postpartum depression
Introduction
Introduction to postpartum depression Postparturm depression (PPD) refers to a maternal mental disorder characterized by a series of symptoms such as depression, sadness, depression, crying, irritability, irritability, and even suicidal or infantile tendency after childbirth. One of the most common types. It usually occurs 2 weeks after birth, and its cause is unknown, which may be related to heredity, psychology, childbirth and social factors. basic knowledge The proportion of illness: 0.004% Susceptible population: pregnant women with 4 to 6 weeks of labor Mode of infection: non-infectious Complications: depression
Cause
Causes of postpartum depression
Psychological factors (30%):
1. Because perfectionism women are too high or unrealistic about their mother's expectations after childbirth, and they are unwilling to seek help when they are in trouble, they may not be able to adapt to being a new mother. And if the husband rarely takes care of the children together or the women lack the spiritual support of the husband, they will feel tremendous pressure. 2. There have been serious emotional fluctuations during pregnancy, such as moving, having relatives and friends, or war, etc. will make pregnant women more likely to produce postpartum depression. Many cases have shown that most women have already shown signs of postpartum depression during pregnancy, and many of them will continue to deepen postpartum depression.
Endocrine (25%):
During the process of pregnancy and childbirth, the endocrine environment of the body has undergone great changes, especially within 24 hours after birth, the rapid change of hormone levels in the body is the biological basis of postpartum depression. The study found that the release of placental steroids before delivery reached the highest value, and the patient showed a pleasant mood; the patient showed depression when the secretion of placental steroids suddenly decreased after secretion.
Genetics (20%):
A family history of mental illness, especially in women with a family history of depression, has a high incidence of postpartum depression, suggesting that family inheritance may affect a woman's susceptibility to depression and her personality. The literature also reported that both twins' self-study studies confirmed that the incidence of single and two-way affective disorder was higher in the family of postpartum depression patients.
The relationship between postpartum depression and postpartum depression is still unclear. People with postpartum depression do not necessarily develop postpartum depression, but those with postpartum depression have an increased likelihood of postpartum depression. It is also possible that some postpartum depression is The heavier type of postpartum depression, or the outcome of postpartum depression.
Pathogenesis
Past studies have suggested that imbalances in hormones, especially estrogen and progesterone, may be the cause of PPD, but the exact mechanism has not yet been elucidated. It is currently believed that the risk factors for PPD include a history of depression (especially postpartum depression), a weak personality, and a lack of Social support, bad marriage, family disputes, accidental life events, perinatal maternal and child comorbidities and poverty, etc. There is a high probability of developing PPD in patients with depression during pregnancy.
Prevention
Postpartum depression prevention
Because all primary PPD precautions are unsuccessful, PPD prevention relies on secondary prevention, early detection and early treatment, routine self-questioning, such as self-evaluation using the Edinburgh Postnatal Depression Rating System (EPDS), for discovery and Diagnosing PPD is very helpful, EPDS has been translated into Chinese and issued, and is effective in research and clinical practice.
Psychological intervention according to various maternal psychological factors or risk factors will help reduce the incidence of PPD.
1. Strengthen the health care during pregnancy, pay attention to the counseling and guidance of pregnant women's mental health, monitor the bad personality, previous PPD history or family history, screen for high-risk pregnant women with mental symptoms, and monitor the necessary interventions, and pay attention to running a good pregnant school and encourage Pregnant women and their husbands come to class to learn about pregnancy and childbirth, to understand the process of childbirth and the combination of relaxation techniques and midwifery during childbirth, to eliminate the negative emotions of nervousness and fear.
2. Improve the childbirth environment, establish a family-based delivery room to replace the previous closed-type delivery room, improve the maternal understanding of the natural process of childbirth, carry out a guided delivery, accompanied by a husband or other relatives after labor, can reduce their complications and The occurrence of psychological abnormalities.
3. Pay attention to the health care during puerperium, especially the maternal mental health care. For women who have long delivery time, dystocia or have adverse pregnancy outcomes, they should give priority psychological care, pay attention to protective medical treatment, avoid mental stimulation, implement maternal and child room, and encourage breastfeeding. Feeding, and do a good job in the health care of newborns, reduce the physical and psychological burden of the mother, and counsel the maternal family to do a good job in maternal and neonatal health care during the puerperium. For those who have had a history of mental depression or have emotional depression Adequate attention, timely identification, and appropriate treatment to prevent postpartum depression.
4. Perinatal health care should pay attention to active medical services, master maternal psychological characteristics and psychological counseling skills, improve service skills and quality, and pay attention to maternal psychological health care during the perinatal period.
Complication
Postpartum depression complications Complications depression
Irritability, horror, anxiety, depression, and excessive anxiety about themselves and their babies often lose their ability to take care of themselves and care for their babies, sometimes getting into trouble or lethargy.
Symptom
Symptoms of postpartum depression Common symptoms Postpartum extreme behavioral anxiety Thinking of spleen postpartum No milk secretion Depressed qi stagnation Constipation Forgetful thyroid function Hypothesis sedative poisoning
According to the definition of PPD, all depressions that occur within 1 year after birth are included, but most of the PPD occurs within the first 3 months after delivery. The main symptoms of PPD are depression, tears and unexplained grief, but irritability, anxiety. Symptoms such as fear and panic are also common in mothers with depression. Lack of motivation and boredom are also important related symptoms. Active neurological symptoms of PPD include low appetite, weight loss, early sleep, fatigue and fatigue. Constipation, in terms of cognition, PPD can cause inattention, forgetfulness and lack of confidence. In more serious cases, there may be self-esteem reduction, disappointment and conscious uselessness. For such cases, you should ask whether they have An attempt to commit suicide.
Its main performance is depression, more than 2 weeks postpartum, and symptoms are obvious 4 to 6 weeks after delivery.
Examine
Postpartum depression check
Auxiliary examination: physical examination and psychological testing.
1. Physical examination refers to the detection and measurement of human body morphological structure and functional development level. Its contents include: (1) history of exercise and disease history; (2) measurement of morphological indicators; (3) physiological function test; (4) determination of body composition; (5) special examination (assay, x-ray, ECG, EEG) , myoelectric, echocardiography, muscle acupuncture biopsy, etc.).
2. Psychological Test is a relatively advanced test method. It refers to a science that measures the difference between individual psychological factors and individual psychological differences through a series of means to quantify some human psychological characteristics. Measurement methods.
Diagnosis
Diagnosis and diagnosis of postpartum depression
Diagnostic criteria
Postpartum women are more fragile, their special mentality is temporary, change at any time, can show postpartum depression, serious can make extreme behavior that is suicide, and even expand suicide (to commit suicide with children, partners), so the correct diagnosis is very important.
1. Possibility factors Posner and other studies have shown that the following manifestations should be brought to the attention of physicians, such pregnant women are prone to post-production depression:
(1) <20 years old.
(2) Unmarried.
(3) Not familiar with medical knowledge.
(4) From a family with multiple brothers and sisters.
(5) The separation of children or adolescence from either or both parents.
(6) Childhood is rarely supported and cared for by parents.
(7) Adulthood is rarely supported by parents.
(8) Poor relationship with husband or boyfriend.
(9) There are economic difficulties in housing or income.
(10) Dissatisfaction with the level of education.
(11) There are emotional problems in the past or now.
(12) Insufficient self-confidence.
In addition, maternal postpartum depression is more common and more severe in families with perinatal deaths. Rowe et al found that 6 of 26 patients with perinatal deaths developed a pathological sad reaction, 5 in infant deaths. Women who are pregnant within a month have a longer sorrowful mood, so medical staff should not follow traditional customs and let women re-pregnancy to replace dead babies. Under normal circumstances, how long sadness can last, different families will definitely In contrast, Locriw and Leiis studied 26 women with a history of stillbirth, and most of them underwent a 2-year follow-up. The data showed that sadness lasted about 18 months in this case and continued to appear in the first anniversary. Now, people have realized that physical discomfort caused by grief, such as nausea, fatigue, weakness, and other psychological manifestations have also been reported. The incidence of spontaneous abortion and infertility increased among women who want to re-pregnancy after neonatal death. Schlecfer found a short-term period. Lymphatic activation is significantly inhibited in patients with breast cancer, and the strongest response occurs mostly in the month of the unfortunate event, but mild The inhibition lasts for 14 months.
2. History: should pay attention to the patient's age, pregnancy, parity, childbirth history, premenstrual tension, postpartum depression history, family history, maternal comorbidities or complications, maternal emotional stress, etc. The mental state factor and whether this is the first onset, the onset time and other medical history, the risk of postpartum depression in recurrence of pregnancy is high (50% to 100%), and the risk of postpartum depression in patients with non-pregnancy depression is 20%~ 30%, so it is very important to ask about the history of mental illness when asking about prenatal medical history. Prenatal screening for high-risk pregnant women who may have post-production depression needs certain inquiry skills. General physicians ask about prenatal medical history and ask these questions. When it comes to risk factors, it should be as good as asking "How are you?"
3. Clinical manifestations: often insomnia, anxiety, irritability, sad tears, low ability to deal with things, mental depression, helplessness, depression, pessimistic disappointment, loss of confidence in life, shyness, loneliness, right after the third day after childbirth The people around them are full of hostility and wariness, and there are obstacles in the coordination of the relationship between husband and family, often accompanied by headaches, loss of appetite, and rapid breathing.
4. Physical examination: No specific positive findings based on physical signs and laboratory tests.
5. Psychological test: There is no specific questionnaire for screening for postpartum depression, but it is commonly used in obstetric work to assist in the diagnosis of postpartum depression.
(1) Edinburgh Edinburgh postnatal depression scale (EPDS).
(2) Self-rating depression scale.
(3) Hamiltons Rating Scale for Depression (HRSD).
(4) 90 symptom self-rating scales (Symptom checklist-90, SCL-90), and other psychological scales, which contribute to the diagnosis of this disease.
At present, the Edinburgh Postpartum Depression Scale established by Cox et al. is included in the EPDS. The EPDS consists of 10 items, which are performed 6 weeks after delivery. Each item is graded 4 (0 to 3 points), and the total score is 13 points. Can be diagnosed as postpartum depression.
Add the scores of each question to the total score. The total score of 12-13 may have different degrees of depressive diseases. This scale cannot be used to detect mothers with anxiety neurosis, phobia or personality disorder. (CoxJL, Holden JM, Sagovsky R. 1987) He Jing et al. used the Depression Self-Assessment Scale in combination with the Hamton Depression Scale for diagnosis. The Depression Self-Assessment Scale has 20 symptoms: depression, morning and evening symptoms. Light, easy to cry, sleep disorder, loss of appetite, loss of sexual interest, feeling of weight loss, feeling of constipation, feeling of guilt, feeling tired, feeling hard, feeling of loss, feeling of restlessness, feeling of despair, irritability, decision Difficulties, uselessness, emptiness in life, sense of worthlessness, loss of interest.
In addition, symptoms of postpartum hypothyroidism include mild irritability, so patients with postpartum depression should check for thyroid function.
Differential diagnosis
Mainly differentiated from puerperal psychosis, puerperal psychosis is an important mental and behavioral disorder related to puerperium. The vast majority occur in the first 2 weeks after delivery, but any degree of mental illness may occur within 6 weeks after delivery. The clinical features are insanity. Acute hallucinations and delusions, polymorphic course and symptom variability of depression and mania, and puerperal psychiatric illnesses occur most frequently within 7 days after delivery, mainly in older primiparas, multiple children, low socioeconomic women, and appeals Patients with causes, incentives and symptoms should consult a psychiatrist for diagnosis and treatment. They should also perform a general examination and laboratory examination to eliminate mental disorders associated with serious physical and brain diseases. Minnesota's multiple personality questionnaires, 90 symptoms. Self-rating scales, self-rating depression scales, and self-rating anxiety scales can help to understand the emotional state of patients.
