Psychiatric aspect of obstetrics and gynecology
•
12 likes•3,427 views
Psychiatric aspect of obstetrics and gynecology
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Similar to Psychiatric aspect of obstetrics and gynecology
Similar to Psychiatric aspect of obstetrics and gynecology (20)
More from Kavindya Fernando
More from Kavindya Fernando (20)
Recently uploaded
Recently uploaded (20)
Psychiatric aspect of obstetrics and gynecology
- 1. Psychiatric aspect of obstetrics and gynecology K. Kavindya M. Fernando JMJ 1
- 2. Psychiatric disorders during Pregnancy • More common in 1st and 3rd trimester • In 1st trimester –unwanted pregnancies • Anxiety • Depression • In 3rd trimester • Fear about impending delivery • Doubts about the normality of the fetus • Psychiatric disorders common in • Previous Hx of psychiatric disorder + • But for some, disorders improve during pregnancy JMJ 2
- 3. During Pregnancy • Unwanted pregnancy (common • Hyperemisis gravidarum (unusual) • Pseudocyesis (rare) • Couvade Syndrome (rare) JMJ 3
- 4. Hyperemisiis gravidarum • Severe and repeated vomiting • Much worse than the usual “morning sickness” • Appears to have a primary physiological cause • But, psychological reaction may exacerbate • Severity • Duration of symptoms JMJ 4
- 5. Pseudocyesis • A condition, which woman believes, • She is pregnant, when she is not • And develops • Amenorrhea • Abdominal distension • Other changes resembling early pregnancy • Usually resolved quickly following diagnosis • May be recurrent JMJ 5
- 6. Couvade Syndrome • A condition in which, • The husband or partner of a pregnant woman, • Experiences some of the symptoms of pregnancy, • Including • minor weight gain, • Morning nausea • Disturbed sleep JMJ 6
- 7. Post partum Mental Disorders Maternity ‘Blues’ Puerperal psychosis Other depressive disorders of moderate severity JMJ 7
- 8. Why is it important? • Pregnancy is a stress and stresses bring about psychological consequences • It is not just a stress, it is a stress that is taken granted for, • Hence the psychological issues could be taken as granted as well, • Specially if the symptoms are mild JMJ 8
- 9. Why is it important? • The awareness of psychological issues may be low among lay people/medical personal • The outcome could be devastating • Bonding/ attachment issues, suicide, infanticides, homicide, violence, divorce etc • It could be prevented or intensity could be reduced JMJ 9
- 10. Maternity ‘Blues’ • Occur in ½ & 2/3rd of woman • Up to 85% of woman experiences • Symptoms are • Irritability • Muddled thinking • Tearfulness • Lability of mood • Common in primigravida JMJ 10
- 11. Maternity ‘Blues’ • Onset during the 1st 48 hours resolves in a few days • Reach peak on 3-4th postpartum day • Common & short lived • No specific treatment needed JMJ 11
- 13. Puerperal psychosis • Begins typically 2-3 days after delivery • Nearly always in the 1st 1-2 postpartum weeks JMJ 13 Puerperal Psychosis Affective syndrome Schizophreniform syndrome Delirium
- 14. Puerperal psychosis • Affective syndromes • Most common in high income nation • Schizophreniform Syndrome • Delirium • Common before antibiotics were introduced to treat puerperal sepsis JMJ 14
- 15. Puerperal psychosis • Occur in about 1 in 500 births • (Handout – 1:1000 births) • Common in • Primiparous woman • Those with previous hx of serious psychiatric disorder • Those who have family history of psychiatric disorder • Puerperal psychosis is not more common after complicated deliveries JMJ 15
- 16. Puerperal psychosis • Assessment • Take the history • Examination – Mental State Examination • It is essential to ascertain the mother’s ideas concerning the baby • Severely depressed mothers may think • Their baby is malformed • Try to kill them to spare it from future suffering • Assess suicidal ideations JMJ 16
- 17. Puerperal psychosis - Tx • For depressive disorders of marked or moderate severity • ECT is often the best treatment • ECT • Rapid effect JMJ 17
- 18. Prognosis • Most recover fully from a puerperal psychosis • But few remain chronically ill (most with schizophrenic psychosis) • At a subsequent birth, • the recurrence rate for puerperal affective disorder is • much higher than in those without previous puerperal affective disorder JMJ 18
- 19. Treatment during subsequent pregnancies • Woman with previous hx • Should be monitored very closely in the hours and days after delivery • For patients with previous history of bipolar disorder • May require lithium prophylaxis • Avoid in 1st trimester • Stop for the short period after delivery JMJ 19
- 21. Other Puerperal Depressive Disorder • Mild or moderate severity depression • More common than puerperal psychosis • 10-15% recently delivered mothers + • Symptoms • Tiredness • Irritability • Anxiety • Above may more prominent than depressive mood • May have prominent phobic symptoms JMJ 21
- 22. Other Puerperal Depressive Disorder • Peak falls 6 months after partus • The majority presents with atypical features of depression whilst a minority as per the ICD 10 • Risk factors • Younger age • Previous psych history • Early post partum blues • Poor support/mariatal relationship • poverty JMJ 22
- 23. Other Puerperal Depressive Disorder • Caused mainly by • Psychological adjustment required after childbirth • By loss of sleep • By hard work involved in the care for the baby • This adversely affect on • Mother – infant relationship • Cognitive & emotional development of the infant • Assessment • Edinburgh Postnatal Depression Scale JMJ 23
- 24. Other Puerperal Depressive Disorder • Assessment • Edinburgh Postnatal Depression Scale • Management • Advise about childcare • Help with childcare • Advice on sexual relationships • More general marital guidance JMJ 24
- 25. Aetiology of abnormal psychology in puerperium • Not known for certain • Hormonal theory • Body cannot cope with the sudden reduction of hormones • Increased CRH in mid pregnancy • Generic predisposition/ social class/ ethnicity • Life events • Complicated or unwanted preganncies JMJ 25
- 26. Management • Immediate physical management • Short term • Long term management JMJ 26
- 27. Immediate physical management • Where she is manage? • Depends on the current problem in/out patient • What is the care of her baby? • How? • Exclude (or attend) physical problems • Sedation • Butyrophenones • Thioxanthines • Benzodiazepines JMJ 27
- 28. Short Term • ECT • Antipsychotics • Antidepressnets • Anxiolytics • REMEMBER • Lactation JMJ 28
- 29. Long term management • Consider the current recovery • Continue the current medication – months 6? 12? • Prevention of relapse • General prophylaxis • Specific therapy – LiCO3 • Look for side effects • Family involvement JMJ 29
- 30. Short and long term psychological intervention • Supportive psychotherapy • To patient and spouse • Share the knowledge with relations • Specific psychological interventions • CBT • Social management • Social case work • Liaison work JMJ 30
- 32. Premenstrual syndrome • Psychological symptoms • Anxiety, irritability and depression • Physical symptoms • Breast tenderness • Abdominal discomfort • Feeling of distension • Psychological problems may exacerbate the symptoms • Treat with - SSRI / TCA and CBT JMJ 32
- 33. Menopause • Psychological symptoms • Anxiety and depression • Hormone replacement therapy (HRT) is not a treatment for this JMJ 33