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

Severe Mental Illness and Mothers

• Severe mental illnesses include Schizophrenia, Bipolar Disorder and Postpartum Psychosis

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

• 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

• 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

Severe Mental Illness and Mothers

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

• Family and Community Support is Key Determinant of Outcome

Severe Mental Illness and Mothers

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

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

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

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

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

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

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

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

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

Key Concept #3:• Postpartum Psychosis is a medical emergency

requiring urgent psychiatric assessment

Severe Mental Illness and Mothers

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

• Severe illness interrupts the mothering role and adjustment; these mothers need particular support and hopefulness for their full recovery

Severe Mental Illness and Mothers

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

Key Resources:

www.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.net : American based patient advocacy site where stories and information are shared

Severe Mental Illness and Mothers

Thank You!