Transcript Postpartum depression postnatal depression, is a form of which can

Postpartum depression
which can affect is a form of ,postnatal depression
.childbirth women, and less frequently men, after
Studies report prevalence rates among women from 5%
to 25%, but methodological differences among the
studies make the actual prevalence rate unclear. Among
men, in particular new fathers, the incidence of
postpartum depression has been estimated to be
.between 1.2% and 25.5%
PPD
Postpartum depression occurs in women after they •
have carried a child, usually in the first few months,
and may last up to several months or even
Symptoms include sadness, fatigue, changes in [.a
sleeping and eating patterns, reduced libido, crying
episodes, anxiety, and irritability. It is sometimes
assumed that postpartum depression is caused by a
lack of vitamins but studies tend to show that more
likely causes are the significant changes in a
On the other .woman's hormones during pregnancy
hand, hormonal treatment has not helped
postpartum depression victims. Many women
recover because of a support group or counseling
symptoms
and include, but ]6[Symptoms of PPD can occur anytime in the first year postpartum
Sadness •
Hopelessness •
Low self-esteem •
Guilt •
A feeling of being overwhelmed •
Sleep and eating disturbances •
]Inability to be comfortable •
Exhaustion •
][Emptiness •
anhedoniaِِ •
[Social withdrawal •
Low or no energy •
Becoming easily •
•
symptoms
][ •
][Feeling inadequate in taking care of the baby •
Impaired speech and writing •
Spells of anger towards others •
Increased anxiety or panic attacks •
Sex after pregnancy Decreased sex drive - see •
One method of detecting Postnatal Depression (PND) is the use
of Edinburgh Postnatal Depression Scale. If the new mother
][.scores more than 13, she is likely to develop PND
Risk factors ][ •
While not all causes of PPD are known, a number of factors •
is effect size have been identified as predictors of PPD (the
given in parentheses, where larger values indicate larger
:)effects
•
Risk factors
][)
•
A history of depression () •
[)Cigarette smoking •
Low self esteem. •
)Childcare stress •
)Prenatal depression during pregnancy •
)Prenatal anxiety •
)Low social support (.36 to .41) Beck (2001 •
)Poor marital relationship (.38 to .39) Beck (2001 •
to Infant temperament problem •
)
Post partum blue-risk factors
Unplanned/unwanted pregnancy •
1-single mother)
-2-low socioeconomical class •
Of these, three factors - formula •
feeding, a history of depression,
and cigarette smoking - have been
[.shown to be additive effects
with PPD., high levels of prenatal depression are associated •
with high levels of postnatal depression, low levels of prenatal
depression are associated with low levels of postnatal
depression But this does not mean the prenatal
depression causes postnatal depression—they
might both be caused by some third factor. In
contrast, some factors, such as lack of social
support,
role of social causal postpartum depression. (The
support in PPD is strongly suggested by several
).studies,
I. •
•
Effect on mother baby relationship
Postpartum depression may lead mothers to be •
Women diagnosed with .childcare inconsistent with
postpartum depression often focus more on the
negative events of childcare, resulting in poor
.)coping strategies
There are four groups of coping methods, each •
.divided into a different style of coping subgroups
is one of the most common Avoidance coping
strategies used). It consists of denial and behavioral
disengagement subgroups (for example, an avoidant
mother might not respond to her baby crying). This
strategy however, does not resolve any problems
and ends up negatively impacting the mother’s
mood,
Coping strategy
Four coping strategies •
behavioral ,denial :Avoidance coping •
disengagement
active coping, :Problem-focused coping •
planning, positive reframing
emotional support, :Support seeking coping •
instrumental support
self-blame ,venting :Venting coping •
Treatment
Women need to be taken seriously when symptoms •
occur. This is a two-fold practice: First, the postpartum
woman will want to trust her intuition about how she is
feeling and believe that her symptoms are real enough to
tell her significant other, a close friend, and/or her
medical practitioner; erring on the side of caution will go
Second, the ][.a long way in the treatment of PPD
people in whom she confides must take her symptoms
seriously as well, aiding her with treatment and support.
Partners, friends and physicians may notice changes in
a postpartum mother that she may not. Knowing that
PPD is treatable with a variety of methods can make
persistence in seeking treatment
Treatment
Medical evaluation to rule out physiological •
problems
a form of( Cognitive behavioral therapy •
)psychotherapy
Possible medication •
Support groups •
Home visits/Home visitors •
Healthy diet •
Consistent/healthy sleep patterns •
a postpartum mother to with An experienced medical professional will work
develop a treatment plan that is right for her. This plan may include any
combination of the above options, and might include some discussion or
feedback from/with a partner. If a woman suffering from PPD does not feel
she is being taken seriously or is being recommended a treatment plan she
[.does not feel comfortable with, she will want to seek a second opinion
confirms that postpartum depressed mothers’ symptoms promptly ,. •
improved at similar rates when treated with cognitive behavioral therapy or
A group of 61 depressed mothers completed “ .fluoxetine the antidepressant
a 12-week treatment program with or without the antidepressant plus one
session versus six sessions of counseling.” Improvement followed after “one
The findings of Appleby et al.’s study ][”.to four weeks of either treatment
did not conclusively showed that combining counseling with drug therapy
This [.add to the improvement of just drug therapy or just counseling
suggests that counseling is equally as effective a treatment for PPD as
medication, and that the
•
Post partum psychosis
First recognized as a disorder in 1850, •
postpartum psychosis is a very serious mental
condition that requires immediate medical
attention. Interestingly, studies on the rates of
the disorder have shown that the number of
women experiencing postpartum psychosis
haven’t changed since the mid 1800s.
Post partum psychosis PPP
affects between one and two women per 1,000 women who have
.given birth
•
Unfortunately, though many women with the disorder •
realize something is wrong with them, fewer than 20%
actually speak to their healthcare provider. Sadder still is
the fact that often postpartum psychosis is misdiagnosed
thereby ,postpartum depression or thought to be
preventing a woman from receiving the appropriate
.medical attention that she needs
Women who do receive proper treatment often respond •
well but usually experience postpartum depression
before completely recovering. However, without
treatment, the psychosis can lead to tragic
consequences. Postpartum psychosis has a 5% suicide
.rate and a 4% infanticide rate
PPP signs
Although the onset of symptoms can occur •
at anytime within the first three months
after giving birth, women who have
postpartum psychosis usually develop
symptoms within the first two to three
weeks after delivery. Postpartum
psychosis symptoms usually appear quite
suddenly; in 80% of cases, the psychosis
occurs three to 14 days after a symptom.free period
PPP signs
Hallucinations •
Delusions •
Illogical thoughts •
Insomnia •
Refusing to eat •
Extreme feelings of anxiety and agitation •
Periods of delirium or mania •
Suicidal or homicidal thoughts •
PPP symptoms
Hallucinations •
Delusions •
Periods of delirium or mania •
Thoughts of harming the baby or oneself •
Irrational feelings of guilt •
Refusing to eat •
Thought insertion - the notion that other beings or forces •
(God, aliens, the CIA, etc.) can put thoughts or ideas into
one's mind
Insomnia - although studies are beginning to show that •
insomnia may be a cause rather than an effect
Reluctance to tell anyone about the symptoms •
PPP -risk factors
1-Women with a personal history of psychosis, •
2-bipolar disorder .
3-women with history of schizophrenia or 3 •
-psychosis
4-women with family history of psychosis, bipolar •
disorder or schizophrenia
5- women who have had a past incidence of •
postpartum psychosis are between 20% and
50% more likely of experiencing it again in a
.future pregnancy
PPP-causes
1- changing hormones being at the top of their list. •
2- lack of social and emotional support; •
3-a low sense of self-esteem •
4- feeling isolated and alone; •
5-having financial problems; •
6- undergoing a major life change such as moving or •
starting a new job
7- previously diagnosed bipolar disorder or •
schizophrenia,
8- family history of one of these conditions. •
9-postpartum depression or psychosis have a 20-50% •
. .chance of having it again at future births
PPP Treatment options
The use of lithium carbonate for prophylaxis of •
postpartum psychosis in such women remains
controversial. Given the apparent safety of lithium
prophylaxis relative to the dangers of postpartum
affective psychosis,
ECT is indicated specially if there is compelling suicidal •
and infanticide tendencies sometimes it is the first line of
treatment
PPP treatment
1-Family support •
2- educating the family, It is important that the •
.affected individual not be labeled a bad mother
3-Anti-psychotic medications do pass into the •
mother's breast milk. Subsequently if the mother
has been breastfeeding and continues to do so,
the baby needs to be monitored for drowsiness
or lethargic behavior, and prescribing the least
amount of anti-psychotic medication in order for
.symptom reduction to occur is also crucial
Postpartum psychosis is one of the serious •
.emergency in psychiatry
PPP treatment
1-Severe agitation and delusions may require rapid •
tranquilization by neuroleptic (antipsychotic) drugs, but
they should be used with caution
2-Electro-convulsive (electroshock) treatment is highly [. •
effective
3-stabilizing drugs such as lithium are also useful in •
treatment .
4-hospitalization is disruptive to the family, and it is •
possible to treat moderately severe cases at home,
where the sufferer can maintain her role as a mother and
build up her relationship with the newborn. This requires
the presence, round the clock, of competent adults (such
as the baby's maternal grandmother), and frequent visits
If hospital[.by professional staff
PPP treatment
there are advantages in conjoint mother and baby •
admission. Yet multiple factors must be considered in the
subsequent discharge plan to ensure the safety and
healthy development of both the baby and its
This plan often involves a multidisciplinary team [.mother
structure to follow-up on mother, baby, their relationship
.and the entire family
Suicide is rare, and infanticide extremely rare, during •
these episodes. It does occur, as illustrated by the
famous cases summarized below. Infanticide after
childbirth is usually due to profound postpartum
depression (melancholic filicide) when it is often
[.accompanied by suicide
Premenstrual Dysphonic Syndrome
(PMS) that is so severe it can be debilitating due to •
either physical, mental or emotional symptoms.
Treatment is recommended because PMDD interferes
with the sufferer's ability to function in her social or
occupational life. The cardinal symptom—surfacing
between ovulation and menstruation, and disappearing
within a few days after the onset of the bleeding—is
irritability Anxiety, anger, and depression may also occur
PMDS symptoms
feelings of deep sadness or despair, possible suicide •
ideation
feelings of tension or anxiety •
increased sensitivity to rejection or criticism •
panic attacks •
mood swings, crying •
lasting irritability or anger, increased interpersonal •
conflicts. Typically sufferers are unaware of the impact
they have on those close to them
apathy or disinterest in daily activities and relationships •
difficulty concentrating •
PMDS Symptoms
fatigue •
food cravings or binge eating •
fatigue •
insomnia or hypersomnia; sleeping more than usual, or •
(in a smaller group of sufferers) being unable to sleep
"feeling overwhelmed or "out of control •
increase or decrease in sex drive •
increased need for emotional closeness •
physical symptoms: bloating, heart palpitations, breast •
tenderness, headaches, joint or muscle pain, swollen
face and nose, feeling fat
PMDS-symptoms
Five or more of these symptoms may indicate PMDD. •
Symptoms occur during the 2 weeks before the •
menstrual cycle and disappear within a few days after •
the onset of the bleeding, •
There are co morbidity of anxiety ,depression, •
. •
recent studies demonstrated that PMDD women had
.greater sensitivity in responding to stress and pain
][ •
•
PMDS -Treatment
1-Lifestyle changes such as regular exercise and a well
balanced diet
•
2-Vit B6 in doses up to 100 mg •
- •
-3- SSRIs-Fluoxetine Escitalopram oxalate Paroxetine •
4-studies showed that L-Tryptophan provide significant
relief when supplemented daily in a large dose of (six
.grams) per day
•
Menopause
is the permanent cessation of the function of the ovaries in human
female
•
.phase of midlife ., •
The word "menopause" literally means the "end of •
pausis monthly cycles" from the Greek words
cessation) meaning (month), (
), where the end of fertility is traditionally indicated by the •
permanent stopping of the menstrual cycle .
also exists in some other animals, many of which do . •
.not have monthly menstruation
The date of menopause in human females is formally •
medically defined as the time of the last menstrual period
(or menstrual flow of any amount however small), in a
woman who has not had a hysterectomy
Menopause signs and symptoms
Not every woman experience the same severity of the •
symptoms that can be started even before cessation of
LMP, symptoms are due to fluctuation of estrogen level
in the blood for example hot flashes and mood changes
that disappear after the transition from pre menapause to
post menopause has over it may take several years
1-hot flashes •
2-palpitation •
3-lethargy ,lack of energy •
4-skin tingling sometimes to the degree of formication •
due to hormone withdrual
Menopause - symptoms
5-skin and vaginal dryness •
6-anxiety ,irritability, depression,mood swings •
7-memory problem and lack of concentration •
8-urgency of urination •
9- night sweat •
10-back ,joint ,muscle pain •
11-desturb sleep, poor quality, insomnia •
12-breast tenderness or atrophy •
13- decreased libido ,dyspronia •
Average age is 51 - •
•
Management
1-Hormonal replacement therapy—premarine- •
raloxifine—tamoxifine
2-anti-depressants –SSRI improve sleep and hot flashes
and mood swings
3-Gabapentin-Lyrica improve hot flashes •
4-Clonidine •
5-education- •
•