Postpartum extreme behavior
Introduction
Introduction Postpartum extreme behavior is one of the clinical manifestations of postpartum depression. Postparturm depression (PPD) is a psychological disorder characterized by a series of symptoms such as depression, sadness, depression, crying, irritability, irritability, and even suicidal or infantile tendency after childbirth. The most common type of levy. It usually occurs 2 weeks after birth, and its cause is unknown, which may be related to genetic, psychological, childbirth and social factors.
Cause
Cause
(1) Causes of the disease
The cause of postpartum depression is more complicated, and it is generally considered to be multifaceted, but mainly the changes in postpartum neuroendocrine and psychosocial factors are related to the occurrence of this disease.
1. Biological aspects: Estrogen and progesterone increased significantly in the late pregnancy, corticosteroids and thyroxine also increased to varying degrees. After delivery, these hormones suddenly retreated rapidly, progesterone and estrogen levels decreased, leading to brain and endocrine tissue. The reduction of catecholamines affects high brain activity.
2. Social factors: family economic status, marital dissonance, housing difficulties, infant gender and health status are all important predisposing factors.
3. Maternal psychological factors: The mother is not suitable for the role of the mother, introverted, conservative and stubborn maternal disease.
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.
(two) pathogenesis
Past studies have suggested that imbalances in hormones, particularly estrogen and progesterone, may be the cause of PPD, but the exact mechanism has not yet been elucidated. High-risk factors for PPD are currently considered to include a history of depression (especially postpartum depression), a weak personality, lack of social support, bad marriage, family disputes, accidental life events, perinatal maternal and child complications, and poverty. There is a high probability that PPD will occur in people with depression during pregnancy.
Examine
an examination
Related inspection
Postpartum examination of neurological examination
All depressions that occur within 1 year postpartum are defined according to the definition of PPD, but most PPD occurs within the first 3 months of postpartum. The main symptoms of PPD are depression, tears and unexplained sadness. However, symptoms such as irritability, anxiety, 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, as well as constipation. In terms of cognition, PPD can cause inattention, forgetfulness, and lack of confidence. In more serious cases, there may also be self-esteem reduction, disappointment and conscious uselessness. In such cases, you should ask if you 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.
Postpartum women are relatively fragile, and their special mentality is temporary, changing at any time, can show postpartum depression, serious can make extreme behavior that is suicide, and even expand suicide (to commit suicide with children and partners). So correct diagnosis is very important.
Fascinating factor
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) lack of self-confidence. (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.
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 who died of perinatal morbidity had a morbid sad response, and the grief of women who had been pregnant within 5 months of the infant's death lasted longer. Therefore, medical staff should not follow traditional customs and let women replace pregnancy with gestation. In normal circumstances, how long sadness can last, different families will certainly be different. Locriw and Lewis 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 occur within the first anniversary. Now people have realized the 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 among women who want to re-pregnancy after neonatal death increases. Schlecfer found that lymphatic activation was significantly inhibited in patients with advanced breast cancer, with the strongest response occurring in the month of the unfortunate event, but mild inhibition lasted for 14 months.
2. Medical history
Should pay attention to the patient's age, pregnancy, parity, childbirth history, premenstrual tension, postpartum depression history, family history, maternal complications or complications, maternal emotional stress and other factors affecting normal mental state And whether this is the first onset, onset time and other medical history. The risk of postpartum depression in recurrence of pregnancy is high (50% to 100%). The risk of postpartum depression in non-pregnant patients with depression is 20% to 30%. Therefore, it is important to ask about the history of mental illness when asking about prenatal history. of. Prenatal screening for high-risk pregnant women who may have post-production depression requires certain inquiring skills. General physicians ask about prenatal medical history. When asking these risk factors, they should be as good as asking "How are you?"
3. Clinical manifestations
Insomnia, anxiety, irritability, sad tears, and low ability to handle things often begin after the third day after delivery. Mental depression, helplessness, and depression. Pessimistic disappointment, loss of confidence in life, shyness, loneliness, hostility and wariness towards the people around them, 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 set up by Cox et al. The EPDS consists of 10 items and is delivered 6 weeks after delivery. Each item is scored in 4 grades (0 to 3 points), and the total score plus 13 points can be diagnosed as postpartum depression.
Add the scores of each question to the total score, and the total score of 12 to 13 may have different degrees of depressive disease. 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 Self-rating Depression Scale and the Hamton Depression Scale. Combine for diagnosis. The Depression Self-Assessment Scale outlines 20 symptoms: depression, early morning and late symptoms, easy to cry, sleep disorders, loss of appetite, loss of sexual interest, weight loss, constipation, palpitations, fatigue, difficulty in thinking Feelings, feelings of decline, feelings of uneasiness, feelings of despair, irritability, feelings of difficulty, uselessness, feelings of emptiness, worthlessness, loss of interest.
In addition, symptoms of postpartum hypothyroidism include mild irritability, so patients with postpartum depression should check for thyroid function.
Diagnosis
Differential diagnosis
Mainly differentiated from puerperal psychosis. Psychiatric puerperal illness is an important mental and behavioral disorder associated with the puerperium, the vast majority occurring in the first 2 weeks after delivery, but any degree of mental illness may occur within 6 weeks after delivery. Its clinical features are insanity, acute hallucinations and delusions, depression and vaginal crossover polymorphic course and symptom variability. Psychiatric illness during the puerperium occurs most frequently within 7 days after childbirth, mainly in primipara, multi-child, and low socioeconomic women. For patients with appeal causes, incentives and symptoms, psychiatrists should be consulted to assist in the diagnosis and treatment, and general examinations and laboratory tests should be performed to eliminate mental disorders associated with serious physical and brain diseases. Minnesota's multiple personality questionnaires, 90 Symptoms Self-Assessment Scale, Self-rating Depression Scale, and Self-rating Anxiety Scale can help understand the emotional state of patients.
