Elaborate the concept and prevalence of Perinatal psychiatric health disorders (PPHD) Discuss the etiology of PPHD Describe the common PPHD Highlight the impact of PPHD Highlight the management approach of PPHD

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PERINATAL MENTAL HEALTH
Prepared
By
LucyKisaka(BSc., MSc., PhD Candidate)
7th , January 2022

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Introduction
Postpartum Period
 About 85% of women experience some type of mood disturbance.
 Most of the symptoms are mild and short-lived
 However, 10-15% of women develop more significant symptoms
of depression or anxiety.
 Postpartum psychiatric disorders are grouped into 3 categories
a) Postpartum blues (mildest)
b) Postpartum depression
c) Postpartum psychosis (most severe)

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Learning Outcomes
1. Elaborate the concept and prevalence of Perinatal
psychiatric health disorders (PPHD)
2. Discuss the etiology of PPHD
3. Describe the common PPHD
4. Highlight the impact of PPHD
5. Highlight the management approach of PPHD

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Concept of PPHD
 Perinatal psychiatric health disorders(PPHD) are illness
that commences at 22 completed weeks (154 days) of
gestation and ends 7 completed days/1 year
postpartum.
 PPHD is known to increase the risk of developing a
serious mental illness in women

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Prevalence of PMD
 Around 10% of pregnant women and 13% of
postpartum women globally experience a mental
illnesses, primarily depression.
 In developing countries: 15.6% prenatally and 19.8%
postpartum.
 In Tanzania: …………………………..Quizz

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Etiology of PPHD
 Genetic predisposition
 Sensitivity to hormonal changes
 Psychosocial factors
 Inadequate social, family, financial support
 Concurrent Stressors
 Sleep disruption
 Poor nutrition
 Health challenges
 Interpersonal stress
 Trauma

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Ruling Out Other Causes
 Post-traumatic stress disorder(PTSD)
 Birthing Trauma
 Undisclosed trauma or abuse
 ACE questionnaire
 Thyroid or pituitary imbalance
 Anemia
 Side effects of other medicines
 Alcohol or drug use/abuse
 Hormone imbalance
 Adrenal Fatigue

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Common PPHD

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Specific to childbirth
Postpartum blues
Perinatal depression
Puerperal psychosis
Bipolar affective disorder
Post-traumatic stress disorder(PTSD)
Anxiety
Panic disorder
Eating disorder

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1. Postpartum Blues
 Around 50-85% of women experience postpartum blues
during the first few weeks after their childbirth.
 Thus, makes it seems somehow a normal experience
following childbirth rather than a psychiatric illness.
 Women with the blues more commonly report mood
lability, tearfulness, anxiety or irritability.

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Activity 1
 In a group of two; Discuss the MYTH related to mental
health etiology in our context (In Tanzania)

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Postpartum Blues
 These symptoms typically peak on the 4th/5th day
postpartum and may last for a few hrs/days.
 They do not interfere with a woman’s ability to
function.
 No specific Rx is required; however, it may trigger
mood disorder, esp. in women with Hx of depression.

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Postpartum Blues
 If symptoms of depression persist for longer than
2wks, the pt should be evaluated to rule out a more
serious mood disorder.

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2. Postpartum Depression(PPD)
 It emerges over the first 2-3mo postpartum BUT may
occur at any point postpartum.
 Some women note the onset of milder depressive
symptoms during pregnancy.
 PPD is clinically indistinguishable from depression
occurring at other times during a woman’s life.

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Causes of PPD
 Rapid shift in the hormonal environment (within the first 48 hrs
postpartum, estrogen and progesterone concentrations fall
dramatically).
 Subgroup of women who are particularly sensitive to the hormonal
changes that take place postnatally thus may be more vulnerable to
PPD and to other hormonally driven mood disturbances, such as those
occurring during the premenstrual phase of the menstrual cycle or
during the perimenopause.

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 Other factors: marital dissatisfaction and/or inadequate
social supports, prenatal stressful life events
Risk factors for PPD
 Previous episode of PPD
 Prenatal Depression
 History of depression or bipolar disorder
 Recent stressful life events
 Inadequate social supports
 Marital problem

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Postpartum Depression(PPD)
 The symptoms of postpartum depression include:
 Depressed or sad mood
 Tearfulness
 Loss of interest in usual activities
 Feelings of guilt
 Feelings of worthlessness or incompetence
 Fatigue
 Sleep disturbance
 Change in appetite
 Anxiety symptoms may occur
 Poor concentration
 Suicidal thoughts

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Postpartum Depression(PPD)
 Some may develop panic attacks or hypochondriasis.
 Postpartum obsessive-compulsive disorder has also
been reported(women report thoughts of harming
their infant).
 Edinburgh Postnatal Depression Scale is a 10-item
questionnaire may be used to identify women with
PPD.

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Postpartum Depression(PPD)
 A score of 12 or > or an affirmative answer on
question 10 (presence of suicidal thoughts) raise
concern and indicate a need for more thorough
evaluation.

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3. Postpartum Psychosis
 The most severe form of postpartum psychiatric
illness.
 Rare (approx.1-2/1000 women postpartum.
 Onset of symptoms: the first 48-72 hrs postpartum.
 Most women with puerperal psychosis develop
symptoms within the first 2wks postpartum.

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Postpartum Psychosis
 Postpartum psychosis represents an episode of bipolar
illness
 Earliest signs are restlessness, irritability, and insomnia.
 Women with this disorder show a rapidly euphoric mood,
disorientation/confusion, and unpredictable/disorganized
behavior.

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Postpartum Psychosis
 Delusional beliefs are common and often center on
the infant.
 Auditory hallucinations that instruct the mother to
harm herself or her infant may also occur.
 Risk for infanticide, as well as suicide, is significant in
this population.

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4. Depression and Obsessive
Compulsive
 3%-9% of new mothers may develop obsessive symptoms
Symptoms:
 Intrusive, repetitive, and persistent thoughts or mental pictures
 Thoughts often about hurting or killing the baby
 Tremendous sense of horror and disgust about these thoughts
 Repetitive counting, checking, cleaning

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5. Postpartum panic disorder
 May occur in about 10% of postpartum women
Symptoms
 Episodes of extreme anxiety: excessive or obsessive worry or fears
 Shortness of breath, chest pain, sensations of choking or smothering, dizziness
 Hot or cold flashes, trembling, palpitations, numbness or tingling sensations
 Restlessness, agitation, or irritability
 Fear she is going crazy, dying, or losing control
 Attack may awaken her from sleep
 Often no identifiable trigger for panic

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6. Post-traumatic stress disorder
(PTSD)
 1-6% of postpartum women
Symptoms
 Recurrent nightmares
 Extreme anxiety
 Relieving past traumatic events
• Sexual
• Physical
• Emotional
• Childbirth

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7. Perinatal eating disorders
 Food becomes a problem when it is used to cope with painful
emotions, feelings and situations.
a) Anorexia Nervosa
b) Bulimia Nervosa
c) Pica

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Impact of PPHD

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Activity 2
1. Why as midwives do we bother about PMH?
2. Discuss the impact of PPHD on the following
 Pregnant women
 Newborn
 Postnatal mothers
 Fathers
 Marital relationship
 Community

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Management approach framework for PPHD
1. Identify women at increased risk of developing perinatal
conditions
2. Develop an individualized plan for a women at increased
risk
3. Ensure the prompt early detection of any illness
4. Ensure early intervention and prompt treatment

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Conclusion
 Despite several studies have reported that maternal anxiety during
pregnancy can negatively affect offspring neurodevelopment, little
attention has been given to postpartum maternal anxiety.
 This may be because of the clinical overlap between depression and
anxiety symptoms.
 Routine postpartum screening generally includes assessing symptoms
of depression but anxiety disorders are often masked.
 Educating clinicians about postpartum anxiety can be very helpful for
patients.
 Recent studies show pregnancy and childbirth are frequently
associated with the onset of the Obsessive Compulsive Disorder
(OCD), one type of anxiety disorder.

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References
 Miller ES, Hoxha D, Wisner KL, Gossett DR.The impact of
perinatal depression on the evolution of anxiety and
obsessive-compulsive symptoms. Arch Womens Ment
Health. 2015
 Miller ES, Hoxha D, Wisner KL, Gossett DR. Obsessions
and compulsions in postpartum women without obsessive
compulsive disorder. J Womens Health (Larchmt). 2015