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Disorders related to puerperium.pptx

  2. CASE SCENARIO 1. • Loretta is a 25 year old first time mother. Her baby, Sarah, is just four days old. Loretta was very excited when she found out she was pregnant. She had always wanted a baby. She and her husband, Bill, had planned the pregnancy. Now that Sarah is here though, Loretta is feeling down and will begin to cry when little things happen, like the other day when she burned the cake she was trying to make for Bill’s birthday. It feels as though she just cannot shake the blues. © 2017 Thomas Owondo. All rights reserved.
  3. CASE SCENARIO 1 conti…. • She tries to sleep, but can’t seem to sleep when Sarah is sleeping. She is trying to breastfeed but she is having a difficult time with this and feels discouraged. Bill has tried to be supportive, but Loretta thinks he doesn’t really understand. She just feels exhausted all the time and has become increasingly nervous and fears that she will have to stop breastfeeding. She wonders if this is normal. © 2017 Thomas Owondo. All rights reserved.
  4. CASE SCENARIO 2. • Francine is a 17 year old single parent who lives with her mother and step-father. Dominique, her son, is 3 weeks old and cries a lot. Francine’s labor was long and hard. Finally after nearly 20 hours of labor, the doctor decided to do a C-section. Francine doesn’t remember much about Dominique during the first two days of his life because she had an allergic reaction to the medication she had been given. She came home when Dominique was about 5 days old. Her mother had said to her, “You made your bed…” Francine has never gotten along with her step-father and has described him to her friends as abusive. She thought she was in love with Terrell, but when she told him she was pregnant, he left.
  5. CASE SCENARIO 2 conti… • She hasn’t seen him since she was about 3 months pregnant. She is finding it difficult to get up to feed Dominique; it seems as though she has no energy and wants to sleep all the time. She would like to go out, but she can’t seem to motivate herself. She doesn’t feel as though she is a very good mother because she can’t seem to stop Dominique from crying. She has had fleeting thoughts of suicide. She remembers when she was 15 and took a handful of Tylenol following an argument with her step-father. At that time, she had been hospitalized for depression. She is beginning to feel depressed like that again. She feels all alone. © 2017 Thomas Owondo. All rights reserved.
  6. CASE SCENARIO 3. • Mary is a 35 year old who is the mother of a four week old baby, Peter. In the past few days, Mary’s boyfriend, Davis, has noticed that she is behaving strangely. For example, one day when she was playing cards with Peter, she suddenly stopped and began to look around as if she was hearing something. Then she said that the devil was telling her to cut her arm with a knife. One night a week ago, Davis awoke to the sounds of Peter crying. At first he couldn’t find Mary. Then he found her on the porch steps with Peter in her arms singing a gospel song to herself. It was about 3 AM, it was quite cold outside, and Mary didn’t even have a sweater on or a blanket for Peter. © 2017 Thomas Owondo. All rights reserved.
  7. CASE SCENARIO 3 conti…. • It seemed as though she didn’t even know Peter was crying or that she was outside in the cold night air with him. Mary has also stopped eating and she can’t seem to stay asleep at night. • Davis has only known Mary for about a year. When they met, she was a very happy, friendly person who worked hard. The pregnancy had not been planned, but when they found out Mary was pregnant, they decided to make the best out of it. Mary’s family told Davis that as an adolescent, Mary was diagnosed with Bipolar Disorder, although he has seen no symptoms of this and Mary has never been on any medication to his knowledge. © 2017 Thomas Owondo. All rights reserved.
  8. • Note the above cases • Lets begin © 2017 Thomas Owondo. All rights reserved.
  9. DEFINITION • Perinatal- the period of time covering pregnancy and up to roughly a year after giving birth. It's made up of two parts: • peri meaning 'around’ • natal meaning 'birth' • You might have also heard terms used to describe the time specifically before or after giving birth, such as: • postnatal or postpartum meaning 'after birth' • antenatal or prenatal meaning 'before birth' © 2017 Thomas Owondo. All rights reserved.
  10. INTRODUCTION • Puerperium: is defined as the time from the delivery of the placenta through the first few weeks after the delivery. • This period usually is considered to be 6 weeks in duration. • By 6 weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the non pregnant state. © 2017 Thomas Owondo. All rights reserved.
  11. INTRODUCTION • Having a baby is a big life event, and it's natural to experience a range of emotions and reactions during and after your pregnancy. But if they start to have a big impact on how you live your life, you might be experiencing a mental health problem. • Around one in five women will experience a mental health problem during pregnancy or in the year after giving birth. This might be a new mental health problem or another episode of a mental health problem you've experienced before. These are known as perinatal mental health problems. © 2017 Thomas Owondo. All rights reserved.
  12. INTRODUCTION • During the postpartum period, about 85% of women experience some type of mood disturbance. For most the symptoms are mild and short-lived; however, 10 to 15% of women develop more significant symptoms of depression or anxiety. • Postpartum psychiatric illness is typically divided into three categories: (1) postpartum blues (2) postpartum depression and (3) postpartum psychosis. © 2017 Thomas Owondo. All rights reserved.
  13. CAUSES OF PERINATAL MENTAL DISORDERS • There are different theories about why one might develop a mental health problem, and particularly why one might develop it during or after pregnancy, but no-one knows for sure. • Some mental health problems like postpartum psychosis or postnatal depression have clearer causes, but for many people it may be a combination of risk factors that mean you develop a mental health problem. These include the following: © 2017 Thomas Owondo. All rights reserved.
  14. Risk factors • Previous experience of mental health problems. • Previous postnatal illness. • Family history of affective illness. • Caesarian section. • Marital conflict. • Mixed feelings about the baby. • Inadequate psychosocial support. • Young age. • Primigravida. • Difficult childhood experiences like physical, sexual or emotional abuse. • Low self-esteem; If your self-esteem is low, you may doubt your ability to cope as a new mother. When your baby cries, for example, you may think it is because of something you have done wrong, or because of something you haven’t • done. The way you think about yourself can put you at risk of developing © 2017 Thomas Owondo. All rights reserved.
  15. Postnatal blues or maternity blues • Also called "baby blues“ or postpartum blues is a transient condition that 75-80% of mothers could experience shortly after childbirth. • Many women experience mild mood changes after having a baby. It is common to feel many different emotions. • Baby blues are feelings of sadness a woman may have in the first few days after having a baby. © 2017 Thomas Owondo. All rights reserved.
  16. Baby Blues  Not a psychiatric disorder  Considered normal experience of childbirth  Peaks 3-5 days after delivery.  Symptoms may distress but typically resolve within two weeks (lasts up to 10-14 days).  Symptoms lasting longer than two weeks are a sign of a more serious type of depression  Usually don’t affect mother’s ability to function and care for child
  17. Causes • The exact cause of the baby blues is unknown. • It is thought to be related to the hormone changes that occur during pregnancy and again after a baby is born. E.g. oestrogen, progesterone. These hormonal changes may produce chemical changes in the brain that result in depression. • The amount of adjustment that comes after the birth of a baby, along with sleep disturbance, disruption of routine, and emotions from the childbirth experience itself can all contribute to the disorder. © 2017 Thomas Owondo. All rights reserved.
  18. Signs and symptoms • Mood lability/swings. • Tearfulness. • Anxiety or irritability. • Feeling separate and distant from the baby • Insomnia • Poor concentration NOTE: Function is not impaired. © 2017 Thomas Owondo. All rights reserved.
  19. Signs and symptoms • These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within two weeks of delivery • While these symptoms are unpredictable and often unsettling, they do not interfere with a woman’s ability to function. • No specific treatment is required; however, it should be noted that sometimes the blues show the development of a more significant mood disorder, particularly in women who have a history of depression. • If symptoms of depression persist for longer than two weeks, the patient should be evaluated to rule out a more serious mood disorder. © 2017 Thomas Owondo. All rights reserved.
  20. Postnatal depression • Postpartum depression may be mistaken for baby blues at first but the signs and symptoms are more intense and last longer, eventually interfering with one’s ability to care for the baby and handle other daily tasks. • Symptoms usually develop within the first few weeks after giving birth, but may begin later (typically emerges over the first two to three postpartum months but may occur at any point after delivery). In some cases, symptoms may develop in the months before childbirth. • Postpartum depression is clinically indistinguishable from depression occurring at other times during a woman’s life. © 2017 Thomas Owondo. All rights reserved.
  21. Postpartum Depression: Effects Depression negatively affects: • Mother’s ability to mother • Mother—infant relationship • Emotional and cognitive development of the child
  22. Signs and symptoms • Depressed or sad mood • Tearfulness • Loss of interest in usual activities • Change in appetite • Poor concentration • Suicidal thoughts • Sleep disturbance • Fatigue • Feelings of guilt • Feelings of worthlessness or incompetence • Significant anxiety symptoms may also occur. © 2017 Thomas Owondo. All rights reserved.
  23. Mild Severe symptoms Severe Symptoms: – Thoughts of dying – Thoughts of suicide – Wanting to flee or get away – Being unable to feel love for the baby – Thoughts of harming the baby – Thoughts of not being able to protect the infant – Hopelessness
  24. Causes of PPD • Cause unclear • Rapid decline in reproductive hormones • Several factors increase risk
  25. Risk factors Risk factors for depression during pregnancy include • Being a very young and/or single mother. • Planned or unplanned pregnancy • Having a history of mental illness or substance abuse. • Experiencing financial or marital difficulties or other stressful life events. • Having a previous history of pregnancy, birth, or postpartum difficulties. After the birth risk factors include • Complications during labor or birth. • Low confidence as a parent. • Problems with the baby’s health. • A major life change at same time as birth of baby. • Mixed feeling about the baby. © 2017 Thomas Owondo. All rights reserved.
  26. Treatment • Combination of medications (antidepressants), psychotherapy and marital therapy. © 2017 Thomas Owondo. All rights reserved.
  27. Postnatal psychosis • Also known as puerperal psychosis. • It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth. • Its presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. • The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks. © 2017 Thomas Owondo. All rights reserved.
  28. Signs and symptoms • Postpartum psychosis is different from postnatal depression. It is a more severe illness. • There are many different ways the illness can start. • Women often have symptoms of depression or mania or a mixture of these (bipolar). • Symptoms can change very quickly from hour to hour and from one day to the next. • Risk for infanticide, as well as suicide, is significant in this population. © 2017 Thomas Owondo. All rights reserved.
  29. © 2017 Thomas Owondo. All rights reserved.
  30. Signs and symptoms in summary • Restlessness • Irritability. • Insomnia. • Rapidly mood swing • Disorientation or confusion. • Disorganized behavior. • Delusional beliefs and often center on the infant. • Auditory hallucinations that instruct the mother to harm herself or her infant. © 2017 Thomas Owondo. All rights reserved.
  31. Causes and risk factors • The exact causes of postpartum psychosis aren’t known. • All women in the postpartum period experience fluctuating hormone levels. However, some seem to be more sensitive to the mental health effects of changes in hormones like estrogen, progesterone, and/or thyroid hormones. • Many other aspects of health can influence causes of postpartum psychosis, including genetics, culture, and environmental and biologic factors. Sleep deprivation may also play a role. © 2017 Thomas Owondo. All rights reserved.
  32. Causes and risk factors • While some women can have postpartum psychosis with no risk factors, there are some factors known to increase a woman’s risk for the condition. They include:  History of bipolar disorder.  history of postpartum psychosis in a previous pregnancy.  history of schizoaffective disorder or schizophrenia  family history of postpartum psychosis or bipolar disorder  first pregnancy.  discontinuation of psychiatric medications for pregnancy © 2017 Thomas Owondo. All rights reserved.
  33. Treatment 1. Admission to hospital: Since it is an emergency, admission is priority. 2. Medication: – Lithium started on the first postpartum day may prevent the onset of postpartum affective psychosis – Low doses of neuroleptics (chlorpromazine or haloperidol) are relatively safe if breastfeeding – Trials of transdermal oestrogen in the prevention of recurrent postpartum 3. Psychotherapy: – Marital therapy is frequently needed © 2017 Thomas Owondo. All rights reserved.
  34. Choice of treatment depends on: • Type of syndrome found • Tolerance to medication • Breast feeding preference • Patients previous response to treatment © 2017 Thomas Owondo. All rights reserved.
  35. Treatment NOTE: 1. Antipsychotics (typical and atypical)  If psychotic symptoms are present (Delusions, Hallucinations, Agitated behaviour) 2. Mood stabilizers  Manic symptoms (especially with a previous manic-depressive episodes) 3. Anti depressants  If depressive symptoms are prominent often in combination with anti psychotics or mood stabilisers
  36. Nursing care plan • Search for it. © 2017 Thomas Owondo. All rights reserved.
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