* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download What is Obsessive-Compulsive Disorder
Deinstitutionalisation wikipedia , lookup
Mentally ill people in United States jails and prisons wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Pyotr Gannushkin wikipedia , lookup
Asperger syndrome wikipedia , lookup
Excoriation disorder wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Conduct disorder wikipedia , lookup
Antipsychotic wikipedia , lookup
Maternal deprivation wikipedia , lookup
Schizophrenia wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Factitious disorder imposed on another wikipedia , lookup
Conversion disorder wikipedia , lookup
Spectrum disorder wikipedia , lookup
Mental disorder wikipedia , lookup
Postpartum depression wikipedia , lookup
Abnormal psychology wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Child psychopathology wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Obsessive–compulsive personality disorder wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Mental status examination wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Bipolar disorder wikipedia , lookup
Bipolar II disorder wikipedia , lookup
History of psychiatry wikipedia , lookup
History of mental disorders wikipedia , lookup
Maternal Mental Illness Serious postnatal concerns Dr Andrew Mayers [email protected] Maternal Mental Illness Overview Serious mental illness Maternal OCD Postpartum psychosis (including bipolar disorders) 2 Maternal OCD What is Obsessive-Compulsive Disorder (OCD)? DSM-5 A. Presence of obsessions, compulsions, or both: Obsessions as defined by (1) and (2): 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress 2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralise them with some other thought or action (i.e. by performing a compulsion) 3 Obsessive-Compulsive Disorder (OCD) DSM-5 Compulsions as defined by (1) and (2): 1. Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rigidly 2. The behaviours or mental acts are aimed at preventing or reducing anxiety or distress ,or preventing some dreaded event or situation; however, these behaviours or mental acts either are not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive 4 Obsessive-Compulsive Disorder (OCD) DSM-5 B. The obsessions or compulsions are time consuming (take more than 1 hour a day), or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning C. The disturbance is not due to the direct physiological effects of a substance or a general medical condition D. The disturbance is not better explained by another mental disorder 5 Maternal OCD Prevalence – 2.5-9% in perinatal period Compare to 1% OCD generally Some ‘mums’ get OCD for 1st time Or can be related to anxiety/uncertainty Over-vigilance on safety/protection can trigger compulsions While, for others, symptoms worsen Increased prevalence may be due to ‘safety’ behaviours And yet, Maternal OCD often overlooked Cleaning, praying, rumination, avoidance… It’s not the ‘thought’ of safety that’s the problem The worry of having thought (and reaction to that) IS See Fairbrother & Abramowitz 2007 6 Maternal OCD Most people don’t give ‘fleeting thoughts’ much attention Someone with maternal OCD will dwell on that intrusive thought Common obsessions Fear of contamination Intrusive thoughts, images, doubts of harm Perfectionism Compulsions serve to counter anxiety from obsession But make it worse Common compulsions Hypervigilance Hiding anything sharp around the house Constantly checking Waking earlier/going to bed later Constant reassurance-seeking 7 Maternal OCD - Impact Not ‘fashionable’ or ‘cool’ No such thing as ‘a little bit OCD’ Significant impact on mother and family Obsessions and compulsion take over Mother may act ‘strangely’ May not take part in everyday family life High risk of suicide VERY distressing for mother and family Here’s a short video from my friends at MaternalOCD https://www.youtube.com/watch?v=VcghErjT5GQ 8 Post-natal psychosis (PNP) PNP needs same DSM-5 diagnosis as any psychotic disorder Schizophrenia Schizoaffective disorder Brief psychotic disorder Can also include manic stages of Bipolar disorder But PNP is not specifically mentioned in DSM-5 Other than ‘postpartum mood (MDD or manic) with psychotic features’ Not particularly helpful Symptoms usually immediately within few weeks of birth But psychotic episodes can also occur during pregnancy 9 Schizophrenia DSM-5 Two or more of following (each present for a significant portion of time during a one-month period – or less is successfully treated). At least one must be 1, 2 or 3 1. Delusions 2. Hallucinations 3. Disorganised speech e.g. frequent derailment or incoherence 4. Grossly disorganised or catatonic behaviour 5. Negative symptoms e.g. diminished emotional expression flattening or avolition 10 Bipolar disorders Bipolar I A. Manic criteria for at least one manic episode The manic episode MAY have preceded or be followed by hypomanic or depressive episodes B. The occurrence of manic and major depressive episode(s) not better explained by schizoaffective disorder/schizophrenia (etc.) Bipolar II A. Hypomanic criteria for at least one hypomanic episode AND there MUST be current/past MDD episode B. There has NEVER been a manic episode C. The occurrence of hypomanic and major depressive episode(s) not better explained by schizoaffective disorder… 11 PNP - features Very serious illness Potential risks for mother and baby Needs quick intervention, usually hospital High risk of suicide and infanticide Delusions may be directed at baby “The child is not mine… it is evil incarnate… must be terminated or he will kill me…” Also called puerperal psychosis Prevalence 1 in 1000 mums may get post-natal psychosis (0.1%) Contrast with baby blues and PND 12 PNP - features First signs… Can start suddenly or a few weeks after birth Mum becomes very restless, or elated, and unable to sleep Becomes confused and disorientated May not recognise friends or family members (or baby) May make bonding with baby difficult May have delusions or hallucinations She may misconstrue events Such as thinking the baby is about to be taken away When staff are taking it for a sleep or a feed Mum may be manic or have wild mood swings Behaviour may become increasingly bizarre May lose touch with reality 13 PNP - Causes Depletion of oestrogen immediately after birth Hormone abnormalities more likely with PNP than with PND Sleep disruptions (before and after birth) Postpartum psychosis may be related to bipolar disorder Psychotic episodes and mood swings may actually represent first bipolar episodes Previous bipolar disorder or schizophrenia is major risk factor Especially in new mothers Or family history of one of these conditions Previous history of PND or psychosis also a risk factor 14 Postpartum psychosis I often use this video when training health profs on maternal MH From BBC Newsnight, August 2012 Click this link and scroll to end “Watch Newsnight's film on postpartum psychosis in full” 15 Exercise How much more serious is postnatal psychosis than PND? What signs should we look out for? Should mother and baby be separated? What is the impact of stigma? What are the options? What are the consequences of PNP for mother and child? 16 PNP and the child Serious illness with extremely serious implications for infant High risk of suicide and infanticide Potentially dangerous delusions Paranoid symptoms may cause mum to hide symptoms Attention and cognition also a problem Both of those are important in caring for baby Or care for herself Mum may harm baby She may not be able to focus properly Or act quickly enough May damage bonding and attachment 17 PNP and the child More evidence Postnatal psychosis (PP) presents dangers to mum and child 70-fold, increase in maternal suicide risk Leading cause of maternal death in first year after birth Homicidal behaviour is rare But 28%–35% PP mums described delusions about infants Only 9% had thoughts of harming the infant And PNP women more likely to state homicidal thought than healthy mums And than mothers with PND Cognitive disorganisation in PNP may cause mum to neglect infant See Sit, et al (2006) for review of puerperal psychosis 18 What we have learned We have examined several aspects of maternal mental illness What is serious maternal mental illness? Postpartum psychosis Maternal OCD 19