Week 6: Antenatal depression and risk assessment Flashcards
What is antenatal depression?
a form of clinical depression that can affect a woman during pregnancy, and can be a precursor to postpartum depression if not properly treated. It is estimated that 7% to 20% percent of pregnant women are affected by this condition
What is therapeutic communication?
•Listening - enables you to hear and analyse everything the patient is saying and alerts you to their communication patterns •Rephrasing - helps ensure you understand and emphasises the important points in the patient’s message E.G. “ you’re feeling angry and you think it’s because of the way your friend treated you yesterday“ • Broad Openings And General Statements - encourages the patient to talk about any subject that comes to mind E.G. “ Is there something that you would like to talk about? •Clarification - Asking the patient to clarify a confusing or vague message demonstrates your desire to understand what they are saying. It can also elicit precise information crucial to their recovery E.G. “ I am not sure I understood what you said“ •Focusing - You can help the patient redirect attention toward something specific so they can accept responsibility for facing problems E.G. “ Lets go back to what we were just talking about •Silence - gives the patient time to talk, think and gain insight into problems. It may also allow you to gather your thoughts. •Suggesting Collaboration - Gives the patient an opportunity to explore the ‘pros and cons’ of a suggested approach. • Sharing Impressions - you attempt to describe the patients feelings and then seek corrective feedback from the patient, clarifying any misconceptions E.G. “Tell me if my understanding is right. I think you are telling me that
Patient Interview
• Establishes a baseline and provides clues to the underlying or precipitating cause of their current problem • Remember the patient may not be a reliable source of information - particularly if they have impaired cognition, reasoning, perception or under the influence of drugs and alcohol • Taking account of confidentiality when verifying situation with family, friends, healthcare professional
Transcultural Communication
Direct eye contact considered disrespectful in some cultures • Some cultures and religions focus on primarily on the present and view the future as something to be accepted as it occurs • In some cultures there is a tendency for the patient to want to please the healthcare practitioner rather than express true feelings or concerns • Gender roles in some cultures
Presenting Complaint
During your assessment you may notice your patient is having difficulty coping, is making poor eye contact, lacks emotional response ‘flattened effect’ or exhibiting unusual behaviour • Often, mental health problems reveal themselves as physical symptoms, such as difficulty sleeping, headaches • Try to explore more deeply
Finding out the background story
• Onset • Location • Duration • Characteristic • Associated factors • Relieving/aggravating factors •Treatment
History of Mental Illness
Discuss any past mental health concerns - episodes of anxiety, depression, delusions, hallucinations, drug/ alcohol abuse, self-harm and any previous psychiatric treatment
Socioeconomic Data
•Patients living in poor socioeconomic situations are more vulnerable to some types of mental health problems• Sensitively gathered information about the patient’s educational level, family, social networks, housing conditions, income and employment status may provide clues to the current situation/problem
Socioeconomic Data
•Patients living in poor socioeconomic situations are more vulnerable to some types of mental health problems • Sensitively gathered information about the patient’s educational level, family, social networks, housing conditions, income and employment status may provide clues to the current situation/problem
Assessing Mental Health Status
Jarvis (2008) suggests there are four main components: • Appearance - dress, grooming, hygiene and posture/body movement, facial expressions • Behaviour - levels of consciousness, mood and speech, extraordinary behaviour, habits, general demeanour, note inconsistencies, defence mechanisms (denial, fantasy, projection and repression, identification) • Cognition -orientation to time, place and person, attention span and memory, listen for indication of delusions, hallucinations, compulsions, obsessions, fantasies or daydreams • Thought Processes - logical thought, perceptions and self destructive behaviour or intent
What are some Patient Reporting Tools?
•Hospital Anxiety and Depression Scale •Beck Depression Inventory •Edinburgh Postnatal Depression Scale •Patient Health Questionnaire •Generalised Anxiety Disorder
Threshold Assessment Grid (TAG)1
TAG 2
TAG 3
TAG 4
TAG 5
TAG 6
