- Maternal mental illness - Mental illness in pregnancy - Types of mental illness - Depression in pregnancy - Postpartum Illness - Management of mental illness in pregnancy

1. Mental Illness in
Pregnancy
Prepared by: Nabina Bhasima
Bsc.Nursing 3rd year

2. Overview
- Maternal mental illness
- Mental illness in pregnancy
- Types of mental illness

3. Maternal Mental Health
• ‘‘A state of wellbeing in which a mother
realizes her own abilities, can cope with the
normal stresses of life, can work productively
and fruitfully and is able to make a
contribution to her community’’
-WHO

4. Maternal mental Illness
• Mental Illness in pregnancy
Pregnancy and the postnatal period are critical
times of psychological adjustment for women,
and there is increasing evidence that a woman’s
mental state during this time influences both
obstetric outcomes and the future development
of the infant, affect other children in the family,
as well as the woman’s partner and their
relationship.

5. Contd…
• A woman with mental illness often does not
have the strength or desire to adequately care
for herself or her developing baby.
• Ex: Babies born to mothers who are
depressed may be less active, show less
attention and be more agitated than babies
born to moms who are not depressed

6. Contd…
• Mental Illness that is not treated can have
potential dangerous risks to the mother and
baby.
• For example, depression and anxiety are
associated with preeclampsia, preterm labor
and delivery, operative delivery, low birth
weight, admission to a neonatal intensive care
unit, intrauterine growth retardation and birth
complications

7. Contd..
• Mental illness Can lead to poor nutrition,
drinking, smoking, and suicidal behavior,
premature birth, low birth weight, and
developmental problems

8. Risk Factors Maternal Mental
illness
• Previous history of depression
• Discontinuation of medication(s) by a woman
who has a History of depression
• Family history of depression
• Negative attitude toward the pregnancy
• Lack of social support

9. Contd..
• Losing a baby
• Having a baby as a teen
• Poverty
• Unintended pregnancy
• Childcare stress
• Marital or partner-related conflict
• Limited social support

10. Signs and Symptoms
1. Insomnia or hypersomnia
2. Reduced interest, loss of pleasure
3. Guilt
4. Mental and physical fatigue

11. Contd..
5. Distractibility, memory disturbance
6. Decreased or increased appetite
7. Psychomotor retardation or agitation
8. Suicidal thoughts, plans, behaviours

12. Prevalence of psychiatric disorders
• National Survey of Mental Health and Wellbeing-
women (2016)
• Any mental disorder 22.3%
• Anxiety disorder 17.9%
• Mood disorder 7.1%
• Substance abuse disorder 5.1%
• Low prevalence disorders
• Psychosis 0.5%
• Bipolar disorder 1-2%

13. Types of Mental Illness/Psychiatric
Issues
• Depression Disorder
• Anxiety Disorder
• Panic Disorder
• Psychosis
• PTSD (Post Traumatic Stress Disorder)
• Eating Disorders
• Cognition
• Substance Use

14. Depression
• Depression is the most common psychiatric
disorder associated with pregnancy.
• 44% had their first episode of major
depression during pregnancy

15. Symptoms of depression
Normal depression Pregnancy
Sadness
Loss of interest
Sleep disturbances
Weight loss/gain
Guilt,worthlessness
Thoughts of death
Appetite disturbances
Fatigue
Sleep disturbances
Weight gain
Appetite disturbances
Fatigue

16. Contd..
• The symptoms of depression and normal pregnancy
overlap. Identification and diagnosis of major
depression is difficult without proper screening and
evaluation.
• 50% of women have undiagnosed depression in a
obstetric/gynecology clinic.
• The rate of detection may be as low as 0.8% among
pregnant women.

17. Depression and the mother
Women with prenatal depression have:
• Poor prenatal care and health behaviours
• Poor weight gain and nutrition
• Fatigue and loss of functioning
• Disturbed sleep
• Use of drugs including cigarettes and drugs

18. Impacts of untreated depression in
pregnancy
1. Spends more time in sleep and exhibits less body
movement than foetus of non-depressed mother.
2. Reduced foetal heart rate response to
vibroacoustic stimulation.
3. Increased frequency of intrauterine growth
retardation.

19. Contd…
4. Increased rates of spontaneous preterm birth
(37 weeks gestation ) risk increases with
increasing severity of depression.
5. Mean gestational age: 29.5 weeks
6. Smaller head circumference, lower APGAR
scores, admission to NICU

20. Treatment
• SSRI medication: Fluoxetine and sertraline

21. 2. Obessive Compulsive disorder
• Women tend to report obsessions pertaining
to cleaning and washing. In contrast, females
with postpartum OCD have shown obsession
thoughts of causing any kind of harm to
baby.
• In some women it can be transitory whereas
in others it can be repetitive.

22. 3. Panic Disorder
• Current evidence suggests that pregnancy
doesnot offer any protection for panic symptoms
and anxiety, and the risk increases further in
postpartum period.
• Cognitive behavioural therapy remains the
treatment of choice for panic disorder during
pregnancy.
• Medications: Benzodiazepines
SSRIs

23. 4. Bipolar Mood Disorder
• Treatment bipolar disorder during pregnancy
is clinically challenging.
• Many primary mood stabilizers are
associated with increased risk of congenital
malformations; however, stopping treatment
during pregnancy may increase the risk of
release.

24. Contd…
• The drugs used for BPAD include:
- Valproic acid
- Lithium
- Carbamazepine
- Lamotrigine

25. Psychiatric disorder during
postpartum period
1. Postpartum depression
• It is observed in 10-20% of pregnant mother
• It is more gradual in onset over the first 4-6 months
following delivery or abortion.
• Manifested by loss of energy and appetite;
insomnia, social withdrawal, irritability and even
suicidal attitude.
• Risk of recurrence is high (50-100%) in subsequent
pregnancies.

26. Treatment
• SSRIs (Fluoxetine, paroxetine) is effective and
has fewer side effects.
• Oestrogen patch has also been used.
• Prognosis is good.

27. 2. Puerperal Blues
• It is transient state of mental illness observed 4-5
days after delivery and its lasts for few days.
• Nearly 50% of postpartum women suffer from the
problem.
• Manifestation : Depression, Anxiety, tearfulness,
insomnia, helplessness and negative feelings
towards the infant.

28. Contd…
• No specific metabolic and endocrine
abnormalities have been detected.
• Treatment is reassurance and psychological
support by the family members.

29. 3. Postpartum
Psychosis(Schizophrenia)
• Observed in about 0.14-0.26% of mothers
• Commonly seen in women with past history of
psychosis or with a positive family history.
• Onset is relatively sudden usually within 4 days
of delivery.

30. Contd…
• Manifested by: Fear, restlessness, confusion
followed by hallucinations, delusions and
disorientation (usually manic or depressive)
• Psychotic women may have delusion
• Sucidal, infanticidal impulses may be present.
• In that case temporary separation and nursing
supervision is needed.

31. Management
1. Psychiatric consultation
2. Hospitalization
3. Chlorpromazine 150mg stat and 50-150mg
three times a day is started.
4. Sublingual estradiol 91mg thrice daily) results
in significant improvement.

32. Contd…
5. Electroconvulsive therapy is needed if it
remains unresponsive or in depressive
psychosis.
6. Lithium is indicated in manic depressive
psychosis. In that case, breast feeding is
contraindicated.

33. Nursing interventions
1. Develop a relationship and monitor suicide risk.
2. Ask if the woman and her partner (if relevant )
have a history of mental health problems and how
they are currently managing.
3. Provide education about the ‘normal’ feeling
experienced in the usual antenatal and postnatal
circumstances.

34. Contd…
4. Provide realistic expectations for parenting
and self-care.
5. Provide information about the attachment
needs of the infant and the importance of the
parental role meeting these needs.

35. Contd..
6. Reassure the woman and her family.
7. Help the person and her partner to identify the
parental role issues that may be impacted on by the
mental illness.
8. Recognition of symptoms and intervention early in
the pregnancy may improve postpartum outcomes.

36. Prevention
1. Identify high- risk sample.
2. Educate women and their partners about the
practical and emotional support necessary for
parenting.
3. Provide training for health professionals
about the nature and effects of childbirth-
related to mental health problems.

37. Contd..
4. Pre-conceptual counselling for couples.
5. Antenatal visits
6. Advise women and men about which
symptoms to observe and act upon promptly.
7. Structured teaching and supportive
counselling programs.

38. Contd…
8. Importance of healthy, balanced diet should
be explained.
9. Importance of mutual love, positive
relationships, dietary importance, and
continuation of drugs during pregnancy and
postpartum should be emphasized.

39. References
•Book References
“D.C Dutta”,”Textbook of Obstetrics”, Revised 7th
Edition, jaYpee publication, page no: 442-443
“R. sreevani”,”A guide to mental health and
psychiatric Nursing”, 4th Edition, Jaypee publication,
page no: 392-395
“Current”,”Obstetric and Gynecologic Diagnosis and
treatment”,8th Edition, Appleton and Lange, Page no:
472-473
“LIvingStone C.C”,”Aids to obstetrics and
gynaecology”,4th Edition, Gordon. M. Strirrat, page
no: 241-243

40. Net references
NHS.Mental health problems and pregnancy. Available
from URL (https://www.nhs.wk) 2018/04/04
Royal college of psychiatrists. Mental health in pregnancy.
Available from https://www.rcpsych.ac.uk) 2016/10/07
Health direct. Mental wellbeing during pregnancy.
Available from (https://www.pregnancybirthbaby.org.au)
October 2017

41. Thank you