2. Perinatal MH

Question 1

What are the common perinatal MH problems?

Answer 1

• physiological: hormone disorder
• psychological:
  > postnatal depression - feel a bit down, tearful after giving birth
  > postnatal psychosis - often present as bipolar disorder, which displays as delusions or strange beliefs about the baby (ie, worries about body’s health … for no identifiable reason)

Question 2

What are perinatal anxiety/depression and perinatal psychosis?

Answer 2

perinatal anxiety/depression:

• worries about baby, often present as fear for baby’s health
• sad, lethargy
• obsessive-compulsive behaviours
• being irritable and socially withdrawing

perinatal psychosis:

• often happens 2 wks after delivery
• it is noticeable with mood swing
• being agitated, and expressing delusions about the baby
• need rapid intervention

Question 3

How to do perinatal MH assessment/screening?

Answer 3

• risk factors
  > social (stigma), cultural, economical, interpersonal (relationship, privacy)
  > healthcare factors, ie service integration, follow-up procedures, effective communication, beliefs about meds
  > individual factors, ie sensitivity to hormones, MI …
• depression score: Edinburgh Depression Score
  > drug health
  > mental health - Do you consider yourself a confident person?
  > psychological risk - Have you ever felt anxious, miserable, depressed?
  > domestic violence - Within the last year, have you been hit, slapped?
  > sexual health - Are there any other issues you would like to mention?

Note:
> ensure PT is followed up
> ask challenging questions if allowed
> manage your own reaction
> seek guidance if needed
> report to "Child Protection Services"

Question 4

What is the nurse’s role in perinatal MH?

Answer 4

• liaise with the team, give meds, use MSE

Assessment: MSE

• Appearance — observing PT’s physical health
• Speech — How do they talk about the baby?
• Mood — How linked to the circumstances is it?
• Affect — Congruence to mood (a patient’s moment to moment expression)
• Thought — thoughts about self & baby
• Perception — abnormal perceptions, ie illusions, hallucinations
• Judgement — What would they do if they weren’t coping?

Treatment:
1st line - non-pharmacological, psychological therapies/supports
2nd line - pharmacological (start with low dose)

Question 5

YB

Answer 5

Family Model：家长精神->小孩精神->家庭关系

• Early Intervention：尽早察觉情绪变化/亲子连接/Perception alteration
• 护士扮演Liaison Team，检查使用MSE

观察母亲反应：
A. Good Interaction：对宝宝有反应/Empathy
B. Concerning Interaction：难以安抚/注视宝宝

Question 6

YB - 母婴Attachment

Answer 6

Attachment Theory：父母/婴儿关系

- Secure Attachment：教管理情绪：）
- Unhealthy Attachment：损失自我认知/焦虑抑郁（比如家暴忽视）：（小孩对话例子：自我介绍->问对方最近困扰->咋影响他们&咋解决->了解爱好和社交