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Mental Health Problems in Pregnancy and Postnatal Period

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Lingeswaran Ampalayan

on 13 March 2017

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Transcript of Mental Health Problems in Pregnancy and Postnatal Period

Mental Health
Problems in
Pregnancy and
Postnatal Period

Importance
Management
Change in sleep
Change in appetite
Lack Energy
Negative perceptions
Stigmatisation
Baby taken away
at birth
Prevalence
High Income Countries
10% Antenatal
13% Postnatal
Middle and Low Income Countries
15.6% Antenatal
19.8% Postnatal
Effects of Pregnancy on Maternal
Mental Health

Depression
Most Common form of mental disorder in pregnancy
More common prenatally compared to postnatal
Peaks in 1st and 3rd trimester, with reduction in 2nd
Risk Factors
Previous History
Depression
Post partum depression
Medication
discontinuation
Family History
Signs and Symptoms of
Depression
Anxiety
Inability to cope
Early Awakening
Sleep Disturbance
Loss of Libido
Psychomotor function
Consequences of
Depression
Self harm
Foetus harming
Poor nutrition and self care
Alcohol and
drug use
Self Medication
Postpartum
Depression
Anxiety Disorder
Panic Disorder
First time > re-emerging attacks
Investigate thyroid function before diagnosis
Generalised Anxiety Disorder
Tendency to worry
Health of foetus
and development
Coping with labour
and bodily changes
Eating Disorder
Anorexia Nervosa and Bulimia
Not so common
Associated with
Miscarriage
Low birth weight infants
Overeating
Higher chance of C-section
Psychoses
Bipolar Disorder
14% relapse in last 5 weeks of pregnancy
Careful monitoring in antenatal follow up
Schizophrenia
Unpredictable
Devastating consequences
Consequences
low birth weight
Prenatal follow up failure
Prematurity
Suicide
Neonaticide
Maternal Mental Health on Foetus
Mothers with mood disorder in early pregnancy - have 2 times higher risk of giving birth to baby with psychiatric disorder
In Depression
Less frequent positive
facial expression
Vocalisation
after birth
Identify
Psychosocial history
Risk factors
Screening tool
Provide information
General management
Talk to the partner and family members
Support services
Group therapy
Individual counselling
Anxiety management
Therapies
Postpartum Psychiatric Illnesses
Postpartum blues
Postpartum depression
Postpartum psychosis
50 - 85% of women
In first 2 weeks of postpartum
Symptoms
Irritability
Anxiety
Fluctuating
mood
Increased emotional reactivity
Mild and spontaneously remits
Not considered psychiatric disorder
No specific treatment required
13 % of mothers
In first 2-3 postpartum months
Symptoms
Depressed mood
Tearfulness
Excessive guilt
Anxiety
Insomnia /hypersomnia
Suicidal ideation
fatigue
Poor concentration
Edinburgh Postnatal Depression Scale
1-2 in 1000 women
In first 3 months postpartum
Symptoms
Agitation
Delusion
Hallucinations
Cognitive impairment
Low insight
Disorganized behavior
Severe
Considered emergency
Often necessitates hospitalization
Past history of mental illness
Current emotional distress
Social isolation
Substance abuse
Family history of mental illness
Pyschotherapy
Pharmacology
Cognitive Behavioral Therapy (CBT)
Treat antenatal depression and anxiety.
Beating Blues Before Birth intervention.

References

Randomized control trial involving 54 pregnant women diagnosed with depression
Cognitive behavioural therapy
Treatment as usual
Interpersonal therapy (IPT)
Treats antenatal depression.
Short term.
Focuses on identifying problems and how the individual interacts with or doesn't interact with others.
Necessary adjustments made.
Anxiety in pregnancy


CBT
is preferred over pharmacological approach.
Medication required when CBT or social support is inadequate.
Selective serotonin reuptake inhibitors
can be used.
- citalopram, fluoxetine, sertraline
- paroxetine is discouraged.
Depression in pregnancy
IPT to improve social interactions and coping with life transitions.
CBT to adjust patient's self-defeating thought patterns.
SSRI or SNRI are used.
Mood stabilizers --> antipsychotics
Lithium
associated with congenital cardiac malformations.
Risk of relapse if drugs are stopped.
Low dose
valproate
or
carbamazepine
may be essential in rapid cycling bipolar.
Postpartum depression
Psychotherapy.
SSRI can be used and not contraindicated in breastfeeding.
Bipolar disorder
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