ppd treatment ubhc ppt
TRANSCRIPT
Treatment and Referral
Steps Toward Intervention
● Listen carefully to what the mother says
● Talk with her about the many factors that could be influencing her emotional state without “explaining away” her symptoms
● Teach some specific strategies that can help
● Help her mobilize her own support system. This includes offering referrals to people or organizations that can offer long-term support
Referral Considerations
Multidisciplinary approach is imperative
• Obstetrician
• Pediatrician
• Nurse
• Primary Care Provider
• Psychiatrist
• Psychologist/Social Worker/Psychotherapist
• Endocrinologist
Laboratory Testing in Postpartum Mood Disorders
● CBC with differential
oRule out anemia
oRule out infection
● Comprehensive metabolic panel
oRule out concomitant medical illness
● Thyroid function tests (TSH, T3, T4, antimicrosomal antibody titers)
oRule out postpartum thyroiditis or other thyroid dysfunction
Overview-Outpatient Treatment Approaches for PPD
● Consumer education
● Psychiatric medications
● Psychotherapy
● Referral
● Self help groups/partner support, telephone support
● Complementary Treatments
Non-pharmacological Therapy
● Psychotherapy
oCognitive Behavioral Therapy
o Interpersonal Therapy
oDialectical Behavior Therapy
● Support Groups
oFound to be highly effective in a variety of forms
• Therapist facilitated
• Self help in postpartum support groups
• Combination of techniques (ITP, CBT and supportive)
Cognitive Behavioral Therapy (CBT)
● Usually is a structured brief therapy.
● Purpose is to recognize and change cognitive errors.
● Usually conducted over a 10 -15 week course.
● Can be done individually or in a group.
● Requires motivated individuals to complete weekly homework assignments.
CBT in Postpartum
● Research has shown efficacy for PPD Treatment
oCBT in group therapy in early motherhood decreased symptoms and improved mother-child interaction
oChanges negative cognitive distortions and aids in the development of coping behaviors
Kolko, E & Roth, E., (2004)Antepartum and Postpartum Depression: Healthy Mom, Healthy Baby
Women’s Health (56)3.
Interpersonal Therapy (IPT)
● Used to treat mild to moderate PPD
● Emphasizes interpersonal disputes and role transitions
● Focuses on important interpersonal changes and challenges women experience during the postpartum period
oFocuses on the effects of depression on interpersonal functioning
● Time limited
oTreatment usually 12 sessions
ITP con’t
• May be integrated into Primary care settings
oPragmatic, specific, problem focused, short term, and effective
• Reduces symptoms and improves social adjustment
• May be used as an alternative to pharmacology
oEspecially with breastfeeding
women
Beck, C., (2006)., Postpartum Depression It isn’t just the blues.
American Journal of Nursing, (106)5.
Dialectical Behavior Therapy
● Developed to treat Borderline Personality Disorder
oNow also used where skill deficits and emotion dysregulation are presenting factors
• Self harm and suicidal behaviors
oIndividual and group therapy
● The treatment is based largely in behaviorist theory with some cognitive therapy elements
● Lengthy process● Stone, S. (2008), Empowering PPD Recovery with Dialectical Behavior Therapy A model to support Multi Axial Focused
● Treatments in Perinatal Mood Disorders)
The Efficacy of Postpartum Support Groups
A psychoeducation group for women with low post partum mood can significantly reduce depressive symptoms
- Honey, J.L, Bennett, P, Morgan M. (2002)
A program of supportive group therapy for post partum mothers can significantly lower or eliminate depressive episodes
- Lane, B., Roufeil, M.M., Williams, S., Tweedie, R..(2001)
Post partum mothers attending a group integrating supportive educational and cognitive behavioral components yielded significant reductions in symptom frequency and intensity after 4 – 6 weeks. - Chabrol, H., Teissedre, F., Saint Jean, M., Teisseyre, N., Sistac, C,
Michaud, C., Roge, B.(2002)
Complementary Therapy
● Acupuncture
● Omega-3 Fatty Acid
● Bright Light Therapy
● Hormonal Therapy/Estrogen
● Exercise/Massage Therapy
o Infant massage
Inpatient Therapy
● May be necessary for comorbidities or severe depression
oEating disorders
oSubstance abuse
oMedical disorders
oSuicidality
oInfant safety concerns
oInability to adhere to outpatient treatment
Inpatient Treatment
● Psychotherapy in conjunction with medication
● ECT -Clinical Indications
oNutritional compromise
oSevere behavioral withdrawal
oPsychosis
oSuicidality
Barriers to Successful Therapy
● The greatest barrier to success is poor compliance
● Understandable in this population
– Symptoms of depression
• Decreased concentration
– Time constraints with newborn
• Missed appointments
• Difficult to attend groups
•The 800-328-3838 telephone number is answered on a 24 hour/7 day per week basis. Calls can come from women experiencing distress, family members asking for information, and clinicians requesting teaching materials. The hotline has the ability to directly link callers with a provider agency through a “warm line transfer” feature.
Family Health Line
Call Family Health Line
Request information
Woman needing further assessment
Brochures mailed
Call transferred to UBHC
Clinician triages call
Immediate Danger
Notify crisis center
Needs Assessment and uninsured or underinsured
Appointment arranged with community mental
health center
Hotline Process
Needs Assessment and has private
insurance
Referred to her insurance company
Self Help and Clinical Resources
● PPD Helpline, 1-800-328-3838
● Postpartum Support International, 1-805-967-7636
● NJ Self Help Clearinghouse, 1-800-367-6274 or http://www.njgroups.org
● http://Postpartum.nichd.nih.gov
● http://4woman.gov/faq/postpartum.htm
Resources Con’t.MATERNAL AND CHILD HEALTH CONSORTIA Contact Telephone E-mail
Northern NJ Maternal Child Health Consortium Irina Ventura 201-843-7400 [email protected]
Mary Wedge 201-843-7400 [email protected]
Gateway Northwest Maternal and Child Health Network Naomi Savitz 973-268-2280 [email protected]
Ruth Brogden 973-268-2280 [email protected]
Hudson Perinatal Consortium, Inc. Judy King 201-876-8900 [email protected]
Mariann Moore 201-876-8900 [email protected]
Central NJ Maternal Child Health Consortium Charlotte Feeney 732-937-5437 [email protected]
Regional Perinatal Consortium of Monmouth & Ocean Counties, Inc. Ann Williams 732-363-5400 [email protected]
Patricia Vena 732-363-5400 [email protected]
Southern NJ Perinatal Cooperative, Inc. Sue Ellis Murphy 856-665-6000 [email protected]
OTHER MENTAL HEALTH RESOURCES
New Jersey Psychological Association Lorryn Wahler 973-243-9800 [email protected]
New Jersey Psychiatric Association Ricardo Fernandez 908-685-0650 [email protected]
Mental Health Association in New Jersey Jennifer Miller 973-571-4100 [email protected]
New Jersey Association of Mental Health Agencies Debra Wentz 609-838-5488 [email protected]
Postpartum Support International Alexis E. Menken 973-783-7681 [email protected]
WEB SITES Web SitesRecognizing Postpartum Depression "Speak Up When You're Down“ www.njspeakup.gov
Postpartum Support International www.postpartumsupportinternational.com
MOMS Club international www.momsclubinternational.com
Postpartum Education for Parents www.sbpep.org
Massachusetts General Hospital Center for Womens Mental Health www.womensmentalhealth.org
Emory University School of Medicine Women's Mental Health Program www.emorywomensprogram.org
UNINSURED OR UNDERINSURED Telephone
MANAGED HEALTHCARE PROVIDERS Telephone Web Page
Aetna Health,Inc. 1-800-323-9930 www.aetnaushc.com
AmeriChoice of New Jersey, Inc. 1-888-362-3368 www.americhoice.com
AMERIGROUP New Jersey, Inc. 1-800-454-3730 www.amerigroupcorp.com
AmeriHealth HMO, Inc. 1-800-422-2457 www.amerihealth.com
CIGNA HealthCare of New Jersey, Inc. 1-800-345-9458 www.cigna.com
Coventry Health Care of Delaware, Inc. 1-800-727-9951 www.cvty.com
Health Net of New Jersey, Inc. 1-800-848-4747 www.health.net
Horizon HMO Horizon BCBS 1-800-624-1110 www.horizon-bcbsnj.com
Oxford Health Plans (NJ), Inc. 1-800-444-6222 www.oxhp.com
United Healthcare of New Jersey, Inc. 1-866-223-5802 www.uhc.com
University Health Plans, Inc. 1-800-564-6847 www.uhpnet.com
WellChoice HMO of New Jersey, Inc. 1-888-476-8069 www.wellchoicenj.com
Contacts for Healthcare Professionals
NJ Family Healthline 1-800-328-3838
NJ PPMD WEBSITEhttp://www.njspeakup.gov