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.
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
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
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
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