Psychological disorders during puerperium

Psychological disorders during puerperium

1. PSYCHOLOGICAL DISORDERS DURING PUERPERIUM Mrs.Jagadeeswari.J M.Sc N

2. INTRODUCTION The events of pregnancy ,labour and during delivery together with the peak experience of giving birth all contribute to a mixture of emotional reactions in the mother during the 1 st week of puerperium.

3. PSYCHOLOGICAL COMPLICATIONS TYPES There are three distinctive types of psychological disturbances seen in the puerperium they are Postnatal blues Postpartum depression Puerperal psychosis

4. INCIDENCE OF PSYCHIATRIC ILLNESS DURING PUERPERIUM 15-20%-postnatal blues 10%-postnatal depression 0.1-0.2%-postpartum psychosis

5. HIGH RISK FACTORS Past history-psychiatric illness, puerperal psychiatric illness Family history-major psychiatric illness, marital conflict Present pregnancy-caesarean delivery, difficulty labour, neonatal complications Others-unmet expectations

6. POSTPARTUM BLUES DEFINITION A brief period of anxiety, mood swings and sadness which occurs in some women after delivery and usually resolves within a week.

7. INCIDENCE Nearly 50% of the postpartum women suffer from baby blues.

8. SYMPTOMS Unprovoked weeping Spikes of elation Irritability Anger Hostility Headache Feeling of unreality Exhaustion Sleep deprivation Restlessness

9. INTERVENTIONS Reassurance and psychological support by family members Social interventions-relative baby sitting so that the mother can get some sleep or assistance with household chores or providing instruction on newborn. Women with previous history are likely to get in subsequent pregnancies

10. POSTPARTUM DEPRESSION DEFINITION Post partum depression /Postnatal depression may seem like baby blues at first however symptoms are more intense and longer lasting eventually impacting a mothers ability to care for her baby.

11. ONSET Onset can be anytime one year after delivery and last more than 2 weeks

12. INCIDENCE It is observed in 10-20% of the postnatal mothers. Risk of reoccurrence is high(50-100%) in subsequent pregnancies

13. CAUSES Demand overload Specific etiology is unknown

14. CONTRIBUTING FACTORS Experiencing stress Low self esteem Lack of support Stress associated with postnatal care Severe maternal blues Demands of motherhood Loss of personal freedom

15. RISK FACTORS Problems with baby’s health Major life changes around time of delivery Lack of support or help with baby Severe premenstrual syndrome

16. CLINICAL MANIFESTATIONS Loss of energy Loss of Appetite Insomnia Social withdrawal Irritability Suicidal attitude Anxiety Excessive guilt Depressed mood Fatigue

17. DIAGNOSIS History collection Edinburgh postnatal depression scale Medical history Perform physical examination and lab test

18. MANAGEMENT Early detection and initiation of appropriate treatment brings best prognosis Less severe cases can be treated with mild sedation or antidepressant Counseling Involvement of spouse and other family members More severe cases admission is necessary Fluxetine or paraxetine (serotonin uptake inhibitors) Breast feeding also can be given to baby

19. POSTPARTUM PSYCHOSIS Post partum psychosis is a very serious mental condition that requires immediate attention. Postpartum psychosis is also one of the rarest usually described as a period when a woman loses touch with reality the disorder occurs in women who have recently given birth.

20. INCIDENCE Observed in about 1/500 to 1000 mothers. Commonly seen in women with past history of psychosis or with a positive family history.

21. ONSET Onset is relatively sudden usually within 4 days of delivery .Risk of reoccurrence in the subsequent pregnancy is 20-25% and there is increased risk of psychiatric illness outside pregnancy also.

22. CAUSES Lack of social and emotional support Low sense of self esteem due to a woman's postpartum appearance Feeling inadequate as a mother Feeling isolated and alone Financial problems Major life changes

23. SIGNS OF POSTPARTUM PSYCHOSIS Hallucinations Delusions Illogical thoughts Insomnia Refusing to eat Extreme feeling of anxiety and agitation Periods of delirium or mania Suicidal or homicidal thoughts

24. RISK FACTORS Woman with a personal history of psychosis, bipolar disorder or schizophrenia have a increased risk of developing postpartum psychosis

25. DIFFERTIAL DIAGNOSIS Postpartum blues Substance induced mood disorders, anaesthesia medication Psychotic disorders resulting from a general medical condition

26. TREATMENT-PRINCIPLES Early identification of psychotic symptoms Emergent evaluation Hospitalization for safety and acute management Pharmacotherapy Co ordination of care among clinicians Involvement of family and other support system for the patient and the newborn Psycho education for the patient and family members

27. TREATMENT Active management Pharmacotherapy Antipsychotic medication Other psychotic medications-Benzodiazepines( lorozepam & clonazepam ) ECT-Electroconvulsive therapy

28. PREVENTION Women with bipolar disorders or a history of postpartum psychosis can be identified through screening during prenatal care. They should be monitored continuously for few weeks of postpartum.

29. NURSING MANAGEMENT 1. Listen to the woman regarding her adjustment to role of mother and observe for any clinical manifestations suggesting depression. 2. Ask the woman about the infant's behaviour. Negative statements about the infant may suggest that the woman is having difficulty coping. 3. Provide support and encourage husband, family and friends to support and assist with the infant and mother. Physical support as well as emotional support may be indicated. 4. Educate the woman that treatment may help alleviate her symptoms and allow her to better care for herself and infant.

30. NURSING DIAGNOSIS Impaired parenting related to postnatal depression Risk for effective ineffective coping related to depression Risk for maternal role attainment related to postnatal psychosis

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