IDENTIFYING AND TREATING POST PARTUM DEPRESSION (PPD): AN IMPROVED (COMPREHENSIVE ) ALGORITHM FOR HEALTH CARE PROFESSIONALS (HCP).
IDENTIFYING AND TREATING POST PARTUM DEPRESSION This paper is on a subject of postpartum depression(PPD) and a development of a comprehensive( improved) algorithm plan for health care professionals to The algorithm that can be followed as a guideline by Advanced Nurse Practitioners or Healthcare Practitioners (Physician Assistants and MD’s) and the implication for practice (prevent PPD, recognize, understand, decrease the severity by recognizing earlier on, provide a safety plan to mothers, make HCP, comfortable with diagnosing a treatment) .
I ll provide the guidelines from the instructor, a sample paper on different subject (dementia) and my research on a subject from the previous class.
This research paper has to include a nursing theoretical framework/ metaparadigm (Hildegard Peplau’s theory of interpersonal relations).
Hildegard Peplau: Four phases define Peplau’s
Interpersonal Theory or nursing. She defines the nurse/patient relationship evolving through orientation, identification, exploitation and resolution. She views nursing as a maturing force that is realized as the personality develops through educational, therapeutic, and interpersonal processes. Nurses enter into a personal relationship with an individual when a felt need is present. Peplau’s model is still very popular with clinicians working with individuals who have psychological problems.
I also have done some research and have full articles available for your use.
Please keep me updated on the outline of the paper. I ll send u my suggested outline.
Thank you
-Please follow the rubric for the class as close as possible, I ll attach the rubric to the order.
PPD ?post partum depression _ the reason, prevalence % of women suffering is more than estimated. Some cases where PPD is a cause of women losing a child during delivery ? grieving depression( death of a child), vs true PPD (where the child is with the mother, and the mother is ?supposed to be happy?)
-.Why it is important subject? In my practice as a nurse practitioner, I have noticed many women who suffer silently, not recognized postpartum depression due to lack of evaluation and health care professionals who feel uncomfortable to evaluate. ? you may put something different or expand on this.
Health care professionals(NPs, PAs, and MD?s are best situated to recognize and assist women to go thru the process and recover.
-.Differences or some information about different types of depression: prenatal depression, baby blues, postpartum depression, postpartum psychosis.
See article Identifying and Treating Maternal Depression: Strategies & Considerations for Health Plans (Final Maternal Depression)
-. review of the literature
– What is the gap in research?
THERE is NO comprehensive algorithm /protocol to follow for HCP in diagnosis and treating PPD.
I have borrowed the algorithm from major depression and adjusted it to PPD
-Related Issues: cultural, health beliefs, spirituality, ethical?
(Ex : new mothers ?supposed to feel happy? is this wrong for me to feel this way, HVCP feel uncomfortable, lack of HCP training on deal with PPD, high liability diagnosis, financial/linguistic issues(no insurance or language barrier), misconception about mental illness(eg, fear, meds are addictive))
– I ll provide the algorithm that I came up with for HCP to follow diagnosing PPD and treating it.
– Based on my research I was able to develop a comprehensive algorithm to guide HCP to decide about appropriate steps to follow with patients who present with PPD. The evidence based practice guidelines are included in the algorithm as well as the diagnostic criteria based on Diagnostic and statistical manual of mental disorders (DSMV) and ICD10 (international classification of disease 10).
% IIIIIDiagnostic Criteria
American Psychiatric Association: Diagnostic and statistical manual of mental disorders (DSM-5) [2]
DSM-5 does not recognize postpartum depression as a separate diagnosis; rather, patients must meet the criteria for a major depressive episode and the criteria for the peripartum-onset specifier. The definition is therefore a major depressive episode with an onset in pregnancy or within 4 weeks of delivery.
The DSM-5 criteria for a major depressive episode are as follows:
a) Five or more out of 9 symptoms (including at least one of depressed mood and loss of interest or pleasure) in the same 2-week period. Each of these symptoms represents a change from previous functioning, and needs to be present nearly every day:
? Depressed mood (subjective or observed); can be irritable mood in children and adolescents, most of the day;
? Loss of interest or pleasure, most of the day;
? Change in weight or appetite. Weight: 5 percent change over 1 month;
? Insomnia or hypersomnia;
? Psychomotor retardation or agitation (observed);
? Loss of energy or fatigue;
? Worthlessness or guilt;
? Impaired concentration or indecisiveness; or
? Recurrent thoughts of death or suicidal ideation or attempt.
b) Symptoms cause significant distress or impairment.
c) Episode is not attributable to a substance or medical condition.
d) Episode is not better explained by a psychotic disorder.
e) There has never been a manic or hypomanic episode. Exclusion e) does not apply if a (hypo)manic episode was substance-induced or attributable to a medical condition.
International classification of diseases 10 (ICD-10) [70]
ICD-10 also does not recognize postpartum depression as a separate diagnosis. In ICD-10 a postpartum onset is considered to be within 6 weeks after delivery. The category “Mental and behavioral disorders associated with the puerperium, not elsewhere classified” is unusual, and ICD-10 recommends that it should be used only when unavoidable. This category includes only mental disorders associated with the puerperium (commencing within 6 weeks of delivery) that do not meet the criteria for disorders classified elsewhere in this chapter, either because insufficient information is available, or because it is considered that special additional clinical features are present that make their classification elsewhere inappropriate.
ICD-10 defines a depressive episode as follows:
? In typical mild, moderate, or severe depressive episodes, the patient has a lowering of mood, reduction of energy, and decrease in activity.
? Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present.
? The lowered mood varies little from day to day, is unresponsive to circumstances, and may be accompanied by so-called “somatic” symptoms, such as loss of interest and pleasurable feelings, waking in the morning several hours before the usual time, depression worst in the morning, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of libido.
? Depending on the number and severity of the symptoms, a depressive episode may be specified as mild, moderate, or severe.
Referenced Articles
2
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.[Full Text]
https://dsm.psychiatryonline.org/book.aspx?bookid=556
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