1. Premenstrual dysphoric disorders & peripartum psychiatric disorders
Done by : Saif Imseeh
Edited by :

2. 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

4. 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

5. Pathophysiology Ovarian hormone hypothesis Serotonin hypothesis
Psychosocial hypothesis
Cognitive and social learning theory
Sociocultural theory

6. Signs and symptoms

7. 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

8. 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.

9. Risk factors Personal history of a major mood disorder
A family history of mood disorder
Premenstrual depression
Premenstrual mood changes

10. 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:
Markedly depressed mood, feelings of hopelessness
Marked anxiety, tension
Marked affective lability
marked anger or irritability
Decreased interest in usual activities
difficulty in concentrating

11. 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

12. 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 picKey=ENDO%2F7382&rank=1~150&source=see_link&search=premenstru al+dysphoric+disorder&utdPopup=true

13. Management
Treatment of PMDD includes both nonpharmacological and pharmacologic therapies.

14. 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

15. 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.

16. Postpartum things.. Three types of postpartum disturbances:
Postpartum blues (“baby blues”)
Postpartum depression
Postpartum psychosis

17. 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,

18. 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.

19. 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.

20. 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

21. Post-Partum Depression Emotional Symptoms
Increased Crying
Irritability
Hopelessness
Loneliness
Sadness
Uncontrollable mood swings
Feeling overwhelmed
Guilt
Fear of hurting self or baby

22. 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

23. Post-Partum Depression Physical Symptoms
Exhaustion, fatigue
Sluggishness
Sleeping problems (not related to screaming baby)
Appetite changes
Headaches
Chest pain
Heart Palpitations
Hyperventilation

24. 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

25. 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.

26. Post-Partum Depression Treatment
Medications:
First-line choices are SSRIs such as fluoxetine (Prozac) mg/d, sertraline (Zoloft) mg/d, paroxetine (Paxil) mg/d, citalopram (Celexa) mg/d, or escitalopram (Lexapro) mg/d
SNRIs such as venlafaxine (Effexor) mg/d or duloxetine (Cymbalta) mg/d, are also highly effective for depression and anxiety.
ECT is effective for those with severe depression/psychosis

27. “Baby Blues” vs. Post-Partum Depression Onset
Onset at 3rd or 4th day post-delivery and can last from a few days to a few weeks
Onset can be anytime one year after delivery

28. “Baby Blues” vs. Post-Partum Depression Onset
70-80% of women will experience depressive symptoms that disappear within a few weeks.
10% experience some degree of postpartum depression which can last a year.

29. Postpartum Psychosis A very small number of women (less than .5%)
% incidence rate
Postpartum Psychosis is considered a medical emergency due to the potential for a mom to harm herself or her baby.

30. 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

31. Postpartum Psychosis
Usually last days to 4-6 weeks
Tt: antidepressants , antipsychotics , possible inpatient hospitalization , assessment of child safety

32. 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.

33. Thank U 