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NIGHTANGLE INSTITUTE OF NURSING
PEER PRESENTATION ON
WOMEN AND MENTAL HEALTH
SUBJECT- MENTAL HEALTH NURSING
SUBMITTED TO SUBMITTED BY
MS. P Elavarsai Lovely Singh
Associate Professor M.SC. 1st
Year
Mental Health Nursing
GENERAL INTRODUCTION
Name of the Student Lovely Singh
Subject Mental Health Nursing
Topic Women and mental health
Group M.SC 1St Yr
Date
Duration 40 Minutes
Method of Teaching Lesson Cum Discussion
Place College
Language English
Name of the Supervisor Ms Elavarsi
Previous Knowledge Group has studied about Women and mental
health
GENERAL OBJECTIVE
After the completion of my topic that is women and mental health, the students will get the
knowledge of women and mental health.
SPECIFIC OBJECTIVES
Introduction of women and mental health
Definition
PMS and women Mental Health
Menopause and women mental health
Polycystic ovarian cyst and women mental health
Conception and women mental health
Pregnancy and women mental health
Summary
Conclusion
Bibliography
Research Abstract
INTRODUCTION
“The reason firm, the temperate will,
Endurance, foresight, strength, and skill;
A perfect woman, nobly planned,
To warn, to comfort, and command.”
William Wordsworth
Mental health is defined as a state of well-being in which every individual realizes his or her
own potential, can cope with the normal stresses of life, can work productively and fruitfully,
and is able to make a contribution to her or his community.
The positive dimension of mental health is stressed in WHO's definition of health as
contained in its constitution: "Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity."
WOMEN’S MENTAL HEALTH: THE FACTS (WORLD HEALTH
ORGANIZATION REPORT, 2001)
 Depressive disorders account for close to 41.9% of the disability from
neuropsychiatric disorders among women compared to 29.3% among
men.
 Leading mental health problems of the elderly are depression, organic
brain syndromes, and dementias, a majority are women.
 An estimated 80% of 50 million people affected by violent conflicts,
civil wars, disasters, and displacement are women and children.
 Lifetime prevalence rate of violence against women ranges from 16%
to 50%
 At least one in five women suffers rape or attempted rape in their
lifetime.
 Pressures created by their multiple roles, gender discrimination and
associated factors of poverty, hunger, malnutrition, overwork,
domestic violence and sexual abuse, combine to account for women's
poor mental health.
 Communication between health workers and women patients is
extremely authoritarian in many countries, making a woman's
disclosure of psychological and emotional distress difficult, and often
stigmatized.
MENSTRUATION, MENOPAUSE, AND MENTAL HEALTH
 Premenstrual mood changes
 Menopause and mood changes
 More information on menstruation, menopause, and mental health
Hormones can affect a woman's mood throughout her lifetime. Sometimes the impact on
mood can affect a woman's quality of life. Many times the symptoms that result can be
managed with medicine and/or therapy.
PREMENSTRUAL MOOD CHANGES
Once a young woman starts menstruating, she may begin to experience emotional
changes around the time of her period. 75 percent of women with regular period cycles
report unpleasant physical or psychological symptoms before their periods. Premenstrual
syndrome, or PMS, affects 30 to 80 percent of women.
Psychological symptoms of PMS include:
 Depression
 Anger
 Irritability
 Anxiety
 Sensitivity to rejection
 Sense of feeling overwhelmed
 Social withdrawal
Physical symptoms of PMS include:
 Fatigue (feeling tired)
 Sleep disturbance
 Increased appetite
 Abdominal bloating
 Breast tenderness
 Headaches (sometimes known as menstrual migraines)
 Muscle aches and joint pain
 Swelling of extremities
PREMENSTRUAL DYSPHORIC DISORDER, OR PMDD, is a more severe form of
PMS. It affects 3 to 8 percent of women of reproductive age. Symptoms of PMDD
include:
 Severe irritability
 Depression
 Anxiety
 Mood swings
The best way to confirm PMDD is to make a chart of symptoms (for example: cramps,
headaches, or weight gain). A woman with PMDD should have symptom-free days
between the start of her period and ovulation. Your doctor or a mental health
professional can use a prospective scale (the Calendar of Premenstrual Experience and
the Prospective Record of the Severity of Menstruation are two examples) to figure out if
you have PMDD.
The causes of PMS and PMDD are not known, but research shows that they are based in
the body and not just in the mind. Women who experience PMS and/or PMDD do not
have higher levels of hormones compared to other women. Instead, women with PMS
and/or PMDD may be extra sensitive to normal hormonal changes.
Treatment
Lifestyle changes may help to make the symptoms of PMS and PMDD better. Some
doctors suggest that women:
 Eat lesser amounts of caffeine, sugar, and sodium
 Drink less alcohol
 Smoke less
 Get plenty of sleep
 Exercise more
 Try talk therapy
Medications or supplements prescribed by the doctor can also help PMS and PMDD.
These may include:
 Calcium (1200 mg per day was shown to reduce PMS symptoms)
 Selective serotonin reuptake inhibitors (SSRIs)
 Hormonal treatments such as oral contraceptives
MENOPAUSE AND MOOD CHANGES
Women may experience a wide range of feelings, from anxiety and discomfort to release
and relief, upon menopause. Most adapt to the changes and continue to live well and
remain healthy through these transitions.
DEPRESSION
Some women, although not all, will experience significant depression before
perimenopause( the period of women’s life shortly before the occurrence of
menuopause). Perimenopause marks the time when your body begins the transition to
menopause. It includes the years leading up to menopause — anywhere from two to
eight years — plus the first year after your final period. There is no way to tell in
advance how long it will last or how long it will take you to go through it. It's a natural
part of aging that signals the ending of your reproductive years. Because of the intense
hormone changes during perimenopause, women are more likely to have menopause-
related depression before they reach actual menopause.
When women go through menopause, some may feel badly at the loss of their ability to
bear children. However, some women look at menopause as a time to expand their work
and social activities, and to dedicate more time to their spouse or partner. Having a
positive attitude about this life change may help.
TREATMENT
There are several treatment options for women who have depression during
perimenopause.
 Menopausal hormone therapy – To help control the symptoms of menopause,
some women can take hormones, called menopausal hormone therapy (MHT).
MHT used to be called hormone replacement therapy or HRT. The use of MHT
has been debated a great deal since the Women's Health Initiative (WHI)
Hormone Study findings were released in 2002. Long-term use of MHT poses
some serious risks. If you decide to try MHT, use the lowest dose that helps for
the shortest time you need it.
 Antidepressants – Antidepressants may be an option for women who are unable
or unwilling to take MHT.
 Talk therapy – Talk therapy may take place one-on-one with a mental health
professional or in a group setting.
Once identified, depression almost always can be treated either by therapy, medicine
called antidepressants, or both. Some people with milder forms of depression do well
with therapy alone. Others with moderate to severe depression might benefit from
antidepressants. It may take a few weeks or months before you begin to feel a change in
your mood. Some people do best with combined treatment: therapy and antidepressants
POST-TRAUMATIC STRESS DISORDER (PTSD) AND WOMEN VETERANS
PTSD can occur through a traumatic event..
Example- If you are in the military, you may have seen combat. You may have been on
missions that exposed you to horrible and life-threatening experiences. You may have
been shot at, seen a friend shot, or seen death. These are types of events that can lead to
PTSD.
Military sexual trauma (MST) can also lead to PTSD. Sometimes, PTSD is also
associated with intimate partner violence(IPV).
Women are more likely than men to develop chronic, or long-lasting, PTSD after
experiencing a trauma. Not all women who experience a traumatic event develop PTSD.
However, women are more likely to develop PTSD if they:
 Have a past mental health problem (like depression or anxiety)
 Experience a very severe or life-threatening trauma
 Were sexually assaulted
 Were injured during the event
 Had a severe reaction at the time of the event
 Experienced other stressful events afterwards
 Do not have good social support
Some PTSD symptoms are more common in women than in men. Women are more
likely to be jumpy, to have trouble feeling emotions, and to avoid things that remind
them of the trauma.
Treatment
PTSD can be treated. A doctor or mental health professional with experience in treating
people with PTSD can help. Treatment may include "talk" therapy, medication, or both.
Treatment might take 6 to 12 weeks. For some people, it takes longer. Treatment is not
the same for everyone. What works for you might not work for someone else.
Drinking alcohol or using other drugs will not help PTSD go away, and may even make
it worse.
INTIMATE PARTNER VIOLENCE (IPV) AND WOMEN VETERANS
IPV is also known as domestic violence. IPV is when a current or former partner uses
behaviours or threats that can make you feel scared, controlled, or intimidated. A
relationship in which IPV occurs is an abusive relationship.
IPV could include any of the following:
 Physical violence – hitting, pushing, grabbing, biting, choking, shaking, slapping
 Sexual violence – attempted or actual sexual contact without your consent
 Threats of physical or sexual abuse – words, looks or gestures to control or
frighten
 Psychological or emotional abuse – humiliating, putting down, isolating,
threatening
 Stalking – following, harassing, or unwanted contact that makes you feel afraid
POLYCYSTIC OVARIAN SYNDROME
A condition that disrupts the lives of millions of women, Polycystic Ovarian Syndrome
(PCOS) is a disorder that causes a variety of painful symptoms. Not merely an affliction of
the physical body, Polycystic Ovarian Syndrome, or as it’s also known, Polycystic Ovarian
Disorder or PCOD, has been linked to emotional and mental disorders. The stress of coping
with the long list of symptoms this condition can cause is significant, but for many women
PCOS mental factors can lead to more serious health conditions.
Research indicates that women with PCOS face greater rates of a variety of emotional and
mental conditions, including anxiety, panic attacks, depression, difficulty concentrating,
fatigue, mood swings, and chronic stress. These conditions go far beyond polycystic ovaries
and physical pain. Furthermore, it means PCOS emotional consequences can be devastating.
A healthy lifestyle, complete with nutritious diet, plentiful exercise, and targeted nutritional
supplements and/or prescription medications can help to bring PCOS mood issues and
symptoms under control.
SYMPTOMS
 Infertility: As one of the most emotionally devastating symptoms on the list,
infertility can cause a woman to question her role in society. Many women associate
their identities as women with the role of being a mother, and not being able to bear
children can challenge this identity.
 Irregular Menstruation: Sporadic, absent, or infrequent menstrual periods often
occur.
 Anovulation and Oligoovulation: Often responsible for infertility, some women’s
ovaries either fail to release an egg or infrequently release an egg. This symptom can
also affect the regularity of a woman’s menstrual period.
 Ovarian Cysts: Although Polycystic Ovarian Syndrome is named after this symptom,
it actually does not have to be present to obtain a diagnosis. However, many women
do have many cysts strung around the outside perimeter of their ovaries, which are
said to resemble pearls.
 Weight Gain and Obesity: Another highly difficult symptom with which to cope,
weight gain is very common but not necessary for a diagnosis. This is an especially
serious symptom, because excess weight can exacerbate other symptoms (such as
high cholesterol and blood pressure) and lead to more serious health conditions.
 Skin Conditions. Acne: acanthosis nigricans (thick, velvety patches of skin), and
other skin irregularities often occur.
 Hirsutism: High levels of testosterone often cause excessive growth of hair in
abnormal places, such as the chest, face, and back.
 Hair Loss: Akin to male pattern baldness, hair loss is another highly embarrassing
and difficult symptom with which women who have Polycystic Ovarian Syndrome
(PCOS) often have to cope.
 High Cholesterol and High Blood Pressure: Excess glucose in the bloodstream can
cause damage to arterial walls, where cholesterol can settle. This causes blood
pressure to rise, which can present a very serious risk, as heart disease is linked with
Polycystic Ovarian Syndrome (PCOS).
 SleepDisorders: Sleep apnea and insomnia, as well as snoring, are often reported by
women who suffer from PCOS.
 Depression: Polycystic Ovarian Syndrome (PCOS) can affect the body and the mind,
causing depression.
CONCEPTION AND WOMEN MENTAL HEALTH
Milestones of Fetal Development
NORMAL REACTION TO CONCEPTION
It is an emotional time for the woman, who becomes pregnant ,especially if she pregnant for
the first time .Forthcoming parenthood causes psychological changes in both mother and
father. Pregnancy is an experience full of growth, change, enrichment and challenge.The
occurrence of physiological changes along with the hormonal changes make pregnancy a
psychological event for the woman. Hormonal levels are constantly fluctuating during
pregnancy, which can lead to feelings of anxiety ,depression, sadness ,elation and even
confusion. The woman can report mood swings and irritability during and after their
pregnancy. The feelings which the mother undergoes include feelings of depression ,
emotional liability , issues of self esteem and body image issues.
PHYSIOLOGICAL CHANGES DURING CONCEPTION WHICH AFFECTS ON
WOMEN MENTAL HEALTH
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a
person’s body undergoes to accommodate the growing embryo or fetus.
These physiologic changes are entirely normal, and include cardiovascular (heart and blood
vessel), hematologic (blood), metabolic, renal (kidney), posture, and respiratory (breathing)
changes. Increases in blood sugar, breathing, and cardiac output are all expected changes that
allow a pregnant person’s body to facilitate the proper growth and development of the
embryo or fetus during the pregnancy. The pregnant person and the placenta also produce
many other hormones that have a broad range of effects during the pregnancy.
PSYCHOLOGICAL CHANGES DURING CONCEPTION
 Panic attacks
 Phobias
 Obsessive-compulsive disorder
 PTSD
 Manic or hypo manic symptoms
 Eating disorders
 Substance abuse
GENETIC ABNORMALITIES DURING CONCEPTION
Abnormalities due to several factors
Some birth defects, such as cleft lip or palate, result from abnormalities in one or more genes
plus exposure to certain other factors, including substances in the environment (called
multifactorial inheritance). That is, the abnormal gene makes the fetus more likely to develop
a birth defect, but the birth defect usually does not develop unless the fetus is exposed to
specific substances, such as certain drugs or alcohol. Many common birth defects, such as
heart malformations, are inherited in this way.
Neural tube defects
Neural tube defects are birth defects of the brain or spinal cord. Examples are spina bifida (in
which the spine does not completely close, sometimes exposing the spinal cord) and
anencephaly (in which a large part of the brain and skull is missing). In the United States,
neural tube defects occur in about 1 in 1,000 births. For most of these defects, inheritance is
multifactorial (abnormal genes plus other factors). Other factors include
 Family history: The risk of having a baby with a neural tube defect is increased by
having a family member, including the couple’s children, with such a defect (family
history). For couples who have had a baby with spina bifida or anencephaly, the risk
of having another baby with one of these defects is 2 to 3%. For couples who have
had two children with one of these defects, the risk is 5 to 10%. However, about 95%
of neural tube defects occur in families without a history of neural tube defects.
 Folate deficiency: Risk may also be increased by a diet that is low in folate, a
vitamin. Folate supplements help to prevent neural tube defects. Therefore, daily
folate supplements are now routinely recommended for all women of childbearing
age, particularly for pregnant women. Folate is usually included in prenatal vitamins.
 Geographic location: Risk also varies based on where a person lives. For example,
risk is higher in the United Kingdom than in the United States.
Chromosomal abnormalities
Many chromosomal abnormalities, mainly those involving an abnormal number of
chromosomes or an abnormality in a chromosome's structure, can be detected by standard
chromosomal testing. These abnormalities occur in about 1 of 140 live births in the United
States and account for at least half of all miscarriages that occur during the 1st trimester.
Most foetuses that have chromosomal abnormalities die before birth. Among live-born
babies, Down syndrome is the most common chromosomal abnormality.
Several factors increase the risk of having a baby with a chromosomal abnormality:
 Woman’s age: The risk of having a baby with Down syndrome increases with a
woman’s age—steeply after age 35.
 Family history: Having a family history (including the couple’s children) of a
chromosomal abnormality increases the risk. If a couple has had one baby with the
most common form of Down syndrome (trisomy 21) and the woman is younger than
30, the risk of having another baby with a chromosomal abnormality is increased to
about 1%.
 Birth defect in a previous baby: Having had a live-born baby with a birth defect or
a stillborn baby—even when no one knows whether the baby had a chromosomal
abnormality—increases the risk of having a baby with a chromosomal abnormality.
About 30% of babies born with a birth defect and about 5% of visibly normal stillborn
babies have a chromosomal abnormality.
 Previous miscarriages: Having had several miscarriages may increase the risk of
having a baby with a chromosomal abnormality. If the fetus in a first miscarriage has
a chromosomal abnormality, a fetus in subsequent miscarriages is also likely to have
one, although not necessarily the same one. If a woman has had several miscarriages,
the couple’s chromosomes should be analyzed before they try to have another baby. If
abnormalities are identified, the couple may choose to have prenatal diagnostic testing
early in the next pregnancy.
INFERTILITY AND MENTAL HEALTH
Infertility means not being able to get pregnant after one year of trying (or after trying
for 6 months if a woman is 35 or older). Women who can get pregnant but are unable to
stay pregnant may also be infertile. Infertility affects 10 to 15 percent of couples.
Women who want a child but have not yet conceived often experience the following:
 Anger
 Depression
 Anxiety
 Marital problems
 Sexual dysfunction
 Social isolation
 Low self-esteem
Researchers are not sure if mental health can affect fertility, although it is clear that
infertility can affect mental health. It's possible, though, that high levels of depression,
anxiety, and stress can affect the hormones that regulate ovulation. This could make it
difficult for a woman to become pregnant.
TREATMENT
Couples with infertility have many treatments available to help them conceive. Most of
these treatments cost a lot of money and may not be covered by health insurance. While
many couples who seek infertility treatment are already stressed, the process and cost of
assisted reproduction itself can also cause anxiety, depression, and stress. If fertility
treatments and they are not working, may be at risk for further depression and self-
esteem problems. Talk therapy, either one-on-one or in a group, can lower stress and
mood symptoms. Women who had talk therapy during their infertility treatments were
more likely to get pregnant than those who did not.
Researchers are still learning whether drugs like antidepressants can help infertile
women. Many women don't want to take medications during infertility treatments
because they are afraid it may affect the outcome of a pregnancy. However, there is no
data that shows that commonly used antidepressants affect a woman's chances of
becoming pregnant.
PREGNANCY AND MENTAL HEALTH
Mental health problems are common in pregnancy. It is a time when women are more
vulnerable to depression or anxiety. Women with a previous personal or family history
of depression or mental illness are at greater risk of depression in the antenatal or
postnatal period. For women with a history of depression or other mental illness, it is
advisable that they have an assessment for depression early in their antenatal period.
Other factors that may be risk factors are an unplanned pregnancy, difficult or
complicated pregnancy, being single or having inadequate partner support, domestic
violence, and drug and or alcohol misuse. Depression is a common problem during and
after pregnancy. When you are pregnant or after you have a baby, you may be depressed
and not know it. Some normal changes during and after pregnancy can cause symptoms
similar to those of depression.
SYMPTOMS OF DEPRESSION INCLUDE:
 Feeling restless or moody
 Feeling sad, hopeless, and overwhelmed
 Crying a lot
 Having no energy or motivation
 Eating too little or too much
 Sleeping too little or too much
 Having trouble focusing or making decisions
 Having memory problems
 Feeling worthless and guilty
 Losing interest or pleasure in activities you used to enjoy
 Withdrawing from friends and family
 Having headaches, aches and pains, or stomach problems that don't go away
 Having suicidal thoughts.
Certain factors may increase risk of depression during and after pregnancy:
 A personal history of depression or another mental illness
 A family history of depression or another mental illness
 A lack of support from family and friends
 Anxiety or negative feelings about the pregnancy
 Problems with a previous pregnancy or birth
 Marriage or money problems
 Stressful life events
 Young age
 Substance abuse
Women who are depressed during pregnancy have a greater risk of depression after
giving birth. It's important to know that if you take medicine for depression, stopping
your medicine when you become pregnant can cause your depression to come back. Do
not stop any prescribed medicines without first talking to your doctor. Not using
medicine that you need may be harmful to you or your baby.
ENCOURAGING GOOD MENTAL HEALTH IN PREGNANCY
 Good mental health in pregnancy can be helped by a number of strategies including
good nutrition and regular exercise reducing or stopping alcohol and or drug use
 Regular antenatal care
gaining information about pregnancy
 Relaxation and anxiety management strategies
talking about your feelings and broadening of social contacts and supports
COMMON PSYCHIATRIC DISORDERS
Given the numerous physiological and hormonal changes the body undergoes and the
stressors involved in pregnancy, anxiety and depression are the most common emotional
disturbances during the perinatal period. Reported rates of depression in pregnant women
have ranged from 5% to almost 30%. In very mild cases, symptoms are usually manageable
with counseling, support groups, environmental manipulation, and diversions such as
walking, warm baths, and keeping up social contacts. When the depression and anxiety does
not respond to these approaches, professional psychotherapy is recommended. Brief hospital
stays, intensive outpatient programs, or, for more severe cases, medication may effectively
treat the illness. Major depression, a mood disorder that affects a person’s ability to
experience normal mood states, affects up to 10% of pregnant women. Symptoms include a
depressed mood most of the day, nearly every day, for two weeks or longer and/or the loss of
interest or pleasure in activities that the person usually enjoys.
Other symptoms can include:
Fatigue or lack of energy
Restlessness or feeling slowed down
Feelings of guilt or worthlessness
Difficulty concentrating
Trouble sleeping or sleeping too much
Recurrent thoughts of death or suicide
DEPRESSION IN PREGNANCY
During pregnancy, symptoms of depression such as changes in sleep, appetite, and energy are
often difficult to distinguish from the normal experiences of pregnancy. Although up to 70%
of women report some negative mood symptoms during pregnancy, the prevalence of women
who meet the diagnostic criteria for depression has been shown to be between 13.6% at 32
weeks gestation and 17% at 35 to 36 weeks gestation. The course of depression varies
throughout pregnancy: most studies report a symptom peak during the first and third
trimesters and improvement during the second trimester In a recent study, more women
became depressed between 18 and 32 weeks gestation than between 32 weeks gestation and 8
weeks postpartum.
Symptoms of depression include:
ss or moody
*Eating too little or too much
and guilty
Treatment of depression in pregnancy relies on the same therapies used for depression at
any time in life, with the added need to ensure the safety of the fetus. Psychotherapies that
have been recognized as effective treatment for depression include cognitive behavioural
therapy and interpersonal psychotherapy.
Education and support are also important, particularly as pregnancy is a unique experience
for women, some of whom may not know what to expect. Pharmacological therapies are also
recognized as effective treatment for depression. However, full disclosure of both the risk and
benefits of various antidepressant medications should be made to the patient and, if possible,
her partner prior to starting any pharmacological treatment.
Anxiety disorders in pregnancy
Data are available on some of the disorders that affect pregnant women (panic disorder and
obsessive compulsive disorder) but very little information exists regarding others
(generalized anxiety disorder and social phobia).
PURPERIUM AND WOMEN HEALTH
PUERPERIUM- is defined as the time from the delivery of the placenta through the first
few weeks after the delivery. This period is usually considered to be 6 weeks in duration. By
6 weeks after delivery, most of the changes of pregnancy, labour, and delivery have resolved
and the body has reverted to the non pregnant state.
POSTPARTUM DEPRESSION
Postpartum depression(PPD) is a complex mix of physical, emotional, and behavioural
changes that happens in a woman after giving birth. According to the DSM IV, a manual used
to diagnose mental disorders, PPD is a form of major depression that has its onset within
four weeks after delivery. The diagnosis of postpartum depression is based not only on the
length of time between delivery and onset, but also on the severity of the depression
What Is Postpartum Depression?
Postpartum depression is linked to chemical, social, and psychological changes associated
with having a baby. The term describes a range of physical and emotional changes that many
new mothers experience. The good news is postpartum depression can be treated with
medication and counselling. The chemical changes involve a rapid drop in hormones after
delivery. The actual link between this drop and depression is still not clear. But what is
known is that the levels of estrogens and progesterone, the female reproductive hormones,
increase tenfold during pregnancy. Then, they drop sharply after delivery. By three days after
a woman gives birth, the levels of these hormones drop back to what they were before she got
pregnant. In addition to these chemical changes, social and psychological changes associated
with having a baby create an increased risk of depression
SYMPTOMS OF POSTPARTUM DEPRESSION
Symptoms of postpartum depression are similar to what happens normally following
childbirth. They include lack of sleep, appetite changes, excessive fatigue, decreased libido,
and frequent mood changes. However, these are also accompanied by other symptoms of
major depression, which may include depressed mood; loss of pleasure; feelings of
worthlessness, hopelessness, and helplessness; and thoughts of death or suicide.
Risk Factors for Getting Postpartum Depression
 A number of factors can increase the risk of postpartum depression, including:
a history of depression during pregnancy age at time of pregnancy -- the younger you are,
the higher the risk ambivalence about the pregnancy
 children -- the more you have, the more likely you are to be depressed in a
subsequent pregnancy
having a history of depression or premenstrual dysphoric disorder (PMDD)
 Limited social support living alone marital conflict
Who Is at Risk for Postpartum Depression?
Most new mothers experience the "baby blues" after delivery. About one out of every 10 of
these women will develop a more severe and longer-lasting depression after delivery. About
one in 1,000women develops a more serious condition called postpartum psychosis.
Are There Different Types of Postpartum Depression?
There are three types of mood changes women can have after giving birth:
The "baby blues," which occur in most women in the days right after childbirth, are
considered normal. A new mother has sudden mood swings, such as feeling very happy and
then feeling very sad. She may cry for no reason and can feel impatient, irritable, restless,
anxious, lonely, and sad. The baby blues may last only a few hours or as long as one to two
weeks after delivery. The baby blues do not usually require treatment from a health care
provider. Often, joining a support group of new moms or talking with other moms helps.
TREATMENT FOR POSTPARTUM DEPRESSION
Postpartum depression is treated differently depending on the type and severity of a woman's
symptoms. Treatment options include anti-anxiety or antidepressant medications,
psychotherapy, and participation in a support group for emotional support and education. In
the case of postpartum psychosis, drugs used to treat psychosis are usually added. Hospital
admission is also often necessary. If you are breastfeeding, don't assume that you can't take
medication for depression, anxiety, or even psychosis. Talk to your doctor. Under a doctor's
supervision, many women take medication while breastfeeding. This is a decision to be made
between you and your doctor.
POST NATAL PSYCHOSIS
Postnatal Psychosis can be a potentially life-threatening condition that can put both mother
and baby at risk so recognising symptoms and seeking urgent medical assistance is essential.
Women with postnatal psychosis will almost always need admission
to hospital for specialised psychiatric assessment, care and treatment. Beyond the immediate
treatment period, significant ongoing support and is required throughout the recovery
process.
Clinical picture
 Prodromal period (approx 2 days after birth) with insomnia, irritability, restlessness,
refusal of food and depression
 This is rapidly followed by the acute onset of confusion, perplexity, excitability,
overactivity, hallucinations, fatigability, very labile mood, in addition to
preoccupations and delusions concerning the baby. Elation, grandiosity and
schizophreniform symptoms are common. Suicidal and infanticidal thoughts may be
present
 Peak onset after birth: 2 weeks
 Duration: 6-12 weeks
EPIDEMIOLOGY
 Incidence: 0.2% (~ 1.5 per 1,000 live births)
CAUSES OF POSTNATAL PSYCHOSIS
 have a family history of mental health illness, particularly postpartum psychosis (even
if you have no history of mental illness)
 already have a diagnosis of bipolar disorder or schizophrenia
 you have a traumatic birth or pregnancy
 you developed postpartum psychosis after a previous pregnancy
Severe sleep deprivation and rapid hormonal changes following childbirth may also be
contributing factors. Many women will have only a single episode of postnatal psychosis,
while others might experience it with more than one baby.
SIGN AND SYMPTOMS OF POSTNATAL PSYCHOSIS
 Hallucinations
 delusions – thoughts or beliefs that are unlikely to be true
 a manic mood – talking and thinking too much or too quickly, feeling "high" or "on
top of the world"
 a low mood – showing signs of depression, being withdrawn or tearful, lacking
energy, having a loss of appetite, anxiety or trouble sleeping
 loss of inhibitions
 feeling suspicious or fearful
 restlessness
 feeling very confused
 behaving in a way that's out of character
AETIOLOGY – RISK FACTORS
 Genetics: family history of major psychiatric disorder predisposes to puerperal psychosis
 Secondary to underlying mental illness (e.g. schizophrenia or BPAD). History of manic
depressive psychosis predicts 20% chance of developing puerperal psychosis
 Biochemical: sudden ↓ of progesterone, oestrogen (super-sensitivity of DA), cortisol
levels, or postpartum thyroiditis
 Older age at birth
 Primigravida status
 Casearean section
 Higher social class
 Perinatal death of the baby
 Lack of social support
 Psychodynamic factors: conflicts about motherhood – unwanted pregnancy, trapped in
an unhappy relationship, fears of mothering
TREATMENT
Postpartum blues, which has little effect on a patient's ability to function, often resolves by
postpartum day 10; therefore, no pharmacotherapy is indicated. Providing support and
education has been shown to have a positive effect.
PPD generally lasts for 3-6 months, with 25% of patients still affected at 1 year. PPD
greatly affects the patient's ability to complete activities associated with daily living.
*Supportive care and reassurance from healthcare professionals and the patient's family is the
first-line therapy for patients with PPD.
*Postpartum psychosis: Treatment of postpartum psychosis should be supervised by a
psychiatrist and should involve hospitalization. Specific therapy is controversial and should
be targeted to the patient's specific symptoms. Patients with postpartum psychosis are thought
to have a better prognosis than those with non puerperal psychosis. Postpartum psychosis
generally lasts only 2-3 months.
Secondary to the overlap between the normal squeal of childbirth and the symptoms of
PPD, the former is often under diagnosed. Screening for PPD increases the identification of
women suffering from this disorder. The Edinburgh Postnatal Depression Scale has proven to
be an effective tool for this type of screening. It requires little extra time and is acceptable to
both patients and physicians.
MEDICATIONS
 Prevention
o Identification & close monitoring, education, support and treatment of ‘at risk’
individuals
 Admission (if needed) – specialist mother and baby unit if available
 Do not leave the infant alone with the mother if she has delusions or ruminations about
the infant’s death
 Biological
o Major affective disorder
 Early use of antidepressants (e.g. Paroxetine or Sertraline are recommended if
breast feeding)
 Mood stabilizer – avoid if breast feeding, Valproate if essential
o Psychotic symptoms: antipsychotic (e.g. Sulpride or Olanzapine are recommended
if breast feeding)
 Antidepressants- to help ease systems of depression
 antipsychotics – to help with manic and psychotic symptoms, such as delusions or
hallucinations
 mood stabilisers (for example, lithium) – to stabilise your mood and prevent symptoms
recurring
Psychological therapy
SUMMARY
Gender differences have an impact on mental health and the experience and course of
women’s mental illness. Women have mental health problems because they have a
biologically based proness to such problems. Comprehensive gender – sensitive mental health
care delivery, monitoring and quality improvement with early and appropriate
pharmachological intervention must be resorted to, with the overall objective of contributing
to effective prevention and promotion of women’s mental health. It is clear that in the recent
past there has been a resurgence of interest in women mental health in the country.
CONCLUSION
Gender differences have an impact on mental health and the experience and course of
women’s mental illness. Women have mental health problems because they have a
biologically based proness to such problems. Comprehensive gender – sensitive mental health
care delivery, monitoring and quality improvement with early and appropriate
pharmachological intervention must be resorted to, with the overall objective of contributing
to effective prevention and promotion of women’s mental health. It is clear that in the recent
past there has been a resurgence of interest in women mental health in the country. Research
on violence against women has figured prominently in the recent past. Although some areas
have been covered, many more deserve attention. For example multiple-perpetrator DV in
married women with severe mental illness, cyber violence against women, stalking, marriage-
related laws and mental illness, Indian legislation and gender specificity, female sexuality,
surrogacy, psychosocial determinants of mental health in women, etc. It is essential to
recognize how the sociocultural, economic, legal, infrastructural, and environmental factors
that affect women& mental health are configured in the given community setting.
women and mental health

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women and mental health

  • 1. NIGHTANGLE INSTITUTE OF NURSING PEER PRESENTATION ON WOMEN AND MENTAL HEALTH SUBJECT- MENTAL HEALTH NURSING SUBMITTED TO SUBMITTED BY MS. P Elavarsai Lovely Singh Associate Professor M.SC. 1st Year Mental Health Nursing
  • 2. GENERAL INTRODUCTION Name of the Student Lovely Singh Subject Mental Health Nursing Topic Women and mental health Group M.SC 1St Yr Date Duration 40 Minutes Method of Teaching Lesson Cum Discussion Place College Language English Name of the Supervisor Ms Elavarsi Previous Knowledge Group has studied about Women and mental health
  • 3. GENERAL OBJECTIVE After the completion of my topic that is women and mental health, the students will get the knowledge of women and mental health. SPECIFIC OBJECTIVES Introduction of women and mental health Definition PMS and women Mental Health Menopause and women mental health Polycystic ovarian cyst and women mental health Conception and women mental health Pregnancy and women mental health Summary Conclusion Bibliography Research Abstract
  • 4. INTRODUCTION “The reason firm, the temperate will, Endurance, foresight, strength, and skill; A perfect woman, nobly planned, To warn, to comfort, and command.” William Wordsworth Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. The positive dimension of mental health is stressed in WHO's definition of health as contained in its constitution: "Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity." WOMEN’S MENTAL HEALTH: THE FACTS (WORLD HEALTH ORGANIZATION REPORT, 2001)  Depressive disorders account for close to 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men.  Leading mental health problems of the elderly are depression, organic brain syndromes, and dementias, a majority are women.  An estimated 80% of 50 million people affected by violent conflicts, civil wars, disasters, and displacement are women and children.  Lifetime prevalence rate of violence against women ranges from 16% to 50%  At least one in five women suffers rape or attempted rape in their lifetime.  Pressures created by their multiple roles, gender discrimination and associated factors of poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse, combine to account for women's poor mental health.  Communication between health workers and women patients is extremely authoritarian in many countries, making a woman's disclosure of psychological and emotional distress difficult, and often stigmatized.
  • 5. MENSTRUATION, MENOPAUSE, AND MENTAL HEALTH  Premenstrual mood changes  Menopause and mood changes  More information on menstruation, menopause, and mental health Hormones can affect a woman's mood throughout her lifetime. Sometimes the impact on mood can affect a woman's quality of life. Many times the symptoms that result can be managed with medicine and/or therapy. PREMENSTRUAL MOOD CHANGES Once a young woman starts menstruating, she may begin to experience emotional changes around the time of her period. 75 percent of women with regular period cycles report unpleasant physical or psychological symptoms before their periods. Premenstrual syndrome, or PMS, affects 30 to 80 percent of women. Psychological symptoms of PMS include:  Depression  Anger  Irritability  Anxiety  Sensitivity to rejection  Sense of feeling overwhelmed  Social withdrawal Physical symptoms of PMS include:  Fatigue (feeling tired)  Sleep disturbance  Increased appetite  Abdominal bloating  Breast tenderness  Headaches (sometimes known as menstrual migraines)  Muscle aches and joint pain  Swelling of extremities
  • 6. PREMENSTRUAL DYSPHORIC DISORDER, OR PMDD, is a more severe form of PMS. It affects 3 to 8 percent of women of reproductive age. Symptoms of PMDD include:  Severe irritability  Depression  Anxiety  Mood swings The best way to confirm PMDD is to make a chart of symptoms (for example: cramps, headaches, or weight gain). A woman with PMDD should have symptom-free days between the start of her period and ovulation. Your doctor or a mental health professional can use a prospective scale (the Calendar of Premenstrual Experience and the Prospective Record of the Severity of Menstruation are two examples) to figure out if you have PMDD. The causes of PMS and PMDD are not known, but research shows that they are based in the body and not just in the mind. Women who experience PMS and/or PMDD do not have higher levels of hormones compared to other women. Instead, women with PMS and/or PMDD may be extra sensitive to normal hormonal changes. Treatment Lifestyle changes may help to make the symptoms of PMS and PMDD better. Some doctors suggest that women:  Eat lesser amounts of caffeine, sugar, and sodium  Drink less alcohol  Smoke less  Get plenty of sleep  Exercise more  Try talk therapy Medications or supplements prescribed by the doctor can also help PMS and PMDD. These may include:  Calcium (1200 mg per day was shown to reduce PMS symptoms)  Selective serotonin reuptake inhibitors (SSRIs)  Hormonal treatments such as oral contraceptives
  • 7. MENOPAUSE AND MOOD CHANGES Women may experience a wide range of feelings, from anxiety and discomfort to release and relief, upon menopause. Most adapt to the changes and continue to live well and remain healthy through these transitions. DEPRESSION Some women, although not all, will experience significant depression before perimenopause( the period of women’s life shortly before the occurrence of menuopause). Perimenopause marks the time when your body begins the transition to menopause. It includes the years leading up to menopause — anywhere from two to eight years — plus the first year after your final period. There is no way to tell in advance how long it will last or how long it will take you to go through it. It's a natural part of aging that signals the ending of your reproductive years. Because of the intense hormone changes during perimenopause, women are more likely to have menopause- related depression before they reach actual menopause. When women go through menopause, some may feel badly at the loss of their ability to bear children. However, some women look at menopause as a time to expand their work and social activities, and to dedicate more time to their spouse or partner. Having a positive attitude about this life change may help. TREATMENT There are several treatment options for women who have depression during perimenopause.  Menopausal hormone therapy – To help control the symptoms of menopause, some women can take hormones, called menopausal hormone therapy (MHT). MHT used to be called hormone replacement therapy or HRT. The use of MHT has been debated a great deal since the Women's Health Initiative (WHI) Hormone Study findings were released in 2002. Long-term use of MHT poses some serious risks. If you decide to try MHT, use the lowest dose that helps for the shortest time you need it.  Antidepressants – Antidepressants may be an option for women who are unable or unwilling to take MHT.  Talk therapy – Talk therapy may take place one-on-one with a mental health professional or in a group setting. Once identified, depression almost always can be treated either by therapy, medicine called antidepressants, or both. Some people with milder forms of depression do well with therapy alone. Others with moderate to severe depression might benefit from antidepressants. It may take a few weeks or months before you begin to feel a change in your mood. Some people do best with combined treatment: therapy and antidepressants
  • 8. POST-TRAUMATIC STRESS DISORDER (PTSD) AND WOMEN VETERANS PTSD can occur through a traumatic event.. Example- If you are in the military, you may have seen combat. You may have been on missions that exposed you to horrible and life-threatening experiences. You may have been shot at, seen a friend shot, or seen death. These are types of events that can lead to PTSD. Military sexual trauma (MST) can also lead to PTSD. Sometimes, PTSD is also associated with intimate partner violence(IPV). Women are more likely than men to develop chronic, or long-lasting, PTSD after experiencing a trauma. Not all women who experience a traumatic event develop PTSD. However, women are more likely to develop PTSD if they:  Have a past mental health problem (like depression or anxiety)  Experience a very severe or life-threatening trauma  Were sexually assaulted  Were injured during the event  Had a severe reaction at the time of the event  Experienced other stressful events afterwards  Do not have good social support Some PTSD symptoms are more common in women than in men. Women are more likely to be jumpy, to have trouble feeling emotions, and to avoid things that remind them of the trauma. Treatment PTSD can be treated. A doctor or mental health professional with experience in treating people with PTSD can help. Treatment may include "talk" therapy, medication, or both. Treatment might take 6 to 12 weeks. For some people, it takes longer. Treatment is not the same for everyone. What works for you might not work for someone else. Drinking alcohol or using other drugs will not help PTSD go away, and may even make it worse.
  • 9. INTIMATE PARTNER VIOLENCE (IPV) AND WOMEN VETERANS IPV is also known as domestic violence. IPV is when a current or former partner uses behaviours or threats that can make you feel scared, controlled, or intimidated. A relationship in which IPV occurs is an abusive relationship. IPV could include any of the following:  Physical violence – hitting, pushing, grabbing, biting, choking, shaking, slapping  Sexual violence – attempted or actual sexual contact without your consent  Threats of physical or sexual abuse – words, looks or gestures to control or frighten  Psychological or emotional abuse – humiliating, putting down, isolating, threatening  Stalking – following, harassing, or unwanted contact that makes you feel afraid POLYCYSTIC OVARIAN SYNDROME A condition that disrupts the lives of millions of women, Polycystic Ovarian Syndrome (PCOS) is a disorder that causes a variety of painful symptoms. Not merely an affliction of the physical body, Polycystic Ovarian Syndrome, or as it’s also known, Polycystic Ovarian Disorder or PCOD, has been linked to emotional and mental disorders. The stress of coping with the long list of symptoms this condition can cause is significant, but for many women PCOS mental factors can lead to more serious health conditions. Research indicates that women with PCOS face greater rates of a variety of emotional and mental conditions, including anxiety, panic attacks, depression, difficulty concentrating, fatigue, mood swings, and chronic stress. These conditions go far beyond polycystic ovaries and physical pain. Furthermore, it means PCOS emotional consequences can be devastating. A healthy lifestyle, complete with nutritious diet, plentiful exercise, and targeted nutritional supplements and/or prescription medications can help to bring PCOS mood issues and symptoms under control. SYMPTOMS  Infertility: As one of the most emotionally devastating symptoms on the list, infertility can cause a woman to question her role in society. Many women associate their identities as women with the role of being a mother, and not being able to bear children can challenge this identity.  Irregular Menstruation: Sporadic, absent, or infrequent menstrual periods often occur.  Anovulation and Oligoovulation: Often responsible for infertility, some women’s ovaries either fail to release an egg or infrequently release an egg. This symptom can also affect the regularity of a woman’s menstrual period.
  • 10.  Ovarian Cysts: Although Polycystic Ovarian Syndrome is named after this symptom, it actually does not have to be present to obtain a diagnosis. However, many women do have many cysts strung around the outside perimeter of their ovaries, which are said to resemble pearls.  Weight Gain and Obesity: Another highly difficult symptom with which to cope, weight gain is very common but not necessary for a diagnosis. This is an especially serious symptom, because excess weight can exacerbate other symptoms (such as high cholesterol and blood pressure) and lead to more serious health conditions.  Skin Conditions. Acne: acanthosis nigricans (thick, velvety patches of skin), and other skin irregularities often occur.  Hirsutism: High levels of testosterone often cause excessive growth of hair in abnormal places, such as the chest, face, and back.  Hair Loss: Akin to male pattern baldness, hair loss is another highly embarrassing and difficult symptom with which women who have Polycystic Ovarian Syndrome (PCOS) often have to cope.  High Cholesterol and High Blood Pressure: Excess glucose in the bloodstream can cause damage to arterial walls, where cholesterol can settle. This causes blood pressure to rise, which can present a very serious risk, as heart disease is linked with Polycystic Ovarian Syndrome (PCOS).  SleepDisorders: Sleep apnea and insomnia, as well as snoring, are often reported by women who suffer from PCOS.  Depression: Polycystic Ovarian Syndrome (PCOS) can affect the body and the mind, causing depression. CONCEPTION AND WOMEN MENTAL HEALTH Milestones of Fetal Development
  • 11. NORMAL REACTION TO CONCEPTION It is an emotional time for the woman, who becomes pregnant ,especially if she pregnant for the first time .Forthcoming parenthood causes psychological changes in both mother and father. Pregnancy is an experience full of growth, change, enrichment and challenge.The occurrence of physiological changes along with the hormonal changes make pregnancy a psychological event for the woman. Hormonal levels are constantly fluctuating during pregnancy, which can lead to feelings of anxiety ,depression, sadness ,elation and even confusion. The woman can report mood swings and irritability during and after their pregnancy. The feelings which the mother undergoes include feelings of depression , emotional liability , issues of self esteem and body image issues. PHYSIOLOGICAL CHANGES DURING CONCEPTION WHICH AFFECTS ON WOMEN MENTAL HEALTH Maternal physiological changes in pregnancy are the adaptations during pregnancy that a person’s body undergoes to accommodate the growing embryo or fetus. These physiologic changes are entirely normal, and include cardiovascular (heart and blood vessel), hematologic (blood), metabolic, renal (kidney), posture, and respiratory (breathing) changes. Increases in blood sugar, breathing, and cardiac output are all expected changes that allow a pregnant person’s body to facilitate the proper growth and development of the embryo or fetus during the pregnancy. The pregnant person and the placenta also produce many other hormones that have a broad range of effects during the pregnancy. PSYCHOLOGICAL CHANGES DURING CONCEPTION  Panic attacks  Phobias  Obsessive-compulsive disorder  PTSD  Manic or hypo manic symptoms  Eating disorders  Substance abuse GENETIC ABNORMALITIES DURING CONCEPTION Abnormalities due to several factors Some birth defects, such as cleft lip or palate, result from abnormalities in one or more genes plus exposure to certain other factors, including substances in the environment (called multifactorial inheritance). That is, the abnormal gene makes the fetus more likely to develop a birth defect, but the birth defect usually does not develop unless the fetus is exposed to specific substances, such as certain drugs or alcohol. Many common birth defects, such as heart malformations, are inherited in this way.
  • 12. Neural tube defects Neural tube defects are birth defects of the brain or spinal cord. Examples are spina bifida (in which the spine does not completely close, sometimes exposing the spinal cord) and anencephaly (in which a large part of the brain and skull is missing). In the United States, neural tube defects occur in about 1 in 1,000 births. For most of these defects, inheritance is multifactorial (abnormal genes plus other factors). Other factors include  Family history: The risk of having a baby with a neural tube defect is increased by having a family member, including the couple’s children, with such a defect (family history). For couples who have had a baby with spina bifida or anencephaly, the risk of having another baby with one of these defects is 2 to 3%. For couples who have had two children with one of these defects, the risk is 5 to 10%. However, about 95% of neural tube defects occur in families without a history of neural tube defects.  Folate deficiency: Risk may also be increased by a diet that is low in folate, a vitamin. Folate supplements help to prevent neural tube defects. Therefore, daily folate supplements are now routinely recommended for all women of childbearing age, particularly for pregnant women. Folate is usually included in prenatal vitamins.  Geographic location: Risk also varies based on where a person lives. For example, risk is higher in the United Kingdom than in the United States. Chromosomal abnormalities Many chromosomal abnormalities, mainly those involving an abnormal number of chromosomes or an abnormality in a chromosome's structure, can be detected by standard chromosomal testing. These abnormalities occur in about 1 of 140 live births in the United States and account for at least half of all miscarriages that occur during the 1st trimester. Most foetuses that have chromosomal abnormalities die before birth. Among live-born babies, Down syndrome is the most common chromosomal abnormality. Several factors increase the risk of having a baby with a chromosomal abnormality:  Woman’s age: The risk of having a baby with Down syndrome increases with a woman’s age—steeply after age 35.  Family history: Having a family history (including the couple’s children) of a chromosomal abnormality increases the risk. If a couple has had one baby with the most common form of Down syndrome (trisomy 21) and the woman is younger than 30, the risk of having another baby with a chromosomal abnormality is increased to about 1%.  Birth defect in a previous baby: Having had a live-born baby with a birth defect or a stillborn baby—even when no one knows whether the baby had a chromosomal abnormality—increases the risk of having a baby with a chromosomal abnormality. About 30% of babies born with a birth defect and about 5% of visibly normal stillborn babies have a chromosomal abnormality.  Previous miscarriages: Having had several miscarriages may increase the risk of having a baby with a chromosomal abnormality. If the fetus in a first miscarriage has a chromosomal abnormality, a fetus in subsequent miscarriages is also likely to have one, although not necessarily the same one. If a woman has had several miscarriages, the couple’s chromosomes should be analyzed before they try to have another baby. If abnormalities are identified, the couple may choose to have prenatal diagnostic testing early in the next pregnancy.
  • 13. INFERTILITY AND MENTAL HEALTH Infertility means not being able to get pregnant after one year of trying (or after trying for 6 months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile. Infertility affects 10 to 15 percent of couples. Women who want a child but have not yet conceived often experience the following:  Anger  Depression  Anxiety  Marital problems  Sexual dysfunction  Social isolation  Low self-esteem Researchers are not sure if mental health can affect fertility, although it is clear that infertility can affect mental health. It's possible, though, that high levels of depression, anxiety, and stress can affect the hormones that regulate ovulation. This could make it difficult for a woman to become pregnant. TREATMENT Couples with infertility have many treatments available to help them conceive. Most of these treatments cost a lot of money and may not be covered by health insurance. While many couples who seek infertility treatment are already stressed, the process and cost of assisted reproduction itself can also cause anxiety, depression, and stress. If fertility treatments and they are not working, may be at risk for further depression and self- esteem problems. Talk therapy, either one-on-one or in a group, can lower stress and mood symptoms. Women who had talk therapy during their infertility treatments were more likely to get pregnant than those who did not. Researchers are still learning whether drugs like antidepressants can help infertile women. Many women don't want to take medications during infertility treatments because they are afraid it may affect the outcome of a pregnancy. However, there is no data that shows that commonly used antidepressants affect a woman's chances of becoming pregnant.
  • 14. PREGNANCY AND MENTAL HEALTH Mental health problems are common in pregnancy. It is a time when women are more vulnerable to depression or anxiety. Women with a previous personal or family history of depression or mental illness are at greater risk of depression in the antenatal or postnatal period. For women with a history of depression or other mental illness, it is advisable that they have an assessment for depression early in their antenatal period. Other factors that may be risk factors are an unplanned pregnancy, difficult or complicated pregnancy, being single or having inadequate partner support, domestic violence, and drug and or alcohol misuse. Depression is a common problem during and after pregnancy. When you are pregnant or after you have a baby, you may be depressed and not know it. Some normal changes during and after pregnancy can cause symptoms similar to those of depression. SYMPTOMS OF DEPRESSION INCLUDE:  Feeling restless or moody  Feeling sad, hopeless, and overwhelmed  Crying a lot  Having no energy or motivation  Eating too little or too much  Sleeping too little or too much  Having trouble focusing or making decisions  Having memory problems  Feeling worthless and guilty  Losing interest or pleasure in activities you used to enjoy  Withdrawing from friends and family  Having headaches, aches and pains, or stomach problems that don't go away  Having suicidal thoughts. Certain factors may increase risk of depression during and after pregnancy:  A personal history of depression or another mental illness  A family history of depression or another mental illness  A lack of support from family and friends  Anxiety or negative feelings about the pregnancy  Problems with a previous pregnancy or birth  Marriage or money problems  Stressful life events  Young age
  • 15.  Substance abuse Women who are depressed during pregnancy have a greater risk of depression after giving birth. It's important to know that if you take medicine for depression, stopping your medicine when you become pregnant can cause your depression to come back. Do not stop any prescribed medicines without first talking to your doctor. Not using medicine that you need may be harmful to you or your baby. ENCOURAGING GOOD MENTAL HEALTH IN PREGNANCY  Good mental health in pregnancy can be helped by a number of strategies including good nutrition and regular exercise reducing or stopping alcohol and or drug use  Regular antenatal care gaining information about pregnancy  Relaxation and anxiety management strategies talking about your feelings and broadening of social contacts and supports COMMON PSYCHIATRIC DISORDERS Given the numerous physiological and hormonal changes the body undergoes and the stressors involved in pregnancy, anxiety and depression are the most common emotional disturbances during the perinatal period. Reported rates of depression in pregnant women have ranged from 5% to almost 30%. In very mild cases, symptoms are usually manageable with counseling, support groups, environmental manipulation, and diversions such as walking, warm baths, and keeping up social contacts. When the depression and anxiety does not respond to these approaches, professional psychotherapy is recommended. Brief hospital stays, intensive outpatient programs, or, for more severe cases, medication may effectively treat the illness. Major depression, a mood disorder that affects a person’s ability to experience normal mood states, affects up to 10% of pregnant women. Symptoms include a depressed mood most of the day, nearly every day, for two weeks or longer and/or the loss of interest or pleasure in activities that the person usually enjoys. Other symptoms can include: Fatigue or lack of energy Restlessness or feeling slowed down Feelings of guilt or worthlessness Difficulty concentrating Trouble sleeping or sleeping too much Recurrent thoughts of death or suicide
  • 16. DEPRESSION IN PREGNANCY During pregnancy, symptoms of depression such as changes in sleep, appetite, and energy are often difficult to distinguish from the normal experiences of pregnancy. Although up to 70% of women report some negative mood symptoms during pregnancy, the prevalence of women who meet the diagnostic criteria for depression has been shown to be between 13.6% at 32 weeks gestation and 17% at 35 to 36 weeks gestation. The course of depression varies throughout pregnancy: most studies report a symptom peak during the first and third trimesters and improvement during the second trimester In a recent study, more women became depressed between 18 and 32 weeks gestation than between 32 weeks gestation and 8 weeks postpartum. Symptoms of depression include: ss or moody *Eating too little or too much and guilty Treatment of depression in pregnancy relies on the same therapies used for depression at any time in life, with the added need to ensure the safety of the fetus. Psychotherapies that have been recognized as effective treatment for depression include cognitive behavioural therapy and interpersonal psychotherapy. Education and support are also important, particularly as pregnancy is a unique experience for women, some of whom may not know what to expect. Pharmacological therapies are also recognized as effective treatment for depression. However, full disclosure of both the risk and benefits of various antidepressant medications should be made to the patient and, if possible, her partner prior to starting any pharmacological treatment. Anxiety disorders in pregnancy Data are available on some of the disorders that affect pregnant women (panic disorder and obsessive compulsive disorder) but very little information exists regarding others (generalized anxiety disorder and social phobia).
  • 17. PURPERIUM AND WOMEN HEALTH PUERPERIUM- is defined as the time from the delivery of the placenta through the first few weeks after the delivery. This period is usually considered to be 6 weeks in duration. By 6 weeks after delivery, most of the changes of pregnancy, labour, and delivery have resolved and the body has reverted to the non pregnant state. POSTPARTUM DEPRESSION Postpartum depression(PPD) is a complex mix of physical, emotional, and behavioural changes that happens in a woman after giving birth. According to the DSM IV, a manual used to diagnose mental disorders, PPD is a form of major depression that has its onset within four weeks after delivery. The diagnosis of postpartum depression is based not only on the length of time between delivery and onset, but also on the severity of the depression What Is Postpartum Depression? Postpartum depression is linked to chemical, social, and psychological changes associated with having a baby. The term describes a range of physical and emotional changes that many new mothers experience. The good news is postpartum depression can be treated with medication and counselling. The chemical changes involve a rapid drop in hormones after delivery. The actual link between this drop and depression is still not clear. But what is known is that the levels of estrogens and progesterone, the female reproductive hormones, increase tenfold during pregnancy. Then, they drop sharply after delivery. By three days after a woman gives birth, the levels of these hormones drop back to what they were before she got pregnant. In addition to these chemical changes, social and psychological changes associated with having a baby create an increased risk of depression SYMPTOMS OF POSTPARTUM DEPRESSION Symptoms of postpartum depression are similar to what happens normally following childbirth. They include lack of sleep, appetite changes, excessive fatigue, decreased libido, and frequent mood changes. However, these are also accompanied by other symptoms of major depression, which may include depressed mood; loss of pleasure; feelings of worthlessness, hopelessness, and helplessness; and thoughts of death or suicide. Risk Factors for Getting Postpartum Depression  A number of factors can increase the risk of postpartum depression, including: a history of depression during pregnancy age at time of pregnancy -- the younger you are, the higher the risk ambivalence about the pregnancy  children -- the more you have, the more likely you are to be depressed in a subsequent pregnancy having a history of depression or premenstrual dysphoric disorder (PMDD)  Limited social support living alone marital conflict
  • 18. Who Is at Risk for Postpartum Depression? Most new mothers experience the "baby blues" after delivery. About one out of every 10 of these women will develop a more severe and longer-lasting depression after delivery. About one in 1,000women develops a more serious condition called postpartum psychosis. Are There Different Types of Postpartum Depression? There are three types of mood changes women can have after giving birth: The "baby blues," which occur in most women in the days right after childbirth, are considered normal. A new mother has sudden mood swings, such as feeling very happy and then feeling very sad. She may cry for no reason and can feel impatient, irritable, restless, anxious, lonely, and sad. The baby blues may last only a few hours or as long as one to two weeks after delivery. The baby blues do not usually require treatment from a health care provider. Often, joining a support group of new moms or talking with other moms helps. TREATMENT FOR POSTPARTUM DEPRESSION Postpartum depression is treated differently depending on the type and severity of a woman's symptoms. Treatment options include anti-anxiety or antidepressant medications, psychotherapy, and participation in a support group for emotional support and education. In the case of postpartum psychosis, drugs used to treat psychosis are usually added. Hospital admission is also often necessary. If you are breastfeeding, don't assume that you can't take medication for depression, anxiety, or even psychosis. Talk to your doctor. Under a doctor's supervision, many women take medication while breastfeeding. This is a decision to be made between you and your doctor. POST NATAL PSYCHOSIS Postnatal Psychosis can be a potentially life-threatening condition that can put both mother and baby at risk so recognising symptoms and seeking urgent medical assistance is essential. Women with postnatal psychosis will almost always need admission to hospital for specialised psychiatric assessment, care and treatment. Beyond the immediate treatment period, significant ongoing support and is required throughout the recovery process. Clinical picture  Prodromal period (approx 2 days after birth) with insomnia, irritability, restlessness, refusal of food and depression  This is rapidly followed by the acute onset of confusion, perplexity, excitability, overactivity, hallucinations, fatigability, very labile mood, in addition to preoccupations and delusions concerning the baby. Elation, grandiosity and schizophreniform symptoms are common. Suicidal and infanticidal thoughts may be present  Peak onset after birth: 2 weeks  Duration: 6-12 weeks
  • 19. EPIDEMIOLOGY  Incidence: 0.2% (~ 1.5 per 1,000 live births) CAUSES OF POSTNATAL PSYCHOSIS  have a family history of mental health illness, particularly postpartum psychosis (even if you have no history of mental illness)  already have a diagnosis of bipolar disorder or schizophrenia  you have a traumatic birth or pregnancy  you developed postpartum psychosis after a previous pregnancy Severe sleep deprivation and rapid hormonal changes following childbirth may also be contributing factors. Many women will have only a single episode of postnatal psychosis, while others might experience it with more than one baby. SIGN AND SYMPTOMS OF POSTNATAL PSYCHOSIS  Hallucinations  delusions – thoughts or beliefs that are unlikely to be true  a manic mood – talking and thinking too much or too quickly, feeling "high" or "on top of the world"  a low mood – showing signs of depression, being withdrawn or tearful, lacking energy, having a loss of appetite, anxiety or trouble sleeping  loss of inhibitions  feeling suspicious or fearful  restlessness  feeling very confused  behaving in a way that's out of character AETIOLOGY – RISK FACTORS  Genetics: family history of major psychiatric disorder predisposes to puerperal psychosis  Secondary to underlying mental illness (e.g. schizophrenia or BPAD). History of manic depressive psychosis predicts 20% chance of developing puerperal psychosis  Biochemical: sudden ↓ of progesterone, oestrogen (super-sensitivity of DA), cortisol levels, or postpartum thyroiditis  Older age at birth  Primigravida status  Casearean section  Higher social class  Perinatal death of the baby  Lack of social support  Psychodynamic factors: conflicts about motherhood – unwanted pregnancy, trapped in an unhappy relationship, fears of mothering
  • 20. TREATMENT Postpartum blues, which has little effect on a patient's ability to function, often resolves by postpartum day 10; therefore, no pharmacotherapy is indicated. Providing support and education has been shown to have a positive effect. PPD generally lasts for 3-6 months, with 25% of patients still affected at 1 year. PPD greatly affects the patient's ability to complete activities associated with daily living. *Supportive care and reassurance from healthcare professionals and the patient's family is the first-line therapy for patients with PPD. *Postpartum psychosis: Treatment of postpartum psychosis should be supervised by a psychiatrist and should involve hospitalization. Specific therapy is controversial and should be targeted to the patient's specific symptoms. Patients with postpartum psychosis are thought to have a better prognosis than those with non puerperal psychosis. Postpartum psychosis generally lasts only 2-3 months. Secondary to the overlap between the normal squeal of childbirth and the symptoms of PPD, the former is often under diagnosed. Screening for PPD increases the identification of women suffering from this disorder. The Edinburgh Postnatal Depression Scale has proven to be an effective tool for this type of screening. It requires little extra time and is acceptable to both patients and physicians. MEDICATIONS  Prevention o Identification & close monitoring, education, support and treatment of ‘at risk’ individuals  Admission (if needed) – specialist mother and baby unit if available  Do not leave the infant alone with the mother if she has delusions or ruminations about the infant’s death  Biological o Major affective disorder  Early use of antidepressants (e.g. Paroxetine or Sertraline are recommended if breast feeding)  Mood stabilizer – avoid if breast feeding, Valproate if essential o Psychotic symptoms: antipsychotic (e.g. Sulpride or Olanzapine are recommended if breast feeding)  Antidepressants- to help ease systems of depression  antipsychotics – to help with manic and psychotic symptoms, such as delusions or hallucinations  mood stabilisers (for example, lithium) – to stabilise your mood and prevent symptoms recurring Psychological therapy
  • 21. SUMMARY Gender differences have an impact on mental health and the experience and course of women’s mental illness. Women have mental health problems because they have a biologically based proness to such problems. Comprehensive gender – sensitive mental health care delivery, monitoring and quality improvement with early and appropriate pharmachological intervention must be resorted to, with the overall objective of contributing to effective prevention and promotion of women’s mental health. It is clear that in the recent past there has been a resurgence of interest in women mental health in the country. CONCLUSION Gender differences have an impact on mental health and the experience and course of women’s mental illness. Women have mental health problems because they have a biologically based proness to such problems. Comprehensive gender – sensitive mental health care delivery, monitoring and quality improvement with early and appropriate pharmachological intervention must be resorted to, with the overall objective of contributing to effective prevention and promotion of women’s mental health. It is clear that in the recent past there has been a resurgence of interest in women mental health in the country. Research on violence against women has figured prominently in the recent past. Although some areas have been covered, many more deserve attention. For example multiple-perpetrator DV in married women with severe mental illness, cyber violence against women, stalking, marriage- related laws and mental illness, Indian legislation and gender specificity, female sexuality, surrogacy, psychosocial determinants of mental health in women, etc. It is essential to recognize how the sociocultural, economic, legal, infrastructural, and environmental factors that affect women& mental health are configured in the given community setting.