 |
|||||||
Marce Society International Conference |
|||||||
 |
 |
 |
 |
 |
|||
|
| Abstracts 1 - 10
ABSTRACT 1
PSYCHOTROPIC MEDICATIONS IN PREGNANT AND BREAST-FEEDING WOMEN: A REVIEW OF THE LITERATURE AND TREATMENT GUIDELINES
Marie-Paule
Austin and Philip B Mitchell Presenting
author: Marie-Paule Austin MBBS, FRANZCP. Staff Specialist in Liaison
Psychiatry, Prince of Wales Hospital and Conjoint Lecturer, School of
Psychiatry, University of New South Wales, Sydney. phone: (02) 93822796; fax: (02) 93822177; email: m.austin@unsw.edu.au
Objectives: To review all studies and case reports examining the impact of psychotropic medications taken during pregnancy and breast-feeding, on infant outcome. To provide clinicians with clinical guidelines for the use of psychotropes in pregnancy and breast-feeding, both acutely and prophylactically.
Results: a) Pregnancy: Several hundred infants exposed to SSRIs and TCAs have now been studied in a small number of prospective, controlled, non-randomised, studies. Findings suggest that neither the SSRIs nor the TCAs cause major congenital anomalies. Conversely, results from small, often less methodologically rigorous studies suggest that benzodiazepines, lithium, anticonvulsants and chlorpromazine do lead to an increased rate of congenital anomalies. Studies of longer-term neurobehavioural sequelae are very limited but at present do not indicate any adverse effects. b) Breast-feeding: on the basis of findings from a small number of prospective controlled studies, the use of SSRIs, TCAs, carbamazepine, sodium valproate and short-acting benzodiazepines in breast-feeding is relatively safe. High dose antipsychotics should be avoided as they may be associated with developmental delays. The potential for neonatal toxicity with lithium is significant.
Conclusions: The use of psychotropes in the perinatal period remains complex. While the available data suggest that antidepressants used in pregnancy and breast-feeding are relatively safe, other psychotropes used in pregnancy are associated with a small risk of congenital anomalies and perinatal complications. Furthermore the long-term sequelae of psychotrope use in pregnancy and breast-feeding is virtually unknown. Conversely, mental illness per se, may also be associated with an adverse outcome in the infant. Clearly, the risks to both mother and infant need to be carefully weighed and discussed with the parents before a decision about medication can be made. Finally, clinicians need to bear in mind the importance of prophylactic psychotrope use in the early post-partum period in women at high risk of relapse.
ABSTRACT 2
THE HONG KONG POSTNATAL DEPRESSION STUDY
Dominic
T.S. Lee, S.K. Yip, Danny T.N. Leung, Helen F.K. Chiu, Tony K.H. Chung
Our understanding of postnatal depression (PND) is predominantly based on research conducted in western populations. It remains unclear if PND is equally prevalent in Chinese societies. Population based psychiatric epidemiological surveys generally show that depressive disorders are less prevalent among Chinese populations. On the other hand, the available evidence so far suggests that the frequency of non-psychotic postpartum depression appears to be rather constant across populations. Two decades ago, Pillsbury reported that there was no PND in Chinese societies and postulated that this was related to the practice of traditional postpartum custom. Subsequently, a few small sample studies attempted to estimate the rates of PND among Chinese women in China, Singapore and Malaysia using partially validated self-report rating scale, yielding varying results ranging from 0 to 18 per cent. Using standardised diagnostic instrument and DSM criteria, the authors showed that among a representative sample of 145 Chinese women in Hong Kong, 12 per cent met the criteria of PND at six weeks postpartum. The same pilot study also showed that risk factors identified in western women are applicable in Hong Kong Chinese. Further validation in a larger sample is needed so that the figure is precise enough for health services planning purpose. From an academic point of view, this will clarify the confusion about the prevalence of PND in Chinese societies. A large study will also be able to identify risk factors, which because of smaller effect size, may not have been identified in the pilot study. This was a prospective, longitudinal observation study. The authors recruited 959 participants among a consecutive series of Chinese women who attended the antenatal booking-in clinic of the Prince of Wales Hospital (PWH). Participants were assessed using a two-stage design (General Health Questionnaire and Structured Clinical Interview for DSM-III-R) at three months postpartum. The estimated prevalence rate of major depression and minor depression (depressive disorders, NOS) was 6.1% and 5.1% respectively. Apart from risk factors commonly reported in the west, acrimonious mother-in-law relationship and absence of peiyue postpartum custom were associated with higher risk of PND among Chinese women in Hong Kong. The implications of the findings will be discussed.
Abstract Objectives: To review all studies and case reports examining the impact of psychotropic medications taken during pregnancy and breast-feeding, on infant outcome. To provide clinicians with clinical guidelines for the use of psychotropes in pregnancy and breast-feeding, both acutely and prophylactically.
Results: a) Pregnancy: Several hundred infants exposed to SSRIs and TCAs have now been studied in a small number of prospective, controlled, non-randomised, studies. Findings suggest that neither the SSRIs nor the TCAs cause major congenital anomalies. Conversely, results from small, often less methodologically rigorous studies suggest that benzodiazepines, lithium, anticonvulsants and chlorpromazine do lead to an increased rate of congenital anomalies. Studies of longer-term neurobehavioural sequelae are very limited but at present do not indicate any adverse effects. b) Breast-feeding: on the basis of findings from a small number of prospective controlled studies, the use of SSRIs, TCAs, carbamazepine, sodium valproate and short-acting benzodiazepines in breast-feeding is relatively safe. High dose antipsychotics should be avoided as they may be associated with developmental delays. The potential for neonatal toxicity with lithium is significant.
Conclusions: The use of psychotropes in the perinatal period remains complex. While the available data suggest that antidepressants used in pregnancy and breast-feeding are relatively safe, other psychotropes used in pregnancy are associated with a small risk of congenital anomalies and perinatal complications. Furthermore the long-tern sequelae of psychotrope use in pregnancy and breast-feeding is virtually unknown. Conversely, mental illness per se, may also be associated with an adverse outcome in the infant. Clearly, the risks to both mother and infant need to be carefully weighed and discussed with the parents before a decision about medication can be made. Finally, clinicians need to bear in mind the importance of prophylactic psychotrope use in the early post-partum period in women at high risk of relapse.
ABSTRACT 3
COMMUNITY BASED SUPPORT GROUPS - THE ROLE THEY PLAY IN SSISTING WOMEN TO RECOVER FROM POSTPARTUM MOOD DISORDERS
Professor
Bryanne Barnett
The purpose of this workshop is to present several different models of community based support for women suffering postpartum mood disorders and their families.
Topics to be covered include:
As discussion highlighting the similarities and differences of the various groups will follow the individual presentations the emphasis will be on teasing out what it is that makes support groups a valuable adjunct to the treatment offered by health professionals for women struggling with postpartum mood disorders.
This workshop will be of interest to health professionals keen to find out what contribution support groups can make to their patient's overall recovery, and to anyone interested in setting up a support group.
ABSTRACT 4
POSTNATAL DEPRESSION: FAMILIES IN TURMOIL
Lara
Bishop (Author of "PND: Families in Turmoil", Marcé Society Member) Email: charles_bishop@deloitte.com.au
This paper considers the impact of PND on the sufferer and her family and draws heavily on my own personal experiences.
PND consumes all in its path. Its impacts are not just confined to the sufferer, but affect the whole family. Previously strong and self contained families have been devastated by PND. But for those who survive it acts as a strengthening exercise in love, commitment and a belief in one's self.
However the path to recovery is a rocky one. Once diagnosed with PND, I could not come to terms with the thought of having a mental illness. I was a capable well educated woman who was no longer rational. I was caught in a dark tunnel and as I sank lower into depression, it started to impact on my family. My husband and I no longer had a love life, we communicated poorly, and he became the carer and I the patient. There was no enjoyment in our life and no laughter. In fact laughter was what we missed the most.
Our family experienced four distinct stages throughout the ordeal. As part of my talk I will address each of these stages of the illness from the perspective of myself, my husband and our family unit.
Despite the heartache along the way I am glad we have experienced PND, for it has made me more aware and more alive. Our family chose to turn our experience into something positive, educating as many people as we could about the illness and writing a book about PND.
We have survived and grown.
ABSTRACT 5
THE COST-EFFECTIVENESS OF TWO ALTERNATIVE STRATEGIES FOR THE TREATMENT OF POSTNATAL DEPRESSION
Elizabeth
Boath & John Cox
A prospective cohort study was used to assess the cost-effectiveness of treating 30 women with postnatal depression at Charles Street Parent and Baby Day Unit (PBDU), a specialised psychiatric day hospital in Stoke-on-Trent, England, compared with 30 women treated using routine primary care (RPC) in Burton-upon-Trent, England. Clinical outcome, social and marital adjustment were assessed on three occasions, three months apart using the Clinical Interview Schedule (CIS), the Edinburgh Postnatal Depression Scale (EPDS), the Work Leisure and Family Life Questionnaire-Modified (WLFLQ-M) and the Dyadic Adjustment Scale (DAS). The direct and indirect costs of the two treatments, to both the National Health Service (NHS) and the women, were collated using NHS finance data, retrospective analysis of case notes and patient interviews. There was no significant difference between the two groups in the socio-demographic or clinical details at baseline. The PBDU was the more effective treatment for postnatal depression and at the 3 and 6 month assessment there was a significant difference between the two groups on the CIS, the EPDS and the WLFLQ-M. There was no significant difference in the DAS at any time point. Twenty-one women in the PBDU group were no longer depressed at 6 months compared with only seven women in the RPC group. The total cost for the PBDU group was £38,809 (mean=£1,294) and £10,032 (mean=£334) for the RPC group. The PBDU is more effective, but more expensive than RPC. The cost-effectiveness ratio (the difference in the costs of the two services divided by the difference in effectiveness) was equivocal and therefore a value judgement would be necessary to assess whether successfully treating a woman with postnatal depression is worth an additional £2,056. Issues of replication and efficiency of the PBDU will be discussed.
ABSTRACT 6
POSTPARTUM MELANCHOLIA: CLINICAL DESCRIPTIONS OF A DISTINCT TYPE OF POSTNATAL DEPRESSION
Philip
Boyce, Sean Stanek, Jemma Gilchrist, Department of Psychological Medicine
Postnatal Depression is a common disorder affecting between 10 and 15% of women in the first six months postpartum. The clinical picture of postnatal depression is generally considered to be that of non-melancholic major depression, with risk factors being predominantly psychosocial. There are however, many women who do not present with this typical clinical picture of postnatal depression. In this paper we will report on the clinical presentation of women who present with a melancholic type of depression. This form of depression arises earlier than the more typical postnatal depression. It is characterised by symptoms of melancholia with psychomotor change, particularly agitation. These women often have an obsessional premorbid personality type, a family history of depression and generally are in a stable and supportive relationship. They respond well to tricyclic antidepressants or ECT but do tend to relapse into depression following subsequent pregnancies.
The relationship of this form of postnatal depression to the more typical form of postnatal depression and puerperal psychosis will be discussed. The clinical similarities between this clinical presentation and that of earlier descriptions of involution of melancholia will be raised as will the role of oestrogen changes contributing to the onset of this disorder.
ABSTRACT 7
CHILDHOOD SEXUAL ABUSE, POSTPARTUM DEPRESSION AND PARENTING
Anne
Buist
The role of childhood abuse in the aetiology and outcome of postpartum depression has received little attention; the author reports on the final stage of a study looking at childhood abuse as a potentially significant factor in the transgenerational transmission of both abuse and psychiatric illness.
Fifty six women and their children were recruited to this three year follow up study focusing on the effect of childhood abuse on mental health, relationships and parenting. Women at recruitment were postpartum and suffering a depressive disorder; half had a history of childhood sexual abuse (CSA) and half (the controls) did not.
Forty five women participated in the follow up study when their child was 21/2 to 31/2 years old. Twenty seven partners also participated. Results gave limited support for the hypothesis that an abuse history was associated with a longer term and more severe illness, but did not support any effect on relationships long term. The initial significantly impaired mother-infant relationship postpartum in the abuse group was not maintained at follow up, but was predictive of later depression. Regression analysis suggested significant links between mood, parenting stress and child outcome.
The male partners of the abuse group women rated their children as being more disturbed, and though their was no cognitive differences between children, scores in both groups were low.
A small subgroup of physically and emotionally abused women will also be reported on; implications for management and further research will also be discussed.
ABSTRACT 8IMPROVING POSTNATAL OUTCOME
Anne
Buist*, Carol Morse, Jeanette Milgrom, Sarah Durkin *Correspondence: Austin Repatriation Medical Centre, Repat Campus, Dept Psychiatry, Locked Bag 1, West Heidelberg 3081
Fourteen per cent of women develop a depressive illness postpartum; a majority of these women are not seen by Mental Health Professionals, though their illness may be chronic and have significant impact on the family and their child's development. The authors report on a project conducted over three years, where education and liaison with Maternal Child Health Nurses and General Practitioners aimed to improve recognition, community management, and improve liaison with specialist mental health services.
Outcomes of women will be reported; a majority were managed successfully in the community, but lack of local services was highlighted by both the women and the MCHN's. GP attendance was poor, but MCHN's were positive and enthusiastic about the education and liaison. Regional differences in support services and the effect this had on community management will be highlighted.
ABSTRACT 9EARLY INTERVENTION IN THE PARENT/INFANT RELATIONSHIP
Judith
Edwards
Each year in Australia 100,000 children and young people develop emotional problems and at any time about 1 million young people are seriously effected by emotional problems. In many of these cases symptoms persist and progress to become long term difficulties often in the form of mental illness. The Benevolent Society's Early Intervention programs contribute to the reduction of mental health problems by identifying high risk families antenatally or in their child's first year and supporting these parents to nurture and protect their children.
The focus of the early intervention programs' multidisciplinary staff is on helping parents understand a) the important issues, faced by all family members, at each of their child's developmental stages, and b) what may be impacting on each parents particular ability to care for their child. The parent child relationship is supported and enhanced in the present alleviating the need to repair it later in the child's life and facilitating the child's present and therefore future mental health.
This paper will explore the importance of the earliest relationships to later psychological health and discuss the work of the Benevolent Society's early intervention programs, particularly how they facilitate secure attachments as an important buffer against emotional distress and later mental health issues
ABSTRACT 10
WHAT ABOUT ME?: THE EXPERIENCE OF DADS
Ms Elke
Andrees
It is often difficult to involve fathers in early intervention work with at risk families.
This paper will report on a series of eight meetings offered to men whose partners are experiencing difficulties such as depression and anxiety. The objective of these meetings was to create an opportunity for men to think about their experience of becoming a father and allow them to express some of their emotional reactions.
The paper will discuss common issues for clinicians in setting up groups for fathers and report on the links the men made between the parenting they received and the expectations and fears they became aware of for themselves as fathers.
|
||||||
| The Marcé Society - Australasian Branch Home - Upcoming Conferences - Conference Abstracts - Office Bearers - Secretariat Designed and built by Tempus4 Design  |
|||||||
 |
|
|
|
|
|
|
|