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psychological disorders during puerperium.pptx

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psychological disorders during puerperium.pptx

  1. 1. Ms. Mandeep Kaur Associate Professor OBG
  2. 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. 3. PSYCHOLOGICAL COMPLICATIONSTYPES There are three distinctive types of psychological disturbances seenin the puerperium theyare Postnatal blues Postpartum depression Puerperal psychosis
  4. 4. INCIDENCE OF PSYCHIATRIC ILLNESSDURING PUERPERIUM 15-20%-postnatal blues 10%-postnatal depression 0.1-0.2%-postpartum psychosis
  5. 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. 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. 7. INCIDENCE Nearly 50% of the postpartum women suffer from baby blues.
  8. 8. SYMPTOMS  Unprovokedweeping  Spikes of elation  Irritability  Anger  Hostility  Headache  Feeling of unreality  Exhaustion  Sleepdeprivation  Restlessness
  9. 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. 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. 11. ONSET Onset can beanytime one year after delivery and last more than 2weeks
  12. 12. INCIDENCE It is observed in10-20% of the postnatal mothers. Risk of reoccurrence is high(50-100%) insubsequent pregnancies
  13. 13. CAUSES Demand overload Specific etiology isunknown
  14. 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. 15. RISK FACTORS Problems with baby’shealth Major life changes aroundtime of delivery Lack of support or helpwith baby Severe premenstrual syndrome
  16. 16. CLINICAL MANIFESTATIONS  Loss of energy  Loss of Appetite  Insomnia  Social withdrawal  Irritability  Suicidal attitude  Anxiety  Excessiveguilt  Depressed mood  Fatigue
  17. 17. DIAGNOSIS History collection Edinburgh postnatal depression scale Medical history Perform physical examination and lab test
  18. 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. 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. 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. 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. 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. 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. 24. RISK FACTORS Woman with apersonal history of psychosis, bipolar disorder or schizophrenia have a increased risk of developing postpartum psychosis.
  25. 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. 26. TREATMENT  Active management  Pharmacotherapy  Antipsychotic medication  Other psychotic medications- Benzodiazepines(lorozepam & clonazepam)  ECT-Electroconvulsive therapy
  27. 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. 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.

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