Psychiatric morbidity and pregnancy


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Psychiatric morbidity and pregnancy

  1. 1. Psychiatric Morbidity And Pregnancy Dr J Romain
  2. 2. Epidemiology <ul><li>15-30% new mothers suffer from mild depression </li></ul><ul><li>10% new mothers likely to suffer with major depressive illness </li></ul><ul><li>Between 1/3- ½ will have a severe depressive illness </li></ul><ul><li>2% women see a psychiatrist within first year after delivery </li></ul><ul><li>4 in 1000 admitted to psychiatric hospital, of which 80% will be suffering from their first ever psychiatric illness </li></ul>
  3. 3. <ul><li>Majority of women suffer mild depressive illness </li></ul><ul><li>Little evidence that this is more common than in the general population </li></ul><ul><li>Risk of developing severe mental illness- puerperal psychosis or severe depression is increased by 16-fold, particularly in the first 3 months post partum </li></ul>
  4. 4. Importance of Psychiatry <ul><li>Substantial Morbidity- leading overall cause of maternal mortality in CEMACH’s ‘Why Mothers Die’ 2000-2002 </li></ul><ul><li>Effective treatment </li></ul><ul><li>Adverse consequences </li></ul><ul><li>Predict risk </li></ul><ul><li>Regular medical contact </li></ul><ul><li>Prevention </li></ul>
  5. 5. Risk Factors for Mild Depression <ul><li>Tend to be psychosocial </li></ul><ul><li>Single (unsupported) </li></ul><ul><li>Young </li></ul><ul><li>Short Interval </li></ul><ul><li>Early deprivation </li></ul><ul><li>Chronic life difficulties </li></ul><ul><li>Society adversity trend </li></ul><ul><li>Past psychiatric hx </li></ul><ul><li>Prior social services involvement </li></ul><ul><li>Life Events </li></ul>
  6. 6. Risk Factors for Serious Mental Illness <ul><li>Often biological </li></ul><ul><li>Primiparity (especially if had a c-section) </li></ul><ul><li>Past psychiatric history (1 in 3-5 risk) </li></ul><ul><li>Family psychiatric history (1 in 3 risk) </li></ul>
  7. 7. Baby ‘Blues’ <ul><li>Majority of women experience some alteration in their mental state between days 3-10. Progesterone dropping. </li></ul><ul><li>Commonly day 5 </li></ul><ul><li>Low, tearful and labile mood, irritability, insomnia. </li></ul><ul><li>Bouts of despair and catastrophizing </li></ul><ul><li>Usually only lasts 48hrs </li></ul><ul><li>Responds to kindness and reassurance </li></ul>
  8. 8. Mild Postnatal Depression <ul><li>At least 7% women meet the criteria </li></ul><ul><li>Vulnerable ‘at risk’ women </li></ul><ul><li>Insidious onset in 1 st week, present 3 months – year via health visitor </li></ul><ul><li>Tearful, difficulty coping, unsatisfied with motherhood, anxiety, phobia’s, loneliness and isolation </li></ul><ul><li>Treatment with counselling (6 weekly) and social support </li></ul>
  9. 9. Severe Major Postnatal Depresssion <ul><li>Affects between 3-5% of women </li></ul><ul><li>Onset in first 2 weeks but can be up to 12 weeks, peak between 2-4, 10-14 </li></ul><ul><li>Biological symptoms; early morning wakening, impaired appetite, concentration and interests, anhedonia </li></ul><ul><li>Mood profoundly low, guilt and incompetent </li></ul><ul><li>Treatment; antidepressants (SSRI’s, tricyclics) need to be continued for 6 months after recovery. Counselling. Good prognosis </li></ul><ul><li>Risk of relapse; 1 in 2 for future pregnancies outside childbirth risk of depression is low </li></ul>
  10. 10. Puerperal Psychosis <ul><li>Abrupt onset 80% 3-14 days, rapidly deteriorates </li></ul><ul><li>Likened to manic-depressive or bipolar affective disorder </li></ul><ul><li>Restless agitation, perplexity, confusion, fear and suspicion, delusions about themselves and their baby </li></ul><ul><li>Many experience first-rank schizophrenic hallucinations and delusions </li></ul><ul><li>Treatment; urgent referral to psychiatrist +/- admission to mother and baby unit. If severe; ECT. </li></ul><ul><li>Recovery 2-6wks, cont. meds for 6 months, Risk of 1 in 2 during subsequent pregnancies. Advised to delay 2 yrs for next baby </li></ul>
  11. 11. Adverse Sequelae of PND <ul><li>Immediate- physical morbidity </li></ul><ul><li> suicide/infanticide </li></ul><ul><li> prolonged psychiatric morbidit </li></ul><ul><li> social bond mother-baby </li></ul><ul><li> emotional development </li></ul><ul><li>Later- social-cognitive affects child </li></ul><ul><li> psychiatric morbidity child </li></ul><ul><li> marital breakdown </li></ul>
  12. 12. Prevention <ul><li>High risk patients (previous psychiatric history, family history) picked up early in pregnancy </li></ul><ul><li>Monitored closely; seen in hospital clinics and by psychiatrist if necessary- prophylactic meds </li></ul><ul><li>Long term follow up postnatally </li></ul>
  13. 13. <ul><li>Thankyou! </li></ul>