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Psychiatric disorders in pregnancy
- 1. PSYCHIATRIC DISORDERS IN PREGNANCY SHARON TREESA ANTONY 2ND YEAR M.SC NURSING
- 2. Most common disorders • Mood disorders ( Depression) • Anxiety disorders
- 3. Depression • Major depressive disorder • Dysthymia • Bipolardisorder
- 4. 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
- 5. 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
- 6. 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
- 7. Bipolar disorder • MAJOR DEPRESSION+ • HISTORY OF MANIA OR • HYPOMANIA
- 8. Symptoms of mania • Inflated self esteem • Decreased need for sleep • Talkative • Flight of ideas • High energy or irritability
- 9. Symptoms of hypomania • Lasts a minimum of 4 days • Briefer duration • Less severe symptoms
- 10. • Change in functioning • Not severe to cause marked impairment in social or occupational functioning • No psychosis
- 11. Screening for depression • Patient health questionnaire-2 • Patient health questionnaire-9 • Beck depression inventory • The centre for epidemiologic studies- depression scale
- 12. Treatment • Cognitive behavioural therapy • Counselling • Faith based therapy • Group therapy • Psychotropic medications • Yoga and acupuncture
- 13. Pharmacotherapy • SSRI • NDRI • SNRI
- 14. • Fluoxetine :10-20mg • Sertraline:m5omg • Escitalopram:10mg • Bupropion :200mg • Venlafaxine:37.5mg
- 15. Teratogenicity • Paroxetine:CVS malformations, persistent pulmonary hypertension, VSD • SSRI: VSD, right ventricular outfloew tract lesions, preterm birth, Low birth weight, RDS
- 16. 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
- 17. • 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
- 18. 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
- 19. Anxiety, stress and obsessive compulsive disorder
- 20. Phobias • Cognitive behavioural therapy • Hypnotherapy • Antidepressants • Beta blockers • Benzodiazepines
- 21. 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
- 23. Panic attack • Unexpected or triggered period of intense anxiety or fear
- 24. Symptoms • Sweating • Trembling or shaking • Nausea • Abdominal pain • Chest discomfort/pain • Dizziness • Light headedness • Unsteadiness • Fainting • Fear of losing control / dying • parasthesias
- 25. Treatment • SSRI • Cognitive behavioural therapy • Meditation • Anti anxiety drugs
- 26. Screening • GAD screening tool-7 • <5: mild • 5-10: moderate • 10 -15: severe
- 27. Risks of untreated depression and anxiety during pregnancy • Burden of disability • Prematurity/IUGR • Risk for postpartum depression/ postpartum psychosis, postpartum OCD/ suicide or infanticide
- 29. Cocaine • Effect on CNS • Sudden vasoconstriction • Increased RR,HR,BP
- 30. • Vasoconstriction: compromise placental circulation, premature placental separation, preterm labour and fetal death
- 31. Infants born to cocaine dependent mother • Intracranial hemorrhage • Withdrawal syndrome
- 33. Amphetamines • High concentration in maternal circulation • Newborn shows jitteriness and poor feeding at birth, growth restriction
- 34. Marijuana and Hashish • Tachycardia • A sense of well being • Excreted in breast milk • Reduced milk production • Loss of short term memory
- 35. Phencyclidine • Crosses placenta • Hallucinations
- 36. Narcotic agonists • Euphoria followed by sedation • Can result in PIH • Withdrawal symptoms
- 37. Effects on infant • Small for gestational age • Fetal distress • Meconium aspiration • Withdrawal symptoms
- 38. Inhalants • Cardiac irregularities • Respiratory depression • Limit fetal O2 supply
- 39. Alcohol • Fetal alcohol syndrome • Cognitive challenges
- 40. Nursing diagnoses • Risk for injury to self and fetus r/t chronic substance abuse
- 42. Etiology • Endocrinal changes • Change in body image • Activation of unconscious psychological conflicts • Intrapsychic recognition of becoming a mother
- 43. Biological factors • Genetic factors • Endocrine • Biochemical • Sleep patterns
- 44. Psychological factors • Psychodynamic explanations • Personality factors
- 45. 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
- 46. Types • Postpartum blues • Postpartum psychoses • Postpartum depression
- 47. Postnatal blues • Transient state of mental illness occuring 3-10 days after birth
- 48. Symptoms • Weepiness • Mood lability • Feeling overwhelmed • Sadness • Frustration • Fatigue/exhaustion • A negative feeling towards child • Helplessness • Insomnia
- 49. Treatment • Psychological support • Self limiting • Her fear and anxiety is dealt with calm and quiet approach • Reassurance • Family support
- 50. Postpartum depression • It develops within 6 months of child birth.
- 51. 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
- 52. 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
- 53. Additional risk factors • Biologic vulnerability • Family history • Unplanned pregnancy • Young maternal age • Lower socioeconomic status • History of interpersonal violence • Thyroid dysfunction
- 54. 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
- 55. Treatment • Psychotherapy • Pharmacotherapy • SSRIs are 1st line drugs ( fluoxetine and citalopram are safe for breast fed infants)
- 56. 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
- 57. 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
- 58. Postpartum psychosis • Develops within 1st month after delivery
- 59. Risk factors • Primipara • Women with underlying psychiatric disorders
- 60. Symptoms • Auditory hallucinations • Delusions • Disorientation • Strong feelings of anger towards self and baby • Paranoidstrong obsessive reaction • Unipolar or bipolar
- 61. Treatment • Lithium • ECT • Support and guidance • Reintroduce mother and baby as soon as possible • Hospitalization and supportive psychotherapy
- 62. Post partum PTSD
- 63. 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
- 64. Treatment • Debriefing and counselling • Cognitive behavioural therapy • Eye movement desensitization and reprocessing
- 65. THANK YOU