Preg n Puerperium Psy

8/3/2019 Preg n Puerperium Psy

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NORMAL REACTIONS AND PROBLEMSRELATED TO CONCEPTION,

PREGNANCY & PUERPERIUM AND ITS

MANAGEMENT



TERMINOLOGIES

PuerperiumPuerperium: The period of about six weeks after: The period of about six weeks afterchildbirth during which the mother's reproductivechildbirth during which the mother's reproductiveorgans return to their originalorgans return to their original nonpregnant nonpregnant condition.condition.

Ambivalence: Having mixed feelings or contradictoryAmbivalence: Having mixed feelings or contradictory

ideas about something or someoneideas about something or someone

Psychosis: A severe mental disorder in whichPsychosis: A severe mental disorder in whichthought and emotions are so impaired that contact isthought and emotions are so impaired that contact islost with external reality.lost with external reality.



Contd«

Trimester: A period of three monthsTrimester: A period of three months

Anticipatory: Regard as probable; expect orAnticipatory: Regard as probable; expect orpredict predict

Blues: Informal feelings of melancholy, sadness,Blues: Informal feelings of melancholy, sadness,or depressionor depression

Exhaustion: A state of extreme physical orExhaustion: A state of extreme physical ormental fatiguemental fatigue



NORMAL REACTIONS TO

CONCEPTION, PREGNANCY

AND PUERPERIUM



PSYCHOLOGICAL ADAPTATION

TO PREGNANCY



BODY IMAGE

Appearance

Appearance Function

Function

Sensation

Sensation Mobility

Mobility



TRIMESTER TASK

Accept thePREGNANCY

Accept the BABY Prepare forPARENTHOOD



PSYCHOLOGICAL ADAPTATIONTO PUERPERIUM



MATERNAL ROLE

DEVELOPMENT

Taking in

phase

Taking in

phase

Taking hold

phase

Taking hold

phase

Letting go

phase

Letting go

phase



ATTAINMENT OF

MATERNAL ROLE

Maternal role attainment is the process byMaternal role attainment is the process by

which the woman learns mothering behaviorswhich the woman learns mothering behaviors

and becomes comfortable with her identity as aand becomes comfortable with her identity as a

mother.mother.



DEVELOPMENT OF PARENT

INFANT ATTACHMENT



PSYCHOLOGICALDISTURBANCE IN

PREGNANCY

´ANTEPARTUM DEPRESSIONµ

Approximately 10-20%

of women will struggle with

symptoms of depression

during their pregnancy.



RISK FACTORS

Having a history of depression or PMDDHaving a history of depression or PMDD

Age at time of pregnancyAge at time of pregnancy

Living alone.Living alone.

Limited social support.Limited social support.

ChildrenChildren ---- the more children they have, the more likelythe more children they have, the more likelythey are to be depressed during a subsequent pregnancy.they are to be depressed during a subsequent pregnancy.

Marital conflict Marital conflict



Contd..

Ambivalence about the pregnancy.Ambivalence about the pregnancy.

Relationship difficultiesRelationship difficulties

Fertility treatment Fertility treatment

Previous pregnancy lossPrevious pregnancy loss

Problems with pregnancyProblems with pregnancy

Stressful life event Stressful life event

Past history of abusePast history of abuse



SYMPTOMS

SadnessSadness ² ² hopelessness, helplessness, tearfulness, etc.hopelessness, helplessness, tearfulness, etc.

Loss of interest in daily activitiesLoss of interest in daily activities

Changes in sleep patternsChanges in sleep patterns

Difficulty focusing or concentrating.Difficulty focusing or concentrating.

Sudden and/or drastic increase or decrease in weight or fatigue.Sudden and/or drastic increase or decrease in weight or fatigue.

Decreased low self Decreased low self--esteem.esteem.

Thoughts of death in regard to self or others.Thoughts of death in regard to self or others.



IMPACT OF DEPRESSION

ON PREGNANCY

Depression can interfere with a woman's abilityDepression can interfere with a woman's abilityto care for her self during pregnancy.to care for her self during pregnancy.

Depression can put her at risk for increased useDepression can put her at risk for increased useof substances that can harm both her andof substances that can harm both her and

developing baby.developing baby.

Depression may interfere with her ability to bondDepression may interfere with her ability to bondwith her growing baby.with her growing baby.



HOW DOES PREGNANCY

IMPACT DEPRESSION??

The stresses of pregnancy can causeThe stresses of pregnancy can cause

depression or a recurrence or worsening of depression or a recurrence or worsening of

depression symptoms.depression symptoms.

Depression during pregnancy can place aDepression during pregnancy can place a

woman at risk for having an episode of woman at risk for having an episode of

depression after delivery.depression after delivery.



TREATMENT

Support groupsSupport groups PsychotherapyPsychotherapy

MedicationsMedications Light therapyLight therapy



LIGHT THERAPY

Treatment consists of

exposure to light of a highintensity and/or specific

spectra for an hour per day

from a light box placed on the

floor or on a table. The light

intensity is usually 10,000 lux,

which is similar to the light of a sunny day.



MECHANISM OF ACTION

MELATONINMELATONIN

SERETONINSERETONIN



CONTRAINDICATION

If they have current medical illness (eye disease)If they have current medical illness (eye disease)

If they are using psychiatric medicationIf they are using psychiatric medication

Who are not able to maintain a regular sleepWho are not able to maintain a regular sleep

scheduleschedule

Use of alcohol or drugsUse of alcohol or drugs



HOW IS IT

ADMINISTERED??Participants will be loaned a portable, lightweight light box forParticipants will be loaned a portable, lightweight light box foruse at home.use at home.

Participants reserve 60 minutes each morning when they sit at Participants reserve 60 minutes each morning when they sit at

the light box and engage in any quiet activity with eyes open.the light box and engage in any quiet activity with eyes open.

Treatment continues daily for five weeks, during which progressTreatment continues daily for five weeks, during which progressis monitored .is monitored .

After the fiveAfter the five--week trial participants will have the opportunity toweek trial participants will have the opportunity to

continue with treatment if it has been successful, or try ancontinue with treatment if it has been successful, or try an

enhanced treatment regimen if it appears that a higher light enhanced treatment regimen if it appears that a higher light

dose would be beneficial.dose would be beneficial.



SIDE-EFFECTS

The potential risks of light therapy are very low.The potential risks of light therapy are very low.

If patients receive too much light, they canIf patients receive too much light, they can

become irritable or show disturbed sleepbecome irritable or show disturbed sleep



PREVENTION

Take it easyTake it easy

Suggest her to bond with her partnerSuggest her to bond with her partner

Talk it out Talk it out

Manage stressManage stress



PSYCHOLOGICAL

DISTURBANCES IN PUERPERIUM



PSYCHOLOGICAL

DISTURBANCES IN PUERPERIUM

Postpartum exhaustionPostpartum exhaustion

Postpartum blues (Baby blues)Postpartum blues (Baby blues)

Baby pinksBaby pinks

Postpartum depressionPostpartum depression

Puerperal psychosisPuerperal psychosis



POSTPARTUM

EXHAUSTION (PPE)

PPE is caused by sleep deprivation coupled withPPE is caused by sleep deprivation coupled withhormonal changes in a woman's body shortlyhormonal changes in a woman's body shortly

after giving birth.after giving birth.

TREATMENTTREATMENT

Medical treatment is minimal. PPE can last fromMedical treatment is minimal. PPE can last from

1 to 20 days and responds with adequate1 to 20 days and responds with adequate

amounts of sleep.amounts of sleep.



POSTPARTUM BLUES



POSTPARTUM BLUES

It is a mild, benign and transient mood changeIt is a mild, benign and transient mood changethat begins within 3 to 4 days after delivery andthat begins within 3 to 4 days after delivery and

peaks on 4peaks on 4thth to 5to 5thth day. It affects nearly 7 in 10day. It affects nearly 7 in 10

mothers.mothers.

CAUSE:CAUSE:

A biological cause rather than a psychologicalA biological cause rather than a psychological

causecause



SYMPTOMS

Unprovoked weepingUnprovoked weeping

Spikes of elation.Spikes of elation.

IrritabilityIrritability

Anger, hostilityAnger, hostility

HeadacheHeadache

Feelings of unrealityFeelings of unreality

ExhaustionExhaustion



Contd..

Sleep deprivationSleep deprivation

RestlessnessRestlessness

Sudden mood swings.Sudden mood swings.

Anxious and hypersensitive to criticism.Anxious and hypersensitive to criticism.

Low spiritsLow spirits

Poor concentration and indecisiveness.Poor concentration and indecisiveness.

Feeling 'Feeling 'unbondedunbonded' with baby' with baby



TREATMENT

Baby blues generally disappear without medicalBaby blues generally disappear without medical

intervention within two weeks.intervention within two weeks.



BABY PINKS

Some women experienceSome women experience baby pinksbaby pinks when theywhen theyare overly and illogically on top of the world (aare overly and illogically on top of the world (a

mild to severe form of mania).mild to severe form of mania).

TREATMENT:TREATMENT:

The pinks do not require treatment.The pinks do not require treatment.



POSTPARTUM

DEPRESSION

The onset of postpartum

depression is gradual, developing

after the second week. The

condition may last for 3-6 months

and in some cases, it will persist

throughout the first year of the

baby·s life.



CAUSES

Experiencing stressExperiencing stress--inducing life events around the time of inducing life events around the time of

childbirth.childbirth.

Low self Low self--esteem and stress associated with postnatal care.esteem and stress associated with postnatal care.

Demands of motherhood and loss of personal freedomDemands of motherhood and loss of personal freedom

Formula feeding rather than breast feedingFormula feeding rather than breast feeding

A history of depressionA history of depression

Cigarette smokingCigarette smoking

Low self esteemLow self esteem

Childcare stressChildcare stress



Contd..

Prenatal depression during pregnancyPrenatal depression during pregnancy

Prenatal anxietyPrenatal anxiety

Low social support Low social support

Poor marital relationshipPoor marital relationship

Infant temperament problems/colicInfant temperament problems/colic

Maternity bluesMaternity blues

Single parent Single parent

Low socioeconomic statusLow socioeconomic status

Unplanned/unwanted pregnancyUnplanned/unwanted pregnancy



SYMPTOMS

Bouts of cryingBouts of crying

SadnessSadness

Emotional liabilityEmotional liability

Guilt Guilt

Loss of appetite or anorexiaLoss of appetite or anorexia

Profound sleep disturbancesProfound sleep disturbances

Poor concentration and memoryPoor concentration and memory

IrritabilityIrritability



Contd..

Feeling of ambivalence toward her infant Feeling of ambivalence toward her infant

Feelings of inadequacy to care for the newbornFeelings of inadequacy to care for the newborn

Constantly feeling tired in spite of adequate periodsConstantly feeling tired in spite of adequate periodsof rest of rest

May experience difficulty falling asleep but onceMay experience difficulty falling asleep but onceasleep, the woman will sleep for long periods.asleep, the woman will sleep for long periods.

They often feel well in the morning but deteriorate asThey often feel well in the morning but deteriorate asthe day goes on.the day goes on.



EFFECTS ON PARENT-

INFANT RELATIONSHIP

TYPES OF COPING STRATEGIES:TYPES OF COPING STRATEGIES:

Avoidance coping:Avoidance coping: denial, behavioral disengagement denial, behavioral disengagement

ProblemProblem--focused coping: focused coping: active coping, planning,active coping, planning,positive reframingpositive reframing

Support seeking coping:Support seeking coping: emotional support,emotional support,instrumental support instrumental support

Venting coping:Venting coping: venting, self venting, self--blameblame



ATTACHMENT STUDY

THREE CLASSIFIED GROUPS:THREE CLASSIFIED GROUPS:

Secure and joyful attachment Secure and joyful attachment

Secure attachment but restricted in expressedSecure attachment but restricted in expressed

enjoyment and pleasureenjoyment and pleasure

Insecure attachment Insecure attachment



PREVENTION

Early identification and intervention improves longEarly identification and intervention improves long--termtermprognoses for most women.prognoses for most women.

A major part of prevention is being informed about the riskA major part of prevention is being informed about the risk factors, and the medical community can play a key role in factors, and the medical community can play a key role inidentifying and treating postpartum depression.identifying and treating postpartum depression.

Women should be screened by their physician toWomen should be screened by their physician todetermine their risk for acquiring postpartum depression.determine their risk for acquiring postpartum depression.

Also, proper exercise and nutrition appears to play a roleAlso, proper exercise and nutrition appears to play a rolein preventing postpartum, and general, depression.in preventing postpartum, and general, depression.



MANAGEMENT

Medical evaluation to rule out physiological problemsMedical evaluation to rule out physiological problems

Cognitive behavioral therapyCognitive behavioral therapy

Medication (Antidepressant)Medication (Antidepressant)

Support groupsSupport groups

Home visits/Home visitorsHome visits/Home visitors

Healthy diet Healthy diet

Consistent/healthy sleep patternsConsistent/healthy sleep patterns



PUERPERAL PSYCHOSIS



PUERPERAL PSYCHOSIS

The onset of puerperal psychosis is usuallyThe onset of puerperal psychosis is usuallyrapid occurring within 4 days of delivery andrapid occurring within 4 days of delivery and

rarely beyond the first 2rarely beyond the first 2--3 weeks.3 weeks.

INCIDENCEINCIDENCE

Less than 1/1,000 deliveriesLess than 1/1,000 deliveries

More common in first time mothers.More common in first time mothers.



CAUSES

Studies suggest that postpartum psychosisStudies suggest that postpartum psychosishas a genetic or biological cause and is morehas a genetic or biological cause and is more

common in women diagnosed with bipolarcommon in women diagnosed with bipolar

disorder or with a family history of mooddisorder or with a family history of mood

disorders. Women with a prior diagnosis of andisorders. Women with a prior diagnosis of anaffective disorder have a 20% to 25% chance of affective disorder have a 20% to 25% chance of

a postpartum psychosis.a postpartum psychosis.



Contd..

May experience delusions or hallucinations andMay experience delusions or hallucinations andbecome detached from the reality of the situation.become detached from the reality of the situation.

May state that her baby is abnormal, believe it to beMay state that her baby is abnormal, believe it to bepossessed and may avoid the baby.possessed and may avoid the baby.

There may be periods of normal behavior and at There may be periods of normal behavior and at other times, she may appear depressed.other times, she may appear depressed.

May experience suicidal impulses or desires to harmMay experience suicidal impulses or desires to harmher baby.her baby.



TREATMENT

Because of extreme nature of illness, medical help isBecause of extreme nature of illness, medical help is

required as a matter of emergency.required as a matter of emergency.

The woman must be kept under constant observation untilThe woman must be kept under constant observation untilappropriate psychiatric help is obtained.appropriate psychiatric help is obtained.

Heavy sedation is given at the time of onset.Heavy sedation is given at the time of onset.

Early treatment with antiEarly treatment with anti--psychotic drugs.psychotic drugs.

Admission to a psychiatric unit and treatment with lithiumAdmission to a psychiatric unit and treatment with lithiumand/or electroconvulsive therapy is given.and/or electroconvulsive therapy is given.

Psychosis may persist for 8Psychosis may persist for 8 ² ² 10 weeks even with prompt 10 weeks even with prompt treatment especially when the woman has a pretreatment especially when the woman has a pre--existingexisting

history of schizophrenia or manichistory of schizophrenia or manic--depressive illnessdepressive illness



PROGNOSIS

While complete recovery is often achieved, it While complete recovery is often achieved, it is possible that further episodes of illness willis possible that further episodes of illness will

occur throughout the woman·s life and there isoccur throughout the woman·s life and there is

an increased risk of recurrence in subsequent an increased risk of recurrence in subsequent

pregnancies.pregnancies.



NURSING MANAGEMENT

NURSING ASSESSMENTNURSING ASSESSMENT

Assess posture and affect Assess posture and affect

Assess thought processAssess thought process

Explore feelingsExplore feelings

Assess physical behaviorAssess physical behavior

Assess for parent Assess for parent--infant bondinginfant bonding



NURSING DIAGNOSIS

1.1. Hopelessness related to depressive thoughts.Hopelessness related to depressive thoughts.

2.2. Social isolation related to lack of interest or energy to interact withSocial isolation related to lack of interest or energy to interact withothers.others.

3.3. Ineffective family coping: compromised related to impact of Ineffective family coping: compromised related to impact of symptoms of depression in one member.symptoms of depression in one member.

4.4. Sleep pattern disturbance related to insomnia.Sleep pattern disturbance related to insomnia.

5.5. Self Self--care deficit related to lack of motivation and poorcare deficit related to lack of motivation and poorconcentration.concentration.

6.6. Risk for injury related to hopelessness an impaired problem solving.Risk for injury related to hopelessness an impaired problem solving.



EDINBURGH POSTNATAL

DEPRESSION SCALE

INSTRUCTIONS:INSTRUCTIONS:

1.1. The mother is asked to check the response that comesThe mother is asked to check the response that comesclosest to how she has been feeling in the previous 7 days.closest to how she has been feeling in the previous 7 days.

2.2. All the items must be completed.All the items must be completed.

3.3. Care should be taken to avoid the possibility of the motherCare should be taken to avoid the possibility of the motherdiscussing her answers with others. (Answers come fromdiscussing her answers with others. (Answers come fromthe mother or pregnant woman.)the mother or pregnant woman.)

4.4. The mother should complete the scale herself, unless sheThe mother should complete the scale herself, unless shehas limited English or has difficulty with reading.has limited English or has difficulty with reading.



CONCLUSION



BIBLIOGRAPHY

1.1. Burroughs. ´Maternity Nursing, An Introductory Textµ. 7Burroughs. ´Maternity Nursing, An Introductory Textµ. 7thth

Edition.Edition.Saunders Publication.Saunders Publication.

2.2. D. C.D. C. DuttaDutta. ´Textbook of Obstetricsµ. 6. ´Textbook of Obstetricsµ. 6thth Edition. CentralEdition. CentralPublications.Publications.

3.3. Gail. W. Stuart. ´Principles and Practice of Psychiatric Nursingµ. 8Gail. W. Stuart. ´Principles and Practice of Psychiatric Nursingµ. 8thth

Edition. Elsevier Publication.Edition. Elsevier Publication.

4.4. Mary C. Townsend. ´Psychiatric Mental Health Nursingµ. 5Mary C. Townsend. ´Psychiatric Mental Health Nursingµ. 5thth Edition.Edition.F. A. Davis Publication.F. A. Davis Publication.

5.5. SandraSandra MettinaMettina. ´Manual of Nursing Practiceµ. 8. ´Manual of Nursing Practiceµ. 8thth Edition.Edition.Lippincott Publication.Lippincott Publication.

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