2burpeePerinatal Mood Disorders - PeaceHealth€¦ · WHAT IS A PERINATAL MOOD & ANXIETY DISORDER (PMAD)? Range of distress: 85% of women experience significant distress postpartum

PERINATAL MOOD DISORDERS: CLINICAL PEARLS OF COUNSELING

Alisa Burpee, PhD

September 2019

DISCLOSURES

Dr. Burpee maintains a private practice in Seattle, WA. She has no financial relationships with commercial interests.

LEARNING OBJECTIVES

1. Distinguish between normative and non-normative distress

2. Define perinatal mood and anxiety disorders (PMADs) and prevalence rates

3. Identify risk factors for PMADs

4. Increase ability to accurately and effectively screen and refer

PREGNANCY

A complex experience encompassing the following shifts:

Physical

Hormonal

CognitiveMaternal preoccupation

Emotional

WHAT IS A PERINATAL MOOD & ANXIETY DISORDER (PMAD)?

Range of distress:

85% of women experience significant distress postpartum

80% experience the “baby blues” or postpartum reactivity If persists beyond 2-3 wks, reassess for PMD

PMAD occurs in 20% of childbearing women Often depression and anxiety coexist Commonly becomes evident 2-3 mos after delivery

Prevalence rates: Postpartum Depression 7-15% Generalized Anxiety Disorder 7-10% Obsessive Compulsive Disorder 5% Panic Disorder 1-5% Post-Traumatic Stress Disorder 6-10% Postpartum Psychosis 0.01-0.02%

20% PMAD

80% Baby Blues

85%Distress

INTRUSIVE THOUGHTS

Involved in each of the PMADs

90-100% of new parents experience unwanted thoughtsUsually related to harm

AvoidanceMay not report due to fear of being deemed “unfit”

Ego-dystonic No increased risk of actual harm

“I don’t know what’s best for my baby”

“Everyone is better at this than me”

“My baby will… have a defect, fail to thrive, be obese”

“I shouldn’t have had this baby”

IMPLICATIONS OF UNTREATED MATERNAL MENTAL ILLNESSChronicity

Increased risk of:Preeclampsia

Preterm labor

Disengagement from prenatal care and self-care

Maladaptive coping

Increased severity

Social withdrawal

Suicide

For infant: Low birth weight

Feeding and sleep challenges

Difficult temperament

Attachment difficulties

Increased cortisol, excessive fear, difficulty regulating emotions

ETIOLOGY/RISK FACTORSBiological Heredity

Hormonal

Poor nutrition

Poor sleep

Psychological Cognitive

Perfectionism

Introversion

Interpersonal sensitivity

History of abuse

Pregnancy history

Social and Environmental Culture

Finances and employment

Responsibility

Support network Martial strain

Housing

Poverty

Age

Mode of delivery

Breastfeeding

SCREENING Follow up question:“Is there anything about what you are experiencing right now that concerns you?” Impact on daily functioning

Sample Script:

Emotional distress is very common during and after pregnancy. It’s hard to predict who might struggle.

Paying attention to risk factors can help us stay alert to any problems that arise.

Let me know if you are bothered by any thoughts or feelings (e.g., sadness, worry, anger)

These might be normal, but they can also be symptoms of a mental health problem.

The earlier we address them, the faster we can help you feel better.

SCREENING TOOLS

1. Two Question Screen

2. PHQ9

3. Edinburgh

4. GAD

5. YBOCS

Limitations: follow up needed for comprehensive assessment and diagnosis.

SCENARIO #1

A mother presents 8 days postpartum confiding that she is overwhelmed and exhausted. She said she has moments of feeling proud and believing she is doing a good job followed by feeling like a failure. She indicates she hasn’t really felt like eating and hasn’t had much time to take care of herself The care team has recently discovered her daughter has ankyloglossia “tongue-tie” which is causing difficulty with feeding. She also reported she has been short with her husband on multiple

occasions.

SCENARIO #2

A 28yo married woman is engaging in her first prenatal visit at about 10 weeks. She wants to know if the wine she sipped at her husband’s work event several weeks ago could cause a birth defect. She asks many questions about if and how it is safe for

her to interact with her cats. She also asks diligent questions about nutritional recommendations and foods she should avoid. She confides in you that she is

spending a lot of time preoccupied with these considerations. She is also worried her stress about the pregnancy is affecting her child negatively. The visit concludes with a diagnosis of a yeast infection and prescribed antibiotics. She expresses reluctance to take the medication for fear of harming her infant even after you have realistically

discussed the level of risk.

TAKE AWAYS

A large majority of pregnant and new mothers will experience some distress (85%)

A significant portion (80%) will experience “baby blues” which arises approx. 1 wkpostpartum and resolves in 2-3 wks

If distress and symptoms last beyond this timeframe, discuss and screen for a PMAD20% of childbearing women meet criteria for a PMAD

Effective screening and early intervention can effectively manage symptoms and reduce negative impacts to the well-being of mom and baby

QUESTIONS

REFERENCES

Manzella, Christiane. (2019). Maternal mental health intensive online: Perinatal mood and anxiety disorders. Online Training. Seleni.org/maternal mental health training.

American Psychiatric Association. (2017). Diagnostic & Statistical Manual of Mental Disorders 5, American Psychiatric Publishing

Swedish Perinatal Center. Retrieved from: https://www.swedish.org/locations/center-for-perinatal-bonding-and-support

SPECIAL ISSUES

Dads

Fertility

Teen Pregnancy

Low income and minorities

LGBTQ

Immigrants and refugees

WHEN TO REFER FOR RX

Anytime history of bipolar, schizophrenia, psychosis, MDD, OCD

Symptoms not alleviated by psychotherapy