Common mental disorders during pregnancy

1. PSYCHIATRIC
DISORDERS DURING
PREGNANCY
PRESENTED BY:
LAMNUNNEM HAOKIP
MSC (N) 2ND YEAR
SNSR, SU

2. INTRODUCTION
• Pregnancy is generally thought to be a time of happiness
and emotional well-being for a woman. However, for
many women, pregnancy and motherhood increase their
vulnerability to psychiatric conditions such as
depression, anxiety disorders, eating disorders, and
psychosis.

3. DEFINITION
Depression: Depression is a state of low mood and aversion
to activity. Classified medically as a mental and behavioural
disorder, the experience of depression affects a person's
thoughts, behaviour, motivation, feelings, and sense of well-
being.
Anxiety: Anxiety is an emotion characterized by feelings of
tension, worried thoughts and physical changes like
increased blood pressure.

4. Eating disorders: Eating disorders are illnesses in which
the person experience severe disturbances in eating
behaviours and related thoughts and emotions.
Psychosis: Psychosis is a mental health problem that causes
people to perceive or interpret things differently from those
around them. This might involve hallucinations or delusions.

5. TYPES OF PSYCHIATRIC
DISORDERS
IN PREGNANCY
CHART

6. TYPES OF
PSYCHIATRIC
DISORDERS
DEPRESSION
ANXIETY
DISORDERS
EATING
DISORDERS
PSYCHOSIS

7. DEPRESSION
 According to The American Congress of
Obstetricians and Gynaecologists (ACOG),
between 14-23% of women will struggle
with some symptoms of depression during
pregnancy.
• RISK FOR DEPRESSION: Having a
history of depression, Age at time of
pregnancy, living alone, having limited
social support, experiencing marital conflict
and feeling ambivalent about pregnancy.

8. Signs of Depression
 Persistent sadness
 Difficulty concentrating
 Sleeping too little or too much
 Loss of interest in activities that you usually enjoy
 Recurring thoughts of death, suicide, or hopelessness
 Anxiety
 Feelings of guilt or worthlessness
 Change in eating habits.

9. Management
Non-Pharmacological treatment
 Psychotherapy
 Behavioural Therapy
Pharmacological Treatment
• Tab. Citalopram 20mg/day, may increase to 40 mg/day.
• Tab. Sertraline 25 – 50 mg/day, may increase to 200
mg/day.

11. ANXIETY DISORDERS
• Anxiety is a feeling of apprehension caused by
anticipation of an ill- defined threat or danger that is not
realistically based.
• It is the emotional reaction to a known, well defined
external threat or danger.

12. Types Of Anxiety
Disorders
 Panic Disorder
 Obsessive Compulsive Disorder
 Generalized Anxiety Disorder
 Phobic disorders

13. Signs And Symptoms
 Palpitations
 Tachycardia
 Restlessness, Profuse Sweating
 Irritability, Worrying thoughts, Diarrhoea,
Frequent or urgent micturition, Sweating,
Flushing or pallor, Feeling dizzy, unsteady or
fainting, Muscle tension, Tremors, Fatigue
Muscle aches, Headache.

14. Management
Psychotherapy
 Supportive Psychotherapy
 Behavioural Therapy
 Cognitive-behavioural therapy
 Psychodynamic (insight-oriented) therapy
Pharmacotherapy
• Selective Serotonin Reuptake Inhibitors (SSRIs) –
Citalopram (Celexa) and Sertraline (Zoloft).

15. EATING DISORDERS
Pregnancy can be a stressful and anxious time for
some women, especially those with an eating disorder. The
accompanying weight gain and change in body shape can
lead to recurrence or worsening of the eating disorder.
Pregnant women with eating disorders need enhanced
monitoring and postnatal support.

16. Types Of Eating Disorders
• Anorexia nervosa: Loss of appetite.
• Bulimia Nervosa: Binge eating.
Symptoms seen in high risk women who should be screened
for eating disorders
• Low body mass index.
• Concerned about weight but not overweight.
• Menstrual disturbances or amenorrhoea.
• Gastrointestinal symptoms.
• Physical signs of starvation or repeated vomiting.
• Psychological problems

17. Management
• Treat the eating disorder before pregnancy.
• Nutritional advice before pregnancy.
• Educate women about nutrition and growth of the fetus.
• Refer the woman to an eating disorder service as early in
pregnancy as possible if she has an active eating disorder.
• Joint obstetric care is needed if the woman has active anorexia
nervosa or there are concerns that she is vulnerable.
• Liaise with the health visitor to monitor infant growth and
weight gain closely.

18. PSYCHOSIS
• Psychosis is a mental health problem that causes people to
perceive or interpret things differently from those around
them. This might involve hallucinations or delusions.
• However, for women with a history of psychosis,
particularly psychosis in previous pregnancies, the relapse
rates are high, with the most common manifestations being
bipolar illness, followed by psychotic depression and
schizophrenia.

19. Types of Psychotic disorders
• Bipolar mood disorder
• Schizophrenia

20. Signs and symptoms
 Hallucinations: Hearing voices, Seeing things which other
people do not see.
 Delusions: Being followed by secret agents or members of
the public, That people are out to get you or trying to kill
you.
 Cognitive experiences: Concentration problems, Memory
problems, Unable understand new information, and,
Difficulty making decisions.

21. Management
Non-Pharmacological
• Cognitive Behaviour Therapy
• Family Intervention
• Art Therapy
Pharmacological
• Olanzapine: Zyprexa, Zalasta, Zolafren, Olzapin, Rexapin 7.5
mg – 10 mg.
• Haloperidol: Halidace, Hexidol, Dolteus, Dolsi, Helinase,
Typidol – 0.5 to 2mg orally 2 – 3 times per day.

23. NURSING RESPONSIBILITIES
 Caring for patient with acute conditions.
 Administering medications
 Helping patient to overcome stressful events
 Interacting with patient families
 Preparing and maintaining patients records, producing care
plans and risk assessments.
 Organizing group therapy sessions, including social and
artistic events, aimed at promoting patients' mental recovery.

25. BIBLIOGRAPHY / REFERENCES
• Annamma Jabob. A comprehensive textbook of
Midwifery and Gynaecological Nursing, Fourth
edition.pp 724-741.
• Lily Podder. Fundamentals of Midwifery and Obstetrical
Nursing. ELSEVIER.pp 374-381.
• DC Dutta’s textbook of Obstetrics. Hiralal Konar 8th
Edition.Jaypee The Health Sciences Publisher.pp 440 –
457.
• DAVIS’S DRUG GUIDE for Nurses TWELFTH
EDITION. Pp 806-808,869-870.
• Mosby’s 2020. Nursing Drug Reference. Skidmore, Third
South Asia Edition. Pp 801-803,732-734.678 – 687.

26. • National Institute for Health and Clinical
Excellence. Eating disorders. Core interventions in the
treatment and management of anorexia nervosa,
bulimia nervosa and related eating
disorders. 2004. www.nice.org.uk/guidance/index.jsp?a
ction=byID&r=true&o=10932
• Karasu TB, Docherty JP, Gelenberg A, et al. Practice
guideline for major depressive disorder in adults.
American Psychiatric Association. Am J Psychiatry
1993;150(suppl 4):1-26. PubMed Citation
• Neziroglu F, Anemone R, Yaryura-Tobias JA. Onset of
obsessive-compulsive disorder in pregnancy. Am J
Psychiatry 1992;149:947-950. PubMed Abstract