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PND,please discuss

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A women who is 33 wks pregnent presents with anxiety symptoms.In her last pregnency she lost the baby because of complications during delivery.How will you manage?

What is the difference between berevement and post natal depression.

Would you advice CS if she remains worried about vaginal delivery?

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1. Make sure the patient is safe

2. Collateral h/o from relatives, past psy and medical notes, specialist services involved

3. Will see her at OPD or hospital; make sure patient knows she has been referred; why the referral now - confirm with referrer

3. DD - Normal anxiety - she has had a past experience, natural to be anxious

Axis 1 - Anxiety d/s; Mood disorder; Psychotic; Substance/ drug use

4. H/o to rule out various axis 1;

medical h/o to know why she lost her previous child;

how she coped then and the state of her pregnancy now...

In social h/o - support and pressure from partner or family...

5. Management of risk and underlying disorder -

Just allay anxiety - by educating her - going thru the risks and chances of another miscarriage

Medical/ Psychosocial - same principles as treating someone during pregnancy - treating 2 people - so be careful - pregnancy, delivery and post natal...

Psychosocial - CBT; counselling; supportive psychotherapy

Support after the delivery - to be arranged - as there is some evidnce to say that anxiety and depression during pregnancy are important risk factors for PND.

Answers to probes:

1. Bereavement is the process by which we overcome/ sail thru our grief - there is a loss - low mood; would not fulfil the criteria for MDD; comes and goes in waves; and goes thru the SABDA stages... may need counselling; support; may need antidepressants if depressed

PND - there may not be a loss... starts 4 to 6 weeks usually; severe symptoms; associated with HHW and suicideal ideation; biological smptoms...

definite biological treatment including ECTs...

2. Decision about the mode of delivery is for the patient to make... on an informed choice... we discuss the risks.... and they decide...

There is some evidence to say that complicated labour and death of the infant may increase the chance of PND.

There is some evidence to say that patients with CS get more support after the pregnancy... but whether this will have effect on symptoms after birth especially if the child is still born is difficult to say

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Thank you Dorian.

HHW -Hopelessness,helplessness and Worthlessness.Am I right ?

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