2. INTRODUCTION
The events of pregnancy and
during delivery together with the
peak experience of giving birth, all
contribute to a mixture of
emotional reactions in the mother
during the 1st week of puerperium.
3. PSYCHOLOGICAL COMPLICATIONSTYPES
There are three distinctive types of
psychological disturbances seenin
the puerperium theyare
Postnatal blues
Postpartum depression
Puerperal psychosis
4. INCIDENCE OF PSYCHIATRIC ILLNESSDURING
PUERPERIUM
15-20%-postnatal blues
10%-postnatal
depression
0.1-0.2%-postpartum
psychosis
5. HIGH RISKFACTORS
Past history-psychiatric illness,
puerperal psychiatric illness
Family history-major psychiatricillness,
marital conflict
Present pregnancy-caesareandelivery,
difficulty labour, neonatal
complications
Others-unmetexpectations
6. POSTPARTUM BLUES
DEFINITION
A brief period of
anxiety, mood swings and
sadness which occurs in
some women after delivery
and usually resolves withina
week.
9. INTERVENTIONS
Reassurance and psychologicalsupport by
family members
Get as much sleep
Partner, family and friends should help the
mother.
Mother should take time for herself.
Don’t drink alcohol. It can affect the mood
and make feel worse.
Try to connect her with new mothers, who
have the same kind of concerns
14. CONTRIBUTING FACTORS
Experiencing stress
Low self esteem
Lack of support
Stress associated with postnatalcare
Severe maternal blues
Demands of motherhood
Loss of personal freedom
15. RISK FACTORS
Problems with baby’shealth
Major life changes aroundtime
of delivery
Lack of support or helpwith
baby
Severe premenstrual syndrome
16. CLINICAL MANIFESTATIONS
Loss of energy
Loss of Appetite
Insomnia
Social withdrawal
Irritability
Suicidal attitude
Anxiety
Excessiveguilt
Depressed mood
Fatigue
18. MANAGEMENT
Early detection and initiation ofappropriate
treatment brings bestprognosis
Less severecasescan be treated with mild
sedation orantidepressant
Counseling
Involvementof spouseand other family members
For more severe casesadmission is necessary
Serotoninuptake inhibitors are given
Breast feeding alsocan begiven to baby
19. POSTPARTUM PSYCHOSIS
Post partum psychosis is a
very serious mental conditionthat
requires immediateattention.
Postpartum psychosis isalsooneof
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 1/500to
1000 mothers. Commonly
seen in women with past
history of psychosis or with a
positive family history.
21. ONSET
Onset is relativelysudden
usually within 4 days ofdelivery.
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 emotionalsupport
Low sense of self esteem due to a
woman's postpartumappearance
Feeling inadequate as amother
Feeling isolated and alone
Financial problems
Major lifechanges
23. SIGNS OF POSTPARTUM
PSYCHOSIS
Hallucinations
Delusions
Illogical thoughts
Insomnia
Refusing toeat
Extreme feeling of anxiety andagitation
Periods of delirium ormania
Suicidal or homicidalthoughts
24. RISK FACTORS
Woman with apersonal
history of psychosis, bipolar
disorder or schizophrenia
have a increased risk of
developing postpartum
psychosis.
25. TREATMENT-PRINCIPLES
Early identification of psychoticsymptoms
Emergentevaluation
Hospitalization for safetyand acute management
Pharmacotherapy
Co ordination of care amongclinicians
Involvementof familyand othersupportsystem
forthe patient and thenewborn
Psycho education forthe patientand family
members
26. TREATMENT
Active management
Pharmacotherapy
Antipsychotic medication
Other psychotic medications-
Benzodiazepines(lorozepam &
clonazepam)
ECT-Electroconvulsive therapy
27. PREVENTION
Women with bipolar disorders
or a history of postpartum
psychosis can be identified
through screening during
prenatal care. They should be
monitored continuously forfew
weeks of postpartum.
28. NURSING MANAGEMENT
1. Listen to thewoman regarding heradjustmentto
role of mother and observe for any clinical
manifestations suggestingdepression.
2.Ask the woman about the infant's behaviour.
Negativestatementsabout the infant maysuggest
that thewoman is having difficulty coping.
3. Provide support and encourage husband, family
and friends to support and assist with the infant
and mother. Physical supportaswell asemotional
support may beindicated.
4.Educate the woman that treatment may help
alleviate hersymptomsand allow her to bettercare
for herself and infant.