Mood

pique turnovers are those disorders that have a disturbance in clime as their predominant feature. This group includes several nosoforms such as affective disorders, psycho bipolar disorder and depressive disorders. The last are presented by the involutional and postnatal slump, dysthymic disorder and seasonal affective disorder. each(prenominal) listed conditions are very frequent astir(predicate) 14.3% of the population is stroked by the way disorders. The aim of this re look out is comparison the contrastive discussions for the temper disorders by modeling of postnatal supposition disorders. Databases searched for this review include PsycINFO only.There are several risk occurrenceors of postnatal mood disturbances. After tar the level of steroid hormones (estrogens, gestagens and cortisol) changes dramatically. Some women are very sensitive to these hormonal changes and back tooth react with changes of the mood. Psycho accessible risk factors include abject i ncome and inadequate genial supports, recent negative life events, marital conflict or dissatisfaction. genetic endowment and individualist susceptibility are risk factors for postnatal picture. Thus women with individual or family history of a mood disorder have high risk of postpartum depression. A prior history of postpartum mood disorder increases the risk of recurrence of the depression in two folds.Postpartum changes of the mood are not rare complications of accouchement. There are several(predicate) symptoms of mood disturbance from transitory and mild signs of postpartum blues and up to the mischievous postpartum depression and puerperal psychosis. Nonacs R. and Cohen LS. (1998) write that mood changes during the puerperium are often overlooked. This fact arouses the risk of the episodes of recurrent depression in m ahead of time(a)s. An new(prenominal) definitive issue of the problem is a risk of the remote consequences of mothers mood disturbance on the future m ental and physical organic evolution of child. To prevent those foresightful-term effects the early diagnostics and effective handling incumbrances should be applied.Some forms of the postpartum mood disorder do not assume any specific intercession, e.g. the most common (30-75% of new mothers) form of the mood disturbances, so called baby blues guide only education, reassurance and support. More hard conditions, like postpartum depression, need more active interventions. This condition occurs in 15-20 % of all women recently confined. It is characterized by anxiety, irritability, insomnia, fatigue, low interest to the baby and other symptoms of major depression.Seyfried LS and Marcus SM. (2003) indicate that pharmacological handling for patients with postpartum depression rout out be limited because some psychoactive drugs are contraindicated in nursling and psychotherapeutic approaches became the method of the choice. On other hand, rare cases of postpartum psychosis requi re psychiatric emergency care and urgent drug intercession. Thus the specialty of treatment mode is authoritative element of the care in the postpartum changes of the mood.Series of works by Dennis CL. et all. (2004) are dedicated to the problem of treatment of postpartum depression. Authors consider that the most effective schemes of psychotherapy include interpersonal psychotherapy, cognitive- behavioral therapy, chum and partner support, nondirective counseling, relaxation/massage therapy, infant nap interventions, infant-mother blood therapy, and agnatic(p) exercise.Unfortunately the available clinical mental tests studied these methods and their effectiveness, were designed poorly and have low level of evidence. Thus definite conclusions about the relative effectiveness of the unalike treatments cannot be reached. Authors advocate to increase the number of randomized controlled trials needed for comparing different treatment schemes, examining the effectiveness of indi vidual treatment components and selecting the optimum treatments for women with different anamnesis and status praesens objectivus.Other group of interventions using in the psychiatry for treatment of postpartum depression includes antidepressant medication, estrogen therapy, critically timed sleep deprivation, and bright light therapy. Some of these interventions can be applied to other types of depressions unrelated to puerperium tho the issues of pharmacological safety can limit them.As an example of mentioned above we can use the results of the study by Reck C. et all. (2004). They name, that mother-infant interaction plays a central role in the treatment of postpartum depression. They explain this fact with high sensitivity of infants to their mothers emotional state. The authors consider that postpartum depression is a risk factor for disturbances of childrens development. They proposed the integrated model of treatment which is based on mother-infant-centered interventions. Similar propositions contains the research paper of Hofecker-Fallahpour M. et all. (2003). This group of Swiss investigators proposed the program of group therapy for depressive mothers, including those who has postpartum depression. The main therapeutic method in this program is behavioral therapy.Clark R, Tluczek A. and Wenzel A. from the University of Wisconsin medical exam School published work (2004) about the priorities of psychotherapy in the patients with postpartum depression. They think that group psychotherapy and interpersonal psychotherapy should be excellent to other methods of non-pharmacological treatment.The main objectives of the proposed treatment is reducing maternalistic depressive symptoms, improving mothers perceptions of their infants adaptability and reenforcement value, and increasing mothers positive affect and verbalization with their infants. Authors urge that early intervention for mothers with postpartum depression is crucial point of successful tr eatment.Different point of view was demonstrated by Cooper PJ, Murray L, Wilson A. and Romaniuk H. (2003). They think that psychological interventions for postnatal depression can be beneficial in the short term but this welfare is not superior to spontaneous remission in the long term. In their research Cooper PJ. et all. used routine primary care, non-directive counseling, cognitive-behavioral therapy and psychodynamic therapy. They found that all chosen treatments had a considerable impact at quaternion months on maternal mood but only psychodynamic therapy reduced depression significantly.The last kind of therapy focal pointed on patients experience and bygone conflicts of childhood and adolescence. All benefits of the treatment were not longer by nine months later delivery and did not reduce of recurrent episodes of depression in semipermanent perspective. These scientists urge that postnatal depression is associated with adverse child cognitive and socio-emotional impress ion (2003). They found that early psychotherapeutic intervention had the short-term benefit to the mother-child relationship and infant behavior.In summarizing of foresaid we could said that the treatment of mood disorders in puerperal issue includes two main components medical interventions and psychotherapy. The choice of the methods and their combination depend on the gruesomeness of signs and risk of the recurrence of mood disorder. Women with mild disturbances of mood (postpartum blues) do not need specific treatment. This condition typically resolves spontaneously during first off weeks.Because the medical interventions are not the subject of our competence we will focus on the findings in the field of psychotherapy. This approach is especially useful in women with mild or moderate severity of postnatal depression. The most of authors recommend group psychotherapy (cognitive-behavioral and interpersonal therapy), but individual therapy is effective too. These methods can be combined with educational programs. OHara MW. and his coauthors evaluated efficacy of different methods of psychotherapy for postpartum depression. They proposed interpersonal psychotherapy as the method of the choice in treatment of postpartum depression.They found that interpersonal psychotherapy reduced depressive symptoms and improved social adjustment, and represents an alternative to pharmacotherapy, particularly for women who are breastfeeding. We can see that the main benefit of psychotherapy is absence of adverse effects of taking medications. But in severe cases of postnatal depression or when patients do not move to non-pharmacological treatment and in all cases of postpartum psychosis the pharmacological treatment is indicated.The popular forms of psychotherapy in the postnatal depression include cognitive therapy, behavioral therapy and interpersonal psychotherapy. Both individual and group therapy can be used. All types of non-pharmacological treatment are effective in mild and moderate severity of the depression.Untreated mood disorders place the mother at risk for recurrent disease. Furthermore, maternal depression is associated with long-term cognitive, emotional, and behavioral problems in the child. One of the most important objectives is to increase awareness across the spectrum of health care professionals who care for women during motherliness and the puerperium so that postpartum mood disorders may be identified early and treated appropriately.Effective pharmacological and non-pharmacological therapies are available. Every approach has the advantages and demerits. But to discriminate their effectiveness we need better-designed clinical trials and the unification of the approaches to the examining of the effectiveness of individual treatment components. Selecting the optimum treatments for women with different background and severity of the postnatal depression should be evidence-based and take into consideration the possibility of l ong-term effects of the mood disorder.References 1.Clark R, Tluczek A, Wenzel A. (2003) psychotherapeutics for postpartum depression a preliminary report. Am J Orthopsychiatry. Oct 73(4) p. 441-454. 2.Cooper PJ, Murray L, Wilson A, Romaniuk H. (2003) Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. I. Impact on maternal mood. Br J Psychiatry. May 182 p. 412-419. 3.Dennis CL, Stewart DE. (2004) intervention of postpartum depression, part 1 a critical review of biological interventions. J Clin Psychiatry. Sep 65(9) p. 1242-1251. 4.Dennis CL. (2004) Treatment of postpartum depression, part 2 a critical review of nonbiological interventions. J Clin Psychiatry. Sep 65(9) p. 1252-1265. 5.Hofecker-Fallahpour M., Zinkernagel-Burri C., Stckli B., Wsten G., Stieglitz RD., Riecher-Rssler A. (2003) Gruppentherapie bei Depression in der frhen Mutterschaft Erste Ergebnisse einer Pilotstudie Der Nervenarzt Sep. slew 74, Nummer 9 S. 767 7 74 6.Murray L, Cooper PJ, Wilson A, Romaniuk H. (2003) Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression 2. Impact on the mother-child relationship and child outcome. Br J Psychiatry. May 182 p. 420-427. 7.Nonacs R, Cohen LS. (1998) Postpartum mood disorders diagnosis and treatment guidelines. J Clin Psychiatry. 59 Suppl 2 p. 34-40. 8.OHara MW, Stuart S, Gorman LL, Wenzel A. (2000) Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry. Nov 7(11) p. 1039-1045. 9.Reck C., Weiss R., Fuchs T., Mhler E., Downing G., Mundt C. (2004) Psychotherapie der postpartalen Depression Mutter-Kind-Interaktion im Blickpunkt. Der Nervenarzt. November Band 75, Nummer 11 S. 1068 1073 10.Seyfried LS, Marcus SM. (2003) Postpartum mood disorders. Int increase Psychiatry. Aug 15(3) p. 231-242.