Perinatal Mood and Anxiety Disorders

Transcription

1 Perinatal Mood and Anxiety Disorders

2 Mother love in infancy and childhood is as important for mental health as are vitamins and proteins for physical health ~ John Bowlby

3 YOU ARE NOT TO BLAME

4 The Spectrum of Perinatal Mood and Anxiety Disorders Onset occurs during pregnancy or within the first year postpartum Depression Generalized Anxiety Disorder Panic Disorder Obsessive/Compulsive Disorder Posttraumatic Stress Disorder Bipolar Disorder Postpartum Psychosis

5 Perinatal Mood and Anxiety Disorders are the most common complication of the childbearing year Approximately 15-20% of women will experience a mood or anxiety disorder during pregnancy and / or postpartum

6 15% of pregnant women with mood disorders are so depressed they attempt suicide. 20% of postpartum deaths are from suicide. This is second only to infection as a cause of maternal mortality.

7 Less than 25% of perinatal mood and anxiety disorders are diagnosed. Of those recognized, less than 20% are treated. Of those treated, less than 50% are treated adequately.

8 Hidden Epidemic One study showed that over 90% of depressed moms realized something was wrong, but less than 20% reported their symptoms to a health care provider. Why is it such a taboo?

9 Stigma and the Myths of Motherhood Immediate and uncomplicated bonding with baby Unwavering, limitless motherly love Total maternal fulfillment by the baby Super-mom: can do it all with no help

10 Baby Blues Not considered a disorder Occurs in approximately 80% of new mothers Usual onset within 1 week postpartum Rapid change in hormone levels contribute Symptoms dissipate within 3 weeks Mood instability Weepiness Sadness Anxiety Lack of concentration Feelings of insecurity/dependency

11 Perinatal Depression Symptoms Include: Excessive worry or anxiety Irritability Feeling overwhelmed Difficulty making decisions Sad mood, crying Feelings of guilt and shame Obsessive thoughts about being a bad mom Hopelessness

12 Perinatal Depression Symptoms Include: Sleep problems Physical symptoms /complaints without apparent physical cause Loss of focus and concentration Discomfort around the baby or lack of feeling for the baby Loss of pleasure, loss of interest Changes in appetite, significant weight loss or gain Suicidal thoughts

13 Perinatal Anxiety Symptoms Include: Excessive concern about baby and /or about own health Racing thoughts High alert state Constant worry Sleep problems Changes in appetite, significant weight loss or gain Feeling overwhelmed Shortness of breath Heart palpitations

14 Postpartum Obsessive-Compulsive Disorder 3-5% of new moms develop obsessive symptoms Symptoms are ego-dystonic Mothers are horrified by the obsessive thoughts and feel guilty about them There are no reported cases of harm to the baby Many times there is a need for long term medication Risk factor: personal or family history of OCD

15 Obsessive-Compulsive Disorder Symptoms Include Intrusive, repetitive and persistent thoughts or mental pictures Thoughts are often about hurting or killing the baby Tremendous sense of horror and disgust about these thoughts Thoughts can be accompanied by behaviors to reduce anxiety for example hiding knives Counting, checking, cleaning or other repetitive behaviors

16 Perinatal Panic Disorder Symptoms Include Panic Attacks: Shortness of breath, Chest pain, Sensations of choking or smothering, Dizziness, Hot or cold flashes, Trembling, Palpitations, Numbness, Tingling sensations, Restlessness, agitation or irritability May fear that she is going crazy, dying or losing control Panic attack may wake her up Often no identifiable trigger Excessive worry and fears (including fears of more panic attacks)

17 Postpartum Posttraumatic Stress Disorder Recurrent nightmares Sleep disturbances Extreme anxiety Excessive worry Flashbacks, reliving past traumatic events Risk factors: past traumatic events, including traumatic birth experience Full PTSD occurs after 0.2%-3% of births Symptoms of PTSD occur after 25% of births

18 Bipolar Disorder Manic Symptoms Include Lack of sleep, no perceived need for sleep Impulsivity Grandiosity Pressured / Rapid Speech Confusion / Distractability Ego syntonic not aware of danger of symptoms

19 Bipolar Disorder 45-50% of stable women experience relapse or exacerbation in pregnancy 85% who go off meds relapse during pregnancy 67-82% chance of postpartum relapse Chance of psychosis increases 100x from % of the general population to as much as 20% of women with bipolar diagnoses

20 Postpartum psychosis Psychosis is a psychiatric emergency Requires immediate intervention Occurs in 1-2 per thousand 0.1%-0.2% 10% - 20% of women with bipolar disorder diagnosis Onset usually within first 2 weeks postpartum, but can occur later 5% suicide rate & 4% infanticide rate

21 Postpartum Psychosis Symptoms Include Visual or auditory hallucinations Delusional thinking (ex, denial of birth or need to kill baby) which is ego-syntonic Delirium and or mania Confusion, disorientation Suspiciousness, paranoia Rapid mood swings No sleep for numerous days Can appear and feel normal for stretches of time between psychotic symptoms

22 YOU ARE NOT TO BLAME

23 Impact on Maternal Attachment Behaviors Less responsive to infant Less stimulating of infant Less likely to monitor infant closely Less emotionally synchronized with infant Less able to support infant s selfregulation More negative perceptions of infant behavior

24 Impact on Maternal Attachment Behaviors 27% less likely to continue breastfeeding 30% less likely to spend time playing with infant 26% less likely to spend time talking to infant 39% less likely to follow 2 or more routines

25 Impact on Infants Lower birth weight Poorer weight gain and growth rates Less responsive More irritable Loss of appetite Sleep disturbances Less exploration of environment Higher heart rates when interacting with mom Elevated stress hormones EEGs abnormal up to 3 years - brain activity looks like that of a depressed adult

26 Long Term Consequences for Children Behavioral problems Learning differences / cognitive delays Increased ADHD diagnoses Increased aggression and conflict More than twice as likely to experience depression and anxiety as adults Consequences increase with length of maternal mood / anxiety disorder, especially if an untreated disorder becomes chronic

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28 Assessment Psychiatric history History of sexual trauma/abuse Fertility issues Pregnancy losses (spontaneous abortion, termination of pregnancy, perinatal loss and early childhood loss) Rule out medical conditions such as thyroid disorder Edinburgh Postnatal Depression Scale is a simple, effective screening tool

29 Risk Factors Biological / Physiological Past or current mental illness History of perinatal mood disorder: 50-80% risk Family history of mood disorders Mood changes while taking hormonal birth control or fertility medication Severe PMS Thyroid dysfunction Abrupt weaning Infertility

30 Risk Factors Psycho-Social Partner relationship issues Medically fragile infant Social isolation / poor social support Unmet expectations about motherhood, birth, family Financial stress Issues with return to work Lack of basic needs Domestic violence Substance use/abuse

31 What We Can Do: Prevention Dispel the myths of motherhood Speak openly about perinatal mood disorders Bio/Psycho Include education about perinatal mood disorders in childbirth classes Encourage all clients to have social support in place for postpartum time Encourage clients to ask for help when needed Help clients to understand/discuss shared responsibilities and changing relationship dynamics with their partners Discourage additional major changes in the childbearing year Educate about self-care: sleep, exercise, nutrition

32 Protective Factors 1. Parental Resilience 2. Social Connections 3. Knowledge of Parenting & Child Development 4. Concrete Support in Times of Need 5. Social and Emotional Competence of Children

33 What We Can Do: Effective Treatments Available Mobilize emotional, practical, and social support systems Support in identifying the importance of self-care and realistic expectations Refer for counseling, support groups, psychotherapy,and/or other resources Refer for in-home visitation programs (i.e. CPI, PHN, Early Head Start) Support mom in getting psychopharmacologic treatment when necessary

34 What We Can Do: Interventions Screen regularly - screen during pregnancy and early postpartum Intervene as soon as possible Support in safe manner, listen openly and without judgment Remind her frequently that she is not alone and she is not to blame Elicit and repeat back her strengths and natural coping skills Help her to prioritize self care activities Sleep when the baby sleeps! Take time for Self Make additional home visits as needed Follow Up is key.

35 Sonoma County s Response - Addressing the Barriers Public Awareness & Professional Education Know onset, treatment, factors involved Stigma Culture, Relationships, Fear, Messages Rec d System Barriers & Linkages Resources Build capacity & increase services, cont. early screening & education

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