ASSIGNMENT ON

Women and mental health

Introduction :
Women represent a special group for the mental health care as in most societies, psychiatric
disorders are more common in women . The common reason are the genetic differences, cultural
expectations etc. The mental disorder more commonly reported in females include major
depressions , anxiety state , phobic, neurosis , hypochrondraisis , dissociative disorder and
adjustment problems .

There are many problems associated with psychiatric disorder are:

1. Premenstrual syndrome
2. Psychiatric disorder related to child birth
3. Menopausal syndrome

Premenstrual syndrome (PMS): is a condition that affects a woman’s emotions, physical

health, and behavior during certain days of the menstrual cycle, generally just before her
menses.PMS is a very common condition. Its symptoms affect more than 90 percent of
menstruating women. Levels of estrogen and progesterone increase during certain times of the
month. An increase in these hormones can cause mood swings, anxiety, and irritability. Ovarian
steroids also modulate activity in parts of your brain associated with premenstrual symptoms.

Serotonin levels affect mood. Serotonin is a chemical in your brain and gut that affects your
moods, emotions, and thoughts.

Risk factors for premenstrual syndrome include:

A. history of depression or mood disorders, such as postpartum depression or bipolar

disorder.
B. family history of PMS
C. family history of depression
D. domestic violence
E. substance abuse
F. physical trauma
G. emotional trauma
H. Associated conditions include dysmenorrhea
I. major depressive disorder
J. seasonal affective disorder

Symptoms of PMS
A woman’s menstrual cycle lasts an average symptoms of PMS include:

 abdominal bloating
 abdominal pain
 sore breasts
 acne
 headaches
 sensitivity to light or sound
 fatigue
 irritability
 changes in sleep patterns
 anxiety
 depression
 sadness
 emotional outbursts

Etiology :

1. Cyclical ovarian activity the central component (ovarian 'trigger', such as ovulation, may
initiate a cascade of events).
2. 2. Central increased responsiveness to a com bination of steroids, chemical messengers
(E2/serotonin, progesterone/GABA)

Diagnosis :

1. Most women self-diagnose.

2. History can suggest a diagnosis of PMS
3. Symptom record can establish its true nature.
4. Symptom charts National Association of Premenstrual Syndrome.
5. Moderate/severe PMS:
1.disruption of work and interpersonal relationships
2.interference with normal activities.

Management: Self-help techniques

1. Dietary alteration less fat, sugar. salt, caffeine. and alcohol, frequent starchy meals more
fibre, fruit, and vegetables 4-hourly small snacks.
 2. Dietary supplement:
•Vitamin B6: possible benefit
•Vitamin E.: promising.
•Calcium: (1200-1600mg) some improvement
•Magnesium; most beneficial for premenstrual anxiety.
•Evening primrose oil of value for mastalgia only.
3. Exercise Moderate : regular aerobic exercise promoting cardiovascular work beneficial
4. Stress reduction Relaxtion techniques, yoga. Meditation, breathing techniques
encouragement of healthier lifestyle.
5. Cognitive behavioural therapy long-term benefit
6. Hormonal:
1. Progesterone and progestogens no benefit of progesterone pessaries, suppostories,
depot injections, or oral formulations.
2. Ovulation suppression agents:
COCP:
•useful for some women.
•Some women have PMS type progestaienic side effects or symptoms during the pill-free
interval
•Yasmin contains drospirenone with a better side effect profile
•Newer pills with a 2-4.day break or with no pill-free interval may be more therapeutic.
non-hormonal
1. SSRlsl seleetive noradrenalin reuptake inhibitors:
•benefit for continuous and luteal phase only treatment.
•Side effects may be problematic, but are reduced by luteal phase only dosing.
2. Antidepressants: tricyclics and anxiolytics have benefits for selected patients
7. Homeopathy: improvement in 90%.

Postpartum blues:
Postpartum blues, also known as baby blues and maternity blues, is a very common but self-
limited condition that begins shortly after childbirth and can present with a variety of symptoms
such as mood swings, irritability, and tearfulness, Mothers may experience negative mood
symptoms mixed with intense periods of joy. Up to 85% of new mothers are affected by
postpartum blues, with symptoms starting within a few days after childbirth and lasting up to two
weeks in duration. Treatment is supportive, including ensuring adequate sleep and emotional
support. If symptoms are severe enough to affect daily functioning or last longer than two weeks,
the individual should be evaluated for related postpartum psychiatric conditions, such as
postpartum depression and postpartum anxiety. It is unclear whether the condition can be
prevented, however education and reassurance are important to help alleviate patient distress.

Signs and symptoms

Symptoms of postpartum blues can vary significantly from one individual to another, and from
one pregnancy to the next. Many symptoms of postpartum blues overlap both with normal
symptoms experienced by new parents and with postpartum depression. Individuals with
postpartum blues have symptoms that are milder and less disruptive to their daily functioning
compared to those with postpartum depression. Symptoms of postpartum blues include, but are
not limited to

 Tearfulness or crying "for no reason"

 Mood swings
 Irritability
 Anxiety
 Questioning one's ability to care for the baby
 Difficulty making choices
 Loss of appetite
 Fatigue
 Difficulty sleeping
 Difficulty concentrating
 Negative mood symptoms interspersed with positive symptoms

Causes:
Psychosocial causes:
Pregnancy and postpartum are significant life events that increase a woman's vulnerability for
postpartum blues. Even with a planned pregnancy, it is normal to have feelings of doubt or
regret, and it takes time to adjust to having a newborn. Feelings commonly reported by new
parents and lifestyle changes that may contribute to developing early postpartum mood
symptoms include:

 Fatigue after labor and delivery

 Caring for a newborn that requires 24/7 attention
 Sleep deprivation
 Lack of support from family and friends
 Marital or relationship strain
 Changes in home and work routines
 Financial stress
 Unrealistic expectations of self
 Societal or cultural pressure to "bounce back" quickly after pregnancy and childbirth
 Overwhelmed and questioning ability to care for baby
 Anger, loss, or guilt, especially for parents of premature or sick infants
Differential diagnosis:
Although symptoms of postpartum blues present in a majority of mothers and the condition is
self-limited, it is important to keep related psychiatric conditions in mind as they all have overlap
in presentation and similar period of onset.
Postpartum anxiety
Symptoms of anxiety and irritability are often predominant in the presentation of
postpartum blues. However, compared to postpartum anxiety, symptoms of postpartum
blues are less severe, resolve on their own, and last fewer than two weeks.
Postpartum depression
Postpartum depression and postpartum blues may be indistinguishable when symptoms
first begin. However, symptoms of postpartum blues are less severe, resolve on their
own, and last fewer than two weeks. Mothers who experience severe postpartum blues
appear to be at increased risk of developing depression.
Postpartum psychosis
Although both conditions can cause periods of high and low moods, the mood swings
in postpartum psychosis are significantly more severe and may
include mania, hallucinations, and delusions. Postpartum psychosis is a rare condition,
affecting 1-2 per 1000 women. Postpartum psychosis is classified as a psychiatric
emergency and requires hospital admission. Additionally, a variety of medical co-
morbidities
Treatment:
Postpartum blues is a self-limited condition. Signs and symptoms are expected to resolve
within two weeks of onset without any treatment. Nevertheless, there are a number of
recommendations to help relieve symptoms, including
 Getting enough sleep
 Taking time to relax and do activities that you enjoy
 Asking for help from family and friends
 Reaching out to other new parents
 Avoiding alcohol and other drugs that may worsen mood symptoms
 Reassurance that symptoms are very common and will resolve on their own
If symptoms do not resolve within two weeks or if they interfere with functioning,
individuals are encouraged to contact their healthcare provider. Early diagnosis and
treatment of more severe postpartum psychiatric conditions, such as postpartum
depression, postpartum anxiety, and postpartum psychosis, are critical for improved
outcomes in both the parent and child.

MENOPAUSAL SYNDROME :
Menopausal Syndrome includes symptoms associated with the physiological changes that take
place in a woman's body as period of fertility ends. Menopause is a normal consequence of the
ageing process and is a natural female hormone deficient state that occurs at the age of 45-55
years. In this stage ovaries gradually become less active and reduce their production of sex
hormone (estrogen and progesterone). As a result, menses cease permanently.Women are usually
considered to be menopausal if she has not had a menstrual period for one year without any
underlying cause. Some women experience mild problems or none at all but some women have
severe symptoms in this period. It has become an inevitable phenomenon in a women's life and
many years are spent in the postmenopausal phase.Similarly in Ayurveda, Acharyas depicted that
menses starts at the age of 12 year and stops at the age of 50 and the whole process is a natural
phase of life.
etiology
1. Reduced production of estrogen and progesterone
2. Less active ovaries
Pathogenesis

It is a natural and normal phenomenon of ageing. Reduced production of sex hormones due

to less active ovaries lead to menopause.

Clinical features

1. Irregular periods with scanty or excessive bleeding

2. Hot flushes

3. Night sweats

4. Vaginal dryness and itching

5. Mood swings

6. Joint pain

7. oedema

8. Sleeplessness
9. lassitude

10. Excessive hair fall

11. Anaemia

12. weakness

13. Stress incontinence

14. Loss of sexual desire

15. Wrinkling of skin etc.

Complications

1. Cardiovascular problems

2. Fractures due to osteoporosis

Investigations/ Examination

1. Haemogram

2. PAP smear

3. Serum FSH levels

4. Serum estrodiol levels

5. Serum L.H. levels

6. Ultrasound abdomen

7. Bone mineral densitometry

8. Mammogram
Management approaches

a. Prevention

1. Consumption of godhuma (wheat), old rice, mudga (green gram), soya, fresh

seasonal fruits, ghee, nuts, milk etc.

2. Regular medicated oil massage and exposure to mild sun light

3. Practice personal and social good conduct

4. Maintain healthy body weight

5. Regular exercises, yoga and meditation

6. Control of blood pressure and cholesterol levels

7. Use of calcium supplements and diet rich in calcium and antioxidants

8. Use of rasayana drugs

9. Avoid heavy and unwholesome food, excess pungent, salty and sour food items.

10. Avoid excessive physical exertion

b. Medical management

Line of treatment

1. Shodhana chikitsa (bio-cleansing therapies) / other therapeutic procedures followed by

Shamana chikitsa (palliative therapy) should be advocated.

i. Snehana: Gentle massage with medicated oils such as :

• Mahanarayana taila
• Ksheerabala taila

• Mahamasha taila

• Bala taila

ii. Internal Snehana (internal oleation) with medicated ghrita (Sukumara ghrta, or Mahtriphala
ghrita,or Dadimadi ghrita etc) 50 ml with 2-3 gm saindhava lavana(sendha namak) daily for 3-7
days before panchakarma (bio-cleansing procedure)

iii. Shirodhara with Yashtimadhu kashaya and milk 45 minutes daily for 15 days

iv. Takra dhara 45 minutes daily for 15 days

v. Matra vasti with Dhanvantara taila / Sukumara ghrta 50 ml daily for 15 days
Yogic Practices - The following yogic practices are beneficial in menopausal syndrome;
however, these should be performed only under the guidance of qualified Yoga therapist.
Duration should be decided by the Yoga therapist.
1. Suryanamaskara, Tadasana, Katichakrasana, Vajrasana, Ushtrasana, Sarvangasana,
Setubandhasana, Baddhakonasana, Pavanamuktasana, Upavishtakonasana, Merudandasn and
chalanasana.
2. Bhramari, Nadi shodhana,Sheetali pranayama.
3. Mulabandha with Ashvini mudra.
4. Deep relaxation technique/ Yoga nidra/ Nadi anusandhana.
Counselling - Advice the patient to
1. Develop positive approach towards menopause
2. Take calcium rich diet
3. Practice yoga and meditation for stress management
4. Check cholesterol levels periodically
5. Limit tea / coffee consumption
6. Avoid sedentary life style
7. Avoid smoking and consumption of alcohol
In addition, adequate counselling regarding cleanliness of genital organs, sexual behavior and for
regular medical check up should be given.
Indications for referral
1. Heavy bleeding which is not responding to medication
2. Menopausal syndrome associated with fracture
3. Menopausal syndrome associated with other serious systemic illness

Reference
1. AYURVEDIC MANAGEMENT OF SELECT GERIATRIC DISEASE CONDITIONS
Department of AYUSH Ministry of Health and Family Welfare, Government of
IndiaCentral Council for Research in Ayurveda and Siddha, New Delhi 201
2. Townsend C. Mary. “Psychiatric mental Health Nursing”.Jaypee Publishers Pvt
limited.8th edition(2012).Page no: 528-557.
3. Sreevani R. A guide to mental health & psychiatric nursing’’. Jaypee Brothers medical
publishers(p) Ltd. 4th edition(2018). Page no 216-236.
4. Ahuja Neeraj. ‘A short textbook of psychiatry.’’ Jaypee Brothers medical publishers(p)
Ltd. 7th edition