Psychic disorders associated with the puerperium


I- Introduction :

The sequence d & rsquo; a pregnancy and the birth of & rsquo; s children & rsquo; accompany any woman to affective changes that originate in the body changes and psychological alterations inherent in purpéralité,many factors may compromise the & rsquo; accession to successful motherhood : factors related to the biological terrain, to & rsquo; individual history and the & rsquo; organization of the personality and factors situationnelstenant to women's relationship to their spouse environment, family, social and cultural environment.

II- Epidemiology :

Psychiatric hospitalizations during the puerpéralié vary 1% 2% o deliveries, particularly in the 02 first months & rsquo; deliveries.

III- During pregnancy :

Pregnancy s & rsquo; often accompanied by minor psychological and behavioral changes : emotional lability, dysphoric periods, moments & rsquo; & rsquo apathy or, irritability, disturbances of eating behavior in type & rsquo; envy or bulimia.

L & rsquo; anxiety is especially 1is trimester (fears about the baby, fear that & rsquo; he dies and that & rsquo; he born malformed and the course of pregnancy and the & rsquo; childbirth.)

L & rsquo; anxiety tends to decrease during the 2nd quarter in the weeks before the & rsquo; & rsquo s birth, anxiety and sleep disorders are common.

Among the psychological disorders is noted :

  • Vomiting and nausea : occur in thec& Lsquo; the last three months, in 4 pregnancies 1000 the become severe vomiting lead to a state of malnutrition or psychopolynévrite to deficiency kind Wernickekorsakoff.
  • Some hypertension of pregnancy : the anxiety and depression are common among those women whose psychological monitoring should accompany somatic monitoring.
  • Depressive manifestations : (10% pregnancy) tearfulness, asthenia, feeling of & rsquo; disability and impairment, emotional quest and various somatic complaints

L & rsquo; depression of the first quarter may be the & rsquo; d & rsquo worsening; a pre-existing condition or anxious is the first manifestation of disease in a woman previously balanced.

We found a positive correlation between the occurrence of & rsquo; gestational depression and young age of the pregnant to lower 20 years, l & rsquo; ambivalence vis-à-vis pregnancy, absence of the stable couple, emotional isolation, material hardship. S melancholic depression :(rare) generally occurs in the 2nd half of pregnancy,near term, it takes a confounding and delirious pace, may continue during the first weeks postpartum.

Pregnancy appears to play a protective role vis-à-vis the average psychiatric conditions.

Psychoses of pregnancy would 5 as frequent as psychoses post- partum.

The melancholy access are rare, manic access are exceptional.

little schizophrenic outbreaks are observed, pregnancy causes a remission of psychotic disorders.

Beware of acute relapses after & rsquo; childbirth.

Il faut signaler les-résurgences anxio délirantes man & rsquo; effet des bêtamimétiques (salbutamol).

A dramatic birth where women s & rsquo; felt in danger and / or gave birth to a dead child or disabled ^ int starting d & rsquo; PTSD. (At & rsquo; & rsquo opportunity; another pregnancy traumatic symptoms are waking up to the 7th month (anxiety, dysphorie, nightmares, phobia d & rsquo; sleep, the risk of recurrence of & rsquo; obstetrical accident is high.

IV- Postpartum blues :

A few days after delivery appear in around half of new mothers (30 at 80%) neuropsychiatric manifestations minor "Post partum blues" "maternity blues" "3rd day syndrome"

The "postpartum blues" has : asthenia, somatic complaints, Crisis iterative tears or prolonged, pessimistic ruminations related to newborn with "fear of not knowing s & rsquo; deal" or "d & rsquo; be overwhelmed"

L & rsquo; mood is unstable Password dysphoria anxious to jubilationintense, difficulty concentrating, memory disorders. Some difficulties in the beginning of & rsquo; breastfeeding reinforce his sense of & rsquo; disability and plunged into disarray. Contemporary lactation "postpartum blues" is attributed to hormonal upheaval the puerperium.

The sudden deflation estrogen and progesterone in the 1st day results in destabilization of the neuronal metabolism.

V- Postpartum psychosis :

L & rsquo; French school speaks of "puerpurale psychosis" which has the following characteristics :

  • Beginning in the first weeks postpartum
  • Clinic & rsquo; a delirious polymorphic with confounding and thymic elements (frenzy centered on marriage denial, motherhood)
  • changing symptomatology
  • Evolution fluctuante
  • prognosis

Infanticide gesture / or suicidal is always possible.

D & rsquo; other tables can be :

→ manic Access : characterized by :
+ sudden onset
early onset (2 weeks following the & rsquo; childbirth)
+ L & rsquo; & rsquo intensity, agitation and psychotic disorganization
+ The frequency of hallucinatory productions and delusional (idea of ​​omnipotence, of divine mission, erotomaniacs or persecutory themes.

→ Mixed states are frequent

→ Major Depressive Access :
+ Early start
+ Allure stuporeuse, confounding or mixed
+ Most have a look of melancholy delusional (the infant) with risk of suicidal raptus and / or infanticide
+ Sometimes table d & rsquo; hypochondriac pace with intense asthenia,insomnia, emaciation, physical and intellectual exhaustion, various somatic complaints, events d & rsquo; neurotic pace.
+ Phobias d & rsquo; pulse or obsessive ruminations.

→ schizophrenic States :
+ Sometimes the puerperium seems to have precipitated the & rsquo; disease in women and rigid schizoid personality until well adapted,
+ 10 at 15 % post-partum psychosis can progress to schizophrenia.

WE- minor depression postpartum :

  • minor depressive state occurs in the & rsquo; year after the & rsquo; childbirth,
  • The prevalence of 10 at 20 %,
  • Age < 20 primipare years or beyond 30 years.
  • Major difficulties in family & rsquo; childhood of the mother and the early separation with parents,
  • Psychiatric disorders existing pregnancy,
  • Psychological disorders during pregnancy,
  • L & rsquo; negative attitude in relation to pregnancy (unwanted pregnancy),
  • emotional tension and isolation,
  • Severity postpartum blues.
  • défavorablesvécus events during the time of the puerpuralité.

The depression in the mother rang on & rsquo; child abuse can lead to serious behavior.

VII- post-abortion depression :

  • Spontaneous abortions are followed in 2/3 cases of & rsquo; a depressive reaction (disappointment,regret, painful sense of loss) d & rsquo; a period less than one week,
  • In abortions : constant is in 5 at 10 % cases a "brief post-abortion blues" marked by & rsquo; astheniafsadness,regrets, tearfulness, hostility to the partner,
  • exceptional therapeutic abortions.

Psychosis and major depression after abortion are rare of that postpartum psychosis probably because the neuro-hormonal changes are less.

VIII- Treatment :

  • Supportive psychotherapy,
  • couples therapy,
  • family therapy.
  • Antidepressants in severe depression,
  • Support for the mother-child relationship,
  • Psychothropes depending on the clinical,
  • ECT sometimes more effective than chemotherapy,
  • As a precaution : preparation methods to & rsquo; childbirth (newsgroup or d & rsquo; collective information).