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    Psychiatric Disorders in Pregnancy

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    Mandeep Kaur
    This document summarizes various psychiatric disorders that can occur during and after pregnancy. It discusses mood disorders like depression and anxiety disorders, describing their symptoms and risk factors. Postpartum disorders like the baby blues, postpartum depression, and postpartum psychosis are also outlined. The document provides an overview of screening tools, treatment options including counseling and medication, and nursing considerations for managing these conditions.

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    Psychiatric Disorders in Pregnancy

    Uploaded by

    Mandeep Kaur
    162 views65 pages
    This document summarizes various psychiatric disorders that can occur during and after pregnancy. It discusses mood disorders like depression and anxiety disorders, describing their symptoms and risk factors. Postpartum disorders like the baby blues, postpartum depression, and postpartum psychosis are also outlined. The document provides an overview of screening tools, treatment options including counseling and medication, and nursing considerations for managing these conditions.

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    This document summarizes various psychiatric disorders that can occur during and after pregnancy. It discusses mood disorders like depression and anxiety disorders, describing their symptoms and risk factors. Postpartum disorders like the baby blues, postpartum depression, and postpartum psychosis are also outlined. The document provides an overview of screening tools, treatment options including counseling and medication, and nursing considerations for managing these conditions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    162 views65 pages

    Psychiatric Disorders in Pregnancy

    Uploaded by

    Mandeep Kaur
    This document summarizes various psychiatric disorders that can occur during and after pregnancy. It discusses mood disorders like depression and anxiety disorders, describing their symptoms and risk factors. Postpartum disorders like the baby blues, postpartum depression, and postpartum psychosis are also outlined. The document provides an overview of screening tools, treatment options including counseling and medication, and nursing considerations for managing these conditions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 65
    At a glance
    Powered by AI
    Some of the key takeaways from the document are that mood disorders like depression and anxiety are among the most common psychiatric disorders during pregnancy. Major depression, dysthymia, and bipolar disorder are also discussed in detail. Risk factors for depression include stressful life events, family history, abuse or trauma exposure. Treatment options discussed include counseling, psychotherapy, and various psychotropic medications.

    The document states that the most common psychiatric disorders in pregnancy are mood disorders (depression) and anxiety disorders. Depression, major depressive disorder, dysthymia, and bipolar disorder are specifically mentioned.

    The document lists several risk factors for depression during pregnancy on pages 3 and 4, including stressful life events, recent death of a loved one, family history, history of abuse or trauma, exposure to traumatic events, intimate partner violence, serious or chronic medical conditions, alcohol or drug abuse, and prior episodes of depression.

    PSYCHIATRIC DISORDERS IN

    PREGNANCY
    SHARON TREESA ANTONY 2ND YEAR M.SC
    NURSING
    Most common disorders
    • Mood disorders ( Depression)

    • Anxiety disorders
    Depression
    • Major depressive disorder
    • Dysthymia
    • Bipolardisorder
    Depression: risk factors
    • Stressful life events
    • Recent death of a loved one
    • Family history
    • History of abuse or trauma
    • Exposure to traumatic events
    • Intimate partner violence
    • A serious or chronic medical condition
    • Alcohol or drug abuse
    • Prior episodes of depression
    Major depression: symptoms
    • Depressed mood + anhedonia+ any 3 of the
    following:
    • Sleep disorders
    • Interest deficit or lack of feeling pleasure
    • Guilt
    • Energy deficit
    • Concentration deficit
    • Appetite disorder
    • Psychomotor retardation or agitation
    • Suicidality
    Dysthymia ( American Psychiatric
    Association)
    • Depressed mood for most of the day* 2years

    • Presence of 2 or more of the symptoms listed

    under major depression

    • Never any mania/hypomania


    Bipolar disorder

    • MAJOR DEPRESSION+

    • HISTORY OF MANIA OR

    • HYPOMANIA
    Symptoms of mania
    • Inflated self esteem

    • Decreased need for sleep

    • Talkative

    • Flight of ideas

    • High energy or irritability


    Symptoms of hypomania
    • Lasts a minimum of 4 days

    • Briefer duration

    • Less severe symptoms


    • Change in functioning

    • Not severe to cause marked impairment in social


    or occupational functioning

    • No psychosis
    Screening for depression
    • Patient health questionnaire-2

    • Patient health questionnaire-9

    • Beck depression inventory

    • The centre for epidemiologic studies- depression

    scale
    Treatment
    • Cognitive behavioural therapy

    • Counselling

    • Faith based therapy

    • Group therapy

    • Psychotropic medications

    • Yoga and acupuncture


    Pharmacotherapy
    • SSRI

    • NDRI

    • SNRI
    • Fluoxetine :10-20mg

    • Sertraline:m5omg

    • Escitalopram:10mg

    • Bupropion :200mg

    • Venlafaxine:37.5mg
    Teratogenicity
    • Paroxetine:CVS malformations, persistent
    pulmonary hypertension, VSD
    • SSRI: VSD, right ventricular outfloew tract
    lesions, preterm birth, Low birth weight, RDS
    Nursing management
    • Disturbed self esteem related to lack of positive
    reinforcement of one’s values and worth
    • Hopelessness r/t lack of energy to mobilize
    resources
    • Risk for fetal injury related to lack of interest in
    self care
    • Disturbed sleep pattern r/t internal stress

    • Social isolation r/t inability to engage in

    satisfying personal relationships

    • Powerlessness related to lack of inability to exert

    control
    Mania
    • Antipsychotics: EPS in neonates
    • Lithium: CVS defects, neonatal cyanosis, lethargy,
    flaccidity, and non toxic goiter: contraindicated for
    1st 3 months
    • Benzodiazepiines: oral clefts
    • Carbamazepine and valproate: NTDs
    • ECT: safest
    Anxiety, stress and obsessive
    compulsive disorder
    Phobia
    s• Cognitive behavioural therapy
    • Hypnotherapy
    • Antidepressants
    • Beta blockers
    • Benzodiazepines
    Generalized anxiety disorder
    • Excessive and uncontrollable anxiety and worry
    about activities or events + 3 of the following:
    • Restlessness
    • Muscle tension
    • Difficulty with concentration
    • Sleep disturbance
    • Fatigue
    • Irritability
    Treatment
    • Antidepressants
    Panic attack
    • Unexpected or triggered period of intense
    anxiety or fear
    Symptoms
    • Sweating
    • Trembling or shaking
    • Nausea
    • Abdominal pain
    • Chest discomfort/pain
    • Dizziness
    • Light headedness
    • Unsteadiness
    • Fainting
    • Fear of losing control / dying
    • parasthesias
    Treatment
    • SSRI
    • Cognitive behavioural therapy
    • Meditation
    • Anti anxiety drugs
    Screening
    • GAD screening tool-7
    • <5: mild
    • 5-10: moderate
    • 10 -15: severe
    Risks of untreated depression and
    anxiety during pregnancy
    • Burden of disability

    • Prematurity/IUGR

    • Risk for postpartum depression/ postpartum

    psychosis, postpartum OCD/ suicide or

    infanticide
    Substance dependence
    Cocaine
    • Effect on CNS

    • Sudden vasoconstriction

    • Increased RR,HR,BP
    • Vasoconstriction: compromise placental

    circulation, premature placental separation,

    preterm labour and fetal death


    Infants born to cocaine dependent
    mother
    • Intracranial hemorrhage

    • Withdrawal syndrome
    Diagnosis
    • Urinalysis
    Treatment
    • Counselliing
    Amphetamines
    • High concentration in maternal circulation

    • Newborn shows jitteriness and poor feeding at


    birth, growth restriction
    Marijuana and Hashish
    • Tachycardia

    • A sense of well being

    • Excreted in breast milk

    • Reduced milk production

    • Loss of short term memory


    Phencyclidin
    e
    • Crosses placenta
    • Hallucinations
    Narcotic agonists
    • Euphoria followed by sedation
    • Can result in PIH
    • Withdrawal symptoms
    Effects on infant
    • Small for gestational age

    • Fetal distress

    • Meconium aspiration

    • Withdrawal symptoms
    Inhalants
    • Cardiac irregularities
    • Respiratory depression
    • Limit fetal O2 supply
    Alcohol
    • Fetal alcohol syndrome
    • Cognitive challenges
    Nursing diagnoses
    • Risk for injury to self and fetus r/t chronic
    substance abuse
    POSTPARTUM PSYCHIATRIC DISORDERS
    Etiology
    • Endocrinal changes

    • Change in body image

    • Activation of unconscious psychological conflicts

    • Intrapsychic recognition of becoming a mother


    Biological factors
    • Genetic factors
    • Endocrine
    • Biochemical
    • Sleep patterns
    Psychological factors
    • Psychodynamic explanations
    • Personality factors
    Social and interpersonal factors
    • Society’s attitudes
    • Husband’s support
    • low social class
    • Unmarried status
    • Early sexual and marital problems
    • Previous abortions
    • Unstable, unsupportive husband
    Type
    s• Postpartum blues
    • Postpartum psychoses
    • Postpartum depression
    Postnatal blues
    • Transient state of mental illness occuring 3-10
    days after birth
    Symptoms
    • Weepiness
    • Mood lability
    • Feeling overwhelmed
    • Sadness
    • Frustration
    • Fatigue/exhaustion
    • A negative feeling towards child
    • Helplessness
    • Insomnia
    Treatment
    • Psychological support
    • Self limiting
    • Her fear and anxiety is dealt with calm and quiet
    approach
    • Reassurance
    • Family support
    Postpartum depression
    • It develops within 6 months of child birth.
    5 of the symptoms* 2 weeks
    • Depressed mood
    • Significant change in weight
    • Sleep disorders
    • Psychomotor agitation or retardation
    • Fatigue
    • Inappropriate feelings of guilt or worthlessness
    • Impaired concentration
    • Recurrent suicidal thoughts
    Strong Risk factors
    • Anxiety during pregnancy
    • Depression during pregnancy
    • Stressful life events during pregnancy
    • Low level of social support; single marital status
    • History of depression
    • Postpartum depression after a prior pregnancy
    Additional risk factors
    • Biologic vulnerability
    • Family history
    • Unplanned pregnancy
    • Young maternal age
    • Lower socioeconomic status
    • History of interpersonal violence
    • Thyroid dysfunction
    Screening for postpartum depression
    • The Edinburgh postnatal depression scale
    >12: require evaluation and possible referral to a
    mental health specialist
    10-12: presence of symptoms of distress
    Repeat test in 1-2 week
    Consider referral
    0-9: if symptoms persist for more tha 1-2 weeks,
    further evaluation
    Treatment
    • Psychotherapy
    • Pharmacotherapy
    • SSRIs are 1st line drugs ( fluoxetine and
    citalopram are safe for breast fed infants)
    Early predictive signs of postnatal
    depression
    • No visitors, not sharing news about birth with
    relatives
    • Unsupportive family
    • Maternal rejection or ambivalence to pregnancy,
    child birth or newborn
    • Aggressiveness to newborn
    • Sleep disturbance or severe nightmares
    • Lack of interest in newborn care
    • Intense feelings of loss
    • Extreme feelings of sadness, anxiety, guilt and
    anger
    Nursing diagnoses
    • Ineffective individual coping r/t stress of child
    birth, negative self concept
    • Impaired social interaction r/t severe
    depression
    • Impaired family processes r/t post partum
    psychosis
    • Impaired parenting r/t postpartum blues
    ,feelings of inadequacy
    • Risk for injury r/t postpartum psychosis
    • Ineffective family coping r/t maternal
    depression
    Postpartum psychosis
    • Develops within 1st month after delivery
    Risk factors
    • Primipara
    • Women with underlying psychiatric disorders
    Symptoms
    • Auditory hallucinations
    • Delusions
    • Disorientation
    • Strong feelings of anger towards self and baby
    • Paranoidstrong obsessive reaction
    • Unipolar or bipolar
    Treatment
    • Lithium
    • ECT
    • Support and guidance
    • Reintroduce mother and baby as soon as
    possible
    • Hospitalization and supportive
    psychotherapy
    Post partum PTSD
    Risk factors
    • Childhood trauma
    • Sexual abuse
    • Depression
    • PTSD preceding the pregnancy
    • Depression , anxiety or a fear of child birth
    • Lack of support from care providers or partner
    Treatment
    • Debriefing and counselling
    • Cognitive behavioural therapy
    • Eye movement desensitization and
    reprocessing
    THANK YOU

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