Mental Disorder During Pregnancy Case Questions

Mental Disorder During Pregnancy Case Questions Mental Disorder During Pregnancy Case Questions I’m trying to learn for my Health & Medical class and I’m stuck. Can you help? You are caring for a 37-year-old female who is pregnant with her second child. The first pregnancy was traumatic as the woman experienced a pelvic fracture during delivery causing excruciating pain. The anxiety from this memory plagues her into this pregnancy. She has been managed on an anti-depressant/anti-anxiety. Her husband is a pharmacist and has attended most visits with the psychiatric-mental health NP for counseling and psychopharmaceutical drug management. NU665C Chamberlain College Mental Disorder During Pregnancy Case Questions What would be your initial approach to assessment with this woman/family? Would you prescribe an antidepressant? If so, why and which one? Explain the pharmacodynamics, pharmacokinetics, contraindications, pregnancy related issues, legal/ethical considerations, testing (if applicable), side effects and relationship to trimester. What would be your overall plan of care? (Be succinct.) Consider supervision/collaboration/type of psychotherapy or complementary modality you might use. Criteria for this paper: Answer these questions succinctly but completely, integrating resources to provide rationale for all decisions. Use APA formatting for all components of your paper. You may use narrative, bullets, or a table format for various sections of this discussion assignment. Your paper should be approximately two to three pages long (including a table if you create a table). Your paper length should not include the reference page. Use at least one nursing journal reference from CINAHL (available through the Regis library) to support your rationale. NU665C Chamberlain College Mental Disorder During Pregnancy Case Questions pregnancy_resources.pdf nu665c__case_study_rubric_1.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Arch Womens Ment Health (2013) 16:391–399 DOI 10.1007/s00737-013-0360-0 ORIGINAL ARTICLE The mental health of mothers of unsettled infants: is there value in routine psychosocial assessment in this context? Bettina Christl & Nicole Reilly & Michelle Smith & Deborah Sims & Fran Chavasse & Marie-Paule Austin Received: 11 December 2012 / Accepted: 20 May 2013 / Published online: 19 June 2013 # Springer-Verlag Wien 2013 Abstract This study aims to investigate the (1) pattern of psychosocial risk factors among mothers of unsettled infants, (2) the relationship between these risk factors and current mental health status and (3) acceptability of psychosocial risk assessment in the parentcraft setting. Women with unsettled infants aged up to 12 months were assessed using the Edinburgh Postnatal Depression Scale, a diagnostic interview (Mini-International Neuropsychiatric Interview (MINI)) and a psychosocial assessment tool, the Postnatal Risk Questionnaire (PNRQ). Of the women, 27.5 % met the MINI diagnostic criteria for a B. Christl : N. Reilly : D. Sims Perinatal and Women’s Mental Health Unit, St John of God Health Care and School of Psychiatry, University of New South Wales, 13 Grantham St., Burwood, NSW 2134, Australia B. Christl e-mail: [email protected] M. Smith St John of God Hospital Burwood, 13 Grantham Street, Burwood, NSW 2134, Australia M. Smith Prince of Wales Hospital Randwick, Randwick, NSW, Australia current (predominantly) anxiety disorder, and 43.1 %, for a past psychiatric diagnosis. On the Edinburgh Postnatal Depression Scale, 29.9 % of women scored above 12 (mean 9.8; SD 5.1). The most common psychosocial risk factors were high trait anxiety (40.9 %), past mental health problems (40.7 %), perfectionistic traits (38.1 %) and ‘abuse trauma’ of any kind (31.6 %). The likelihood of meeting diagnostic criteria for a current mental illness was significantly increased for women who experienced emotional abuse during childhood (adj. odds ratio (OR) 3.386; p=0.006), had high trait anxiety (adj. OR=2.63, p=0.003) or had a negative birth experience (adj. OR 2.78; p=0.015). The majority of women (78 %) felt moderately to very comfortable completing the PNRQ. The results showed high rates of current anxiety disorders (almost twice that of the general postnatal population) and multiple significant psychosocial risk factors among mothers with unsettled infants. Identification of specific psychosocial risk factors in mothers of unsettled infants can help to address issues beyond infant settling difficulties such as mother–infant interaction, especially for mothers with unresolved issues around their own parenting or trauma history. Keywords Postnatal period . Mental health . Psychosocial risk assessment . Parent craft . Unsettled infants M. Smith University of New South Wales, Randwick, NSW, Australia F. Chavasse Tresillian Family Care Centre, McKenzie Street, Belmore, NSW 2192, Australia F. Chavasse University of Technology Sydney, Sydney, NSW, Australia M.3). They were then tested for univariate association with the dependent variable; all items with p<0.25 were entered into logistic regression analysis (Hosmer and Lemeshow 2004). All items except item 3 (emotionally supportive partner) and item 12 (baby unsettled or not feeding well) met this criterion and were entered into the logistic regression model. The regression analysis was iterated, and the item that rendered the highest p value in the regression model was excluded from the subsequent iteration; this process was repeated until the model included only items that were significantly associated with the dependent variable (p?0.05). Results A total of 250 women completed a diagnostic interview. We excluded six women who attended with twins and another 12 women whose diagnostic interview was after more than 2 months after their admission to the Tresillian Family Care Centre. Thus, 232 women were included in the data analysis, 66.4 % from residential unit and 33.6 % from day-stay unit. Socio-demographic and obstetric characteristics The average age of participants was 33.6 years (SD=4.7; range 17–45) with most women falling into the age group of 394 26 to 35 years. Almost two thirds of women were born in Australia. NU665C Chamberlain College Mental Disorder During Pregnancy Case Questions The sample had a high educational level with 88.6 % having some form of tertiary education. The average infant age at presentation to Tresillian was 5.7 months (SD= 2.9), and 60.4 % of women attended within the first 6 months post-partum. Almost two thirds of women were primiparous (62.1 %), and most women had a partner (95.7 %). Half of the women had a normal vaginal delivery (50.4 %); 15.1 % had an elective caesarean section, and 35.3 % had experienced at least one complication of pregnancy or delivery, while most pregnancies were full term (95.3 %). Slightly more women presented with male infants (51.7 %) than female infants (see Table 1 for more details). In regards to maternal age, infant age, marital status or type of stay, participants were comparable to the sample of dropouts (i.e. did not complete a diagnostic interview). Furthermore, our participants were comparable to women who gave birth in New South Wales (NSW) in 2009, in regards to gestation (92.5 % full term) and NICU admission rates (14.2 %). However, rates of vaginal delivery were slightly lower in our sample compared to NSW data (58.6 % noon, instrumental vaginal) (Li et al. 2011). Mental health status The results of the EPDS and MINI assessments are summarised in Table 2. The average EPDS score at admission was 9.8 (SD=5.1), with 29.9 % of participants scoring above the clinical cut-off point of 12. This was similar to the average EPDS score of dropouts (M=9.9; SD=5.3). A total of 31.9 % of participants reported having a family member with a mental illness; 9.5 % (n=22) of our participants were taking psychotropic medication at the time of assessment, mostly selective serotonin reuptake inhibitors (n =19). A MINI diagnostic interview was conducted with each participant when attending the care facility (19.4 %) or via phone (80.6 %). The MINI interview identified 27.6 % of women meeting criteria for a current mental health diagnosis, mostly anxiety disorders (22.8 %); 43.5 % of women met criteria for the past mental health diagnosis, mostly major depression (40.1 %). There was no difference between women attending the residential and those attending the day-stay programme in regards to current diagnosis, EPDS scores or medication status. However a higher proportion of women attending the day-stay programme met criteria for any past mental health problem when compared to women in the residential programme (52.6 vs. 39.0 %; ?2 =3.897; p= 0.051). As expected, women who scored above the EPDS clinical cut-off of 12 were more likely to meet criteria for any current MINI diagnosis (?2 =29.409; p<0.001) and any current anxiety disorder (?2 =23.466; p<0.001). Because of small cell sizes (n<5), the association between Christl et. al EPDS score and current depressive disorder could not be tested. Psychosocial risk profile The results of the PNRQ assessment are summarised in Table 3. We have only reported those responses that were defined as in a previously developed algorithm as ‘significant’, i.e. for the Likert scale items those scoring >3 (as per Priest et al. 2008). For questions 2 and 4, with an initial dichotomous ‘yes/no’ prompt, we have further characterised the following as significant: question 2 (past mental health episode) required either endorsement of the episode (a) as interfering with work/relationships (i.e. score of >3) or (b) requiring professional help (‘yes’). Question 4 (presence of major stressors, losses in the last 12 months) was considered significant if, additionally, the degree of distress was scored above 3. A total of 53 % of women endorsed three or more and 35.8 % endorsed four or more significant PNRQ risk factors. Only 9.1 % did not endorse any significant risk factors. The mean total score for the PNRQ was similar for the residential (33.12; SD=13.17) and day-stay groups (31.8; SD=11.51), and there was no difference to the dropouts (32.7; SD 12.6). As would be expected, most mothers (93.8 %) reported having a baby with settling and/or feeding problems as the reason for attending, but interestingly, only 47 % of women reported significant settling or feeding difficulties on the PNRQ. The other risk factors of significant magnitude (scores of >3 on Likert scale items) were high trait anxiety (40.9 %), significant past mental health episode (38.1 %) and perfectionistic traits (39.3 %). When these are combined, 54.7 % of the women had high anxiety or perfectionistic personality traits. In terms of ‘trauma’ history, 18.5 % reported an emotionally unsupportive mother when growing up; 12.9 %, emotional abuse when growing up; and 17.3 %, having ever been physically or sexually abused. A total of 66 women (28.4 %) reported experiencing a stressor(s) (in addition to having an unsettled … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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