Transcript Bipolar Disorder - IWK Health Centre

Severe and Persistent
Mental Illness and Mothers
A Mothers’ Mental Health Toolkit Project Learning Video
with Dr. Joanne MacDonald
Reproductive Mental Health Service
IWK Health Centre
Halifax, NS
Severe Mental Illness and Mothers
• Severe mental illnesses include Schizophrenia,
Bipolar Disorder and Postpartum Psychosis
Severe Mental Illness and Mothers
Key Concepts:
• Mothering is an important social role for many women
• Mothering with a previously known or new more severe
mental disorder can be challenging
• Support from partner, family and community is critical to
how the affected woman will function as a mother
• Women with severe mental illness can mother safely
and effectively with treatment and support
Severe Mental Illness and Mothers
• Schizophrenia occurs in less than 1% of the general population
• Schizophrenia is a partially understood illness but thought to be
a vulnerability from early life that presents usually in early adult
life
• It is a brain illness that has a spontaneous onset
• Prominent symptoms include loss of initiative, lowered attention
to real life experience and reduced thinking generally and
planning and decision-making particularly, unusual sometimes
suspicious ideas, abnormal sensory experiences such
hallucinations, and change in personality or behaviour from
usual
• The impact on usual function is great
Severe Mental Illness and Mothers
• Women suffering with Schizophrenic Illness are often disadvantaged
regarding their education level, social opportunities, employment
and housing by the onset of a severe illness early in life
• They experience poorer physical health than unaffected women
• Family support is critical to parenting potential and stability
• Pregnancy is not always planned but mothering may be a very
wanted role
Severe Mental Illness and Mothers
Severe Mental Illness and Mothers
Treatments?
• Key to recovery usually are antipsychotic medications
• Safety in pregnancy and use when breastfeeding
must be carefully assessed
• Outcomes for infants exposed in pregnancy can be
very good
• Parenting education and support may be needed
Severe Mental Illness and Mothers
• Family and Community Support is Key
Determinant of Outcome
Severe Mental Illness and Mothers
Bipolar Disorder
• A disorder of cycling changing mood and behaviour
from ‘low’ depressed presentations to ‘high’ over
energized states
• Highly variable severity
• Symptoms can vary from woman to woman and in
same woman over time
• Difficult to diagnose; typically months to years delay
in firm diagnosis
Severe Mental Illness and Mothers
Bipolar Disorder Spectrum:
• Cyclothymic Disorder – mild, fluctuating mood
states, minimal triggers, less impact function
• Bipolar I – typical illness, highs and lows of equal
severity
• Bipolar II – more depressive phases, of more
severity, minimal highs that can be brief
Severe Mental Illness and Mothers
Key Concept #1:
• Women with known Bipolar Disorder at high risk
of relapse in first 3 months after a baby is born
Severe Mental Illness and Mothers
Key Concept #2:
• Bipolar Disorder can be very influenced by
women’s hormonal changes, for example premenstrually or after a baby is born
• Postpartum is a period of high risk for a woman
vulnerable to Bipolar Disorder
• Family history can be a key risk factor
Severe Mental Illness and Mothers
Features of Bipolar Disorder:
• High or Up phases marked by increased speed of
thinking and sometimes actions, impulsive ideas, rapid
shifts in attention and thought connections, mood can
be very excited to irritable, decision-making or
judgement often off
• Depressed or Down phases marked by slowed thinking,
sometimes deep fatigue and sense of heaviness
physically, very low mood and initiative, hopelessness
and very negative thinking
Severe Mental Illness and Mothers
Interventions?
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Expert mental health assessment is important
Minimize stress
Improve self-care, particularly sleep and daily routines
Stabilizing medications may be necessary
Family involvement, education and support key to
recovery
Severe Mental Illness and Mothers
Bipolar Disorder Outcomes:
• With effective treatment, recovery can be solid
• Medication long term can be necessary for stabilization
• Self-care strategies and social support enhance ongoing
stability
Severe Mental Illness and Mothers
Postpartum Psychosis
• 1 in 1000 women delivering a baby are at risk for
Postpartum Psychosis
• Rare but severe illness that can present rapidly over 1-3
days
Severe Mental Illness and Mothers
What are warning signs of Postpartum
Psychosis?
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Sudden change in awareness, attention and memory
Can be preceded by excited sleepless confused period
Behavioral change dramatic from that woman’s usual
Will seem clearly out of character, thinking and behavior
not making sense, not connected to the current situation
• May have unusual or suspicious ideas and hallucinations
suddenly
Severe Mental Illness and Mothers
Key Concept #3:
• Postpartum Psychosis is a medical emergency
requiring urgent psychiatric assessment
Severe Mental Illness and Mothers
Postpartum Psychosis Treatment:
• Often requires initial inpatient treatment
• Typically need antipsychotic medications
• Should have ongoing mental health care and follow-up for
monitoring
• Safety of infant or other children should be considered
• Most women recover fully with treatment
• Treatments may not be safe for infant in breastfeeding
Severe Mental Illness and Mothers
• Severe illness interrupts the mothering role and
adjustment; these mothers need particular support
and hopefulness for their full recovery
Severe Mental Illness and Mothers
Learning Points:
Roles of community support providers include
• continuing support to mothering adjustment
• despite illness, reducing stigma and providing inclusion
• self-care support and strategies over a longer time are key
in recovery from severe illness
Severe Mental Illness and Mothers
Key Resources:
www.cmha.ca : The Canadian Mental Health
Association is a patient and family advocacy
organization with information on a wide variety of
mental health problems
www.postpartum.net : American based patient
advocacy site where stories and information are
shared
Thank You!