Postpartum Mood And Anxiety Disorders: A Clinician's Guide

257 Pages·2005·3.08 MB·English

by  Cheryl Tatano Beck

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POSTPARTUM MOOD
AND ANXIETY DISORDERS
A CLINICIAN’S GUIDE
Cheryl Tatano Beck
DNSc, CNM, FAAN
Professor, University of Connecticut
School of Nursing
Jeanne Watson Driscoll
PhD, APRN, BC
Principal: JWD Associates, Inc.
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ISBN-13: 978-0-7637-1649-3
ISBN-10: 0-7637-1649-9
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Library of Congress Cataloging-in-Publication Data
Beck, Cheryl Tatano.
Postpartum mood and anxiety disorders : a clinician’s guide / Cheryl Tatano Beck and Jeanne Wat-
son Driscoll.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-7637-1649-9 (pbk.)
1. Postpartum psychiatric disorders. 2. Postpartum depression. 3. Affective disorders. 4. Anxi-
ety in women. 5. Mothers—Mental health. 6. Childbirth—Psychological aspects. 7. Mother-
hood—Psychological aspects.
[DNLM: 1. Depression, Postpartum—diagnosis. 2. Depression, Postpartum—therapy.
3. Anxiety Disorders. 4. Mood Disorders. WQ 500 B393p 2006] I. Driscoll, Jeanne. II. Title.
RG850.B43 2006
618.7'6075—dc22
6406 2005007809
Printed in the United States of America
10 09 08 07 06 10 9 8 7 6 5 4 3 2
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To our mothers, Nancy Tatano and Lorraine Watson,
without whose love and support we would not be
the woman we are today.
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C
ONTENTS
1 Introduction 1
2 The Process of Assessment 5
Genetics 9
Life Events/Stressors/Responses to Them 11
Reproductive Hormonal Events 12
Differential Diagnosis 15
The NURSE Program Model of Care 17
Nourishment and Needs 17
Understanding 18
Rest and Relaxation 20
Spirituality 20
Exercise
Summary 21
3 Maternity Blues 23
Case Study: Maternity Blues 27
Assessment 28
Diagnosis 30
Kate’s NURSE Program 31
Case Study: Complicated Baby Blues 33
4 Postpartum Psychosis 45
Diagnostic Criteria for Brief Psychotic Disorder 45
Treatment 49
Case Study 50
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vi Contents
5 Postpartum Depression 57
Criteria for Major Depressive Episode 57
Introduction 58
Postpartum Depression Risk Factors 60
Epidemiology of Postpartum Depression 64
Culture 66
Phenomenology of Postpartum Depression 71
Encountering Terror 71
Dying of Self 73
Struggling to Survive 75
Regaining Control 77
Postpartum Depression: A Metasynthesis 78
Postpartum Depression Symptomatology in Adolescents 80
Postpartum Depression in Adoptive Mothers 80
Postpartum Depression in Pregnancy Loss 82
Postpartum Depression Symptomatology in Fathers 83
Postpartum Depressed Mothers’ Experiences in Interacting
with Their Children 84
The Effects of Postpartum Depression on Maternal–Infant
Interaction 90
Impact on Children’s Cognitive Development and
Emotional Behavior 93
Treatment 95
Secondary Interventions 95
Secondary Prevention Strategies: Support Groups 96
Secondary Prevention Strategies: Health Visitor Programs 100
Secondary Prevention Strategies: Interpersonal
Psychotherapy 101
Secondary Prevention Strategies: Massage and
Relaxation Therapy 102
Psychopharmacologic Treatments 102
Case Study 104
NURSE Program 111
6 The Postpartum-Depression Imposter: Bipolar II Disorder
123
Diagnostic Criteria for Bipolar II Disorder 123
Introduction 123
Assessment 129
Treatment 130
Case Study 131
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Contents vii
Nurse Program 138
7 Postpartum Anxiety Disorders 143
Panic Disorder with Postpartum Onset 143
Treatment 149
Case Study 149
Obsessive Compulsive Disorder (OCD) with a Postpartum Onset 158
Diagnostic Criteria for OCD 158
Postpartum OCD 159
Assessment 161
Treatment 162
Case Study 164
8 Posttraumatic Stress Disorder Secondary to Birth Trauma
177
Diagnostic Criteria for Posttraumatic Stress Disorder 177
PTSD Caused by Childbirth 179
Birth Trauma 182
PTSD Caused by Childbirth: The Aftermath 188
Clinical Implications Based on Cheryl’s Research 195
Treatment 196
Case Study 197
9 Screening Instruments 211
Postpartum Depression 211
Postpartum Depression Screening Scale 214
PDSS Total Scores 216
Symptom Content Scores 217
Psychometrics of the PDSS 218
Edinburgh Postnatal Depression Scale 218
Screening Women at Risk for Postpartum Depression 219
Postpartum Depression Predictors Inventory (PDPI) Revised 219
Screening for Maternity Blues 222
Screening for PTSD After Childbirth 223
Screening for Bipolar II Disorder 226
Screening for Obsessive Compulsive Disorder 227
Appendix 231
Index 235
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viii Figures and Tables
F
IGURES
Figure 2.1: The Earthquake Assessment Chart 8
Figure 3.1: The Earthquake Assessment: Kate 28
Figure 3.2: The Earthquake Assessment: Ginny 35
Figure 4.1: The Earthquake Assessment: Madison 51
Figure 5.1: The Four-Stage Process of Teetering on the Edge 72
Figure 5.2: Four Perspectives of Postpartum Depression 79
Figure 5.3: The Earthquake Assessment: Lorraine 110
Figure 6.1: The Earthquake Assessment: Reilly 137
Figure 7.1: The Earthquake Assessment: Marissa 152
Figure 7.2: The Earthquake Assessment: Lisa 170
Figure 8.1: The Earthquake Assessment: Kesha 205
T
ABLES
Table 5.1: Thirteen Significant Predictors of Postpartum Depression
from Beck’s 2001 Meta-Analysis 61
Table 5.2: International Rates of Postpartum Depression 68
Table 5.3: International Rates of Postpartum Depressive Symptoms 69
Table 5.4: Secondary Prevention for Postpartum Depression 97
Table 8.1: List of Birth Traumas 183
Table 8.2: Five Essential Themes of PTSD Caused by Childbirth 189
Table 9.1: Postpartum Depression Screening Scale: Selected Items
by Dimension 215
Table 9.2: Postpartum Depression Predictors Inventory (PDPI)—
Revised and Guide Questions for Its Use 220
Table 9.3: Blues Questionnaire: Kennerley 224
Table 9.4: Perinatal PTSD Questionnaire 225
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C 1
HAPTER
I
NTRODUCTION
In 1993, at the annual convention of the Association of Women’s Health,
Obstetrical, and Neonatal Nursing in Reno, Nevada, we (Cheryl and
Jeanne) were walking down the hall from opposite directions when our
eyes met each other’s name tag; our walking came to a halt. We were finally
going to meet, something that each of us had hoped would happen for a
long time. We were aware of the other’s experience and contributions to
women’s health. It was the meeting of kindred spirits. It was that meeting
that had set the stage for the evolution of the book that you are holding.
Over the years, we have collaborated in various facets of research and ed-
ucation. Using the metaphor of the hand and glove, we have been a perfect
fit—the researcher and the clinician. I (Cheryl) invited Jeanne to be a
member of my research team in the validation of the Postpartum Depres-
sion Screening Scale. As a result of that connection, I (Jeanne) enrolled in the
doctoral program at the University of Connecticut, with Cheryl as my major
advisor. Five years later, with my doctorate behind me, we arrive at this col-
laboration, Postpartum Mood and Anxiety Disorders: A Clinician’s Guide. The
premise of this book is the integration of research and clinical practice. This
partnership of our research program (Cheryl’s) and clinical practice
(Jeanne’s) is the cornerstone of this book. Cheryl brings to this book over 20
years of researching postpartum mood and anxiety disorders. Jeanne brings
over 24 years of clinical practice as a psychiatric clinical nurse specialist in
private practice focusing on the mental health care of women during their
reproductive years. It is the alliance of practice and research that leads to
advances in clinical practice, theory development, and policy.
1