Professional Documents
Culture Documents
Perinatal Psychiatry
2
Contoh Kasus
Ny. A 37 th, G4 P2 A1 kehamilan 28-30 minggu,
datang dengan keluhan teriak-teriak, marah-
marah, dan perilaku tidak wajar. Kejadian
tersebut sudah berlangsung 2 minggu terakhir
yang semakin hari semakin berat. Stresor
masalah marital konflik dan sosioekonomi.
Tujuan Pembelajaran
• Menjelaskan hubungan psikologis ibu dan
anak
• Menjelaskan gangguan jiwa yang dapat timbul
pada ibu & anak pasca melahirkan
Hubungan
Psikologis
Ibu dan Anak
Hubungan Psikologis Ibu dan Anak
• Fisiologis
– Pola asuh / correct
parenting
• Patologis
– Postnatal mental
illness
• Early pregnancy
• Denial or conceal pregnancy
• During – Antenatal (partial – total)
• Postnatal • Komorbiditas
• Komplikasi
Sigmund Freud: The Psyche
The Psyche
Freud: Psychosexual Stages
Fixated Stages
Mother and Child Attachment
• An enduring emotional tie to a special person,
characterized by a tendency to seek and
maintain closeness, especially during times of
stress
Other risk factors – postnatally in terms of environment,
relationship and attachment – thanks to Robin Balbernie
• Crying
• Loneliness
• Anxiety
• Exhaustion
• Insomnia
• Restlessness
• Irritability
• Difficulty concentrating
Risk Factors for Baby Blues
• Hormonal fluctuations- Decreased estrogen, progesterone, and
thyroid. Increased prolactin.
• Sudden loss of circulating volume, weight, internal organ
rearrangement.
• Stress, isolation, lack of social support.
• Sleep disruption.
• Low self esteem, preterm birth, problems with newborn, hx of
infertility.
• Feelings of loss – identity, freedom, control.
• Concurrent losses – family death, job loss, relocation.
Postpartum Depression
• Most common complication of childbirth
• Onset after 2 weeks, usually up to 6-12 months
• Duration: weeks to months
• Treatment necessary
– Psychological interventions or
– Medication
• Clinically no different from depression occurring at other
times
• High risk of further episodes following childbirth is 40-60%
• Estimated risk of depression unrelated to childbirth is 25%
Post-Partum Depression
Causes
• Exact cause not known. Levels of estrogen,
progesterone, cortisol, and thyroid hormones
drop sharply after birth.
Diagnostic Problems
• Differentiating between clinical symptoms of
depression and normal sequelae of childbirth
• Symptoms include
– Emotional
– Behavioral
– Physical
• Caused disability / disorder
• Women can be reluctance to disclose symptoms or
to recognize them as pathological
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
Risk Factors:
Postpartum Depression
• Undesired/ unplanned pregnancy
• Hx of depression or previous PPD
• Lack of social support
• Recent major life change: family death,
financial stress, job loss, relocation, marital
discord, homelessness.
Treatment
• Medication and non medication
• 70-80% of women recover with treatment
– Antidepressants (issues relating to breastfeeding)
– Psychotherapy – CBT
– Supportive counseling, peer support groups
– ECT
• For mild to moderate symptoms, focus less on
pharmacological treatment and more on
counseling and group therapy.
Post-Partum Depression
Treatment
• In addition to counseling or talk-therapy (individual or group
therapy), other steps can be taken by the mother to fight the
depressive symptoms:
– Exercise
– Eat healthy
– Use an outlet, such as a diary, a family member, or a
friend.
– Try not to isolate one’s self
– Promote sleep
– Take breaks, and make time to do the things you enjoy
“Baby Blues” vs. Post-Partum Depression
Onset