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Perinatal psychiatry: a new specialty or everyone's business?

  • Jacqueline Humphreys, Janet Obeney-Williams, Rachael W. Cheung and Nisha Shah
Summary

Perinatal psychiatry is a relatively new subspecialty and controversy exists about such specialist provision. Differences can occur in how mental illnesses present in pregnancy, and there is a need to take into account both mother and baby. The risks of not treating perinatal mental illness can be both acute and chronic, and suicide in the context of untreated illness remains a leading indirect cause of maternal mortality. Despite the government's agenda of preventive healthcare, service provision is inequitable across the UK. Advice regarding treatment continues to be complex, and perinatal psychiatrists need to keep abreast of a growing evidence base. This review offers an overview of some current issues in the care of patients in the perinatal period and shows how specialised perinatal services are uniquely placed to meet their needs. Hopefully, it will prove useful to all clinicians responsible for the perinatal care of women and their families.

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Copyright
Corresponding author
Dr Jacqueline Humphreys, East London NHS Foundation Trust, Perinatal Mental Health Team, Newham University Hospital, Glen Road, London E13 8SL, UK. Email: jacqueline.humphreys@elft.nhs.uk
Footnotes
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LEARNING OBJECTIVES

• Acquire increased awareness of pre-conception planning for women at risk of perinatal mental illness

• Understand the need for lower thresholds for intervention in perinatal populations

• Appreciate the particular characteristics in risk assessment in perinatal populations, taking into account the impact of perinatal psychiatric disorder on both mother and baby

DECLARATION OF INTEREST

None

Footnotes
References
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Almond, P (2009) Postnatal depression: a global public health perspective. Perspectives in Public Health, 129: 221–7.
Anderson, EL, Reti, IM (2009) ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosomatic Medicine, 71: 235–42.
Ayers, S (2004) Delivery as a traumatic event: prevalence, risk factors, screening and treatment. Clinical Obstetrics & Gynecology, 47: 552–67.
Bauer, A, Parsonage, M, Knapp, M et al (2014) The Costs of Perinatal Mental Health Problems. London School of Economics and Centre for Mental Health.
Bergman, K, Sarkar, P, Glover, V et al (2010) Maternal prenatal cortisol and infant cognitive development: moderation by infant–mother attachment. Biological Psychiatry, 67: 1026–32.
Brown, G, Moran, P (1997) Single mothers, poverty and depression. Psychological Medicine, 27: 21-33.
Dennis, CL, Hodnett, E (2007) Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Systematic Review, 4: CD006116.
Department of Health (2011) No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of all Ages. Department of Health.
Department of Health (2014) Delivering High Quality, Effective, Compassionate Care: Developing the Right People with the Right Skills and the Right Values. A Mandate from the Government to Health Education England: April 2014 to March 2015. Department of Health.
Everyone's Business (2014) UK Specialist Community Perinatal Mental Health Teams (Current Provision). everyonesbusiness.org. uk (http://everyonesbusiness.org.uk/wp-content/uploads/2014/07/UK-Specialist-Community-Perinatal-Mental-Health-Teams-current-provision.pdf).
Fisher, J, Cabral de Mello, M, Patel, V et al (2012) Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review. Bulletin of the World Health Organization, 90: 139G-49G.
Glangeaud-Freudenthal, NMC, Howard, LM, Sutter-Dallay, AL (2014) Treatment: mother–infant inpatient units. Best Practice & Research Clinical Obstetrics & Gynaecology, 28: 147–57.
Halbreich, U, Karkun, S (2006) Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. Journal of Affective Disorders, 91: 97-111.
Hale, T (2014) Medications and Mothers' Milk (16th edn). Hale Publishing.
Hall, KS, Kusunoki, Y, Gatny, H, Barber, J (2014) The risk of unintended pregnancy among young women with mental health symptoms. Social Science & Medicine, 100: 62-71.
Hipwell, AE, Kumar, R (1996) Maternal psychopathology and prediction of outcome based on mother–infant interaction ratings (BMIS). British Journal of Psychiatry, 169: 655–61.
Hogg, S (2012) Prevention in Mind. All Babies Count: Spotlight on Perinatal Mental Health. NSPCC.
Howard, L, Shah, N, Salmon, M et al (2003) Predictors of social services supervision of babies of mothers with mental illness after admission to a psychiatric mother and baby unit. Social Psychiatry and Psychiatric Epidemiology, 38: 450–5.
Howard, L, Thornicroft, G (2006) Patient preference randomised controlled trials in mental health research. British Journal of Psychiatry, 188: 303–4.
Howard, LM, Flach, C, Mehay, A et al (2011) The prevalence of suicidal ideation identified by the Edinburgh Postnatal Depression Scale in postpartum women in primary care: findings from the RESPOND trial. BMC Pregnancy and Childbirth, 11: 57.
Howard, LM, Oram, S, Galley, H et al (2013) Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Medicine, 10(5): e1001452.
Howard, LM, Molyneaux, E, Dennis, CL et al (2014) Non-psychotic mental disorders in the perinatal period. Lancet, 384: 1775–88.
Jasinski, JL (2004) Pregnancy and domestic violence: a review of the literature. Trauma, Violence, & Abuse, 5: 47-64.
Joint Commissioning Panel for Mental Health (2012) Guidance for Commissioners of Perinatal Mental Health Services. Vol. Two: Practical Mental Health Commissioning. JCPMH.
Källén, B, Borg, N, Reis, M (2013) The use of central nervous system active drugs during pregnancy. Pharmaceuticals, 6: 1221–86.
Kenny, M, Conroy, S, Pariante, CM et al (2013) Mother–infant interaction in mother and baby unit patients: before and after treatment. Journal of Psychiatric Research, 47: 1192–8.
Khan, L (2015) Falling Through the Gaps: Perinatal Mental Health and General Practice. Centre for Mental Health.
Killaspy, H (2006) From the asylum to community care: learning from experience. British Medical Bulletin, 79: 245–58.
Knight, M, Tuffnell, D, Kenyon, S et al (eds) (2015) Saving Lives, Improving Mothers' Care: Surveillance of Maternal Deaths in the UK 2011–13 and Lessons Learned to Inform Maternity Care from the UK and Ireland Confdential Enquiries into Maternal Deaths and Morbidity 2009–13. National Perinatal Epidemiology Unit, University of Oxford.
Lancucki, L, Sasieni, P, Patnick, J et al (2012) The impact of Jade Goody's diagnosis and death on the NHS Cervical Screening Programme. Journal of Medical Screening, 19: 89-93.
Larsson, C, Sydsjö, G, Josefsson, A (2004) Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms. Obstetrics & Gynecology, 104: 459–66.
Lehnen, H, Zechner, U, Haaf, T (2013) Epigenetics of gestational diabetes mellitus and offspring health: the time for action is in early stages of life. Molecular Human Reproduction, 19: 415–22.
Leiknes, KA, Cooke, MJ, Jarosch-von Schweder, L et al (2015) Electro-convulsive therapy during pregnancy: a systematic review of case studies. Archives of Women's Mental Health, 18: 1-39.
Lindahl, V, Pearson, L, Colpe, L (2005) Prevalence of suicidality during pregnancy and the postpartum. Archives of Women's Mental Health, 8: 77-87.
Marcé, LV (1858) Traité, de la folie des femmes enceintes des nouvelles accouchées et des nourrices et considérations médico-légales qui se rattachent à ce sujet [Treatise on Madness in Pregnant Women, in Women who Have Recently Given Birth, and in Wet Nurses, and Medical/Legal Considerations on this Subject]. JB Baillière et fils.
McCue Horwitz, S, Briggs-Gowan, MJ, Storfer-Isser, A et al (2007) Prevalence, correlates, and persistence of maternal depression. Journal of Women's Health, 16: 678–91.
Meltzer-Brody, S, Stuebe, A (2014) The long-term psychiatric and medical prognosis of perinatal mental illness. Best Practice & Research: Clinical Obstetrics & Gynaecology, 28: 49-60.
National Institute for Health and Care Excellence (2014) Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance (Clinical Guidance CG192). NICE.
Nicholson, J, Sweeney, EM, Geller, JL (1998) Focus on women: mothers with mental illness: I. The competing demands of parenting and living with mental illness. Psychiatric Services, 49: 635–42.
North East London Strategic Health Authority (2003) Report of an Independent Inquiry into the Care and Treatment of Daksha Emson M.B.B.S, MRCPsych, MSc. and her Daughter Freya. North East London Strategic Health Authority (http://www.simplypsychiatry.co.uk/sitebuildercontent/sitebuilderfles/deinquiryreport.pdf).
O'Donnell, K, O'Connor, TG, Glover, V (2009) Prenatal stress and neurodevelopment of the child: focus on the HPA axis and role of the placenta. Developmental Neuroscience, 31: 285–92.
O'Mahen, H, Fedock, G, Henshaw, E et al (2012) Modifying CBT for perinatal depression: what do women want? A qualitative study. Cognitive and Behavioral Practice, 19: 359–71.
Patel, SR, Wisner, KL (2011) Decision making for depression treatment during pregnancy and the postpartum period. Depression and Anxiety, 28: 589–95.
Pearson, RM, Evans, J, Kounali, D et al (2013) Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry, 70: 1312–9.
Royal College of Psychiatrists (2010) A Draft Competency Based Curriculum for Specialist Training in Psychiatry: Specialist in General Psychiatry with Sub-Specialty in Perinatal Psychiatry. Royal College of Psychiatrists (http://www.rcpsych.ac.uk/pdf/PerinatalPsychiatryDraftCurriculumNovember2010.pdf).
Rüsch, N, Angermeyer, AC, Corrigan, PW (2005) Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20: 529–39.
Russell, S (2006) Barriers to care in postnatal depression. Community Practitioner, 79: 110–1.
Russell, J, Fawcett, JM, Mazmanian, D (2013) Risk of obsessive–compulsive disorder in pregnant and postpartum women: a meta-analysis. Journal of Clinical Psychiatry, 74: 377–85.
Segre, LS, O'Hara, MW, Arndt, S et al (2007) The prevalence of postpartum depression. Social Psychiatry and Psychiatric Epidemiology, 42: 316–21.
Shah, N, Howard, L (2006) Screening for smoking and substance misuse in pregnant women with mental illness. The Psychiatrist, 30: 294–7.
Snellen, M, Mack, K, Trauer, T (1999) Schizophrenia, mental state, and mother–infant interaction: examining the relationship. Australian and New Zealand Journal of Psychiatry, 33: 902–11.
Stein, A, Pearson, RM, Goodman, S et al (2014) Effects of perinatal mental disorders on the fetus and child. Lancet, 384: 1800–19.
Thompson, P, Rodell, H (eds) (2014a) Service Standards: Second Edition. Perinatal Community Mental Health Services (CCQI171). Royal College of Psychiatrists, College Centre for Quality Improvement (http://www.rcpsych.ac.uk/pdf/Perinatal%20Comunity%20Standards%20Cycle%203.pdf).
Thompson, P, Mahon, K (eds) (2014b) Service Standards for Mother and Baby Units: Fourth Edition (CCQI161). Royal College of Psychiatrists, College Centre for Quality Improvement (http://www.rcpsych.ac.uk/pdf/Perinatal%20Inpatient%20Standards%20Cycle%208.pdf).
UK Government (2015) Shared Parental Leave and Pay. GOV.UK (https://www.gov.uk/shared-parental-leave-and-pay/overview). Accessed 23 June 2016.
Viguera, AC, Whitfeld, T, Baldessarini, RJ et al (2007) Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. American Journal of Psychiatry, 164: 1817–24.
Winnicott, DW (1953) Transitional objects and transitional phenomena – a study of the first not-me possession. International Journal of Psychoanalysis, 34: 89-97.
Wisner, KL, Sit, DK, Hanusa, BH et al (2009) Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Psychosomatic Medicine, 7: 374–84.
Wisner, KL (2012) The last therapeutic orphan: the pregnant woman. American Journal of Psychiatry, 169: 554–6.
Yonkers, KA, Norwitz, ER, Smith, MV et al (2012) Depression and serotonin reuptake inhibitor treatment as risk factors for preterm birth. Epidemiology, 23: 677–85.
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Perinatal psychiatry: a new specialty or everyone's business?

  • Jacqueline Humphreys, Janet Obeney-Williams, Rachael W. Cheung and Nisha Shah
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