Thinh Nguyen

Obstetric and neonatal outcomes of pregnant women with severe mental illness at a specialist antenatal clinic

OBJECTIVE To evaluate the obstetric and neonatal outcomes of pregnant women with severe mental illness (SMI) who attended a specialist multidisciplinary antenatal clinic in Perth, Western Australia. DESIGN, SETTING AND PARTICIPANTS A retrospective case-note audit of outcomes from the Childbirth and Mental Illness Antenatal Clinic (CAMI clinic) at King Edward Memorial Hospital for pregnant women with severe mental illness (SMI), aged 18-41 years, who gave birth between December 2007 and April 2011, and their babies. MAIN OUTCOME MEASURES Obstetric and neonatal outcomes for 138 women and newborns from singleton live births. Data were compared between three diagnostic groups (schizophrenia, bipolar and non-psychotic SMI), and with WA obstetric and perinatal statistics for 2008. RESULTS 44 women with schizophrenia, 56 with bipolar disorder and 38 with non-psychotic SMI attended antenatal care for an average of 7.7 (SD, 3.3) visits. The proportion of women who smoked tobacco was significantly higher than that in the WA antenatal population (46% v 15%; P < 0.0001). Alcohol use, illicit substance use and psychotropic medication exposure during pregnancy were high. The women were at increased risk of developing gestational diabetes mellitus (15% v 4%; P < 0.0001) and pre-eclampsia (9% v 3%; P < 0.0001), and birth complications were more common. Babies born to CAMI clinic women were less likely to have Apgar scores ≥ 8 at 1 minute and 5 minutes. Pregnant women with schizophrenia had more psychiatric relapses during pregnancy, and had more statutory child welfare involvement. Gestational age at birth and infant birth weights were similar for the pregnant women with SMI and the WA population in 2008. CONCLUSIONS Women attending our specialist clinic had increased rates of obstetric and neonatal complications compared with the general population, and were exposed to a cluster of risk factors. We report encouraging trends in antenatal attendance, gestational age at birth, and birth weights. Managing pregnant women with SMI will require a comprehensive approach aimed at early detection of obstetric complications and psychosocial difficulties, as well as neonatal monitoring. Optimising prepregnancy maternal health and welfare may also be of benefit.

Pregnancy Experiences of Western Australian Women Attending a Specialist Childbirth and Mental Illness Antenatal Clinic

Our purpose was to explore the pregnancy experiences of Australian women attending a specialized childbirth and mental illness (CAMI) antenatal clinic. A qualitative exploratory design was selected to give voice to women with severe mental illness receiving antenatal care. Telephone interviews with 41 women, 24 primiparous and 17 multiparous, were analyzed using thematic analysis. Three themes emerged: “building relationships,” “acknowledging me as a person with special needs,” and “respecting and understanding without stigma.” Findings offer insight into care experiences possible within a multidisciplinary model developed to address psychiatric and obstetric needs of pregnant women with severe mental illness.

The preconception needs of women with severe mental illness: a consecutive clinical case series.

Abstract Introduction: Women with severe mental illness (SMI) are having babies at an increasing rate, but continue to face many challenges across the perinatal period. There is little research into the preconception needs of women with SMI and the aim of this study was to investigate the social circumstances, general health, mental health and reproductive health care needs in these at risk women. Method: Women with SMI referred for specialist preconception counselling at a tertiary obstetric hospital in 2012 were eligible to participate. The data source was a semi-structured study-specific interview schedule with open-ended questions incorporated into the routine assessment protocol. Results: In a one-year period, 23 women were referred to the service and 22 consented to data from the interview being pooled for the study. All women were taking at least one psychotropic medication at the time of referral. Overall, 40% (n = 9) were aged at least 35 years, 36% (n = 8) smoked cigarettes daily and over half (54.5% n = 12) reported their body mass index as being in the overweight or obese range. Thematic analysis revealed the importance of maternal desire, and concerns relating to age and biological time pressure, the impact of the illness and medication on pregnancy and motherhood. Conclusion: Our data indicate that preconception counselling should be routine in the care of women with SMI of reproductive age, and should take into account the potential centrality of motherhood in the woman’s rehabilitation, as well as the complex appraisals of risks, general health and support.

Sexual and Reproductive Health Trends Among Women With Enduring Mental Illness: A Survey of Western Australian Community Mental Health Services

An exploratory cross-sectional survey was conducted to determine associations and potential modifiable risk factors for management of sexual and reproductive health needs for women attending community mental health services. Women (n = 220) had on average three pregnancies; 61.2% were unplanned. One quarter who were sexually active within the past 12 months denied using contraception with 51% using less effective methods. The majority (81.7%) engaged in Pap smear screening, and those with a general practitioner (GP) were more likely to participate (p =.004). Findings highlight GPs’ potential in optimizing womens health. Considering unplanned pregnancies and contraception trends, we suggest improved access to contraception options, particularly long-acting reversible methods.

Characteristics of men accompanying their partners to a specialist antenatal clinic for women with severe mental illness

PURPOSE Partners are often enlisted in the care and management of pregnant women with severe mental illness (SMI); however their needs and capacity to provide support is not yet well understood. We aim to describe the psychosocial characteristics, health behaviours and appraisals of parenthood of men accompanying their partners with SMI to a specialist antenatal clinic. METHODS A 36-question, study-specific cross sectional survey was completed by men whose partners with SMI were receiving antenatal care at a specialist multidisciplinary clinic over a 12-month period. RESULTS A high percentage of eligible participants (40/41, 97.5%) completed the survey. Overall 25% depended for income on social security benefits; 60% reported smoking, alcohol and drug using behaviours that carried high health risks; 18% had a history of domestic violence order (DVO) being taken out against them, and 12.5% a documented history of bipolar or schizophrenic illnesses. Despite these risk factors they reported high satisfaction with their intimate partner relationships, and all anticipated the birth of the baby and impending fatherhood with enthusiasm, optimism and perhaps idealisation. CONCLUSIONS Men who are the pregnancy partners of women with SMI, appear to be an especially vulnerable population, who report high rates of psychosocial difficulties, which are likely to have an adverse impact on their capacity for realistic planning and support of their partners in this critical period of adjustment to parenthood. We recommend enhanced models of clinical care in which assessment and provision of support for partners is incorporated in comprehensive care of the pregnant woman with SMI.

Managing pregnant women with serious mental illness: using the Edinburgh Postnatal Depression Scale as a marker of anxiety and depressive symptoms

Objective: To examine the course of depressive and anxiety symptoms using serial measurements of the Edinburgh Postnatal Depression Scale (EPDS) in pregnant women with serious mental illness (SMI) attending a specialist multi-disciplinary antenatal clinic in Perth, Western Australia. Method: A retrospective review of case notes was undertaken for 48 Western Australian pregnant women with schizophrenia and related psychoses and bipolar affective disorders who attended the Childbirth and Mental Illness (CAMI) antenatal clinic between December 2007 and November 2009. Of these patients, 27 completed the EPDS at booking (first appointment) and at 32 weeks gestation. Additional variables collected were demographic data, gestation at booking, and attendance rates for these 27 women, and for comparison another 21 women who did not complete the EPDS for one or both screening periods. Results: Mean total EPDS score decreased from 12.2 (SD 7.6) at booking to 8.5 (SD 6.4) at 32 weeks gestation (p = 0.007). Overall mean attendance rates and number of appointments were similar to the non-SMI population and in keeping with standard guidelines. Conclusions: We speculate from these preliminary findings that being managed by a consistent small multi-disciplinary team and knowing that they will be supported throughout their pregnancy could lead to improvement of anxiety and depressive symptoms in pregnant women with SMI, and has the potential to increase their attendance for antenatal care.

Commentary on RANZCP clinical practice guidelines for the management of schizophrenia and related disorders

Australian & New Zealand Journal of Psychiatry, 51(3) focus on familial abuse/neglect, the importance and influence of peer relationships is also critical. Nonetheless, further research is needed to ascertain the appropriate treatment methods. While recent research has delivered promising results using several cognitive behavioural therapy (CBT) techniques, unfortunately these studies are underpowered and in some cases lack control groups (Bendall et al., 2013). However, several challenges integral to ensuring quality clinical outcomes for this population are evident. For example, how best to address trauma and schizophrenia simultaneously in clinical settings remains a medical and psychosocial challenge for mental health clinicians. Restricted access to clinical resources necessitates a clinical focus that remains primarily on clinically addressing illness symptomology. This in turn can limit a clinician’s capacity to address other underlying psychosocial issues related to schizophrenia and trauma. Although health and psychiatric comorbidities related to schizophrenia and trauma can be a significant clinical concern, they remain an underexplored area for both mental health research and psychiatric clinical practice. Thus, determining trauma histories of people with psychiatric disorders can be significant in determining clinical pathways for recovery. However, there remain significant challenges in assessing trauma. For example, there is a need for safe interview environments, access to appropriate trauma measurement tools and the provision of welltrained and experienced clinicians. Most significantly, it is imperative to minimise re-traumatisation and to provide psychosocial supports on discharge from the service for consumers.

Neuroimaging in psychiatry: an update on neuroimaging in the clinical setting.

Objective: We offered guidance on the role of structural and functional neuroimaging modalities for the general psychiatrist and for trainees in the clinical setting. Methods: We outlined the utility of neuroimaging modalities in the clinical setting, specifically with a view to understanding the pathophysiology of manifestations of disease. Results: Both structural and functional neuroimaging modalities have a clear role in diagnostic evaluation in the spectrum of neurodegenerative disorders. Conclusions: Whilst the role of neuroimaging in patients with mood, anxiety and psychotic disorders is less clear, structural and functional imaging modalities have utility in the clinical setting in the form of diagnostic refinement and in understanding the pathophysiology of disorders, towards explaining manifestations and planning treatment.

Severe mental illness and induction of labour: outcomes for women at a specialist antenatal clinic in Western Australia

Limited evidence is available around induction of labour (IOL) and obstetric outcomes for pregnant women with severe mental illness (SMI).

The effects of gestational use of antidepressants and antipsychotics on neonatal outcomes for women with severe mental illness

Psychotropic medication use occurs in 8% of pregnancies, with rates increasing, and often multiple medications prescribed.