1. Impaired bonding
2. Neglect of the baby or infanticide
3. Suicide
4. Bipolar

Question 15

Prognosis

Answer 15

1. Usually last for 3-6 months
2. Higher risk of recurrence
3. Depends on the the persistence of the adverse circumstances
4. Early-onset depression (within the first 6-8 weeks), severe depression, and depression with bipolar or psychotic symptoms suggest the presence of a specific puerperal trigger,