Docstoc

Psychiatric _ Mental Disorders During Pregnancy

Document Sample
Psychiatric _ Mental Disorders During Pregnancy Powered By Docstoc
					  PSYCHIATRIC &
MENTAL DISORDERS
DURING PREGNANCY

   Supervised by:
     Dr. Suresh
                 OUTLINES


Psudocyesis

Puerperal mental disorders
• Postpartum blues.
• Postpartum depression.
• Postpartum psychosis
Psychotropic medication in pregnancy
WHY IS IT IMPORTANT ?
Women are at the greatest risk of developing a
 psychiatric disorder during childbearing age .

The psychiatric disorders with the highest prevalence
 in women are depressive and anxiety disorders up t o
 20 % .

 Women with histories of these disorders are at risk
 for relapse during pregnancy, particularly if they
 have experienced two or more relapses of the
 disorder.

Ideally, women with a history of any recurrent
 psychiatric disorder should obtain a pre pregnancy
 consultation to discuss the safest treatment approach
 as they try to conceive and during the pregnancy
PSEUDOCYESIS (FALSE
PREGNANCY)
PSEUDOCYESIS

 (False pregnancy) is a
  condition in which a
   woman feels she is
  really pregnant, but
   she is not actually
        pregnant.
PSEUDOCYESIS
• It is generally estimated that false
  pregnancy is caused due to changes in the
  endocrine system of the body, leading to
  the secretion of hormones which translate
  into physical changes similar to those
  during pregnancy.


• The underlying cause is often:   MENTAL.
PSEUDOCYESIS
There are various explanations:
                                Hypothala
                                  mic


                        Psychogen
                                           Endocrine
                            ic



                                Cortical



 Psychodynamic theories:
 - attribute the false pregnancy to emotional
 conflict.
 - intense desire to become pregnant, or an
 intense fear of becoming pregnant.
 - internal conflicts and changes in the endocrine
 system.
SIGNS & SYMPTOMS:
SIGNS & SYMPTOMS:
l   similar to the symptoms of true pregnancy and
    are often hard to distinguish from it .
l   natural signs of pregnancy :amenorrhoea, morning
    sickness, tender breasts, and weight gain .
l   The most common symptom is: Abdominal distension(60
    -90%)
    *N.B: often resolve under general anesthesia and the woman's
    abdomen returns to its normal size   .
l   The second most common physical sign of
     pseudocyesis is menstrual irregularity
    (50–90%).
    * Women are also reported to experience the
    sensation of fetal movements known as
     quickening
SIGNS & SYMPTOMS:
Other common signs and symptoms:
 -gastrointestinal symptoms.
 - breast changes or secretions.
 -labor pains (One percent of women eventually
 experience false labor.)
 -uterine enlargement
 - and softening of the cervix .

  **The hallmark sign of pseudocyesis that is common to all
  cases is that the affected patient is convinced that she is
  pregnant.
PUERPERAL MENTAL DISORDERS
PUERPERAL MENTAL DISORDERS
 During the postpartum period, up to 85% of women suffer
  from some type of mood disturbance. Most women,
  symptoms are transient and relatively mild (ie, postpartum
  blues).

 10-15% of women experience a more disabling and
  persistent form of mood disturbance (eg, postpartum
  depression, postpartum psychosis).

 More recent evidence suggests that postpartum psychiatric
  illness is virtually indistinguishable from psychiatric
  disorders that occur at other times during a woman's life.

 Types:
   Postpartum blues.
   Postpartum depression.
   Postpartum psychosis.
POSTPARTUM BLUES:
 Up to 85% of women experience postpartum affective
  instability.

 Symptoms :
* Rapidly fluctuating mood        * tearfulness
* Irritability                    * Poor concentration
* Depression and anxiety          * Sleep disturbance

 Symptoms peak on the fourth or fifth day after delivery
  and last for several days.

 Generally time-limited and self - limited with
  spontaneously remit within the first 2 postpartum weeks.

 Symptoms do not interfere with a mother's ability to
  function and to care for her child.
POSTPARTUM DEPRESSION (PPD):
 Postpartum depression occurs in 10 -20 % of women in the general
  population with risk of recurrence 50 % .

 postpartum depression develops insidiously over the first 3 postpartum
  months, more acute onset.

 Postpartum depression is more persistent and debilitating than
  postpartum blues.

 Suspect if the blues last beyond 2 weeks with :
 * Depressed mood                           * Tearfulness
 *Inability to enjoy pleasurable activities * Insomnia & Fatigue
 * Appetite disturbance                     * Suicidal thoughts
 *Recurrent thoughts of death.

 Anxiety is prominent, including worries or obsessions about the infant's
  health and well-being
 Postpartum depression often interferes with the mother's ability to care
  for herself or her child.
POSTPARTUM PSYCHOSIS:
 Postpartum psychosis is the most severe form of postpartum psychiatric
  illness.
 1-2 per 1000 women after childbirth.

 Postpartum psychosis has a dramatic onset, emerging as early as the first
  48-72 hours after delivery. In most women, symptoms develop within the
  first 2 postpartum weeks.

 The condition resembles a rapidly evolving manic episode with symptoms
   include :
 * Hallucinations                          *Delusions .
 * Restlessness and insomnia
 * Rapidly shifting depressed or elated mood, and disorganized behavior.

 Post partum psychosis is a psychiatric Emergency that typically requires
  inpatient treatment .

 Risks for infanticide and suicide are high among women with this disorder.
PATHOPHYSIOLOGY
 Hormonal factors
  Levels of estrogen, progesterone, and cortisol fall dramatically
   within 48 hours after delivery.

 Psychosocial factors
  Inadequate social supports
  marital discord or dissatisfaction, or recent negative life
   events are more likely to experience postpartum depression.

 Biologic vulnerability
 _ prior history of depression or family history of a mood disorder
   are at increased risk for postpartum depression.
  Women with a prior history of postpartum depression or
   psychosis have up to 90% risk of recurrence.
SCREENING FOR POSTPARTUM MOOD
DISORDERS:
 Predicting who is at risk for postpartum depression is difficult.
  Individuals at great risk often have some of this risk factors :

     Prior history of postpartum depression.
     Personal or family history of mood disorder
     Depression during a current pregnancy.
     Inadequate social supports.
     Marital dissatisfaction or discord
     Recent negative life events such as a death in the family, financial
      difficulties, or loss of employment.

 Screening of all mothers during the postpartum period is
  indicated.

 The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self
  -rated questionnaire used extensively for detection of
  postpartum depression.
POSTPARTUM BLUES TREATMENT
Postpartum blues typically is mild in severity
 and resolves spontaneously.
No specific treatment is required, other than
 support and reassurance.
Further evaluation is necessary if symptoms
 persist more than 2 weeks.
POSTPARTUM DEPRESSION TREATMENT
 Exclude medical causes for mood disturbance (eg, thyroid
  dysfunction, anemia).

 Milder forms may respond to supportive psychotherapy. More
  severe may require pharmacological treatment.

 Nonpharmacological treatment for women with mild-to-moderate
  symptoms. These modalities may be especially useful for mothers
  who are nursing and who wish to avoid taking medications.

 Psychoeducational groups may be helpful. Individual or group
  psychotherapy (cognitive-behavioral and interpersonal therapy)
  are effective.

 Pharmacological strategies are indicated for moderate-to-severe
  depressive symptoms or when a woman fails to respond to
  nonpharmacological treatment.
PHARMACOLOGICAL TREATMENT CONT,
  Selective serotonin reuptake inhibitors (SSRIs) :
   are first-line agents and are effective in women with
  postpartum depression. eg, fluoxetine and sertraline

  Serotonin-norepinephrine reuptake inhibitors
   (SNRIs) or Tricyclic antidepressants :
  may be useful for women with sleep disturbance eg ,
  Nortriptyline and venlafaxine.

  Anxiolytic agents : such as lorazepam and
  clonazepam may be useful as adjunctive treatment in
  patients with anxiety and sleep disturbance.

  Preliminary data suggest that estrogen, alone or in
   combination with an antidepressant, may be beneficial;
   however, antidepressants remain the first line of
   treatment.
SPECIAL CONCERN (PPD)
 First episode of depression, 6-12 months of treatment is
  recommended. For women with recurrent major depression,
  long-term maintenance treatment with an antidepressant
  is indicated.

 Inadequate treatment increases the risk of morbidity in
  both mother and infant.

 Earlier initiation of treatment is associated with better
  prognosis.

 Inpatient hospitalization may be necessary for severe
  postpartum depression.

 Electroconvulsive therapy (ECT) is rapid, safe, and
  effective with severe postpartum depression, especially
  those with active suicidal idea.
PUERPERAL PSYCHOSIS TREATMENT
 Puerperal psychosis is a psychiatric emergency requires
  inpatient treatment.

 Most patients with puerperal psychosis suffer from bipolar
  disorder. Acute treatment includes a mood stabilizer (eg,
  lithium, valproic acid, carbamazepine) in combination with
  antipsychotic medications and benzodiazepines.

 ECT (often bilateral) is tolerated well and rapidly effective.

 Risk of suicide is significant in this population.

 Rates of infanticide associated with untreated puerperal
  psychosis are as high as 4%.
SPECIAL CONCERNS:
 Breastfeeding and psychotropic medications :

 All psychotropic medications, including antidepressants, are
  secreted into breast milk. Concentrations in breast milk vary
  widely.

 Tricyclic antidepressants during breastfeeding are encouraging.
  Reports of toxicity in nursing infants are rare, although the long-
  term effects of exposure to trace amounts of medication are not
  known.

 Avoid breastfeeding in women treated with lithium because this
  agent is secreted at high levels in breast milk and may cause
  significant toxicity in the infant.

 Avoid breastfeeding in premature infants or in those with hepatic
  insufficiency who may have difficulty metabolizing medications
  present in breast milk.
SPECIAL CONCERNS:(CON’T)
 Impact of postpartum depression on child development :

 Postpartum depression may negatively affect these mother-infant
  interactions.

 Mothers with postpartum depression are more likely to express
  negative attitudes about their infant and to view their infant as
  more demanding or difficult.

      Children of mothers with postpartum depression are more
    likely than children of nondepressed mothers to exhibit
    behavioral problems .

*   sleep and eating difficulties     * temper tantrums
*   hyperactivity                     * delays in cognitive development
*   emotional and social dysregulation
*   early onset of depressive illness.
THANK YOU

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:0
posted:9/9/2013
language:
pages:25