Sarah Short Circuit

Heal, Nourish, Nurture

Category: Research

Focus Group for Mother Baby Unit in NSW

Are you experienced a hospital visit as part of your treatment of perinatal mental illness in NSW? I am reaching out to see if you would like to be a part of the focus group for the following project. This is a very exciting paid opportunity to be part of the focus group planning the first public psychiatric Mother-Baby Unit (MBU) in NSW. At this time this opportunity is available to women who experienced hospitalisation as part of their treatment in NSW.

The first meeting will be held this month (August) which depending on everyone’s availability will hopefully be face to face, the location is TBC but they’re hoping to have it at where the MBU will be located (Newtown Royal Prince Albert Hospital). If travelling for meetings will be a problem please let Tracey (program manager) know as there may Teleconferencing options available. The intention is for the focus group to be an ongoing partnership with the planning team as the MBU is developed. However there is no pressure for you to continue if time commitments do not allow.

If interested in being having your say please get in touch with Tracey as soon as possible.

Seeking mental health consumers, peer workers and carers for participation in a focus group for the planning of a public psychiatric Mother-Baby Unit (MBU) in NSW

 

What’s the purpose of the project?

We are seeking the input and advice from consumers and carers for the planning of a Psychiatric Mother-Baby Unit. Mental Health-Children and Young People, NSW Health is currently writing a planning guide for a dedicated public psychiatric Mother-Baby Unit (MBU) in NSW. An MBU is a specialist mental health facility which accommodates pregnant women or mothers with their infants in times where acute psychiatric care is required.  MBU’s provide specialist care to empower the women’s recovery and support the development of an optimal parent-infant relationship.

 

Who are we looking for: female consumers, carers or peer workers who have had a lived experience of mental ill health during the perinatal period (pregnancy and up to 2 years post birth), including a psychiatric hospital admission in NSW.

 

What does it involve: Participants would be invited to participate in a single, small focus group for up to three hours at a venue in Sydney (to be determined). Participants will be involved in a discussion and asked to comment on questions, or express their views on the discussed planning guide. There will be no expectations for participants to read lengthy documents however a survey may be administered in addition to the focus group.

 

Are the consumers/carers paid: Yes, participants would be paid a fee of $30/hr

 

Contact Details: Tracey Fay-Stammbach, Program Manager Perinatal & Infant Mental Health, MH-Children and Young People, NSW Health.  Tel 02 9859 5330 or email tracey.faystammbach@moh.health.nsw.gov.au

 

Postpartum and the Thyroid

Listening to Dr Kelly Brogan on the Thyroid Sessions back in 2014 was the first realisation that my thyroid may be a piece of my postpartum psychosis puzzle. Dr Kelly discussed the triangle of psychiatric symptoms, gluten intolerance and thyroid dysfunction and this was the first time I heard a medical doctor discuss postpartum psychosis directly. Women with first episode postpartum psychosis were 19% positive for thyroid antibodies and within 9 months 67% had a higher risk to develop autoimmune hypothyroidism (1). Dr Kelly discussed how postpartum thyroid symptoms can be easily attributed to being a new mum, such as lead limbs, feeling fatigued, super forgetful, mentally disorganised which at 9 months postpartum could be symptoms of Hashimoto’s disease or postpartum thyroiditis. Postpartum issues lead straight to psychiatry, no acknowledgement of the female hormones, not even a test for thyroid function. Dr Kelly says that psychiatric symptoms are usually endocrine related: thyroid or adrenal or blood sugar regulation with insulin or leptin or your sex hormones progesterone or oestrogen. Also, zinc, selenium, magnesium and iodine are key nutrients in thyroid function. To find out more about these psychiatric pretenders I recommend reading A Mind of Your Own.

Typically when you go to your General Practitioner, the thyroid test is limited to blood test TSH, which is a pituitary hormone measure, an indirect measure of thyroid function. To get the full picture of your thyroid free thyroid levels T3 and T4, reverse T3 and thyroid autoantibodies. My GP was reluctant to do further tests as my TSH came back ‘normal’ until I showed him a copy of the research paper (1). Remember there is not one size fits all, you may have symptoms even being in the ‘normal’ range.

The Thyroid Secret is on now and I am looking forward to tuning in to Episode 7: Motherhood Interrupted to discover more about the role of thyroid in the postpartum period (starts on Wednesday 8 March 10am Sydney time).

PS: My test results including my thyroid antibodies came back all good and my GP has noted on my file to check and monitor my thyroid function  if and when I fall pregnant.

References

1. Prevalence of autoimmune thyroid dysfunction in postpartum psychosis. The British Journal of Psychiatry Mar 2011, 198 (4) 264-268

Further Reading

 

Pharmacological Lactation Suppression

Contemporary models of severe psychotic forms of mental illness assume it is triggered by dysregulation of dopamine, i.e. chemical imbalance, arising from adverse interaction of predisposing risk genes and environmental factors. All successful antipsychotic agents have the ability to act as a D2 receptor antagonist (dopamine inhibitor), raising the question as to whether those with have or at risk of psychosis are susceptible to onset or exacerbation of psychosis when prescribed D2 agonists (dopamine activator).

Early postnatal period is a time of high risk for psychosis. The underlying pathophysiological mechanisms of postpartum psychosis are poor understood.

FDA recommends against the practice of prescribing D2 agonists (activator) due to longstanding evidence about cardiovascular disease and neurological risks.

Pharmacological Lactation Suppression with D2 Receptor Agonists and Risk of Postpartum Psychosis – Dr Josephine Power, International Marce Society Conference 2016.

Reference

Snellen et al. 2016. Pharmacological lactation suppression with D2 receptor agonists and risk of postpartum psychosis: A systematic review.

Transmission of Trauma

Post Traumatic Stress Disorder (PTSD) is the long lasting effects of stress. In the flight/fight response to a threat, the sympathetic nervous system is activated, adrenaline is released to cope with the stress, then cortisol is released to stop the stress response and breaks down when the threat is removed. In PTSD the cortisol levels are lower, which are a reflection of a greater dysregulation of the HPA axis, including circadian rhythm alteration, glucocorticoid receptivity and alterations in cortisol metabolism.

In trauma survivors the stress responsive can be a transformative experience. The offspring of trauma survivors, such as the Holocaust, were also more likely to experience anxiety and depression and have lower levels of cortisol associated with child adversity.

Offspring make their own changes – is this transmission or accommodation? Developmentally programmed changes allow more flexible responding but may be a mismatch for the offspring.

Intergenerational Transmission of Trauma – Epigenetic mechanisms, the in Utero Environment and Early Attachment – Dr Rachel Yehuda, International Marce Society Conference 2016.

Further reading

Yehuda & Le Doux 2007. Response variation following trauma: a translational neuroscience approach to understanding PTSD.

Yehuda & Bierer 2008. Transgenerational transmission of cortisol and PTSD risk.

Prenatal stress

A mother’s emotional state while pregnant has long lasting effects with cultural, environmental and biological differences. Foetal programming has different sensitive periods and our environment starts in the womb. Sensitive early mothering helps attachment, and can counteract some of what happens in the womb.

It is not just toxic stress that is associated with changes in development and behaviour. Prenatal stress can be pregnancy specific anxiety, maternal mental health and daily hassles. The associated risks in children are that they are more likely to have anxiety and depression, increased aggression, impaired cognitive development, sleep problems, temperament issues. There are risks of physical changes including low birth weight, preterm delivery, decreased telomere length (impacts longevity), decreased immune function and altered microbiome. Some are more affected than others due to the gene-environment interactions, for example, the more depressed, more methylation, more epigenetic changes. 

Just think of the impact globally stress may be having on the next generations. For more info check out http://www.beginbeforebirth.org/

Effects of prenatal anxiety, depression and stress on the child: global implications – Professor Vivette Glover, International Marce Society Conference 2016.

Factors influencing decision making

1 in 5 risk of postpartum psychosis and half are considering pregnancy plans. Research is revealing the large variety of factors influencing decision making for women with bipolar disorder including social support, family history, stigma and fear.

Understanding the importance of stigma, contextual factors such as time pressures and social support from their partner and family, local service provision, fear including the fear of becoming ill and fear of social services, and the centrality of motherhood.

This study also enabled the inclusion of views of women who decided against having a child because of bipolar disorder (26%).

This highlights the problems of getting reliable information and advice to women with bipolar disorder and what women want from services as well as the need for more training for health professionals.

Read the full study here http://bjpo.rcpsych.org/content/2/5/294 (open access).

Factors influencing women with bipolar disorder when making decisions about pregnancy and childbirth: a qualitative study – Clare Dolman, International Marcè Society Conference 2016.

At risk

131,000 women a year with postpartum psychosis, of which it’s suspected they do not get top care if getting any care at all, with a higher prevalence and worse care in developing countries.
Launch of the Global Alliance for Maternal Mental Health – Dr Alain Gregoire, International Marce Society Conference 2016.

Severe Postpartum Mood Disorders – Who’s Really at High Risk? – Professor Ian Jones, International Marcè Society Conference 2016.

It is important to know more about the risk for postpartum psychosis as an opportunity for intervention and prevention to avoid devastating outcomes. Postpartum psychosis has a rapid onset with the vast majority of cases in the first 3 days to 1 week.

The risk for developing postpartum psychosis is not evenly spread across the perinatal spectrum. Certain groups of women are at a higher risk including  bipolar disorder and those who have previously experienced postpartum psychosis.

The risk for postpartum psychosis is about 50% if the mother has experienced a previous episode. The recurrence rate range is 14-57%, the differences in rates accounted by the differences in methodologies, differences in managements and the differences in the classification of bipolar disorder.

The risk profile for postpartum psychosis is different to bipolar disorder warranting different approaches for treatment. The lifetime pattern of postpartum psychosis has a strong association with bipolar I. A problem with diagnosis of postpartum psychosis occurs as 10% of the population is on the bipolar spectrum, along with with over-diagnosis, perceptions of psychiatrists, pressure from patients to give a label. All this matters because of the overburden of services, worry women unnecessary, combining bipolar disorder with postpartum psychosis underestimates the risk and can include the wrong women in research studies.

Women who have no perinatal episode have a 32% risk of postpartum psychosis. Further variables do not add to the predictive value of having an episode in a first pregnancy. There is a vulnerability of sleep loss in experiencing a manic episode.


There is research into the genetic markers of postpartum psychosis however this is dependent on sample size. Professor Ian Jones is seeking DNA samples from women who have experienced postpartum psychosis.

References

Di Florio et al. 2013. Perinatal episodes across the mood disorder spectrum.

Langan Martin et al. 2016. Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study.

Kendell et al. 1987. Epidemiology of puerperal psychoses.

Robertson et al. 2005.  Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis.

Bergink et al. 2012. Prevention of postpartum psychosis and mania in women at high risk.

Katie Lewis et al. 2016. Is sleep disruption a trigger for postpartum psychosis?

Jones & Craddock 2007. Searching for the puerperal trigger: molecular genetic studies of bipolar affective puerperal psychosis.

Bergink et al 2013. Immune system dysregulation in first-onset postpartum psychosis.

 

 

PPD ACT

Want to be part of the largest ever international study of PND and postpartum psychosis? I know I do (especially as I am a researcher!)

The Queensland Brain Institute and Postpartum Depression and Action Towards Causes and Treatment (PACT) have introduced a free app to launch the largest ever international study of postnatal depression (PND) and postnatal psychosis. Available on iPhone and iPads (and desktop), the app aims to help researchers understand why some women get PND or postnatal psychosis and others don’t. The results will then assist in developing more effective treatments and help new mums struggling with PND or postnatal psychosis.

The Australian arm of the PPD ACT study is designed to collect more detailed information about health and lifestyle as part of our “Genetics of Risk and Response to Treatment of Depression” study.

Mothers must be over 18 to participate and have struggled with either PND or postnatal psychosis at some stage in their life. Those currently being treated and those who were affected years ago all qualify to take part in the study.

Visit pactforthecure.com to find out more and join in!

Who ya gonna call?

“For women to remain empowered as they take on the joys and challenges of motherhood ideologies of mothering and femininity must be moderated. They serve to isolate and undermine women as they set unreasonable expectations of women and make fathers contribution an optional extra.”

Recovery from Postnatal Depression: Endurance, sedition and sorting the family baggage – Dr Sue Cowie, International Marcè Society Conference 2016.

Women who experience postpartum depression are greater risk to experience this again in a second pregnancy. Dr Cowie has studied how taking in the context of women’s lives and womens’ experiences and expectations and how they prepare for second birth. Four general circumstances appeared to make motherhood more difficult: traumatic or difficult birth, women’s physical health problems, child’s health and feeding problems and lack of support. Second time experience recovery themes included endurance test e.g. ‘such is life;, it just slowly got better ‘finding the baby more enjoyable’, other to mother experiences in knowing what a child needs, and seditious talk with friends to help feel normal when talking about the depression and postnatal stressors of the new baby. Having a baby the second time after experiencing postpartum depression resulted in the mother having a less idealised view of the baby, more experienced and knowledgeable, and a transformational experience .

Recovering from postpartum mood disorders? Who ya gonna call? We need to start talking more about the challenges of motherhood and talk more about the context of how things get better.

 

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