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CHAPTER 16: Psychiatric Symptoms and Pregnancy

CHAPTER 16: Psychiatric Symptoms and Pregnancy. Introduction. Many women experience a spectrum of psychiatric symptoms around the time of childbearing. Antenatal = during pregnancy Postnatal = following pregnancy

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CHAPTER 16: Psychiatric Symptoms and Pregnancy

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  1. CHAPTER 16:Psychiatric Symptoms and Pregnancy

  2. Introduction • Many women experience a spectrum of psychiatric symptoms around the time of childbearing. • Antenatal = during pregnancy • Postnatal = following pregnancy • Some women will experience psychiatric disorders, which are burdensome, costly, and require safe, efficacious treatment.

  3. The Burden of Antenatal and Postnatal Psychiatric Symptoms • Reproductive events are not protective against psychiatric symptoms. • True prevalence is unclear due to methodological limitations. • E.g., timing and method of assessment • In DSM-IV-TR, there is no distinct prenatal or postpartum psychiatric disorder classification.

  4. Mood Symptoms • Antenatal Depressive Symptoms • Prevalence: 8.5% to 11% • Pregnancy is a time of increased risk for women with a history of depression. • There is a potential for adverse consequences to pregnancy health, fetal development, birth outcomes, and postnatal health.

  5. Mood Symptoms • Antenatal Hypomanic and Manic Symptoms • Antenatal manic symptoms seem to be the least common affective experience. • Bipolarity is the most robust predictor of severe postnatal mental health complications, including psychosis .

  6. Mood Symptoms • Postnatal Depressive Symptoms • “Baby blues” • Mood lability, depressed or irritable mood, interpersonal hypersensitivity, tearfulness, and preoccupation with infant well-being

  7. Mood Symptoms • Major Depressive Episodes (MDEs) With Postpartum Onset • Similar to MDE that occurs at nonreproductive times • More anxiety, somatic complaints, sleep disturbances • Distressing, intrusive thoughts about infant safety or parenting competency and guilt

  8. Mood Symptoms • Postnatal Hypomanic Symptoms • Similar to hypomania that occurs at nonreproductive times • May be more difficult to detect • An incorrect diagnosis may lead to: • Subsequent use of antidepressant pharmacotherapy for later postnatal depressive symptoms • An underestimation of risk for postpartum psychosis • Both of which are associated with increased risk for suicide and infanticide.

  9. Intervention Recommendations • Evaluate pregnant women for risk factors at least once every trimester. • Provide early and frequent psychoeducation, assessment, and treatment. • Screen for personal or family history of bipolarity, especially before initiating pharmacotherapy. • Discourage abrupt changes in treatment regimen.

  10. Psychotic Symptoms • In postpartum psychosis, symptom onset is often rapid, and there is a dramatic change in the woman’s functioning. • Symptoms may consist of: • Severe mood lability • Marked cognitive disturbance and impairment • Delusional beliefs about her infant • Bizarre behavior • Hallucinations • Unusual psychotic symptoms, such as tactile or olfactory hallucinations, and command hallucinations to kill her infant

  11. Anxiety Symptoms • Obsessive-Compulsive Disorder • Intrusive thoughts often center on causing harm to fetus or infant. • Differs from postpartum psychosis in that the woman recognizes that the thoughts are unreasonable and avoids action. • Inhibits bonding or attachment. • Associated with depressive symptoms.

  12. Sociodemographic and Environmental Risk Factors • Factors that contribute to risk during and following pregnancy: • Poverty • Unintended pregnancy • Single relationship status • Good to poor overall health • Marital or partner-related conflict • Limited social support • Childhood adversity • Negative life events • Intimate partner violence before or during pregnancy • Childcare stress

  13. Effects on Women and Their Families • Consequences of Antenatal Mood and Anxiety Symptoms • Adverse pregnancy, childbirth, and neonatal outcomes • Consequences of Postnatal Mood and Anxiety Symptoms • Impairments in mothering, poor mother–infant interactions, disrupted infant behavior and development, and inadequate infant health management

  14. Engaging Women in Treatment • Identification Women in Need • Motivation and Practical Barriers to Care • Stigma • Treatment Acceptability

  15. Conclusion • Puerperal psychiatric disorders are of great clinical and public health importance • Further study should address: • Strategies for understanding for whom to intervene, how to intervene, and how to engage • Whether there is a risk threshold for illness duration and severity, and whether there are sensitive periods when susceptibility and impact peak

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