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Preconceptual to postpartum mental health: mental illness and psychosomatic disease 

Preconceptual to postpartum mental health: mental illness and psychosomatic disease
Chapter:
Preconceptual to postpartum mental health: mental illness and psychosomatic disease
Author(s):

Mira Lal

and Roch Cantwell

DOI:
10.1093/med/9780198749547.003.0004
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date: 22 November 2017

Chapter 4 examines the advancing field of mental health and psychosomatic disease from preconception to the postpartum period. The reader is reminded of the normal adaptation of different organ systems to pregnancy. This adaptation affects both physical and emotional functioning, and is further modified by the pregnant woman's social circumstances. The transition to the pathological or diseased condition may follow an exaggeration of the physiological alterations or could occur due to health conditions specific to pregnancy. This may result in manifestations due to mind-body interactions that cause psychosomatic disease. Common and unfamiliar psychosomatic clinical conditions associated with childbearing such as anxiety and mood disorders, eating disorders, hyperemesis gravidarum, and substance misuse are discussed, along with the unfamiliar, such as schizophrenia and seizures. Pregnancy-related acute-on-chronic psychosomatic presentations, besides those arising de novo in labour, are illustrated by vignettes representing real-life encounters. Controversies in management are debated to acquaint the less familiar with these clinical challenges, which require patient-centred care. Promoting health during childbearing not only pertains to the health of the mother, but also to the well-being of her infant. This entails concomitant attention to both in order to enhance the physical, mental and social health of the mother-infant dyad. An urgency for improved understanding of biopsychosocial initiating factors is reflected in an UK surveillance report, `Saving Lives Improving Mother's Care: It confirms the continuing fall in fatalities from 'direct' pregnancy-related physical causes, but a rise due to under-recognition of 'indirect' psychiatric causes that represent the psychosomatic interface.

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