Neuroscience Week 7: Infant attachment Flashcards
The most prevalent perinatal illness
Depression
Perinatal depression prevalence during and after pregnancy
is one of the most common medical complications during and after pregnancy
Perinatal depression is associated with?
adverse consequences for mother, child and family
Perinatal depression prevalence
Perinatal anxiety disorders
Bipolar affective disorder example
Postpartum psychosis
% of mothers receive treatment for perinatal psychiatric disorders
Media portrayal of perinatal medication research
Peripartum depressive disorders how to differentiate or is it something more?
Peripartum depression symptoms
Peripartum depression symptoms: Emotional
6 listed
- Guilt
- Depressed mood
- Reduced interest or pleasure
- Suicidal ideation
- Obsessions and compulsions
- Anxiety
Peripartum depression symptoms: somatic
5 listed
- Difficulty sleeping
- Diminished energy
- Reduced concentration
- Appetite or weight changes
- Psychomotor functioning changes
Postpartum blues occurs in what & of new mothers?
50 - 80%
Postpartum depression occurs in what % of women following childbirth?
13-20%
Baby blues vs Postpartum Depression (PPD)
Baby blues onset
begins within the first few days
Baby blues prognosis
resolves within 1-2 weeks
Postpartum Depression (PPD) onset
- generally begins 2 weeks after birth
- occurs within the 1st year
Postpartum Depression (PPD) increased risks
increased risk for suicide
Postpartum Depression (PPD) symptoms
7 listed
- Feelings of anger or irritability
- Lack of interest in the baby
- Appetite and sleep disturbance
- Crying and sadness
- Feelings of guilt, shame or hopelessness
- Loss of interest, joy or pleasure in things previously enjoyed
- Thoughts of harming self or baby
Baby blues symptoms
3 listed
- Sad, tearful or irritable
- Overwhelmed
- usually resolves without intervention
BPAD AKA
Peripartum Bipolar Affective Disorder
Peripartum Bipolar Affective Disorder increased risk of psychiatric hospitalization
23x risk in the first postpartum month
Peripartum Bipolar Affective Disorder adverse gestational outcomes
6 listed
- gestational hypertension
- antepartum hemorrhage
- increased rates of induction of labor and C-section
- severe growth retardation (<2nd or 3rd percentile)
- increased neonatal morbidity
- preterm birth
Peripartum Bipolar Affective Disorder relapse
- 80-100% who discontinue mood stabilizing meds relapse soon after medication discontinuation
- occurs rapidly and often within a few days of delivery
Overview of Peripartum Bipolar Affective Disorder
Postpartum Psychosis prevalence
1 to 2 out of every 1000 deliveries
Postpartum Psychosis symptoms
7 listed
Postpartum Psychosis onset
Sudden, usually within 2 weeks
Postpartum Psychosis Suicide and infanticide rate
- 5% suicide
- 4% infanticide
Postpartum Psychosis Risk factor
a history of bipolar affective disorder or a previous psychotic episode
Postpartum Psychosis recurrence rate
50-80% chance of another episode in recurrent pregnancies
Depression after child birth
postpartum obsessions onset
most common in first-time mothers
can occur during and after pregnancy
postpartum obsessions risk factors
increased risk with previous hx of OCD
postpartum obsessions symptoms
4 listed
- a sense of horror about the obsessions
- fear of being left alone with the infant
- Hypervigilance in protecting the infant
- Moms know their thoughts are bizarre and are very unlikely to ever act on them
postpartum obsessions egodystonic thoughts and obsessions
6 listed
postpartum obsessions: Compensatory behaviors
7 listed
postpartum obsessions: Postpartum compulsions
4 listed
impact of untreated perinatal mood and anxiety disorders
Untreated perinatal mental illness impact on pregnancy
4 listed
Higher rates of preeclampsia, gestational diabetes, preterm and low birth weight
Untreated perinatal mental illness: epigenetic effects of antenatal stress and depression
4 listed
on infant
Untreated perinatal mental illness: impact on infant
5 listed
Untreated perinatal mental illness: impact on child development
6 listed
Attachment theory
First attachment theorist
John Bowlby
Bowlby’s Ethological theory
Attachment functions
3 listed
Attachment styles
4 listed
- secure attachment
- avoidant attachment
- ambivalent attachment
- disorganized attachment
Secure attachment % of sample (generalized to represent U.S. population)
65%
Avoidant attachment % of sample (generalized to represent U.S. population)
20%
Ambivalent attachment % of sample (generalized to represent U.S. population)
10-15%
Disorganized attachment % of sample (generalized to represent U.S. population)
10-15%
Secure attachment child’s general state of being
- secure
- explorative
- happy
Avoidant attachment child’s general state of being
- not very explorative
- emotionally distant
Ambivalent attachment child’s general state of being
- Anxious
- insecure
- angry
Disorganized attachment child’s general state of being
- Depressed
- angry
- completely passive
- non-responsive
Secure attachment Mother’s responsiveness to her child’s signals and needs
- quick
- sensitive
- constant
Avoidant attachment Mother’s responsiveness to her child’s signals and needs
- Distant
- disengaged
Ambivalent attachment Mother’s responsiveness to her child’s signals and needs
- Inconsistent
- sometimes sensitive
- sometimes neglectful
Disorganized attachment Mother’s responsiveness to her child’s signals and needs
- Extreme
- erratic
- frightened or frightening
- passive or intrusive
Secure attachment fulfillment of the child’s needs (why the child acts the way it does)
believes and trusts that his/her needs will be met
Avoidant attachment fulfillment of the child’s needs (why the child acts the way it does)
subconsciously believes that his/her needs probably won’t be met
Ambivalent attachment fulfillment of the child’s needs (why the child acts the way it does)
cannot rely on his/her needs being met
Disorganized attachment fulfillment of the child’s needs (why the child acts the way it does)
severely confused with no strategy to have his/her needs met
Secure attachment: Parental style
- Aligned with the child
- In tune with the child’s emotions
Secure attachment: Resulting adult characteristics
- Able to create meaningful relationships
- empathetic
- able to set appropriate boundaries
Avoidant attachment: Parental style
unavailable or rejecting
Avoidant attachment: Resulting adult characteristics
- Avoids closeness or emotional connection
- distant
- critical
- ridgid
- intolerant
Ambivalent attachment: Parental style
inconsistent and sometimes intrusive parent communication
Ambivalent attachment: Resulting adult characteristics
- Anxious and insecure
- controlling
- blaming
- erratic
- unpredictable
- sometimes charming
Disorganized attachment: Parental style
- Ignored or didn’t see the child’s needs
- parental behavior was frightening/traumatizing
Disorganized attachment: Resulting adult characteristics
- Chaotic
- insensitive
- explosive
- abusive
- untrusting even while craving security
Evaluation for perinatal depression
Validated screening tool for perinatal depression
Basics of promoting maternal well-being
Treatment options for perinatal depression and anxiety: Non-medication treatments
Treatment options for perinatal depression and anxiety: Psychotropics
Treatment decision making for perinatal depression and anxiety
Resources for perinatal depression and anxiety:
Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
