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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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