Transcript Hi There - Andrew Mayers

Maternal Mental Illness
Attachment
Dr Andrew Mayers
[email protected]
Maternal Mental Illness
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Overview
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Maternal mental illness
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Post-natal depression
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Post-natal psychosis
Effect on relationship between them
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The importance of attachment
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Why is attachment important between mother and infant?
 Early mother–infant bond may have sig. impact on developing
infant (e.g. Bowlby, 1953; Ainsworth, 1993)
Infant’s internal working model (IWM) is very important
 Expectations about themselves in relation to others
 Model of self and of other
If infant’s carer attends positively and responds to needs
  Infant has positive IWM:
 High self-worth, availability of others, resolution of crises
Infant’s carer inconsistent response and attention
  Infant’s has negative IWM:
 Low or ambivalent self-worth, unavailable others, crises not
resolved
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Post-natal depression (PND)
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Baby blues
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Two to four days after birth (quite normal – but not PND)
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Emotional/liable to burst into tears, for no apparent reason
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Difficult sleeping (even when baby permits)
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Loss of appetite
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Feeling anxious, sad, or guilty
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Questioning maternal skills
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Effects up to 75% of mums
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May relate to changes in post-birth hormone levels
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Or could be related to being in hospital
Key is that this doesn't last long – usually only a few days
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If it persists it may develop into PND
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PND: Features
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PND needs same DSM-5 diagnosis as major depressive disorder
 But relates specifically to the peripartum period
 Pregnancy and/or within 4 weeks of birth
 Additional features may also indicate presence
 Sense of inadequacy, inability to cope
 Feeling guilty
 Being unusually irritable
 Which makes the guilt worse
 Being hostile/indifferent to husband/partner/baby
 Panic attacks
 Excessive unwarranted anxiety
 Such as being alone in the house
 Obsessive fears about the baby's health or wellbeing
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PND: Prevalence
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PND affects about 10% of new mums
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Although DSM-5 states ‘must be within 4 weeks of birth’
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Compare to baby blues
Quite clear that symptoms last MUCH longer
Vulnerable mums usually referred in ‘perinatal’ period
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During pregnancy up until baby is 1 year
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Can come on gradually or all of a sudden
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Can range from being relatively mild to very hard-hitting
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At LEAST 50% PND women afraid to tell health profs about it
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Scared it will lead to social services taking child away
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Or that they would be seen as bad mothers
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Post-natal psychosis (PNP)
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PNP needs same DSM-5 diagnosis as any psychotic disorder
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Schizophrenia
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Schizoaffective disorder
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Brief psychotic disorder
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Can also include manic stages of Bipolar disorder
But PNP is not specifically mentioned in DSM-5
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Other than ‘postpartum mood (MDD or manic) with psychotic
features’
Not particularly helpful
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Symptoms usually immediately within few weeks of birth
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But psychotic episodes can also occur during pregnancy
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PNP - features
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Prevalence
 1 in 1000 mums may get post-natal psychosis (0.1%)
 Contrast with baby blues and PND
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Attachment and bonding
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Research with Clinical Doctorate student (see Steadman, et al 2007)
 We explored serious mental illness in mothers (vs. controls)
 Bipolar disorder, schizophrenia, schizoaffective disorder,
severe depression
 Sample
 6 ill mums; 12 healthy controls
 First 8 weeks after birth
 We measured a number of key aspects
 Cognitive functioning (computerised tests)
 Memory, speed of functioning, attention
 Perceptions of parenting skills and stress (questionnaire)
 Observation of interaction with baby (video)
 Quality, sensitivity, appropriateness, etc.
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Attachment and bonding
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Observation of interaction with baby
 Undertaken with video
 From behind mother (to see baby’s face)
 But in front of mirror (to see mum’s face)
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Attachment and bonding
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Observation of interaction with baby
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Quality and appropriateness of interaction
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Assessed via Crittenden CARE Index (Crittenden, 2004)
Aims of CARE Index
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Mothers and infants rated on 7 aspects
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Facial expression
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Verbal expression
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Position and body contact
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Affection and sensitivity
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Turn-taking and co-operation
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Control
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Choice of activity
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Attachment and bonding
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Look at these two videos…
Note that these videos are only available in the lecture. They will
be not be posted on myBU. This is to protect confidentiality
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Attachment and bonding
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This interaction was warm, affectionate and rewarding for both
mum and baby
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Attachment and bonding
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This interaction was not so good
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Mum appeared disinterested: blank face…
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Baby was unsure and uncomfortable
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PNP and the child
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Results
 Significant differences found for several measures
 Mothers with serious mental illness (SMI) vs. controls
 Poorer mother–infant interaction
 Poorer perceived maternal competence
 Poorer cognitive function
But how could we extend this?
 We could examine the effect of SMI on other factors
 Attachment and bonding
 Long term affect on child development
 Social, emotional, educational, language, forensic
 Studies are now at planning stage
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Attachment and bonding
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What should we do?
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How can we improve bonding?
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Encourage breastfeeding?
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Or is there already too much pressure?
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Implications with medication?
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Alternatives?
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Bonding classes
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Mindfulness, relaxation and positive therapy?
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