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Health care providers - Introduction
 Introduction
 Incidence
and symptoms of PPMD
Postpartum
psychosis
Recognizing
mothers with PPMD
Top
5 risk factors for PPMD
Screening
and diagnosis
What
you can do
Talk
to your patient and validate her feelings
Be
aware of barriers mothers face recognizing and/or disclosing
PPMD
Help
overcome barriers
Treatment
should include
Treatment
options
Resources
Introduction
Postpartum Mood Disorders (PPMD) affect
not only the mother but her child, her partner and the rest
of her family. PPMD is not clinically different from a depression
or anxiety that can occur at any time, but it may have greater
ramifications, because much of the important psychological
attachment between mother and infant is formed during the
postpartum period.
As a health care provider you have an important
role in the detection, diagnosis, and treatment plan of your
patients who develop PPMD. If left untreated, the risks for
the mother include:
Poor
self-care
Poor nutrition
Sleep disturbance
Substance
abuse
Increased
and chronic anxiety and depression
Interpersonal/family
conflict
There are risks to the baby which can lead
to abnormal infant attachment and behaviour as well as decreased
and delayed cognitive development. The effects of these can
be seen from early childhood through adolescence into adulthood.
Incidence and Symptoms of PPMD
PPMD can affect any mother, in fact 13%
of new mothers will suffer a moderate to major episode of
postpartum depression, the most common and most researched
PPMD and more will experience other mild to moderate or severe
mood or personality disorders such as anxiety, obsessive compulsive
disorder, mania, neurosis and others.
Up
to 80% of mothers will experience postpartum blues
Up to 20%
will experience a mild to severe postpartum mood disorder
1 - 2 in
1000 will suffer a postpartum psychosis
Mothers will present with a variety of symptoms,
many of them common occurrences after childbirth. [Also see,
PPMD Tear-off sheet]
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Postpartum psychosis
The onset of postpartum psychosis is usually
48 hours to 2 weeks after birth, but can occur later, too.
If a new mother is psychotic she may experience the following
symptoms.
Thinking and possibly planning of harming self or baby
Hearing
or seeing things that are not there (hallucinations)
Believing
people or things are going to harm her or the baby (paranoia)
Feeling
confused and out of touch with reality (includes delusions)
This is a medical emergency. The mother
needs treatment immediately and should not be left alone or
alone with the baby until she has had a psychiatric assessment.
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Recognizing Mothers with PPMD
Mothers with PPMD can present differently.
The scenarios presented here may help you recognize some warning
signs in your clients. Other warning signs can also be frequent
visits or trips to their care provider with physical symptoms
or concerns about the infant.
[Also see, Family and Friends section]
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Top
5 Risk Factors for PPMD
Depression
or anxiety in pregnancy
Recent stressful
life events (e.g., moving, relationship problems, death
of a loved one).
Lack of
social supports
Past personal
history of mental illness
Family history
of mental illness
Other risk factors include: maternal personality,
low self-esteem, relationship difficulties, low socio-economic
status (SES) or a change in SES and obstetric and pregnancy
complications.
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Screening and Diagnosis
There are different tools that can help
assess a new mother's mental health. Health care providers
can use the 4 PASS-CAN questions or use another well-validated
screening tool such as the:
The Edinburgh Postnatal Depression Scale
(EPDS)
British Journal of Psychiatry June, 1987, Vol. 150 by J.L.
Cox, J.M. Holden, R. Sagovsky.
The EPDS is a tool used to assist health
care professionals in screening mothers for postpartum depression.
It is internationally accepted by both researchers and health
care providers. It is convenient to administer as it only
takes a few minutes to fill out, it is easily incorporated
into everyday clinical practice and has a high acceptability
in diverse cultures. The EPDS may be used at 6-8 weeks to
screen postnatal women. The child health clinic, postnatal
check-up or a home visit may provide suitable opportunities
for its completion. It can also be used during the prenatal
period or at any time during the first year postpartum or
beyond. During the first two weeks postpartum results should
be viewed with caution because many mothers experience feelings
of postpartum "blues".
The EPDS has been translated into 23 different
languages. Caution should be exercised when using it with
different ethnic populations as different cut-off scores have
been suggested for different populations and research has
validated the tool with women speaking their native tongue
in their native country.
[Also see, Edinburgh
Postnatal Depression Scale (EPDS)]
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