Role of Nurse in Postpartum Psychiatric Disorders

Postpartum psychiatric disorders pose a significant mental health problem in the community because of their prevalence and their impact of parent infant and couple relationship [1]. The World Health Organization (WHO) designates the first 28 days after birth as the neonatal period. Although it has never been officially designated, the postpartum period is considered to start about an hour after the delivery of the placenta and is complete six weeks after birth. After six weeks, the mother’s physical status will largely return to nonpregnant state in most instances. Any psychiatric symptoms appearing within six weeks period after delivery are called postpartum psychiatric disorders, if they do not fulfill the criteria of major psychiatric disorders. Postpartum psychiatric illness is divided into three main categories, postpartum depression, and postpartum psychosis


Introduction
Women are at the greatest risk of developing a psychiatric disorder between the ages of 18 and 45 years Women in the puerperium are susceptible to the whole spectrum of psychiatric disorders. The bonds to the infant as well as the interaction with the baby are two aspects of the mother-infant relationship that can be disturbed by mothers with postpartum psychiatric disorders.

Definition
Postpartum psychiatric disorders pose a significant mental health problem in the community because of their prevalence and their impact of parent -infant and couple relationship [1]. The World Health Organization (WHO) designates the first 28 days after birth as the neonatal period. Although it has never been officially designated, the postpartum period is considered to start about an hour after the delivery of the placenta and is complete six weeks after birth. After six weeks, the mother's physical status will largely return to nonpregnant state in most instances. Any psychiatric symptoms appearing within six weeks period after delivery are called postpartum psychiatric disorders, if they do not fulfill the criteria of major psychiatric disorders. Postpartum psychiatric illness is divided into three main categories, postpartum depression, and postpartum psychosis

Postpartum Blue
Postpartum blues are transient, a self limiting condition with no known serious after effect. Most women recover from the blues within a day or two. It occurs at any time between the third and tenth postnatal day. It is considered as a normal reaction to child birth and affects and 70% to 80% of all postnatal mothers [2]. These are common in Primigravida and in those who complain of premenstrual tension. Careful monitoring during this period is essential, since a small proportion of women with postpartum blues may develop postpartum, depression.

Postpartum Depression
Depression has been identified by the World Organization as a major cause of morbidity in the 21st century. The Global Burden of study states that major depression will become the second leading worldwide cause of en by 2020. Postpartum depression is a serious mood can cripple a woman's first month as a new mother. Postpartum depression is defined as, depression that occurs within weeks of postpartum (DSM-IV-TR). Postnatal the most frequent neurotic disorder during postnatal period and occurs at any point after the delivery with a peak of incidence within the first 4 months of postpartum. It occurs in 10% -15% of women.

Postnatal Psychosis
The postpartum, psychosis is a most severe psychotic episode occurring during the postpartum period. Symptoms often begin as postpartum blues or postpartum depression. It is a rare event that occurs in approximately 1 to 2 per 1000 births and should be considered as a medical, psychiatric and obstetrical emergency [3]. Its presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of postpartum psychosis develops symptoms within the first two postpartum weeks.

Summary
You have completed Unit I of this structured teaching programme in this unit you have learn about the meaning of postpartum psychiatric disorders and its types.

Ebiological Factors
The postpartum period is generally regarded as a period of maturational crisis similar to the adolescence and menopause. The various stresses during the postpartum period include. a) Endocrine change, b) Changes of body images, c) Activation of unconscious psychological conflicts. d) Intra psychic recognition of becoming a mother.
On the light of these changes, etiological factors classifies into.

i. Biological
ii. Psychological

iii. Social and interpersonal factors
Biological: Hereditary: Children of women treated for puerperal psychosis had a significantly higher prevalence of psychiatry disorders.
Endocrine Changes: The predominant explanation for the postpartum blue and depression is that levels of hormones such as? Progesterone, prolactine, and cortisol are either too high or too low in the puerperium, or that changes in the levels of these hormones occur too quickly so not quickly enough [4]. a) Hypothalamic -pituitary-gonadal axis: High progesterone, low estrogen and high prolactine levels are associated more often with affective disturbance especially blues. Progesterone and estrogen levels drop suddenly during the first 7-10 days postpartum, while prolactine level rise by ht 3rd day. b) Cortisol: Abnormal cortisol levels are often associated with postpartum blues. Cortisol level increase during pregnancy, peak at birth and decline suddenly after childbirth.

Psychological Factors Psychodynamic Explanations:
Gender bias include preference to male child, presence of conflicting feeling within the mother with regard to her mothering experience, her new baby, her husband and herself.

DSM-IV Classification
According to DSM-IV, postpartum psychiatric illnesses may be indicated with a postpartum onset specifies can be applied to the current or most recent major depressive, manic, or mixed episode in major depressive disorders, bipolar I bipolar II, or brief psychotic disorders.

Section -I Clinical features
Post partum blues

Prevention and treatment
Initial evaluation should include a thorough history (antenatal, intranatal), physical examination and routine laboratory tests. The clinical evaluation should include CBC, complete blood chemistry, thyroid function and antithyroid antibody tests, and calcium, vitamin B12 and folate levels. b) Identify the risk factors associated with postpartum psychiatric disorders including prenatal depression child care stress life stress lack of social support prenatal anxiety maternity blues marital dissatisfaction history of previous depression difficult infant temperament low self-esteem low socioecomic status, unplanned/unwanted pregnancy, single marital status preterm birth and multiple birth. c) Nurse should be recognize the symptoms for the spectrum of postpartum psychiatric disorders ranging from baby blues" to life -threatening postpartum psychoses and being knowledgeable about the range of treatment options available for the variety of postpartum psychiatric disorders. d) Nurse should assess the women thoughts and ensure the safety of mother and her child and delusions, compounded with feelings of irritability and difficulty in controlling emotions psychiatric disorders. e) Nurse must be alert for signs of dysfunction and be prepared to help promote attachment between mother and baby, referral of the mother and family for support services and counseling and assisting the family prioritizing and performing necessary family functions f) Assist the mother in breast feeding techniques. Nurses serve a vital role in maximizing the health and health care experiences of pregnant women and new mothers and encourages federal and private health insurance plans to provide appropriate treatment options to women suffering with postpartum psychiatric disorders [6].
A. What are preventive measures of postpartum depression?

B.
What are preventive measures of postpartum psychosis?

Summary
You have completed unit V of this module, in this unit you have learn about the preventive and treatment measures of postpartum psychiatric disorders.