PSI Chapter 2: Perinatal Mental Health Risks, PRotective Factors, and Interactions (Blueprint - 10%)

PSI Chapter 2: Perinatal Mental Health Risks, PRotective Factors, and Interactions (Blueprint - 10%) Genetic and Family History: - Genetic Factors: - ️ Biological sensitivities to hormonal changes (runs in families). - ️ Genetic predisposition. - ️ Faulty belief systems (old vs. new view of self). - ️ Previous history of PMADs. - ️ Symptoms during pregnancy. Sensitivity to Hormonal Changes: - ️ Women with PMADs exhibit hormone levels similar to non-PMAD women but may be more sensitive to changes in those hormone levels, especially during pregnancy. Evidence-Based Risk Factors: - ️ A history of significant mood reactions to hormonal changes (such as puberty, PMS, or hormonal birth control) is a known risk factor. - ️ A personal history of PMADs is considered a risk factor. Non-Pregnancy Related Mental Health Disorders: - ️ History of depression, anxiety, OCD, eating disorders, and bipolar disorders. Epigenetics: - ️ Refers to biological mechanisms through which relationships, environments, and early nutrition affect "chemical signatures" on genes, influencing how they are turned on or off, affecting well-being across a lifetime. Exacerbating Factors for PMADs: - ️ Pain can exacerbate PMADs. - ️ A history of thyroid imbalance increases the risk of PMADs; it’s crucial to assess patients for thyroid dysfunction. Increased Risk Groups for PMADs: - ️ Women with endocrine disorders. - ️ Women experiencing fertility challenges. - ️ Those with thyroid imbalances. - ️ Individuals experiencing pain. Hormonal Interactions: - ️ Thyroid dysfunction and anemia can reduce milk supply and potentially cause depression. - ️ Galactagogues can help increase milk supply but may also cause depression. - ️ Breastfeeding and depression have a bi-directional relationship. - ️ Depression suppresses prolactin and oxytocin, both crucial hormones for lactation. Impact of Delivery Method: - ️ Suppression of oxytocin can occur with C-section deliveries, stressful or traumatic births, as well as with interventions like epidurals, leading to potential lactation problems. Pregnancy and Diabetes: - ️ True: Postpartum depression (PPD) is more common among women with pre-pregnancy diabetes (34.8% prevalence). - ️ Gestational diabetes is not associated with increased rates of PPD. Polycystic Ovarian Syndrome (PCOS): - ️ A hormonal disorder that can lead to perinatal symptoms such as anxiety and depression. Common Exacerbating Factors for PMADs: - ️ Lack of sleep. - ️ Abrupt discontinuation of breastfeeding. - ️ Breastfeeding complications. - ️ Labor and delivery complications. - ️ Social factors and interpersonal violence. - ️ Financial stress and poverty. - ️ Recent loss or moves. - ️ Barriers to accessing care (including institutional racism). - ️ Child care stress and relationship stress. - ️ Perinatal loss or history of childhood sexual abuse. - ️ Health complications and climate stressors. - ️ Returning to work and baby's temperament. - ️ Age-related stress and deployments of spouses. Timing for Perinatal Stress Risk: - ️ Most prevalent three months after birth. Recommended Screening by PSI: - ️ 1st prenatal visit - ️ At least once in the first trimester - ️ At least once in the third trimester - ️ 6-week postpartum visit - ️ Repeated screenings at 6 and 12-month OB or PCP visits - ️ 3, 9, and 12-month pediatric visits Types of Support: - Professional Support: - ️ Individual, couples, and group therapy. - ️ Pelvic floor physical therapy. - Informal Social Support: - ️ Family and friends. - Formal Social Support: - ️ Peer support groups. - ️ Email and online support. - ️ Phone support. Faith based and spiritual support ️- Another support resource for client and family. - Often "first responders" to mailise and it is important to evaluate such support during the assessment. What is most important for treatment? ️- Sleep. Mothers will not improve without adequate sleep. Will medications work without sleep? ️- No. Does a lack of sleep put mom at risk for mania? ️- Yes. Women with bipolar disorder are at higher risk of PMADs and need at least ________________ of continuous sleep. ️- 6 hours Proper postpartum sleep hygiene practices ️- No electronics 30-60 minutes before bed - go to bed when sleepy - Avoid alcohol, caffeine, and nicotine before bed - Pre bed ritual (bath, shower) - Small protein snack - Dark, comfortable sleeping environment - Educated about baby sleep - Enlist partner support in taking shifts - Consider children/pets in bed that may disturb sleep - Plan for "me time" and "us time' What is the mortality rate for pregnant women? ️- 43.5 deaths per 100,000 live births for black