PSYCHIATRIC DISORDERS IN

PREGNANCY
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 (selective serotonin reuptake inhibitors)

• NDRI (norepinephrine dopamine reuptake

inhibitors)

• SNRI(serotonin and norepinephrine reuptake

inhibitors)
• 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