Postpartum Mood Disorders

Description

1. The Diagnostic and Statistical Manual of Mental Disorders contains official guidelines for the assessment and diagnosis of psychiatric illness. The disorders recognized during the postpartum period are:
   • Postpartum blues
   • Postpartum depression without psychotic features
   • Postpartum depression with psychotic features (postpartum psychosis)
2. Between 50% and 80% of all new mothers report some form of postpartum blues.
3. The incidence of moderate or major postpartum depression or postpartum bipolar disorder ranges from 30 to 200 per every 1,000 live births; the incidence of brief psychotic disorders with postpartum onset is about 1 in every 1,00 live births.

Etiology

1. Predisposing factors include a history of puerperal psychosis, bipolar (for merly manic-depressive) disorder, delirium and hallucinations, rapid mood changes, agitation or confusion, and the potential for suicide or infanticide.
2. Postpartum depression with and without psychosis is being studied from three perspectives.
   • Biologic theories include alteration in hypothalamic function, possibly related to altered hormonal influence.
   • Psychological theories include poor support systems, psychologic stress, or poor relationship with partner.
   • Socio-cultural theories include low levels of social gratification, support, and control both at work and in the parenting role.

Comparison of Postpartum Blues, Depression and Psychosis
	POSTPARTAL BLUES	POSTPARTAL DEPRESSION	POSTPARTAL PSYHOSIS
ONSET	1-10 days after giving birth	1-2 months after giving birth	Within first to third month after giving birth
SYMPTOMS	Sadness, tears	Anxiety, feelings of loss, sadness	Delusions or hallucinations of harming infant or self
INCIDENCE	70% of all births	10% of all births	1% to 2% of all births
ETIOLOGY	Probably caused by hormonal changes, stress of life changes	History of previous depression, hormonal response, lack of social support	Possible activation of previous mental illness, hormonal changes, family history of bipolar disorder
THERAPY	Support, empathy	Counseling, drug therapy	Psychotherapy, drug therapy
NURSING NOTE	Offering compassion and understanding	Referring to counseling	Referring to counseling, safeguarding mother from injury to self or to newborns.

Comparison Table Source: Pillitteri, A. (2007). Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family. 5^th Edition

Assessment Findings

• Serious postpartum depression or psychosis usually does not occur until 3 to 5 days after delivery, at which time the client is usually discharged from the hospital or birthing center. Clinical manifestations depend on the type of mood disorder.

1. Postpartum blues manifestations include fatigue, weeping, anxiety, mood instability with onset 1 to 10 days postpartum and lasting 2 weeks or less.
2. Postpartum depression without psychosis manifestations include confusion, fatigue, agitation, feelings of hopelessness and shame, and alterations in mood.
3. Postpartum depression with psychosis manifestations include symptoms of postpartum depression plus delusions, auditory hallucinations, and hyperactivity.

Nursing Management

1. Identify postpartum mood disorders.

1. Be aware of signs and symptoms of postpartum mood disorders.
2. Teach the client and family about these disorders.

2. Support and treat the client and family.

1. Develop specific therapeutic goals.
2. Maintain the prescribed medication schedule.
3. Keep communication open with the health care providers; coordinate social services.
4. Include family participation and involvement in plans of care.
5. Make appropriate referrals.

3. Support efforts at parent-newborn bonding.

1. Provide support for the mother’s continued are of the newborn, if appropriate and safe for the newborn.
2. Plan for continuity of are for the mother, newborn, and family.

Exam

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Nursing Care Plan

Nursing Diagnosis

Risk for Ineffective Coping Related to Depression in response to stressors associated with childbirth and parenting.

Expected Outcome

After implementation of nursing care, client will verbalize feelings with the significant other and health care provider throughout the postpartum period.

Nursing Intervention

Intervention	Rationale
Active- listen and identify client’s perceptions of current situation.	To assess client’s coping abilities and evaluate her ability to understand present situation.
Encourage significant other (SO) to spend time with the client.	One of the best strategy to help mothers decrease their well-being during the postpartum period is conveying a caring attitude. This is demonstrated by the SO spending quality time with her.
Emphasize the need for continued communication with the partner or a close friend who is available to provide support when loneliness or anxiety becomes a problem.	Frequent contact with other adults (SO or close friend) keeps away feelings of isolation.
Encourage verbalization of fears and anxieties and expressions of feelings depression.	Allowing the client to vent out negative feelings helps meet the new mother’s psychological needs. It is important to recommend to her though, to acknowledge these ‘negative feelings’.
Discuss the realities of parenting and the fact that it may be exhausting. It may be helpful to rehearse some of the situations that may occur such as a fussy baby or being home alone.	This is a good way to help the woman develop perspective and accept her new role as a mother.
Point out infant cues and explain their meaning. Suggest measures that may enhance her sensitivity to infant cues.	Model behavior to show the mother how to respond to the infant’s cues can help her be more sensitive to her infant’s needs. This helps her feel better about herself and her ability to care for the infant.
Include the spouse in discussions about the woman’s condition. Offer practical ways the spouse can help the new mother manage the changes in their lives.	The way the spouse responds and handles the situation can affect the woman positively or negatively.
Emphasize the importance of the mother taking the medication as ordered.	Antidepressants are often used for PPD and may be continued for 6months or more.
Assist the mother and her partner in identifying people who are available to provide support.	Depression responds best to a combination of psychotherapy, social support and medication. It is important to identify other support people (apart from the spouse) to serve as the woman’s social support.