Postpartum depression postnatal depression, is a form of which can affect women, and less frequently men, after childbirth. Studies report prevalence rates among women from 5% to 25%, but methodological differences among the studies make the actual prevalence rate unclear. Among men, in particular new fathers, the incidence of postpartum depression has been estimated to be between 1.2% and 25.5%.
PPD
Postpartum depression occurs in women after they have carried a child, usually in the first few months, and may last up to several months or even a.[Symptoms include sadness, fatigue, changes in sleeping and eating patterns, reduced libido, crying episodes, anxiety, and irritability. It is sometimes assumed that postpartum depression is caused by a lack of vitamins but studies tend to show that more likely causes are the significant changes in a woman's hormones during pregnancy. On the other hand, hormonal treatment has not helped postpartum depression victims. Many women recover because of a support group or counseling
symptoms
Symptoms of PPD can occur anytime in the first year postpartum[6] and include, butSadnessHopelessnessLow self-esteemGuiltA feeling of being overwhelmed Sleep and eating disturbancesInability to be comfortable]ExhaustionEmptiness[] ِِanhedonia Social withdrawal[ Low or no energyBecoming easilysymptoms
[] Feeling inadequate in taking care of the baby[] Impaired speech and writing Spells of anger towards others Increased anxiety or panic attacks Decreased sex drive - see Sex after pregnancy One method of detecting Postnatal Depression (PND) is the use of Edinburgh Postnatal Depression Scale. If the new mother scores more than 13, she is likely to develop PND.[] [] Risk factors While not all causes of PPD are known, a number of factors have been identified as predictors of PPD (the effect size is given in parentheses, where larger values indicate larger effects):Risk factors
)[] A history of depression () Cigarette smoking)[ Low self esteem. Childcare stress ) Prenatal depression during pregnancy) Prenatal anxiety) Low social support (.36 to .41) Beck (2001) Poor marital relationship (.38 to .39) Beck (2001) Infant temperament problem to )Post partum blue-risk factors
Unplanned/unwanted pregnancy )1-single mother 2-low socioeconomical class- Of these, three factors - formula feeding, a history of depression, and cigarette smoking - have been shown to be additive effects.[with PPD., high levels of prenatal depression are associated with high levels of postnatal depression, low levels of prenatal depression are associated with low levels of postnatal depression But this does not mean the prenatal depression causes postnatal depression—they might both be caused by some third factor. In contrast, some factors, such as lack of social support, postpartum depression. (The causal role of social support in PPD is strongly suggested by several studies,.)I.
Effect on mother baby relationship
Postpartum depression may lead mothers to be inconsistent with childcare. Women diagnosed with postpartum depression often focus more on the negative events of childcare, resulting in poor coping strategies).There are four groups of coping methods, each divided into a different style of coping subgroups. Avoidance coping is one of the most common strategies used). It consists of denial and behavioral disengagement subgroups (for example, an avoidant mother might not respond to her baby crying). This strategy however, does not resolve any problems and ends up negatively impacting the mother’s mood,Coping strategy
Four coping strategies Avoidance coping: denial, behavioral disengagement Problem-focused coping: active coping, planning, positive reframing Support seeking coping: emotional support, instrumental support Venting coping: venting, self-blame
Treatment
Women need to be taken seriously when symptoms occur. This is a two-fold practice: First, the postpartum woman will want to trust her intuition about how she is feeling and believe that her symptoms are real enough to tell her significant other, a close friend, and/or her medical practitioner; erring on the side of caution will go a long way in the treatment of PPD.[] Second, the people in whom she confides must take her symptoms seriously as well, aiding her with treatment and support. Partners, friends and physicians may notice changes in a postpartum mother that she may not. Knowing that PPD is treatable with a variety of methods can make persistence in seeking treatmentTreatment
Medical evaluation to rule out physiological problems Cognitive behavioral therapy (a form of psychotherapy) Possible medication Support groups Home visits/Home visitors Healthy diet Consistent/healthy sleep patternsAn experienced medical professional will work with a postpartum mother to develop a treatment plan that is right for her. This plan may include any combination of the above options, and might include some discussion or feedback from/with a partner. If a woman suffering from PPD does not feel she is being taken seriously or is being recommended a treatment plan she does not feel comfortable with, she will want to seek a second opinion.[., confirms that postpartum depressed mothers’ symptoms promptly improved at similar rates when treated with cognitive behavioral therapy or the antidepressant fluoxetine. “A group of 61 depressed mothers completed a 12-week treatment program with or without the antidepressant plus one session versus six sessions of counseling.” Improvement followed after “one to four weeks of either treatment.”[] The findings of Appleby et al.’s study conclusively showed that combining counseling with drug therapy did not add to the improvement of just drug therapy or just counseling.[This suggests that counseling is equally as effective a treatment for PPD as medication, and that the
Post partum psychosis
First recognized as a disorder in 1850, postpartum psychosis is a very serious mental condition that requires immediate medical attention. Interestingly, studies on the rates of the disorder have shown that the number of women experiencing postpartum psychosis haven’t changed since the mid 1800s.
Post partum psychosis PPP
affects between one and two women per 1,000 women who have given birth. Unfortunately, though many women with the disorder realize something is wrong with them, fewer than 20% actually speak to their healthcare provider. Sadder still is the fact that often postpartum psychosis is misdiagnosed or thought to be postpartum depression, thereby preventing a woman from receiving the appropriate medical attention that she needs. Women who do receive proper treatment often respond well but usually experience postpartum depression before completely recovering. However, without treatment, the psychosis can lead to tragic consequences. Postpartum psychosis has a 5% suicide rate and a 4% infanticide rate.PPP signs
Although the onset of symptoms can occur at anytime within the first three months after giving birth, women who have postpartum psychosis usually develop symptoms within the first two to three weeks after delivery. Postpartum psychosis symptoms usually appear quite suddenly; in 80% of cases, the psychosis occurs three to 14 days after a symptom-free period.PPP signs
Hallucinations Delusions Illogical thoughts Insomnia Refusing to eat Extreme feelings of anxiety and agitation Periods of delirium or mania Suicidal or homicidal thoughts
PPP symptoms
Hallucinations Delusions Periods of delirium or mania Thoughts of harming the baby or oneself Irrational feelings of guilt Refusing to eat Thought insertion - the notion that other beings or forces (God, aliens, the CIA, etc.) can put thoughts or ideas into one's mind Insomnia - although studies are beginning to show that insomnia may be a cause rather than an effect Reluctance to tell anyone about the symptomsPPP -risk factors
1-Women with a personal history of psychosis, 2-bipolar disorder . 33-women with history of schizophrenia or psychosis- 4-women with family history of psychosis, bipolar disorder or schizophrenia 5- women who have had a past incidence of postpartum psychosis are between 20% and 50% more likely of experiencing it again in a future pregnancy.PPP-causes
1- changing hormones being at the top of their list. 2- lack of social and emotional support; 3-a low sense of self-esteem 4- feeling isolated and alone; 5-having financial problems; 6- undergoing a major life change such as moving or starting a new job 7- previously diagnosed bipolar disorder or schizophrenia, 8- family history of one of these conditions. 9-postpartum depression or psychosis have a 20-50% chance of having it again at future births. .PPP Treatment options
The use of lithium carbonate for prophylaxis of postpartum psychosis in such women remains controversial. Given the apparent safety of lithium prophylaxis relative to the dangers of postpartum affective psychosis, ECT is indicated specially if there is compelling suicidal and infanticide tendencies sometimes it is the first line of treatment
PPP treatment
1-Family support 2- educating the family, It is important that the affected individual not be labeled a bad mother. 3-Anti-psychotic medications do pass into the mother's breast milk. Subsequently if the mother has been breastfeeding and continues to do so, the baby needs to be monitored for drowsiness or lethargic behavior, and prescribing the least amount of anti-psychotic medication in order for symptom reduction to occur is also crucial. Postpartum psychosis is one of the serious emergency in psychiatry.PPP treatment
1-Severe agitation and delusions may require rapid tranquilization by neuroleptic (antipsychotic) drugs, but they should be used with caution .[2-Electro-convulsive (electroshock) treatment is highly effective 3-stabilizing drugs such as lithium are also useful in treatment . 4-hospitalization is disruptive to the family, and it is possible to treat moderately severe cases at home, where the sufferer can maintain her role as a mother and build up her relationship with the newborn. This requires the presence, round the clock, of competent adults (such as the baby's maternal grandmother), and frequent visits by professional staff.[If hospitalPPP treatment
there are advantages in conjoint mother and baby admission. Yet multiple factors must be considered in the subsequent discharge plan to ensure the safety and healthy development of both the baby and its mother.[This plan often involves a multidisciplinary team structure to follow-up on mother, baby, their relationship and the entire family. Suicide is rare, and infanticide extremely rare, during these episodes. It does occur, as illustrated by the famous cases summarized below. Infanticide after childbirth is usually due to profound postpartum depression (melancholic filicide) when it is often accompanied by suicide.[
Premenstrual Dysphonic Syndrome
(PMS) that is so severe it can be debilitating due to either physical, mental or emotional symptoms. Treatment is recommended because PMDD interferes with the sufferer's ability to function in her social or occupational life. The cardinal symptom—surfacing between ovulation and menstruation, and disappearing within a few days after the onset of the bleeding—is irritability Anxiety, anger, and depression may also occurPMDS symptoms
feelings of deep sadness or despair, possible suicide ideation feelings of tension or anxiety increased sensitivity to rejection or criticism panic attacks mood swings, crying lasting irritability or anger, increased interpersonal conflicts. Typically sufferers are unaware of the impact they have on those close to them apathy or disinterest in daily activities and relationships difficulty concentratingPMDS Symptoms
fatigue food cravings or binge eating fatigue insomnia or hypersomnia; sleeping more than usual, or (in a smaller group of sufferers) being unable to sleep feeling overwhelmed or "out of control" increase or decrease in sex drive increased need for emotional closeness physical symptoms: bloating, heart palpitations, breast tenderness, headaches, joint or muscle pain, swollen face and nose, feeling fatPMDS-symptoms
Five or more of these symptoms may indicate PMDD. Symptoms occur during the 2 weeks before the menstrual cycle and disappear within a few days after the onset of the bleeding, There are co morbidity of anxiety ,depression, . recent studies demonstrated that PMDD women had greater sensitivity in responding to stress and pain. []
PMDS -Treatment
1-Lifestyle changes such as regular exercise and a well balanced diet 2-Vit B6 in doses up to 100 mg - SSRIs-Fluoxetine Escitalopram oxalate Paroxetine 3-- 4-studies showed that L-Tryptophan provide significant relief when supplemented daily in a large dose of (six grams) per day.Menopause
is the permanent cessation of the function of the ovaries in human female ., midlife phase of. The word "menopause" literally means the "end of monthly cycles" from the Greek words pausis (cessation) meaning (month), ), where the end of fertility is traditionally indicated by the permanent stopping of the menstrual cycle . . also exists in some other animals, many of which do not have monthly menstruation. The date of menopause in human females is formally medically defined as the time of the last menstrual period (or menstrual flow of any amount however small), in a woman who has not had a hysterectomyMenopause signs and symptoms
Not every woman experience the same severity of the symptoms that can be started even before cessation of LMP, symptoms are due to fluctuation of estrogen level in the blood for example hot flashes and mood changes that disappear after the transition from pre menapause to post menopause has over it may take several years 1-hot flashes 2-palpitation 3-lethargy ,lack of energy 4-skin tingling sometimes to the degree of formication due to hormone withdrual