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Here is a compilation of essays on ‘Disorders Related to Women’ for class 11 and 12. Find paragraphs, long and short essays on ‘Disorders Related to Women’ especially written for school and college students.
Essay on Disorders Related to Women
Essay Contents:
- Essay on Premenstrual Syndromes
- Essay on Psychiatric Disorders of Child Birth
- Essay on Termination of Pregnancy
- Essay on Menopause
- Essay on Couvade Syndrome
- Essay on Tokophobia
1. Essay on Premenstrual Syndromes:
Menstruation (Menses) is a cyclic phenomenon usually occurring every 21 to 30 days and includes uterine bleeding for about 3 to 7 days.
Epidemiology:
Normal menstruation causes tension (Premenstrual syndrome) in about one third to two thirds of women. The syndrome of ‘pre, peri or paramenstrual tension’ typically starts about 5 to 10 days before onset of menses and lasts till the end of menses. Premenstrual syndrome is also called late luteal phase dysphoric syndrome.
Etiology:
(i) Ovarian:
Ovarian altered ovarian activity i.e. altered ratio of estrogen and progesterone.
(ii) Fluid and Electrolyte (hormonal):
Fluid and Electrolyte (hormonal) increased water and electrolytes retention, due to aldosterone rise in mid-cycle.
(iii) Other hormonal:
Vitamin B or Magnesium deficiency: changes in glucose levels; premenstrual change in endorphins; increased melatonin.
(iv)Psychological:
Psychological e.g., anxiety neurosis, prolonged or excessive stress e.g., examination, marriage, divorce, martial disharmony, death or separation of a parent, depression, hysterical, inadequate or obsessive personalities etc. can precipitate premenstrual syndromes in 50-75 percent of susceptible women.
Diagnosis:
In 1968, Moos devised a 47 item “Menstrual Distress Questionnaire” consisting of 8 symptom groups, (see above box).
Treatment:
The different kinds of treatment available for this disorder are:
(i) Hormones:
Oral contraceptives, progesterone tablets, androgens, antihormonal (danazol) etc.
(ii) Psychotropic Drugs:
Sedatives, antidepressants, lithium.
(iii) Other Agents:
Pyridoxine, Vitamin B- complex, dietary restriction of salt etc., diuretics, bromocriptine, Prostaglandin inhibitor-analgesics (Aspirin etc.).
(iv) Psychotherapy:
The treatment of associated physical, mood, behavioural or cognitive disturbances should also be treated with psychotherapy for better outcome.
2. Essay on Psychiatric Disorders of Child Birth:
(a) Psychological Problems in Pregnancy Epidemiology:
Minor psychological symptoms are common however, 66% of women have some psychological symptoms during pregnancy, especially in the first and last trimesters.
Clinical Picture:
Anxiety is common, as is a tendency to irritability and minor lability of mood. About 10% pregnant women have depression more commonly in first trimester which usually lasts less than 12 weeks. It is often associated with previous history of abortion or depression, pregnancy being unwanted, marital complications and anxieties about the fetus. It is characterized by fatigue, irritability, increased neuroticism scores and denial of the pregnancy.
Etiology:
The following factors may be associated:
(i) Age of the Mother
(ii) Parity
(iii) Relationship with her Husband
(iv) Type of Family
(v) Employment
(vi) Physical or Mental Complications during Pregnancy
(vii) Attitude towards Pregnancy
(viii) Changes during Pregnancy
(ix) Other Factors, e.g., Immature personality, hostility towards husband and parents, unusual fears about self, about body changes, operation, job, the husband’s love and affection.
Management:
(i) Counselling:
Increased support by medical, nursing and other services as well as by family and reduction in the need to contact psychiatric services.
(ii) Medication:
Conjoint marital therapy or individual counselling of the husband may be used. Minor tranquilizers and tricyclic antidepressants may be indicated in second and third trimesters.
(b) Disorders of the Puerperium:
(i) Normal Postpartum Reaction:
First few days following delivery are psychologically stressful. Women frequently complain of anxiety, irritability, dysphoria, emotional stability, tearfulness, fatigue and mild vegetative symptoms (such as disturbances in appetite, sleep) and a desire for intimacy.
(ii) Puerperal Disorders:
(c) Transitory Mood Disturbances (Postnatal Blues):
At least 50% women have a short-lived emotional disturbance commencing on the third day and lasting for 1 to 2 days. These are more common in primigravida and in those who complain of premenstrual tension.
Clinical Picture:
Unfamiliar episodes of crying, irritability, depression, emotional lability, feeling separate and distant from the baby, insomnia and poor concentration. This coincides with sudden weight loss, decreased thirst and increased urinary sodium excretion.
Etiology:
(i) Biochemical:
The cause of postnatal blues is unknown but increased levels of urinary cyclic AMP and reduced plasma levels of free tryptophan have been reported.
(ii) Others:
There is evidence that depression and mood instability are maximal on the fifth postpartum day and that women with higher neuroticism scores are more likely to experience ‘the blues’.
(d) Puerperal Neuroses:
Postnatal depression is not only the most frequent but also the most disabling neurotic disorder at this time.
Epidemiology:
About 10 to 15% of mothers may develop a non- psychotic depression.
Onset is usually within the first postpartum month, often on returning home and usually between day 3 and day 14.
Predispositions:
Postnatal depression is associated with increasing age, childhood separation from father; problems in relationship with mother-in-law and father-in-law; marital conflict; mixed feelings about the baby; physical problems in the pregnancy and prenatal period, a tendency to be more neurotic and less extroverted personalities; a previous psychiatric history; family distress; lower social class or a hereditary pre-disposition.
Clinical Picture:
(See Table 29.1)
I. Loneliness or worry about a physical illness
II. Excessive anxiety about her baby’s health that cannot be diminished by reassurance
III. Self-blame
IV. Sad mood
V. Worry at her rejection of the baby
VI. Irritability and loss of libido
VII. Sleep difficulty
VIII. A fear that baby may not be hers
IX. Suicidal thoughts or a fear of harming the baby
X. The other symptoms include feeling tired, despondent and anxious, poor appetite, decreased libido.
Management:
The treatment consists of counselling and antidepressant drugs. Breast-feeding is not contra- indicated but should be discontinued if treatment with lithium carbonate is maintained.
(e) Other Neurotic Disorders:
Phobias, anxiety states and obsessive-compulsive neuroses may also occur and interfere markedly with care.
(f) Puerperal Psychoses:
Epidemiology:
1 to 2 per 1,000 deliveries.
Clinical Picture:
(See Table 29.1):
i. Puerperal psychoses are not widely held to be distinct and unitary form of psychosis but to be divided into affective psychoses (70%), schizophrenia (25%) and organic psychoses (2 to 5%). In India and other developing countries, schizophrenic and organic types of psychosis are believed to be the more common than affective type.
Common symptoms of a puerperal psychosis are:
a) Severe insomnia and early morning waking.
b) Lability of mood, sudden tearfulness or inappropriate laughter.
c) Persistent perplexity, disorientation or depersonalization.
d) Abnormal (unusual) behaviour such as restlessness, excitement or sudden withdrawal.
e) Paranoid ideas that may involve close family relations or hospital staff.
f) Unexpected rejection of the baby or a conviction that baby is deformed or dead.
g) Suicidal or infanticidal threats.
h) Excessive guilt, depression or anxiety.
Etiology:
The exact etiology is unknown but the following factors are important:
(i) Genetic factors:
A family history of major psychiatric disorder; a past history of bipolar disorder also predisposes to the development of postpartum mood disorder.
(ii) Biochemical factors:
Alterations in the hormonal levels of hypothalamic-pituitary- gonadal axis. The greater pre-delivery estrogen level (greater irritability) and lower postpartum estogen level (sleep disturbance) and progesterone level (depression) are associated with symptoms of postpartum psychosis.
a) Larger increases in cAMP during pregnancy.
b) Urinary free Cortisol excretion increases late in pregnancy, surges at birth and then rapidly declines. Persistent increase in alpha-2-adrenoceptor capacity.
c) Alterations in thyroid hormone level.
d) Decreased endorphins levels are correlated with dysphoria, decreased motor activity, lability and lethargy
e) Sleep. Decrease in stage 4 sleep time and is correlated with mood irritability.
(iii) Psychodynamic factors:
‘Patients ‘relationship with her own mother, her feelings about the responsibility of motherhood, her reaction to assertion of her female role, her relationship with her husband and his personality (over passive or over dominant) and obsessive compulsive traits.
(iv) Obstetrical factors:
Obstetrical events other than parity have not proven to be significant.
Management:
(i) Hospitalization:
Puerperal psychosis is a psychiatric emergency.
Admission of both mother and baby together is always advisable if possible.
(ii) Drugs and physical treatment:
Drugs and physical treatment should be given as appropriate to the symptoms. Electroconvulsive therapy is very effective. If baby is breast fed, major tranquilizers may cause over sedation in baby.
(iii) Psychotherapy:
Psychotherapy usually of supportive kind is required.
Outcome:
About 70% recover fully, affective psychosis having a better prognosis than schizophrenic.
Poor prognosis is indicated by:
1. A positive family history
2. A history of schizophrenia
3. Neurotic personality
4. Presence of severe marital problems
5. Schizophrenic type of puerperal psychosis.
3. Essay on Termination of Pregnancy (Abortion):
Serious psychiatric illness is very rare following termination, the incidence being about 0.1 to 0.3 per 1,000 terminations.
Clinical Picture:
The common psychological symptoms include— feeling of guilt and regret, emotional instability, a changed attitude towards sex, irritability, anxiety, depression, suicide, homicide, multiple somatic complaints (aches and pains), hysterical conversion symptoms and social and occupational maladjustment.
Since most of the psychological reactions following an abortion are short lasting and tend to disappear themselves in a few weeks to few months, they are appropriately called ‘Post-abortion blues’.
Management:
Counselling, reassurance and supportive psychotherapy.
4. Essay on Menopause:
‘Menopause’ refers to the time of cessation of menstrual periods and can therefore only be noted in retrospect. The word ‘climacteric’s is defined as a critical phase in life when a major change is occurring but menopause is now also used with this wider meaning.
Clinical Picture:
(i) Gynecological View:
The various symptoms like depression, irritability, lack of confidence, poor concentration, autonomic symptoms are attributed to menopause.
The term ‘Menopausal syndrome’ has been used to describe symptoms related to estrogen deficiency and include—hot flushes, sweats, atrophic vaginitis, osteoporosis and other symptoms depending on personality.
(ii) Psychiatric View:
The belief that the menopause is an item of high risk for psychiatric disorder in women is not upheld in the psychiatric literature.
Etiology:
(i) Biological Factors:
Abnormalities in:
a) Control of Cortisol secretion.
b) Response of thyroid stimulating hormone (TSH) to Thyrotropin releasing hormone (TRH).
c) Response of growth hormone to clonidine.
d) Fluctuations in level of prolactin, Cortisols, TSH and Triiodothyronine.
e) Upward LSH, FSH and Oestradiol.
(ii) Psychoanalytic Views:
a) A time of great loss of femininity and reproductive potential.
b) A time of increased importance of penis envy.’
c) ‘Loss of femininity and fear of growing old and associated loss of self-esteem.
(iii) Cultural, Social and Family Factors:
Negative expectations of menopause may be culture bound. The major influences on the risk of developing depression are reported as—worries about work, adolescent children, ailing husbands and ageing parents.
Management:
(i) Hormone replacement:
Oestrogen therapy is believed to control many symptoms especially hot flushes and vaginal atrophy or dryness but the symptoms such as insomnia, irritability, palpitations, depression, vertigo, backache, fatigue and reduced libido are not relieved which respond to other medication such as antidepressants and benzodiazepines. Combined oestrogen and testosterone implants may improve sexual problems especially loss of libido.
(ii) Psychotherapy Explanation and reassurance.
5. Essay on Couvade Syndrome (Syndrome of Male Pregnancy):
There are a number of psychiatric conditions which affect pregnant women but the father-to-be also suffers from a variety of symptoms which are in some ways related to his wife’s pregnancy. This is called Couvade syndrome.
Prevalence:
About 20% of the men, among a group of couples awaiting their first child, develop this syndrome.
Clinical Features:
The physical symptoms like nausea, vomiting, belching, weakness, loss of appetite, diarrhoea or constipation, abdominal pain (labour pains of men) etc. are commonly encountered while the mental symptoms include sleep disturbances, difficulty in concentration, preoccupation with pregnancy, parturition or the health of the child at birth, palpitations, sweating, fatigue, depressed mood, prolonged absence from leave (maternity leave in men) etc.
Treatment:
Psychotherapy is the treatment of choice and it’s important to treat the couple and not the pregnant woman alone.
6. Essay on Tokophobia (An Unreasoning Dread of Childbirth):
Fear of parturition was described by Marce (1858) as follows:
“If they are primiparous, the expectation of unknown pain preoccupies them beyond all measure, and throws them into a state of inexpressible anxiety. If they are already mothers, they are terrified of the memory of the past and the prospect of the future.”
It is well known that pregnancy may be a time of considerable anxiety, with symptoms escalating in the third trimester. Women in the 1990s still suffer from the fear of death during delivery. When this specific anxiety or fear of death during parturition precedes pregnancy and is so intense that tokos (‘childbirth’) is avoided whenever possible, it is a phobic state called ‘tokophobia’.
Primary tokophobia:
Women have a dread of childbirth that pre-dated pregnancy, that is, primary tokophobia. The dread of childbirth starts in adolescence.
Secondary tokophobia:
Secondary tokophobia occurs after a traumatic or distressing delivery.
Tokophobia as a symptom of other psychiatric disorders:
Some women have a phobic dread and avoidance of tokos as a symptom of depression in the prenatal period. It may also be associated with childhood sexual abuse, termination of pregnancy, hyperemesis, gravidarum, PTSD and sterilization.