Jody Glance

Guidelines for the Management of Pregnant Women With Substance Use Disorders

BACKGROUND Women of reproductive potential with substance use disorders, especially those who are pregnant, present many clinical challenges to healthcare providers, including comorbid psychiatric disorders, a history of trauma and abuse, avoidance of or poor access to prenatal care, fear of legal consequences, and countertransference reactions. METHODS In November 2013, members of the Womens Mental Health Special Interest Group of the Academy of Psychosomatic Medicine presented a Workshop reviewing substance abuse in pregnancy, highlighting the specific contributions that psychosomatic medicine specialists can make in the care of these patients. The discussion focused on epidemiology; maternal and fetal risks; and screening and treatment considerations for tobacco, alcohol, cannabis, opioids, benzodiazepines, stimulants, and several other substances. OBJECTIVE Our purpose in publishing this review is to provide clinicians and educators with the most up-to-date summary in this field to better engage these patients in care and break the intergenerational cycle of abuse and addiction.

Postpartum Depression Screening: A Review for Psychiatrists.

Learning ObjectivesAfter participating in this activity, learners should be better able to:• Evaluate the rationale for screening women for postpartum depression• Assess tools for screening for postpartum depression ObjectiveTo perform a qualitative literature review on screening for postpartum depression (PPD), as applicable to the general psychiatrist. Results are classified by instrument, timing, and clinical setting of the screen. Data sourcesA literature search was conducted using the PubMed database for English-language articles published since January 1987. Of the 2406 citations initially identified, 61 articles remained after application of inclusion and exclusion criteria. ResultsAmong numerous screening tools for PPD, the Edinburgh Postnatal Depression Scale is the most widely used. Data suggest that screening for PPD should commence soon after delivery, with subsequent screens at multiple time-points in the postpartum period. Primary care, pediatric, and obstetric settings are all viable locations for screening, but are ineffective without follow-up mental health evaluations. Less data are available to define optimal patterns either for screening in psychiatric settings or for the psychiatrist’s role in managing perinatal depression. ConclusionsThe American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, and most authors firmly recommend screening for PPD. The Edinburgh Postnatal Depression Scale can be administered in various clinical settings. Screening should occur at multiple time-points throughout the first postpartum year. The psychiatrists role in early detection and prevention of PPD requires further exploration.

Mirtazapine in comorbid major depression and an alcohol use disorder: A double-blind placebo-controlled pilot trial.

This was a first double-blind, placebo-controlled pilot study to evaluate the efficacy of the novel antidepressant medication mirtazapine for treating both the depressive symptoms and the level of alcohol consumption of subjects with comorbid major depressive disorder and an alcohol use disorder (MDD/AUD). The results of two previous studies of mirtazapine in MDD/AUD subjects had suggested efficacy for mirtazapine for decreasing their level of depressive symptoms, but level of alcohol consumption had not been assessed in those studies. All subjects in this 12-week pilot study were randomized to either mirtazapine or placebo, and also received motivational enhancement therapy. Between-group analyses involving the outcome measures of depressive symptoms, level of alcohol consumption, and level of alcohol craving indicated no significant differences between groups, possibly because of limited sample size. However, within-group t tests in the mirtazapine group showed a significant decrease in depressive symptoms by week 2, also noted at all subsequent assessments (weeks 3, 4, 6, 8, 10, and 12) during the 12-week study. In contrast, no significant decrease in depressive symptoms was noted in the placebo group until week 8. No evidence of efficacy was found for mirtazapine for decreasing level of alcohol consumption in MDD /AUD subjects.

Managing benzodiazepine withdrawal during pregnancy: case-based guidelines.

Substance use disorders during pregnancy pose serious risks for both the mother and the fetus, demanding careful monitoring by the patient’s medical providers. Sedative-hypnotic use, in particular, is common but remains poorly studied. Management of withdrawal from chronic benzodiazepine use during pregnancy presents unique challenges to the treating physician. We present two pregnant patients with dependence on sedative-hypnotic agents, outline principles of benzodiazepine withdrawal, and suggest guidelines for detoxification during pregnancy.

Development of a women’s mental health curriculum and evolution to a Women’s Mental Health Area of Concentration in a psychiatry residency program

In 2014, the U.S. Department of Health and Human Services’ Office on Women’s Health emphasized the importance of women’s health education, particularly in the realm of behavioral health. In order to support the professional interests of psychiatry trainees, a women’s mental health study group (WMHSG) was developed and implemented. The WMHSG aimed primarily to supplement the resident curriculum and promote consideration of careers in women’s mental health. After successful implementation, the curriculum was formalized into a Women’s Mental Health Area of Concentration within the Department of Psychiatry’s residency training program. Participants found the WMHSG to be interesting, to increase knowledge and improve clinical practice, and to facilitate mentorship opportunities. The creation and evolution of a WMHSG into an Area of Concentration offers an example for enhancing training in WMH topics and principles that can be extended to other medical specialties.

Self-Assessment of Teaching Skills Among Psychiatric Residents

ObjectivePsychiatry residency programs have increasingly emphasized the role of resident-as-teacher; however, little is known about resident self-perceptions of teaching skills. This study reports on psychiatry residents’ self-perceived skills in teaching medical students and compares cohort ratings with anonymous medical student evaluations of residents as teachers at our large academic residency program.MethodsIn May–June 2016, 84 residents in our program were surveyed using an anonymous, web-based survey, and this data was then compared to 3 years of aggregate data from anonymous student evaluations of resident teaching at our institution.ResultsForty-seven (47) residents responded to the survey (56% response rate). Residents reported self-perceived deficits in several specific teaching competencies. Medical students consistently rated residents higher with respect to teaching skills than residents rated themselves, and these data were highly statistically significant.ConclusionThis study underscores the benefits of resident self-assessment in comparison to medical student evaluations of residents as teachers and this information can be used to inform training programs’ resident-as-teacher curricula.