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Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
Psychiatric morbidity and pregnancy
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Psychiatric morbidity and pregnancy

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

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