1. Severe and Persistent Mental Illness and Mothers A Mothers’ Mental Health Toolkit Project Learning Video with Dr. Joanne MacDonald Reproductive Mental Health Service IWK Health Centre Halifax, NS

2. Severe Mental Illness and Mothers Severe mental illnesses include Schizophrenia, Bipolar Disorder and Postpartum Psychosis

3. Key Concepts: Mothering is an important social role for many women Mothering with a previously known or new more severe mental disorder can be challenging Support from partner, family and community is critical to how the affected woman will function as a mother Women with severe mental illness can mother safely and effectively with treatment and support Severe Mental Illness and Mothers

4. Schizophrenia occurs in less than 1% of the general population Schizophrenia is a partially understood illness but thought to be a vulnerability from early life that presents usually in early adult life It is a brain illness that has a spontaneous onset Prominent symptoms include loss of initiative, lowered attention to real life experience and reduced thinking generally and planning and decision-making particularly, unusual sometimes suspicious ideas, abnormal sensory experiences such hallucinations, and change in personality or behaviour from usual The impact on usual function is great Severe Mental Illness and Mothers

5. Women suffering with Schizophrenic Illness are often disadvantaged regarding their education level, social opportunities, employment and housing by the onset of a severe illness early in life They experience poorer physical health than unaffected women Family support is critical to parenting potential and stability Pregnancy is not always planned but mothering may be a very wanted role Severe Mental Illness and Mothers

7. Treatments? Key to recovery usually are antipsychotic medications Safety in pregnancy and use when breastfeeding must be carefully assessed Outcomes for infants exposed in pregnancy can be very good Parenting education and support may be needed Severe Mental Illness and Mothers

8. Family and Community Support is Key Determinant of Outcome Severe Mental Illness and Mothers

9. Bipolar Disorder A disorder of cycling changing mood and behaviour from ‘low’ depressed presentations to ‘high’ over energized states Highly variable severity Symptoms can vary from woman to woman and in same woman over time Difficult to diagnose; typically months to years delay in firm diagnosis Severe Mental Illness and Mothers

10. Bipolar Disorder Spectrum: Cyclothymic Disorder – mild, fluctuating mood states, minimal triggers, less impact function Bipolar I – typical illness, highs and lows of equal severity Bipolar II – more depressive phases, of more severity, minimal highs that can be brief Severe Mental Illness and Mothers

11. Key Concept #1: Women with known Bipolar Disorder at high risk of relapse in first 3 months after a baby is born Severe Mental Illness and Mothers

12. Key Concept #2: Bipolar Disorder can be very influenced by women’s hormonal changes, for example pre- menstrually or after a baby is born Postpartum is a period of high risk for a woman vulnerable to Bipolar Disorder Family history can be a key risk factor Severe Mental Illness and Mothers

13. Features of Bipolar Disorder: High or Up phases marked by increased speed of thinking and sometimes actions, impulsive ideas, rapid shifts in attention and thought connections, mood can be very excited to irritable, decision-making or judgement often off Depressed or Down phases marked by slowed thinking, sometimes deep fatigue and sense of heaviness physically, very low mood and initiative, hopelessness and very negative thinking Severe Mental Illness and Mothers

14. Interventions? Expert mental health assessment is important Minimize stress Improve self-care, particularly sleep and daily routines Stabilizing medications may be necessary Family involvement, education and support key to recovery Severe Mental Illness and Mothers

15. Bipolar Disorder Outcomes: With effective treatment, recovery can be solid Medication long term can be necessary for stabilization Self-care strategies and social support enhance ongoing stability Severe Mental Illness and Mothers

16. Postpartum Psychosis 1 in 1000 women delivering a baby are at risk for Postpartum Psychosis Rare but severe illness that can present rapidly over 1-3 days Severe Mental Illness and Mothers

17. What are warning signs of Postpartum Psychosis? Sudden change in awareness, attention and memory Can be preceded by excited sleepless confused period Behavioral change dramatic from that woman’s usual Will seem clearly out of character, thinking and behavior not making sense, not connected to the current situation May have unusual or suspicious ideas and hallucinations suddenly Severe Mental Illness and Mothers

18. Key Concept #3: Postpartum Psychosis is a medical emergency requiring urgent psychiatric assessment Severe Mental Illness and Mothers

19. Postpartum Psychosis Treatment: Often requires initial inpatient treatment Typically need antipsychotic medications Should have ongoing mental health care and follow-up for monitoring Safety of infant or other children should be considered Most women recover fully with treatment Treatments may not be safe for infant in breastfeeding Severe Mental Illness and Mothers

20. Severe illness interrupts the mothering role and adjustment; these mothers need particular support and hopefulness for their full recovery Severe Mental Illness and Mothers

21. Learning Points: Roles of community support providers include continuing support to mothering adjustment despite illness, reducing stigma and providing inclusion self-care support and strategies over a longer time are key in recovery from severe illness Severe Mental Illness and Mothers

22. Key Resources: www.cmha.cawww.cmha.ca : The Canadian Mental Health Association is a patient and family advocacy organization with information on a wide variety of mental health problems www.postpartum.netwww.postpartum.net : American based patient advocacy site where stories and information are shared Severe Mental Illness and Mothers

23. Thank You!