PSYCHIATRIC DISORDERS IN

PREGNANCY
SHARON TREESA ANTONY 2ND YEAR M.SC
NURSING
Most common disorders
• Mood disorders ( Depression)

• Anxiety disorders
Depression
• Major depressive disorder
• Dysthymia
• Bipolardisorder
Depression: risk factors
• Stressful life events
• Recent death of a loved one
• Family history
• History of abuse or trauma
• Exposure to traumatic events
• Intimate partner violence
• A serious or chronic medical condition
• Alcohol or drug abuse
• Prior episodes of depression
Major depression: symptoms
• Depressed mood + anhedonia+ any 3 of the
following:
• Sleep disorders
• Interest deficit or lack of feeling pleasure
• Guilt
• Energy deficit
• Concentration deficit
• Appetite disorder
• Psychomotor retardation or agitation
• Suicidality
Dysthymia ( American Psychiatric
Association)
• Depressed mood for most of the day* 2years

• Presence of 2 or more of the symptoms listed

under major depression

• Never any mania/hypomania

Bipolar disorder

• MAJOR DEPRESSION+

• HISTORY OF MANIA OR

• HYPOMANIA
Symptoms of mania
• Inflated self esteem

• Decreased need for sleep

• Talkative

• Flight of ideas

• High energy or irritability

Symptoms of hypomania
• Lasts a minimum of 4 days

• Briefer duration

• Less severe symptoms

• Change in functioning

• Not severe to cause marked impairment in social

or occupational functioning

• No psychosis
Screening for depression
• Patient health questionnaire-2

• Patient health questionnaire-9

• Beck depression inventory

• The centre for epidemiologic studies- depression

scale
Treatment
• Cognitive behavioural therapy

• Counselling

• Faith based therapy

• Group therapy

• Psychotropic medications

• Yoga and acupuncture

Pharmacotherapy
• SSRI

• NDRI

• SNRI
• Fluoxetine :10-20mg

• Sertraline:m5omg

• Escitalopram:10mg

• Bupropion :200mg

• Venlafaxine:37.5mg
Teratogenicity
• Paroxetine:CVS malformations, persistent
pulmonary hypertension, VSD
• SSRI: VSD, right ventricular outfloew tract
lesions, preterm birth, Low birth weight, RDS
Nursing management
• Disturbed self esteem related to lack of positive
reinforcement of one’s values and worth
• Hopelessness r/t lack of energy to mobilize
resources
• Risk for fetal injury related to lack of interest in
self care
• Disturbed sleep pattern r/t internal stress

• Social isolation r/t inability to engage in

satisfying personal relationships

• Powerlessness related to lack of inability to exert

control
Mania
• Antipsychotics: EPS in neonates
• Lithium: CVS defects, neonatal cyanosis, lethargy,
flaccidity, and non toxic goiter: contraindicated for
1st 3 months
• Benzodiazepiines: oral clefts
• Carbamazepine and valproate: NTDs
• ECT: safest
Anxiety, stress and obsessive
compulsive disorder
Phobia
s• Cognitive behavioural therapy
• Hypnotherapy
• Antidepressants
• Beta blockers
• Benzodiazepines
Generalized anxiety disorder
• Excessive and uncontrollable anxiety and worry
about activities or events + 3 of the following:
• Restlessness
• Muscle tension
• Difficulty with concentration
• Sleep disturbance
• Fatigue
• Irritability
Treatment
• Antidepressants
Panic attack
• Unexpected or triggered period of intense
anxiety or fear
Symptoms
• Sweating
• Trembling or shaking
• Nausea
• Abdominal pain
• Chest discomfort/pain
• Dizziness
• Light headedness
• Unsteadiness
• Fainting
• Fear of losing control / dying
• parasthesias
Treatment
• SSRI
• Cognitive behavioural therapy
• Meditation
• Anti anxiety drugs
Screening
• GAD screening tool-7
• <5: mild
• 5-10: moderate
• 10 -15: severe
Risks of untreated depression and
anxiety during pregnancy
• Burden of disability

• Prematurity/IUGR

• Risk for postpartum depression/ postpartum

psychosis, postpartum OCD/ suicide or

infanticide
Substance dependence
Cocaine
• Effect on CNS

• Sudden vasoconstriction

• Increased RR,HR,BP
• Vasoconstriction: compromise placental

circulation, premature placental separation,

preterm labour and fetal death

Infants born to cocaine dependent
mother
• Intracranial hemorrhage

• Withdrawal syndrome
Diagnosis
• Urinalysis
Treatment
• Counselliing
Amphetamines
• High concentration in maternal circulation

• Newborn shows jitteriness and poor feeding at

birth, growth restriction
Marijuana and Hashish
• Tachycardia

• A sense of well being

• Excreted in breast milk

• Reduced milk production

• Loss of short term memory

Phencyclidin
e
• Crosses placenta
• Hallucinations
Narcotic agonists
• Euphoria followed by sedation
• Can result in PIH
• Withdrawal symptoms
Effects on infant
• Small for gestational age

• Fetal distress

• Meconium aspiration

• Withdrawal symptoms
Inhalants
• Cardiac irregularities
• Respiratory depression
• Limit fetal O2 supply
Alcohol
• Fetal alcohol syndrome
• Cognitive challenges
Nursing diagnoses
• Risk for injury to self and fetus r/t chronic
substance abuse
POSTPARTUM PSYCHIATRIC DISORDERS
Etiology
• Endocrinal changes

• Change in body image

• Activation of unconscious psychological conflicts

• Intrapsychic recognition of becoming a mother

Biological factors
• Genetic factors
• Endocrine
• Biochemical
• Sleep patterns
Psychological factors
• Psychodynamic explanations
• Personality factors
Social and interpersonal factors
• Society’s attitudes
• Husband’s support
• low social class
• Unmarried status
• Early sexual and marital problems
• Previous abortions
• Unstable, unsupportive husband
Type
s• Postpartum blues
• Postpartum psychoses
• Postpartum depression
Postnatal blues
• Transient state of mental illness occuring 3-10
days after birth
Symptoms
• Weepiness
• Mood lability
• Feeling overwhelmed
• Sadness
• Frustration
• Fatigue/exhaustion
• A negative feeling towards child
• Helplessness
• Insomnia
Treatment
• Psychological support
• Self limiting
• Her fear and anxiety is dealt with calm and quiet
approach
• Reassurance
• Family support
Postpartum depression
• It develops within 6 months of child birth.
5 of the symptoms* 2 weeks
• Depressed mood
• Significant change in weight
• Sleep disorders
• Psychomotor agitation or retardation
• Fatigue
• Inappropriate feelings of guilt or worthlessness
• Impaired concentration
• Recurrent suicidal thoughts
Strong Risk factors
• Anxiety during pregnancy
• Depression during pregnancy
• Stressful life events during pregnancy
• Low level of social support; single marital status
• History of depression
• Postpartum depression after a prior pregnancy
Additional risk factors
• Biologic vulnerability
• Family history
• Unplanned pregnancy
• Young maternal age
• Lower socioeconomic status
• History of interpersonal violence
• Thyroid dysfunction
Screening for postpartum depression
• The Edinburgh postnatal depression scale
>12: require evaluation and possible referral to a
mental health specialist
10-12: presence of symptoms of distress
Repeat test in 1-2 week
Consider referral
0-9: if symptoms persist for more tha 1-2 weeks,
further evaluation
Treatment
• Psychotherapy
• Pharmacotherapy
• SSRIs are 1st line drugs ( fluoxetine and
citalopram are safe for breast fed infants)
Early predictive signs of postnatal
depression
• No visitors, not sharing news about birth with
relatives
• Unsupportive family
• Maternal rejection or ambivalence to pregnancy,
child birth or newborn
• Aggressiveness to newborn
• Sleep disturbance or severe nightmares
• Lack of interest in newborn care
• Intense feelings of loss
• Extreme feelings of sadness, anxiety, guilt and
anger
Nursing diagnoses
• Ineffective individual coping r/t stress of child
birth, negative self concept
• Impaired social interaction r/t severe
depression
• Impaired family processes r/t post partum
psychosis
• Impaired parenting r/t postpartum blues
,feelings of inadequacy
• Risk for injury r/t postpartum psychosis
• Ineffective family coping r/t maternal
depression
Postpartum psychosis
• Develops within 1st month after delivery
Risk factors
• Primipara
• Women with underlying psychiatric disorders
Symptoms
• Auditory hallucinations
• Delusions
• Disorientation
• Strong feelings of anger towards self and baby
• Paranoidstrong obsessive reaction
• Unipolar or bipolar
Treatment
• Lithium
• ECT
• Support and guidance
• Reintroduce mother and baby as soon as
possible
• Hospitalization and supportive
psychotherapy
Post partum PTSD
Risk factors
• Childhood trauma
• Sexual abuse
• Depression
• PTSD preceding the pregnancy
• Depression , anxiety or a fear of child birth
• Lack of support from care providers or partner
Treatment
• Debriefing and counselling
• Cognitive behavioural therapy
• Eye movement desensitization and
reprocessing
THANK YOU