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Ms. Mandeep Kaur
Associate Professor
OBG
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.
PSYCHOLOGICAL COMPLICATIONSTYPES
There are three distinctive types of
psychological disturbances seenin
the puerperium theyare
Postnatal blues
Postpartum depression
Puerperal psychosis
INCIDENCE OF PSYCHIATRIC ILLNESSDURING
PUERPERIUM
15-20%-postnatal blues
10%-postnatal
depression
0.1-0.2%-postpartum
psychosis
HIGH RISKFACTORS
 Past history-psychiatric illness,
puerperal psychiatric illness
 Family history-major psychiatricillness,
marital conflict
 Present pregnancy-caesareandelivery,
difficulty labour, neonatal
complications
 Others-unmetexpectations
POSTPARTUM BLUES
DEFINITION
A brief period of
anxiety, mood swings and
sadness which occurs in
some women after delivery
and usually resolves withina
week.
INCIDENCE
Nearly 50% of the
postpartum women
suffer from baby blues.
SYMPTOMS
 Unprovokedweeping
 Spikes of elation
 Irritability
 Anger
 Hostility
 Headache
 Feeling of unreality
 Exhaustion
 Sleepdeprivation
 Restlessness
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
POSTPARTUM DEPRESSION
DEFINITION
Post partumdepression
/Postnatal depression mayseem
like baby blues at first however
symptoms are more intense and
longer lasting eventually
impacting a mothers ability to
care for herbaby.
ONSET
Onset can beanytime
one year after delivery and
last more than 2weeks
INCIDENCE
It is observed in10-20%
of the postnatal mothers.
Risk of reoccurrence is
high(50-100%) insubsequent
pregnancies
CAUSES
Demand overload
Specific etiology isunknown
CONTRIBUTING FACTORS
 Experiencing stress
 Low self esteem
 Lack of support
 Stress associated with postnatalcare
 Severe maternal blues
 Demands of motherhood
 Loss of personal freedom
RISK FACTORS
Problems with baby’shealth
Major life changes aroundtime
of delivery
Lack of support or helpwith
baby
Severe premenstrual syndrome
CLINICAL MANIFESTATIONS
 Loss of energy
 Loss of Appetite
 Insomnia
 Social withdrawal
 Irritability
 Suicidal attitude
 Anxiety
 Excessiveguilt
 Depressed mood
 Fatigue
DIAGNOSIS
History collection
Edinburgh postnatal depression
scale
Medical history
Perform physical examination
and lab test
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
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.
INCIDENCE
Observed in about 1/500to
1000 mothers. Commonly
seen in women with past
history of psychosis or with a
positive family history.
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.
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
SIGNS OF POSTPARTUM
PSYCHOSIS
 Hallucinations
 Delusions
 Illogical thoughts
 Insomnia
 Refusing toeat
 Extreme feeling of anxiety andagitation
 Periods of delirium ormania
 Suicidal or homicidalthoughts
RISK FACTORS
Woman with apersonal
history of psychosis, bipolar
disorder or schizophrenia
have a increased risk of
developing postpartum
psychosis.
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
TREATMENT
 Active management
 Pharmacotherapy
 Antipsychotic medication
 Other psychotic medications-
Benzodiazepines(lorozepam &
clonazepam)
 ECT-Electroconvulsive therapy
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.
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.
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psychological disorders during puerperium.pptx

  • 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.
  • 7. INCIDENCE Nearly 50% of the postpartum women suffer from baby blues.
  • 8. SYMPTOMS  Unprovokedweeping  Spikes of elation  Irritability  Anger  Hostility  Headache  Feeling of unreality  Exhaustion  Sleepdeprivation  Restlessness
  • 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
  • 10. POSTPARTUM DEPRESSION DEFINITION Post partumdepression /Postnatal depression mayseem like baby blues at first however symptoms are more intense and longer lasting eventually impacting a mothers ability to care for herbaby.
  • 11. ONSET Onset can beanytime one year after delivery and last more than 2weeks
  • 12. INCIDENCE It is observed in10-20% of the postnatal mothers. Risk of reoccurrence is high(50-100%) insubsequent pregnancies
  • 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
  • 17. DIAGNOSIS History collection Edinburgh postnatal depression scale Medical history Perform physical examination and lab test
  • 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.