The document discusses psychological disturbances during the puerperium, highlighting risks for women with psychiatric disorders, including conditions such as postpartum blues, postpartum depression, and puerperal psychosis. It outlines various factors contributing to these disorders, symptoms, and management options, emphasizing the importance of early detection and treatment. Medical interventions may include medications, psychotherapy, and social support, while addressing the serious impact of postpartum psychological issues on maternal well-being.

1. PSYCHOLOGICAL DISTURBANCES
IN THE PUERPERIUM

2. INTRODUCTION
Women with psychiatric disorders are at
elevated risks of cesarean delivery, placental
abruption, pre-term delivery, PROM,
Hemorrhage, FGR, Fetal distress, and even fetal
death.

3. HIGH RISK FACTORS FOR POSTPARTUM
DEPRESSIVE DISORDERS (PPDD)

4. FACTORS
• Past History
• Family History
• Marital Conflict
• Poor social Situation
• Young age
• Cesarean delivery
• Difficult labor
• Neonatal complications

5. PSYCHOLOGICAL DISORDERS IN PREGNANCY
• Bipolar Affective Disorders (BPAD)
• Perinatal Mood and Anxiety Disorders
(PMADs)
• Obsessive-Compulsive Disorder (OCD)

6. BIPOLAR AFFECTIVE DISORDERS(BPAD)
• It is a severe mood disorder characterized by
periods of depression and periods of
abnormally elevated mood.
• Genetic involvement is stronger in BPAD.
• Suspected cases should be reported to
psychiatrist.

7. PERINATAL MOOD AND ANXIETY
DISORDERS(PMADs)

8. OBSESSIVE-COMPULSIVE
DISORDER(OCD) IN PREGNANCY

9. INCIDENCE

10. OCD
• OCD is not uncommon in pregnancy and
postpartum period.
• Obsessions are repetitive, intrusive, less wanted
thoughts and can be directed toward the fetus or
the infant.
• Thoughts may be the fear of loss or death, fear of
infections.
• Patient recognizes obsessions as irrational but
unable to control them.
• Delusion is a false belief but the patient firmly
believes it is true, despite the evidence of contrary.

12. COMMONLY USED DRUGS
• SSRI: Escitalopram, Sertraline, Fluoxetine
• Tricyclic antidepressants-Amitriptyline, Imipramine,
Duloxetine.
• Antipsychotics: Olanzapine, Lithium, Carbamazepine
• Psychotherapy
• Electro-Convulsive Therapy
• Congenic Behavioral Therapy (CBT)
• Interpersonal Psychotherapy (IPT)
• Perinatal Mood and Anxiety (PMAD)

14. Psychological Disturbances in the
Puerperium
• The events of pregnancy, labor and delivery
together with the peak experience of giving birth,
all contribute to a mixture of emotional reactions
in the mother during 1st
week of puerperium.
• There are 3 distinctive types of psychological
disturbances seen in the puerperium-
1. Postpartum blues
2. Postpartum Depression
3. Puerperal Psychosis

15. POSTPARTUM BLUES

16. Postpartum blues is a mild, benign and transient mood change
that begins within 3-4 days after delivery and peaks on the 4-
5day.
It affects nearly 7in 10 mothers.
The most common symptom is…
Unprovoked weeping
Spikes of elation
Irritability
Anger
Hostility
Headache
Feelings of unreality
Exhaustion
Sleep deprivation
Restlessness

17. • Baby blue generally disappears without
medical intervention within 2 weeks.
• If the symptoms persist longer, another
diagnosis may be identified.
• Social interventions such as baby sitting for
few hours, for household chores on newborn
care.

18. POSTPARTUM DEPRESSION
• The onset of postpartum depression is gradual
developing after the 2nd
week.
• The condition may last for 3-6months, and in
some cases, it will persist throughout the 1st
year of the baby's life.

19. CAUSES
• Demand overload
• Exact Etiology is unknown
• Stress inducing life events
• Low self esteem
• Lack of support
• Stress associated with postnatal care
• Severe maternal blues-----depression
• Loss of personal freedom

22. MANAGEMENT
• Early detection
• Initiation of appropriate treatment
• Mild sedation
• Antidepressants
• Counseling-spouse and family members
includes…
• Advanced symptoms-hospitalization is
required.

24. Puerperal Psychosis
• The onset of puerperal psychosis is usually
rapid occurring within the first few days of
delivery and rarely beyond the first 2-3 weeks.
• The condition is more common in primi-
parous women.
• Previous psychosis