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Premenstrual dysphoric
disorders & peripartum
psychiatric disorders
DONE B Y : SA I F IMSEEH
E D I T ED B Y :
Introduction
Premenstrual dysphoric disorder (PMDD) is:
• a diagnosis used to indicate serious premenstrual distress with
associated deterioration in functioning
• a severely distressing and disabling condition that requires treatment.
• characterized by depressed or labile mood, anxiety, irritability, anger,
and other symptoms occurring exclusively during the 2 weeks preceding
menses.
• The symptoms must be severe enough to interfere with occupational
and social functioning
Epidemiology
• Epidemiologic studies indicate that as many as 80% of
women in the United States experience emotional,
behavioral, or physical premenstrual symptoms.[Between
3% and 8% of women meet the diagnostic criteria for
PMDD.
• women in the late third to middle fourth decades of life are
most vulnerable to experience PMDD
Pathophysiology
• Ovarian hormone hypothesis
• Serotonin hypothesis
• Psychosocial hypothesis
• Cognitive and social learning theory
• Sociocultural theory
Signs and symptoms
Signs and symptoms
• The most common primary symptom of premenstrual dysphoric
disorder (PMDD) is irritability
• by depressed or labile mood
• Anxiety
• Anger
• Decreased interest in usual activities
• difficulty in concentrating
• Lethargy, easy fatigability
• change in appetite
• pain
Signs and symptoms
• The symptoms must have been present for most of the time during
the last week of the luteal phase.
• must have begun to remit within a few days of the onset of menstrual
flow.
• must be absent in the week after menses.
Risk factors
• Personal history of a major mood disorder
• A family history of mood disorder
• Premenstrual depression
• Premenstrual mood changes
Diagnosis
DSM V :
• (A) ; that in most menstrual cycles during the past year, at least 5 of
the following 11 symptoms (including at least 1 of the first 4 listed)
were present:
1. Markedly depressed mood, feelings of hopelessness
2. Marked anxiety, tension
3. Marked affective lability
4. marked anger or irritability
5. Decreased interest in usual activities
6. difficulty in concentrating
Diagnosis
DSM V :
7- Lethargy, easy fatigability
8- Marked change in appetite
9- Hypersomnia or insomnia
10- A subjective sense of being overwhelmed or out of control
11- Other physical symptoms, such as breast tenderness or swelling,
headaches, joint or muscle pain, a sensation of bloating, or weight gain
Diagnosis
DSM V :
• (B) : that the symptoms must be severe enough to interfere significantly
with social, occupational, sexual, or scholastic functioning.
• (C) : the symptoms must be discretely related to the menstrual cycle and
must not merely represent an exacerbation of the symptoms of another
disorder, such as major depressive disorder, panic disorder, dysthymic
disorder, or a personality disorder
• (D) : that criteria A, B, and C must be confirmed by prospective daily ratings
during at least 2 consecutive symptomatic menstrual cycles.
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Management
• Treatment of PMDD includes both nonpharmacological and
pharmacologic therapies.
Prognosis
• PMDD is a multifactorial syndrome that occurs with varying degrees
of severity and thus may have a range of potential adverse effects on
work, social activities, and interpersonal relationships.
• Upon treatment, symptoms tend to improve rapidly. After cessation
of treatment, symptoms recur rapidly
• Problems tend to recur each cycle
• Problems may become more severe over time
• Problems may not go away if ignored
• Problems can be readily diagnosed and effectively treated
Postpartum things..
• There are large changes in the levels of several psychologically active
hormones over the peripartum period
• Their evolutionary role is probably to help coordinate both parturition and
the new maternal role of the mother
• These large hormonal changes may also contribute to changes in mood in
vulnerable women
• caused by changes in biology, psychology, environment and hormones
• Maternal anxiety and depression are the most common complications of
childbirth.
Postpartum things..
•
Three types of postpartum disturbances:
1.
Postpartum blues (“baby blues”)
2. Postpartum depression
3.
Postpartum psychosis
Baby blues
• The postpartum blues, maternity blues, or baby blues is a transient
condition that 75-80% of mothers could experience shortly
after childbirth with a wide variety of symptoms which generally
involve mood lability, tearfulness, and some mild anxiety and
depressive symptoms.
• Baby blues is not postpartum depression,
Causes
• After the placenta is delivered, the placental "hormone factory" shuts
down causing radical changes in hormone levels, and the woman can
suffer symptoms due to withdrawal from the high pregnancy levels of
oestrogen, progesterone and endorphins. Combined with this shift in
hormone levels is the physical, mental and emotional exhaustion - as
well as sleep deprivation typical of parenting a newborn. All of these
factors contribute to the condition.
Symptoms
• Weepiness and bursting into tears.
• Sudden mood swings.
• Anxiousness and hypersensitivity to criticism.
• Low spirits and irritability.
• Poor concentration and indecisiveness.
• Feeling 'unbonded' with baby.
• Restless insomnia.
Postpartum depression
• 6.8% to 16.5% of women experience postpartum depression (PPD)
also known as postpartum major depression (PMD)
• Onset can be as early as 24 hours or as late as several months
following delivery
Post-Partum Depression
Emotional Symptoms
• Increased Crying
• Irritability
• Hopelessness
• Loneliness
• Sadness
• Uncontrollable mood swings
• Feeling overwhelmed
• Guilt
• Fear of hurting self or baby
Post-Partum Depression
Behavioral Symptoms
• Lack of, or too much, interest in the baby
• Poor self-care
• Loss of interest in otherwise normally stimulating activities
• Social withdrawal and isolation
• Poor concentration, confusion
Post-Partum Depression
Physical Symptoms
• Exhaustion, fatigue
• Sluggishness
• Sleeping problems (not related to screaming baby)
• Appetite changes
• Headaches
• Chest pain
• Heart Palpitations
• Hyperventilation
Post-Partum Depression
Risk Factors
• Self or family history of mental illness or substance abuse
• Marital or financial stresses
• Birth complications
• Lack of self-confidence as a parent
• Problem’s with baby’s health
• Major life changes around time of delivery
• Lack of support or help with baby
• The mother being of young age
• Severe premenstrual syndrome
Post-Partum Depression
Treatment
• Treatments can include:
•
•
•
•
Counseling/psychotherapy
Medication
Support groups
Self-help
• For mild to moderate symptoms, focus less on
pharmacological treatment and more on counseling and
group therapy.
• All antidepressants pass through breast milk.
Post-Partum Depression
Treatment
• Medications:
• First-line choices are SSRIs such as fluoxetine (Prozac) 10-60 mg/d,
sertraline (Zoloft) 50-200 mg/d, paroxetine (Paxil) 20-60 mg/d,
citalopram (Celexa) 20-60 mg/d, or escitalopram (Lexapro) 10-20
mg/d
• SNRIs such as venlafaxine (Effexor) 75-300 mg/d or duloxetine
(Cymbalta) 40-60 mg/d, are also highly effective for depression and
anxiety.
• ECT is effective for those with severe depression/psychosis
“Baby Blues” vs. Post-Partum Depression
Onset
Baby Blues
Onset at 3rd or 4th day postdelivery and can last from a
few days to a few weeks
Postpartum Depression
Onset can be anytime one
year after delivery
“Baby Blues” vs. Post-Partum Depression
Onset
Baby Blues
70-80% of women will
experience depressive
symptoms that disappear
within a few weeks.
Postpartum Depression
10% experience some
degree of postpartum
depression which can last a
year.
Postpartum Psychosis
• A very small number of women (less than .5%)
• 0.1-0.2% incidence rate
• Postpartum Psychosis is considered a medical emergency due to the
potential for a mom to harm herself or her baby.
Symptoms
• Extreme confusion
• Distrusting other people
• Seeing things or hearing voices that are not there, which may seem like
greater forces, like God or the devil
• Thoughts of hurting herself, the baby, or others
• Hopelessness
• Inability to Sleep (even when exhausted)
• Refusing to eat
Postpartum Psychosis
• Usually last days to 4-6 weeks
• Tt: antidepressants , antipsychotics , possible inpatient
hospitalization , assessment of child safety
Pregnancy and Postpartum Anxiety Disorders
• Up to fifteen percent (15%) of women will develop postpartum anxiety
disorders
• •Generalized anxiety disorder (GAD) - excessive worry or anxiety which
the mother finds difficult to control and associated with restlessness,
fatigue, irritability, muscle tension or insomnia.
• •Obsessive-compulsive disorder (OCD)- including obsessions or thoughts
that are persistent, frequently about hurting the baby and/or compulsions
that are repetitive, ritualistic behaviors that the mother finds difficult to
control
• •Panic disorder - extreme anxiety with chest pains, dizziness, sweating,
shaking, etc. often associated with a certain place or event.
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