Perinatal and Postpartum Mood Disorders : Perspectives and Treatment Guide for the Health Care Practitioner

"As a psychotherapist and educator of future mental health practitioners, I believe this work fills an important gap in reference books for professionals who care for childbearing women. Since the volume provides invaluable neurobiological research on depression and anxiety, I recommend this work to all health and mental health professionals."-- Illness, Crisis and Loss Over the past three years, pregnancy related mood disorders have become the focus of health care advocates and legislators alike with subsequent reflection in nationwide media. Statistics on the prevalence of perinatal mood disorders suggest that up to 20% of women experience diagnosable pregnancy related mood disorders. The growing recognition of these common disorders, coupled with an increasing knowledge base about the dire consequences of untreated maternal depression, has propelled this issue to the fore of national public health priorities. This increasing awareness has also resulted in recent legislative and healthcare initiatives to screen, assess, and treat such disorders. On April 13, 2006, Governor Jon S. Corzine (D -NJ) signed a law requiring all new mothers to be educated and screened for postpartum depression. This law is the first of its kind in the country, but many states and federal advocates are proposing similar laws. The motivation for states and the federal government to adopt education and screening program is high and may soon be a federal mandate. But a major barrier to successful implementation of such programs is the lack of available resources to train healthcare professionals in this specialty. This book offers a major resource for healthcare professionals, mental health professionals, and medical, nursing, psychology, and social work students who will be confronting this problem in their practices. The contributions, by renowned experts, fill a glaring gap in the knowledge professionals need in order to successfully manage maternal mental health. Contents......Page 8 Contributors......Page 14 Foreword......Page 20 Acknowledgments......Page 24 Introduction......Page 28 PART I: THE IMPORTANCE OF MATERNAL MENTAL HEALTH......Page 32 1 The Effects of Maternal Stress, Anxiety, and Depression During Pregnancy on the Neurodevelopment of the Child......Page 34 Studies Showing a Link Between Antenatal Stress and Anxiety and the Neurodevelopment of the Child......Page 35 Clinical Implications and Opportunity for Interventions......Page 41 Conclusion......Page 43 2 Maternal Attachment and Bonding Disorders......Page 48 Review of the Literature......Page 50 Illustrative Cases......Page 64 Summary......Page 67 3 Effects of Maternal Postpartum Depression on the Infant and Older Siblings......Page 72 Effects of Maternal Depression on the Infant......Page 73 Effects of Postpartum Depression on the Older Children......Page 78 Caveat: Interpretation of Statistical Correlations......Page 81 Intervention: Helping Mother and Child......Page 82 Summary......Page 90 4 Perinatal Mood Disorders: An Introduction......Page 96 Prevalence......Page 97 Risk Factors......Page 98 Diagnosis......Page 101 Screening......Page 104 Consequences......Page 106 PART II: PERSPECTIVES ON RISK FACTORS, SCREENING, AND DIAGNOSIS......Page 116 5 Diagnosis and Screening of Perinatal Mood Disorders......Page 118 History......Page 120 Prevalence and Risk Factors......Page 122 Assessments......Page 127 Conclusion......Page 133 Why Patients Use Alternative and Complementary Treatments......Page 138 Inflammation and Depression......Page 140 Omega-3 Fatty Acids......Page 141 Exercise......Page 148 St. John’s Wort......Page 151 Conclusion......Page 158 7 Stress System Dysregulation in Perinatal Mood Disorders......Page 164 Hypothalamic-Pituitary-Adrenal Axis......Page 165 HPA in Perinatal Mood Disorders......Page 173 Case Study Illustrating Postpartum Depression and HPA Dysregulation......Page 176 Summary......Page 179 Review of the Literature......Page 184 Issues of Pregnancy and Postpartum......Page 187 Summary......Page 195 PART III: PROFESSIONAL PERSPECTIVES......Page 198 9 Perinatal Mood Disorders: An Obstetrician’s Perspective......Page 200 Case Reports......Page 201 Routine Obstetrical Care and Screening......Page 202 Care for Women With a History of Mood Disorders......Page 204 Symptomatic Illness in Pregnancy and Postpartum......Page 205 Breastfeeding......Page 206 Obstacles for the Patient......Page 207 Obstacles for the Obstetrician......Page 208 Summary......Page 210 10 The Pediatrician’s Role in Identifying Postpartum Mood Disorders......Page 214 Who Is Our Patient?......Page 215 The Importance of Attachment......Page 216 What Does a Mood Disorder Look Like?......Page 217 Opportunities in Pediatric Practice......Page 219 Obstacles and Challenges for the Pediatrician......Page 223 Taking Action and Overcoming Obstacles......Page 225 Summary......Page 228 11 The Nurses’ Vantage Point......Page 234 The NURSE Program Model of Care......Page 235 Nurses’ Caring......Page 236 Postpartum Depression Screening......Page 243 Posttraumatic Stress Disorder Due to Childbirth......Page 244 12 Mothers Who Suffer From Postpartum Illnesses and the Pitfalls of the Criminal Justice System......Page 250 Prologue......Page 251 Insanity Standards......Page 253 Postpartum Illnesses and the Insanity Standard......Page 257 Clark v. Arizona......Page 258 The Failures......Page 261 Summary......Page 263 PART IV: TREATMENT OPTIONS FOR PERINATAL MOOD DISORDERS......Page 266 13 To Medicate or Not: The Dilemma of Pregnancy and Psychiatric Illness......Page 268 Literature Review......Page 271 Case Studies......Page 284 Conclusion......Page 291 14 Comorbid Presentations in Perinatal Mental Health: Dialectical Behavior Therapy as a Treatment Model......Page 298 Commonly Occuring Perinatal Comorbid Disorders......Page 301 Dialectical Behavior Therapy......Page 305 Case Study: Introduction of DBT Skills in a Support Group for Postpartum Depression......Page 311 Summary......Page 313 Antepartum Depression......Page 320 Interpersonal Psychotherapy (IPT)......Page 321 Depression During Pregnancy......Page 323 Guidelines for Interpersonal Psychotherapy......Page 324 Problem Areas for Treatment......Page 326 The Efficacy of IPT-P......Page 327 Discussion......Page 332 16 A Psychodynamic Approach to Treatment for Postpartum Depression......Page 340 Maternal Identity......Page 341 Conclusion......Page 350 17 Health Literacy and Maternal Empowerment......Page 352 Prenatal Care and Public Health Experiences......Page 353 What Is Health Literacy?......Page 356 Health Literacy and the Perinatal Experience......Page 358 The Baby Basics Program......Page 360 18 The Role of Social Support in the Prevention, Intervention, and Treatment of Perinatal Mood Disorders......Page 370 The History of Social Support: A Convergence of Science and Self-Help for Perinatal Families......Page 371 The Self-Help Movement......Page 374 The Emergence of the Perinatal Social Support Movement......Page 376 The Principles of Social Support......Page 377 The Types of Social Support......Page 378 Summary......Page 383 Resource List......Page 388 A......Page 390 C......Page 391 D......Page 392 G......Page 393 I......Page 394 M......Page 395 N......Page 396 P......Page 397 S......Page 400 Z......Page 401 As a psychotherapist and educator of future mental health practitioners, I believe this work fills an important gap in reference books for professionals who care for childbearing women. Since the volume provides invaluable neurobiological research on depression and anxiety, I recommend this work to all health and mental health professionals."-- Illness, Crisis and Loss Over the past three years, pregnancy related mood disorders have become the focus of health care advocates and legislators alike with subsequent reflection in nationwide media. Statistics on the prevalence of perinatal mood disorders suggest that up to 20% of women experience diagnosable pregnancy related mood disorders. The growing recognition of these common disorders, coupled with an increasing knowledge base about the dire consequences of untreated maternal depression, has propelled this issue to the fore of national public health priorities. This increasing awareness has also resulted in recent legislative and healthcare initiatives to screen, assess, and treat such disorders. On April 13, 2006, Governor Jon S. Corzine (D -NJ) signed a law requiring all new mothers to be educated and screened for postpartum depression. This law is the first of its kind in the country, but many states and federal advocates are proposing similar laws. The motivation for states and the federal government to adopt education and screening program is high and may soon be a federal mandate. But a major barrier to successful implementation of such programs is the lack of available resources to train healthcare professionals in this specialty. This book offers a major resource for healthcare professionals, mental health professionals, and medical, nursing, psychology, and social work students who will be confronting this problem in their practices. The contributions, by renowned experts, fill a glaring gap in the knowledge professionals need in order to successfully manage maternal mental health.

Over the past three years, pregnancy related mood disorders have become the focus of health care advocates and legislators alike with subsequent reflection in nationwide media. Statistics on the prevalence of perinatal mood disorders suggest that up to 20% of women experience diagnosable pregnancy related mood disorders. The growing recognition of these common disorders, coupled with an increasing knowledge base about the dire consequences of untreated maternal depression, has propelled this issue to the fore of national public health priorities.

This increasing awareness has also resulted in recent legislative and healthcare initiatives to screen, assess, and treat such disorders. On April 13, 2006, Governor Jon S. Corzine (D -NJ) signed a law requiring all new mothers to be educated and screened for postpartum depression. This law is the first of its kind in the country, but many states and federal advocates are proposing similar laws. The motivation for states and the federal government to adopt education and screening program is high and may soon be a federal mandate. But a major barrier to successful implementation of such programs is the lack of available resources to train healthcare professionals in this specialty.

This book offers a major resource for healthcare professionals, mental health professionals, and medical, nursing, psychology, and social work students who will be confronting this problem in their practices. The contributions, by renowned experts, fill a glaring gap in the knowledge professionals need in order to successfully manage maternal mental health.