Perinatal & infant mental health Flashcards
Examples of perinatal-associated mental illnesses and their prevalence?
- “Baby blues” ~ 50%
- Perinatal depression
- anxiety disorders
- maternal OCD]- higher risk in perinatal periods
- psychotic disorders]- studies show no sig. difference between preg and non-preg
- eating disorders
[learn prevalences of these]
Pharmacological interventions: Benefits
- maternal outcomes
- foetal/neonatal outcomes
- infant/child outcomes
Pharmacological interventions: Risks
- teratogenicity
- obstetric complications
- neonatal toxicity/withdrawal
- neonatal complications (pulm HTN)
- risks by incompatibility w/ breastfeeding
- neuro-dvpmnt disorders (autism)
- child psychopathology (depres/ADHD/anxiety)
How to categorise risks of untreated maternal mental illness?
- maternal outcomes
- foetal/neonatal outcomes
- infant/child outcomes
[references?]
Untreated maternal mental illness -> maternal outcomes?
MATERNAL OUTCOMES
- increased relapse risk
- increased hospitalisation risk
- worsened long-term prognosis
- suicide
Untreated maternal mental illness -> foetal/neonatal outcomes?
FOETAL/NEONATAL OUTCOMES
- antenatal depression]- from increased premature delivery risk
- [anxiety could be related to adverse foetal outcomes]- currently evidence is inconsistent
- maternal anorexia nervosa -> low birth weight
- schiz. associated w/ low birth weight, preterm delivery, stillbirth and infant death within 1 year post birth
Untreated maternal mental illness -> infant/child outcomes?
INFANT/CHILD OUTCOMES
- infant regulatory disturbances (excess crying, feed/sleep difficulties, attacment problems) could predict long-term disabilities i.e. delayed cog. development
- internalising difficulties (symptoms/diagnosis of depression and anxiety are assoc w/ antenatal and postnatal depression and PTSD
- externalising difficulties (ADHD, defiant/conductional disorders)
- attachment disorders (insecure attachment)
- cognitive development
Outline UK longitudinal studies on the effect of untreated maternal depression?
South London Child Dvpmt Study
- any assoc between maternal depression and child outcome
- see optimal time to detect depression to avoid consequences
- > exposure to mat. dep. in uteru increases risk of child/adolesc psychopathology
Avon Longitudinal Study of Parents and Children
- untreated mental illness has long-last effects on psych development of children
- antenatal maternal anxiety predicts behav/emotional problems in boys
Outline the Barker Hypothesis
Heart disease, T2DM, stroke, HTN all originate during intrauterine development
[see slide for more details]
4 pathways involved in perinatal mental health?
Adrenaline-Cortisol Pathways
- anxiety
- diathesis stress model of depression
- ?foetal programming?
DA Pathways
- psychosis
- reward behaviour (parenting)
5-HT Pathways
- depression
Oxytocin system
- breastfeeding (milk ejection) AND parental reward signalling
Main classes of psychotropic medication?
- anti-psychotics/neuroleptics]- DA antagonists
- SSRIs]- more 5HT in syn cleft
- SNRIs]- more NA+5HT in syn cleft
- mood stabilisers]- reduces neuronal membrane excitability e.g. Lithium for BP
- anxiolytics/sedatives]- potentiate GABA
What is the theory of the “inflamed mind” and what are its implications?
Inflammation -> depression?
Genes assoc w/ major depression have similarities with genes assoc w/ immune system
Implications:
- > we can use anti-inflammatories to treat depression
- > we can self-modulate immune response w/ brain via mindfulness and meditation
Importance of the quality of parenting?
One of the most important predictors of healthy psychological development
Explain the attachment theory
2 key features:
Attachment: from infant to care giver (wants security+protection)]- developms in first year
Bonding: care giver to infant (to provide protection)]- develops quickly
The early natures of these can be very predictive of future functioning
What makes a care-giver responsive?
- attunement]- contingency between parent and infant
- mind-mindedness or reflective function]- parent’s capacity to understand the infant behaviour in terms of internal feeling states
