Psychological disorders during puerperium

1. Mrs.Jagadeeswari.J
M.Sc N

2. INTRODUCTION
The events of pregnancy ,labour
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. PSYCHOLOGICAL COMPLICATIONS TYPES
There are three distinctive types of
psychological disturbances seen in
the puerperium they are
Postnatal blues
Postpartum depression
Puerperal psychosis

4. INCIDENCE OF PSYCHIATRICILLNESS DURING
PUERPERIUM
15-20%-postnatal blues
10%-postnatal
depression
0.1-0.2%-postpartum
psychosis

5. HIGH RISK FACTORS
 Past history-psychiatric illness,
puerperal psychiatric illness
 Family history-major psychiatric illness,
marital conflict
 Present pregnancy-caesarean delivery,
difficulty labour, neonatal
complications
 Others-unmet expectations

6. POSTPARTUM BLUES
DEFINITION
A brief period of
anxiety, mood swings and
sadness which occurs in
some women after delivery
and usually resolves within a
week.

7. INCIDENCE
Nearly 50% of the
postpartum women
suffer from baby blues.

8. SYMPTOMS
 Unprovoked weeping
 Spikes of elation
 Irritability
 Anger
 Hostility
 Headache
 Feeling of unreality
 Exhaustion
 Sleep deprivation
 Restlessness

9. INTERVENTIONS
 Reassurance and psychological support
by family members
 Social interventions-relative baby
sitting so that the mother can get some
sleep or assistance with household
chores or providing instruction on
newborn. Women with previous history
are likely to get in subsequent
pregnancies

10. POSTPARTUM DEPRESSION
DEFINITION
Post partum depression
/Postnatal depression may seem
like baby blues at first however
symptoms are more intense and
longer lasting eventually
impacting a mothers ability to
care for her baby.

11. ONSET
Onset can be anytime
one year after delivery and
last more than 2 weeks

12. INCIDENCE
It is observed in 10-20%
of the postnatal mothers.
Risk of reoccurrence is
high(50-100%) in subsequent
pregnancies

13. CAUSES
Demand overload
Specific etiology is unknown

14. CONTRIBUTING FACTORS
 Experiencing stress
 Low self esteem
 Lack of support
 Stress associated with postnatal care
 Severe maternal blues
 Demands of motherhood
 Loss of personal freedom

15. RISK FACTORS
Problems with baby’s health
Major life changes around time
of delivery
Lack of support or help with
baby
Severe premenstrual syndrome

16. CLINICAL MANIFESTATIONS
 Loss of energy
 Loss of Appetite
 Insomnia
 Social withdrawal
 Irritability
 Suicidal attitude
 Anxiety
 Excessive guilt
 Depressed mood
 Fatigue

17. DIAGNOSIS
History collection
Edinburgh postnatal depression
scale
Medical history
Perform physical examination
and lab test

18. MANAGEMENT
 Early detection and initiation of appropriate
treatment brings best prognosis
 Less severe cases can be treated with mild
sedation or antidepressant
 Counseling
 Involvement of spouse and other family members
 More severe cases admission is necessary
 Fluxetine or paraxetine(serotonin uptake
inhibitors)
 Breast feeding also can be given to baby

19. POSTPARTUM PSYCHOSIS
Post partum psychosis is a
very serious mental condition that
requires immediate attention.
Postpartum psychosis is also one of
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. INCIDENCE
Observed in about 1/500 to
1000 mothers. Commonly
seen in women with past
history of psychosis or with a
positive family history.

21. ONSET
Onset is relatively sudden
usually within 4 days of delivery
.Risk of reoccurrence in the
subsequent pregnancy is 20-25%
and there is increased risk of
psychiatric illness outside
pregnancy also.

22. CAUSES
 Lack of social and emotional support
 Low sense of self esteem due to a
woman's postpartum appearance
 Feeling inadequate as a mother
 Feeling isolated and alone
 Financial problems
 Major life changes

23. SIGNS OF POSTPARTUM
PSYCHOSIS
 Hallucinations
 Delusions
 Illogical thoughts
 Insomnia
 Refusing to eat
 Extreme feeling of anxiety and agitation
 Periods of delirium or mania
 Suicidal or homicidal thoughts

24. RISK FACTORS
Woman with a personal
history of psychosis, bipolar
disorder or schizophrenia
have a increased risk of
developing postpartum
psychosis

25. DIFFERTIAL DIAGNOSIS
Postpartum blues
Substance induced mood
disorders, anaesthesia
medication
Psychotic disorders resulting
from a general medical
condition

26. TREATMENT-PRINCIPLES
 Early identification of psychotic symptoms
 Emergent evaluation
 Hospitalization for safety and acute management
 Pharmacotherapy
 Co ordination of care among clinicians
 Involvement of family and other support system
for the patient and the newborn
 Psycho education for the patient and family
members

27. TREATMENT
 Active management
 Pharmacotherapy
 Antipsychotic medication
 Other psychotic medications-
Benzodiazepines(lorozepam &
clonazepam)
 ECT-Electroconvulsive therapy

28. PREVENTION
Women with bipolar disorders
or a history of postpartum
psychosis can be identified
through screening during
prenatal care. They should be
monitored continuously for few
weeks of postpartum.

29. NURSING MANAGEMENT
1. Listen to the woman regarding her adjustment to
role of mother and observe for any clinical
manifestations suggesting depression.
2. Ask the woman about the infant's behaviour.
Negative statements about the infant may suggest
that the woman is having difficulty coping.
3. Provide support and encourage husband, family
and friends to support and assist with the infant
and mother. Physical support as well as emotional
support may be indicated.
4. Educate the woman that treatment may help
alleviate her symptoms and allow her to better care
for herself and infant.

30. NURSING DIAGNOSIS
Impaired parenting related to postnatal
depression
Risk for effective ineffective coping
related to depression
Risk for maternal role attainment
related to postnatal psychosis