Anxiety and Panic Attacks Natural Medicine

Panic Away Handbook

The author of the Panic Away program, Barry began his research studying books on psychology, but he was not so happy with what he found there. The method described promise to teach people to get rid of the panic attacks and anxiety permanently, but they just teach methods for managing it. The two main goals of Panic Away are to stop panic attacks and to eliminate general anxiety and the 21 7 Technique is the core of the Panic Away program. Barry McDonagh describes the 21 7 technique as first aid for anxiety and it is made up of two components: 1. The 21 Second Countdown Technique which is designed to stop panic attacks, and 2. The Seven Minute Exercise which is designed to reduce general feelings of anxiety. Panic Away by Barry McDonagh, in my experience can help reduce panic and in the very least substantially reduce anxiety. It is simple and can be used anywhere and anytime. Once you Get that you no longer have to fear the thought of a panic attack, anything can happen. More here...

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Prevalence of Mood and Anxiety Disorders During Pregnancy

Whereas certain psychiatric disorders may be readily detected during pregnancy (e.g., psychosis, panic disorder), depression that emerges during pregnancy is frequently overlooked. Many of the neurovegetative signs and symptoms characteristic of major and subsyndromal depression (e.g., disturbance in sleep and appetite, diminished libido, fatigue) are also observed in nondepressed women during pregnancy. In addition, certain medical disorders commonly seen during pregnancy, such as Although modest to moderate levels of anxiety during pregnancy are common, pathologic anxiety during pregnancy does occur and has been associated with poor neonatal outcome and obstetric complications (Andersson et al. 2004 Cohen et al. 1989 Crandon 1979 Istvan 1986). The prevalence of clinically significant anxiety symptoms during pregnancy has not been well studied. In a community sample of 8,323 pregnant women, it was observed that 21.9 of the women had clinically significant symptoms of anxiety (Heron...

2 Prevalence Of Perinatal Anxiety Disorders

The prevalence ofperinatal anxiety disorders ranges widely from study to study (8.7-30 ) (5-7). One explanation for this diversity is that the screening and diagnostic instruments used in these studies varied in sensitivity. A second reason for the variability in findings is that the studies assessed women at different time points. Recently, Wenzel and colleagues (8) conducted a comprehensive investigation ofthe prevalence ofpostpar-tum anxiety disorders. They administered a standardized clinical interview to a community sample of147 women approx 8 wk after giving birth and found that the most common forms of clinical and subsyndromal postpartum anxiety problems were generalized anxiety disorder (GAD) (19.7 ) and social anxiety (15.0 ). About half of the women meeting criteria for an anxiety (or depressive) disorder reported a postpartum onset of these symptoms. Moreover, the overall rates of postpartum anxiety disorders were higher than that of postpartum depression (PPD)....

Treatment of Anxiety Disorders During Pregnancy

The use of nonpharmacologic treatments such as CBT and supportive psychotherapy may be of great value in attenuating symptoms of anxiety in some cases (Otto et al. 1993 Robinson et al. 1992). While patients with severe illness may opt to continue to take medication during pregnancy, those with milder forms of illness may consider discontinuing treatment during pregnancy. For patients with panic disorder who wish to conceive, a slow taper of antipanic medications is recommended. Adjunctive CBT may be of some benefit in helping patients discontinue antipanic agents and may increase the time to relapse (Robinson et al. 1992). Some patients may conceive inadvertently while taking antipanic medications and may present for emergent consultation. Abrupt discontinuation of antipanic maintenance medication is not recommended, given the risk of rebound panic symptoms or a potentially serious withdrawal syndrome. However, gradual tapering of antipanic medications (i.e., 2 weeks) with adjunctive...

4 Presentation Of Anxiety Disorders In Pregnancy And The Postpartum

Although the fourth edition of the Diagnostic and Statistical Manual ofMental Disorders (13) includes a specifier indicating postpartum onset of a mood disorder, there is no such specifier for the anxiety disorders. As with the mood disorders, diagnosis of an anxiety disorder is made on the basis of the same set of criteria whether it occurs in the perinatal period or some other stage of life. However, it is important to consider the effects of somatic symptoms accompanying pregnancy and the post-partum period (i.e., fatigue, sleep disturbance) when making a diagnosis (14). More is known about perinatal panic disorder, OCD, and posttrau-matic stress disorder (PTSD) than the other anxiety disorders.

Anxiety and panic attacks during pregnancy

In Chapter 3 much was said about fears and anxieties particularly early on in pregnancy. It is very common to be fearful about labour, about your capacity to be a parent or the health of your baby. However, if you are continually gripped by these fears or experiencing regular panic symptoms, then you may need to look a little deeper into what is going on. Chapter 8 looks at understanding and dealing with anxiety symptoms. Below is a brief outline of issues to do with anxiety but Chapter 8 is essential reading for a fuller understanding of the issues.

What are panic attacks

At some point in their life most people will have a panic attack. You may start to shake or tremble, feel your heart racing, feel short of breath or start to hyperventilate. You are likely to interpret these as signs of some imminent danger, 'I'm having a heart attack' or 'I'm going mad' and these panic thoughts will cause you to leave the situation run from the supermarket or leave the meeting at work. This extremely unpleasant experience will usually lead you to avoid the feared event or situation, 'I'll never go in a lift again'. Unfortunately the next time you approach a similar situation the panic will start again. Panic attacks are often an aspect of most anxiety problems. Sometimes people talk about dealing with stress and often if someone is feeling 'stressed', they are experiencing symptoms of panic and anxiety. Whatever you call these symptoms, the process of beginning to understand them is the same.

46 Anxiety Problems Associated With Miscarriage

Pregnancy loss may be a risk factor for elevated symptoms of anxiety or the development of an anxiety disorder (28-30). Most studies of women's psychological functioning following miscarriage have focused on depression rather than the anxiety disorders. However, one study compared rates of anxiety disorder in a matched comparison group of community women who had not been pregnant in the past year and a group of women who attended a hospital following a miscarriage (28). Results indicated that women experiencing miscarriage were at a greater risk for a recurrent episode of OCD (relative risk 8.0), whereas the incidence of panic disorder, phobic disorders, or agoraphobia was not statistically different between groups (28). Studies with larger samples are warranted so that the prevalence of anxiety disorders in this population may be better understood.

21114 Other anxiolytic drugs

Buspirone binds to serotonin and dopamine receptors, opipramol is a dibenzazepine derivative, and kavain is a cavalactone that is present in the roots of Piper methysticum (Cava-Cava). In the USA, cava was also used in health foods in some countries it was removed from the market because of hepatotoxicity. No data are available for the use of any of these drugs during pregnancy (see also Chapter 2.19). Hydroxyzine is an antihistamine with sedative and anxiolytic properties. Several studies covering about 240 pregnancies have been published (e.g. Diav-Citrin 2003, Einarson 1997, Schatz 1997). No increased incidcnce of malformations has been found, but more data are needed to exclude a possible teratogenic risk. Meprobamate is one of the oldest tranquilizers on the market. Sincc the introduction of benzodiazepines, there are very few indications for its use in pregnant women. In the 1970s, the use of meprobamate in the first trimester was associated with a possible increase in cardiac...

34 Benzodiazepines and Other Sedative Hypnotic Agents

Benzodiazepines are used commonly as adjunctive medications for mood stabilization or for anxiety, agitation, and sleep problems. Knowledge regarding the use of this class of medication during pregnancy and its impact on outcome is reviewed below. Oral clefts develop in the first trimester, with closure being complete by the 10th week of gestation (68,69). The risk for the anomaly cleft palate in the general population appears to be 6 in 10,000 (0.06 ) (31). The extent to which benzodiazepines heighten risk for oral cleft or other anomalies in humans remains controversial. In more than 14 different studies in which the relationship between first-trimester exposure to benzodiazepines and risk for congenital anomalies was assessed, no more than 4 studies used the same design to answer any particular question, and often a number of different benzodiazepines were reported on together (31,70-83). These differences contribute to the confusion and controversy regarding the safety...

Managing anxiety and depression

The journey through pregnancy and into parenthood brings with it psychological risks. The previous chapters have outlined different types of psychological difficulties mothers might experience and why. The emphasis of this book has been about trying to prevent problems by being more aware and informed about the emotional pressures that you might experience when you embark upon having a family. However, for some women the events of pregnancy and childbirth will lead to significant levels of anxiety or depression or these may have been around for most of your life. Each chapter has tried to highlight issues specific to problems at that stage such as the reasons for depression in pregnancy what follows here are some general points about dealing with these problems whenever they occur.

Understanding and coping with stress and anxiety

Everyone experiences stress or anxiety at some point in his or her life. It is usually viewed as a problem but moderate levels of stress actually help us to perform better. If about to have an interview or raise a difficult issue with a friend, it is perfectly normal to feel 'butterflies' in your stomach or to breathe faster than usual. Our bodies are preparing us for action or to face perceived challenges. At times we have all felt 'panicky', been preoccupied with worries or avoided something we would rather not deal with. However, when these signs become regular or intense or in the 'wrong' situation, then anxiety can be a cause of much dread and misery as well as being detrimental to health in the long term. The aim of this chapter is 'coping' and 'understanding' NOT 'avoiding' anxiety. Many people I have worked with have wanted to know how to avoid the problem. Avoiding the problem only ever makes things worse in the long run. Anxiety can only be solved by learning to cope with...

21112 Benzodiazepines

Benzodiazepines arc among the most commonly used anxiolytic drugs by women of reproductive age and pregnant women. They have anxiolytic, anticonvulsant, hypnotic-sedating, and muscle-relaxing properties. They are structurally related, and act on specific benzodiazepine receptors. The half-life may vary considerably, and depends mainly on the biologic activity of the metabolites, which are formed in the liver via oxidation. Benzodiazepines cross the placenta. The rate of metabolism in the neonate is very low, and accumulation may occur. Benzodiazepines with a very short half-life (

Designing diaries Anxiety depression drinking

When you want to change something in your life such as the amount of alcohol you are drinking or if you want to monitor your experience of depression, then it can be useful to keep a 'diary'. The examples below show you how you might record this information. You really can do this any way that you find helpful. You might just want to write down a record of your day but it can be useful to divide up your page into columns and record the same information every time you feel anxious or every time you have a drink.

Why do panic attacks happen

There is some evidence that for those who have a history of anxiety problems, their symptoms can improve in pregnancy. If you are experiencing regular panic symptoms, then this can actually have negative effects on your pregnancy. High levels of anxiety in pregnancy have been linked to higher levels of hypertension in mothers. Often when people are experiencing panic attacks it is because problems are not being addressed or fearful thoughts or situations are being avoided. If you are terrified of hospitals, then it doesn't help to avoid the problem until you go into labour. Facing up to the problem might be as simple as needing to discuss your thoughts and feelings with a trusted friend or partner. It may be that you need to seek professional help if there are more complicated issues that need unravelling or if you need specific help to deal with the anxiety symptoms. (See'Who can help 'on p. 83.)

General Guidelines for Treatment of Mood and Anxiety Disorders During Pregnancy

The past decade has brought increased attention to the question of how to best manage women who suffer from psychiatric illness during pregnancy. The management of mood and anxiety disorders during pregnancy is largely guided by practical experience, with few definitive data and, for obvious ethical reasons, no controlled treatment studies to inform treatment. Clinically, the most appropriate treatment algorithm is contingent on the severity of the disorder and ultimately on the wishes of the patient. Clinicians must work collaboratively with the patient to arrive at a decision based on available information and the patient's wishes. A patient's past psychiatric history and current symptoms, as well as her attitude toward the use of psychiatric medications during pregnancy, must be carefully assessed and factored into treatment decisions. Women with histories of mood or anxiety disorders frequently present for consultation regarding the use of psychotro- Nonpharmacologic interventions...

Anxiety Disorders

Although modest to moderate levels of anxiety during pregnancy are common, pathologic anxiety may occur in certain women. Anxiety disorders are common among women, but little is known about the prevalence of anxiety disorders during pregnancy and the postpartum period. In a recent prospective longitudinal study of a community sample of 8,323 pregnant women in England, it was observed that 21.9 of the women had clinically significant symptoms of anxiety (Heron et al. 2004). Among the women who reported elevated levels of anxiety during pregnancy, most (64 ) also reported elevated levels of anxiety after delivery. Furthermore, antenatal anxiety predicted postpartum depression at 8 weeks and at 8 months, even after controlling for the presence of antenatal depression. There are few data regarding the impact of pregnancy on the course of specific anxiety disorders. Several anecdotal reports and case series have described a reduction in the severity and frequency of panic symptoms during...

2102 Benzodiazepines

Benzodiazepines are used as AEDs, tranquilizers, and hypnotics. In the following pages, only those representatives of this group which are currently used for antiepileptic therapy will be discussed (for details on benzodiazepines, sec also Chapter 2.11). Diazepam and clonazepam have proven themselves as AEDs. They inhibit the spread of pathological excitation, but not focal activities. Following Clonazepam and clobazam are similar to diazepam, chemically and structurally. Earlier publications have described an increased risk of cleft lip and cleft palate with diazepam treatment (Saxen 1975). This could not be substantiated in a later trial (Rosenberg 1983), In view of one case report describing an oblique facial cleft in a newborn of a mother who attempted suicide in early pregnancy with 50 tablets of diazepam (Rivas 1984), and given the rarity of this malformation, an increased risk with extremely high dosages can be suspected. Other birth defects, i.e. inguinal hernia, were...


Although pregnancy is a normal, physiological life event, impending motherhood can also give rise to a great deal of anxiety, stress and fear. This may be caused by It is probable that maternal anxiety may increase the perception of pain, increasing the need for pain relief in labour. It may also interfere with normal uterine activity in labour, slowing down contractions. Therefore the more realistic reassurance that can be given to a woman to help her to handle her fears, the better.

85 Benzodiazepines

The AAP categorizes benzodiazepines as drugs for which the effect on nursing infants is unknown, but may be of concern (162). There are no controlled studies in breast-feeding women however, the risk of untoward effects to the breast-fed infant is possible (162). No described complications have been observed with lorazepam and clonazepam (6). However, alprazolam, clonazepam, diazepam, and lorazepam fall under the moderately safe lactation risk category there has been at least one case report associated with diazepam causing sedation in neonates (170). Other studies show that diazepam during lactation is not recommended because of potential for sedation, lethargy, and weight loss in nursing infants (162,171). Short-acting benzodiazepines (alprazolam, lorazepam) may be safer for use during lactation as long as their use is short term, intermittent, low dose, or occurs after the first week postpartum (162). The available literature suggests that in order to minimize the risks of...

499 Benzodiazepines

In the last 30 years, a number of benzodiazepines have been introduced into therapy. Structurally, they arc related to each other. Primarily medium- and long-acting benzodiazepines arc used as anxiolytics and sedatives the shorter-acting substances are available for the induction of anesthesia and as hypnotics. Among full-term newborns, the elimination capacity for benzodiazepines develops within the first week of life. Shorter-acting benzodiazepines (24 hours) are chlordiazepoxide, clobazam, diazepam, dikaliumclorazepat, medazepam, nordazepam, and prazepam. In the following sections, each of the benzodiazepines for which there is experience during breastfeeding will be discussed in alphabetical order. Nitrazepam has a half-life of just under 30 hours and an M P ratio of 0.3. Among nine women, a maximum transfer dosage of 2.6 was calculated. During 5 days of treatment with 5 mg nitrazepam, an increase in the concentration in the milk from 8.4 to 13.5 ng 1 was measured (Matheson...

The beginning of our journey

Sylvia was genuinely surprised to discover that her feelings were not unusual for women who had experienced a complicated delivery. She was particularly amazed to discover that her symptoms were anxiety symptoms she had heard of post-natal depression but didn't realise that very many types of emotional reaction are common to having a baby. Sylvia had experienced little support and care from the professionals around her and, like many women of her generation, she was somewhat isolated from other new parents. It seemed heart-breaking that 40 years after having her baby, Sylvia was still trying to understand exactly what had happened to her. For some women, however, the chaos is all that they see. By six weeks a significant number of women are depressed and feel that they are not coping. Chapter 8, therefore, offers some suggestions on how to deal with anxiety and depression, while the final chapter, Chapter 9, looks forward to the future.

115 Risk communication regarding the safety or otherwise of drugs already used in pregnancy

When drag exposure has already taken place during pregnancy, a different approach is required from that used in cases of planning future pharmacotherapy. The latter allows the calm and fully confident selection of a safe drug. However, when the treatment has already begun, the pregnant patient will mainly be concerned about any possible disorder of the unborn. These different cases therefore require different communication strategies. When drug exposure has already taken place, the consultant should avoid vague comments that increase anxiety. Experimentally derived results or unconfirmed hypotheses based on individual case reports should not be referred to, as these could alarm the already anxious patient and perhaps lead to a drastic decision - for example, the termination of a wanted pregnancy based on a misinterpreted product warning such as inadequately studied , experimentally suspected or contraindicated in pregnancy . If no exposure-associated risk is known or strongly...

When pregnancy doesnt happen

Other factors may affect your view of your potential fertility. If you have a history of any gynaecological problems, a previous sexually transmitted disease, a previous termination of pregnancy or a previous miscarriage or stillbirth, any of these factors may increase your sense of anxiety if conception does not occur immediately. For most women these anxieties Clearly, a number of highly individual factors will contribute to you viewing yourself as having a problem and it is always worth discussing these feelings with someone you trust. A visit to the GP might be appropriate for you but it does also represent the first step in identifying a 'problem', which can increase your anxiety about the situation. Everyone's expectations are different.

4 Psychiatric Medication Use Near Term

Some medications may produce toxicity or withdrawal effects in the newborn. These include the selective serotonin reuptake inhibitors (e.g., fluoxetine, paroxetine), which have been linked with neonatal jitteriness, respiratory distress, and hypoglycemia (19,20), and benzodiazepines (e.g., clonazepam, diazepam, lorazepam), which can produce excessive

The emotional impact of fertility problems and treatments

Again, there isn't room here to cover the vast array of treatments and procedures that are involved in assisted conception. However, it is clear that the emotional costs of fertility problems can be significant. Those diagnosed with fertility problems are more likely to be diagnosed as depressed to have anxiety problems to report relationship problems and specifically higher levels of difficulty with their sexual relationship. The treatments themselves can exert extreme physical and psychological pressures and as many as two-thirds of procedures do not result in a baby. For some couples, despite massive intervention at great personal and financial cost, a baby is never achieved.

Prenatal Care To Reduce Psychosocial And Environmental Risk

Domestic violence, in addition to jeopardizing maternal and fetal physical well-being, generates stress and anxiety in pregnant women. Evaluations of the effectiveness of prenatal care have generally focused on the biological and physiologic aspects of pregnancy, but the psychosocial environment also may have a significant impact on pregnancy outcome as well as maternal and familial welfare. Thus, prenatal care offers an opportunity to attempt to decrease psychosocial stressors. By assessing the need for and then offering social supports, from classes that help women prepare for childbirth and those that provide health education to referrals to social service agencies and programs such as Women, Infants and Children, providers may have a substantial impact on not only the biological outcome of pregnancy but also the health and happiness of an entire family. For example, childbirth education classes have been shown to diminish maternal anxiety and the need for medication and other...

32 physiological changes in pregnancy

Special consideration must be given to changes that occur during each trimester of pregnancy that could result in injury from physical activity in pregnancy. Physical activity in pregnancy can be affected by the following progressive anatomical and physiological changes change in center of gravity, increased connective tissue laxity resulting in joint instability, lordosis and kyphosis, generalized edema possibly resulting in nerve compression syndrome, increase in blood volume, tachycardia, hyperventilation, and reductions in cardiac reserve and residual lung capacity 10 . Figure 3.1 lists the etiology for potential injury that can occur during exercise in pregnancy and the gestational age during which the injury is most likely to occur. The goal of exercise is to maintain physical fitness within the physiological limitations of pregnancy. Exercise prescriptions should be geared towards muscle strengthening to minimize risk of joint injury and towards correcting postural changes thus...

Ectopic Pregnancy 8 Weeks

Transvaginal Ultrasound Ring Fire

For years the management of early pregnancy complications was very much the poor relation when training in gynaecology. In general the most junior doctor available was delegated to see the patient and perform any surgery, if indicated. Yet they are among the most common conditions seen by gynaecologists and cause a huge amount of anxiety and distress for patients.

Forbidden points of pregnancy

Other schools of thought warn against needling below the knee at certain times in pregnancy. When I first started to treat, there was so much conflicting advice that I often found it hard to work out what I could and could not do. I had a long list of points that I repeatedly referred to, and there was always a nagging anxiety at the end of the day if I had used an unfamiliar point. Soon I began to feel very restricted. But the more experienced I became, the less I worried. The cardinal rules are

What does it mean to be a mother Changes for women

Rosemary came for help with depression the roots of which seemed to stem from dealing with her three-year-old son. Alex seemed a very active and healthy boy but he ate hardly anything throughout the day, which caused his parents an enormous amount of anxiety. John and Rosemary had married early in their twenties and had hoped to have children but the years had rolled on with nothing happening. They had approached their doctor but initial tests revealed no reasons for their not conceiving and they decided to 'wait and see'. After 13 years they were finally rewarded with a healthy baby boy. Rosemary admitted that they had found the adaptation to parenthood enormously difficult. Their lives had become very ordered and predictable over their married life and now they had sleepless nights, tantrums and constant mess around the house. Rosemary felt guilty about feeling angry with Alex at times and realised that she let him 'get away with everything' for an easy life. Rosemary gradually...

Overwhelming Emotions for Parents

It's common for families to experience symptoms of anxiety and depression during this time. Some parents turn to their extended family, friends, and clergy or seek professional help. The doctors, nurses, and social workers in the newborn special care unit can be wonderful sources of support as well. Many units have parent support groups comprised of parents who have already experienced what you are going through. Advice from a veteran parent can be comforting. The doctor you have chosen to care for your baby after discharge can also be a source of support to you while your baby is in the special care nursery. You should not be shy about seeking out professional help to deal with anxiety and depression.

41 Functional Impairment

Recent research suggests that women who are either depressed or are experiencing severe anxiety during the first trimester of their pregnancies exhibit some degree of functional impairment (51). This impairment may take the form of reduced work productivity, continuous and or prolonged absence from work (52), and increased health care utilization (53). In cases where the depressed woman is the only working member of a family, such an impairment could also have negative consequences on her family her family's financial status, for example, would likely decline.

Taking Your Infant Home

Most parents are surprised when they feel anxious and sad about discharge. After all, taking the baby home is all they have thought about since the baby was born. But this is a natural reaction. Taking home this tiny baby who has had intensive, round-the-clock care can be a little frightening. Don't worry the doctors, nurses, and social workers will continue to give you plenty of support for the tremendous change your family is about to experience. By the time your baby is ready to go home, you'll be nervous but ready. And your baby will love being home with you.

But how many babygros do I need

On a practical level, one has to make a space for the baby and begin to think about what he might need in those early weeks.This is really as much a psychological task as a practical one in that it involves imagining having this new person in your home and dependent on you for his needs. Awhole new area of knowledge needs to be acquired such as how to attach the baby's seat to the car or how to place a baby in a cot to sleep. In fact, most of these things don't really make sense until the baby arrives. It is easy for this planning in itself to become a source of stress and anxiety. Many parents are bamboozled by the vast array of goods, intensively marketed, that lead us to believe that we must acquire them otherwise our baby will not be safe or will not be 'stimulated'. Finding the money to pay for everything can be a source of stress parents may feel cheated if right from the start they cannot get 'the best' for their baby. Few of the things that we buy for babies are really...

Breast Feeding Summary

Because of the potent effects the drug may have on a nursing infant's neurodevelopment, the case of probable alprazolam withdrawal, and the lethargy and loss of body weight observed with the chronic use of other benzodiazepines (see Diazepam), alprazolam should be avoided during lactation.

What do the contractions feel like Learning new skills for pregnancy and birth

Overall, it is probably not worth worrying too much aboutthe content of the classes as the chance of being with other parents-to-be and sharing your experiences of pregnancy is just as useful as the factual information given. If fathers attend groups too, this can really help a mother to feel supported and can help the father to feel more involved, more informed and less anxious. If the group can continue to meet after the babies are born, then this will offer great support in those early months with the baby. It may be hard in pregnancy to believe that you want to keep meeting with a group of 'strangers' but the shared experience of having a new baby can be very important especially if all your friends are at work during the week.

Risks of Untreated Illness in the Mother

Anxiety symptoms have also been associated with poor neonatal outcome and obstetric complications, including low Apgar scores, premature labor, and low birth weight (Cohen et al. 1989 Crandon 1979 Istvan 1986). Additionally, antenatal anxiety has been linked to childhood behavioral problems (O'Connor et al. 2003). Furthermore, one prospective, longitudinal study of 8,323 women suggested that antenatal anxiety predicts postpartum anxiety and depression (Heron et al. 2004). This is concerning because maternal mood disturbances postpartum may negatively affect childhood development (Murray 1992 Murray and Cooper 1996). The physiologic mechanisms by which symptoms of depression and anxiety might affect neonatal outcome are not clear. However, increased serum cortisol and catecholamine levels, which are typically observed in patients with depression and anxiety, may affect placental function by altering uterine blood flow and inducing uterine irritability (Glover 1997 Teixeira et al....

How Can You Tell if Your Baby Is Getting Enough Milk

This is one of the major concerns of new parents, especially if their baby was born small or premature. It is normal for a baby to lose up to 7 to 10 percent of her birthweight in the first week of life and to regain it by the end of the second week. The dip in weight, however, may increase parents' anxiety.

11 The Mental Health Friendly Environment

The creation of a clinical environment, including the physical space as well as the medical and office staff, that explicitly and implicitly includes mental health as a vital part of a healthy lifestyle is key to enabling women to divulge their concerns regarding their mood, thought processes, and behaviors during pregnancy and the postnatal period. Prominently displaying educational materials about anxiety and depression during pregnancy and the puerperium along with information about other common pregnancy-related issues helps to destigmatize mental disorders. Directly inquiring about symptoms of depression and anxiety at every pre- and postnatal appointment sends the unequivocal message that the clinician values the patient as an individual with specific needs and concerns.

13 The Differential Diagnosis

Once a postpartum woman has been identified as suffering from a mood disturbance, determining the nature, timing of onset, duration, and severity ofthe symptoms is essential to making a correct diagnosis (Table 1). The differential diagnosis ranges from normal adjustment and the baby blues to anxiety disorders, PPD, postpartum psychosis, and or bipolar disorder. Anxiety V V dysphoric mood, tearfulness, irritability, emotional lability, anxiety, and sleep disturbance, peaks around 3-4 d postpartum and resolves within hours to a few days. Although the baby blues are self-limited in duration, the more severe the symptoms during this time period, the more likely the woman is to meet criteria for major depressive disorder (MDD) at Although the intensity of obsessions and compulsions do not differ between women with puerperal and nonpuerperal depression, aggressive obsessions regarding the infant are more common in women who present with depression after delivery (27). Thus, unless other...

241 Nausea and vomiting in pregnancy

The pathogenesis of NVP has been attributed to multiple factors such as elevated levels of 3-hCG, prostaglandin levels (by relaxing the gastroesophageal sphincter), gastric dysrhythmia, vitamin B6 deficiency, and hyperolfaction. Psychological factors (depression, anxiety, eating disorders), once considered the only etiology of NVP, might in fact be a result of the NVP. A genetic predisposition has been suggested based on the concordance in monozygotic twins, variation within ethnic groups, and the fact that siblings and mothers of patients with NVP are likely to have experienced NVP themselves (Goodwin 2002).

The Blues and Depression

It's estimated that baby blues strike about 50 percent of all new mothers in the first week after birth, and they strike many fathers and adoptive mothers as well. Usually lasting only a few days, the blues may bring anxiety, sadness, irritability, and insomnia. You may swing from joy to weepiness and back again for no apparent reason. Don't let these feelings worry you. They are normal and will pass.

Risks of Untreated Maternal Illness During Pregnancy

Depression or severe anxiety often present with decreased appetite and consequently lower-than-expected weight gain in pregnancy, factors that have been associated with negative pregnancy outcomes (Zuckerman et al. 1989). In addition, pregnant women with psychiatric illness are more likely to smoke and to use either alcohol or illicit drugs (Zuckerman et al. 1989) behaviors that further increase risk to the fetus. Similarly, stress and anxiety during pregnancy have been associated with a variety of poor outcomes, including low Apgar scores, premature labor, low birth-weight, and placental abruption (Cohen et al. 1989 Crandon 1979 Istvan 1986). Additionally, antenatal anxiety has been linked to childhood behavioral problems (O'Connor et al. 2003). Furthermore, one recent prospective, longitudinal study of 8,323 women suggests that antenatal anxiety can predict postpartum anxiety and depression (Heron et al. 2004). This finding is concerning because postpartum mood disturbances may...

Specific psychological difficulties in pregnancy

Most people have heard of 'post-natal depression' and are prepared for the weeks after the birth possibly being difficult, but it still remains something of a 'secret' that depression occurs in pregnancy too. As was stated earlier, we enter pregnancy from a particular place in our lives, which might mean struggling to control alcohol or drug problems, or with a tendency to experience panic attacks or anxiety symptoms in certain situations. Pregnancy can re-ignite old difficulties such as problems with body image and fears about controlling your eating. For women who have experienced childhood sexual abuse, pregnancy may trigger or exacerbate

Jonathan S Abramowitz Karin Larsen and Katherine M Moore

This chapter begins with a review of the prevalence, assessment, and clinical presentation of anxiety in the perinatal period. Next, we discuss two forms of treatment for anxiety that have been found effective in clinical research cognitive-behavioral therapy and certain classes of medication. The effectiveness of these treatments with each of the anxiety disorders is discussed, as is the issue of how medication might affect the unborn and breast-feeding infant. Finally, we present a case study of a representative patient with postpartum obsessive-compulsive disorder who was evaluated and treated in our anxiety disorders program. Key Words Anxiety postpartum pregnancy cognitive-behavioral therapy pharmacotherapy.

3 Identification And Assessment

Approximately 30 of women will experience an anxiety disorder over the course of their lives, and prenatal visits provide an ideal oppor tunity for health care providers to assess and treat these disorders (11). Furthermore, during the prenatal and postpartum periods, women may look to their obstetrician as their primary care provider. Therefore, obstetrical visits may be the best opportunity for a provider to assess a woman's psychological well-being. Unfortunately, however, studies suggest that pregnant women do not discuss their emotional difficulties with their health care providers, even when significant levels of anxiety and depression are present (6,12). Recognition of psychiatric morbidity in obstetric clinics may occur in as few as 26 of cases, suggesting that most women requiring psychological services are overlooked and untreated (12). Despite the failure to actually raise such concerns, research suggests most women are willing to discuss their psychiatric symptomatology...

Fetal Risk Summary

Alprazolam, a member of the benzodiazepine class of agents, is used for the treatment of anxiety. Although no congenital anomalies have been attributed to the use of alprazolam during human pregnancies, other benzodiazepines (e.g., see Diazepam) have been suspected of producing fetal malformations after 1st trimester exposure. In pregnant rats, the drug produced thoracic vertebral anomalies and increased fetal death only at the highest dose (50 mg kg) tested (1). Researchers described the effects of alprazolam exposure on gestational day 18 (i.e., near term) on the neurodevelopment of mice in a series of reports (2,3 and 4). In one strain of mice, exposure induced persistent imbalance in the newborn and hind limb impairment in the adult offspring suggesting a defect in cerebellar development (2). In the second part of this study, in utero exposure to the drug (0.32 mg kg orally) did not increase anxiety in adult offspring but did reduce motivation (3). A decrease in the tendency to...

5 Treatment 51 Psychological Treatment

The psychological treatment of choice for clinical anxiety problems is CBT, and there is no theoretical or practical reason why this choice should not extend to perinatal anxiety problems. CBT is a skills-based approach that is derived from an empirically based conceptual model of anxiety. In contrast to psychodynamic or psychoanalytic psychotherapy, CBT is not concerned with intrapsychic conflicts or uncovering the root causes of the patient's problems. In fact, CBT assumes that the causes of anxiety are manifold and cannot be easily determined. As opposed to supportive therapy, which emphasizes giving advice, CBT is a goal-oriented treatment involving the learning of theoretically derived strategies to reverse processes that maintain pathological anxiety. The therapist assumes the role of a teacher or coach, and the patient, the role of student. CBT incorporates homework assignments in which the patient practices the necessary skills between treatment sessions. Here we describe the...

Second trimester 13 to 28 weeks

During the second trimester of her pregnancy, a woman usually starts to feel better. Feelings of exhaustion generally diminish and the traditional 'bloom' of pregnancy takes over. There are, however, a number of minor ailments that may be experienced. Although these are rarely life threatening, they can cause varying degrees of discomfort and anxiety and spoil a woman's enjoyment of her pregnancy.

Survivors of childhood sexual abuse

With increasing awareness of the occurrence of the sexual abuse of children, more women and some men too are willing to come forward and seek help in dealing with the consequences of abuse in childhood. Often women come for help with depression or an eating disorder and later on in the therapy reveal that they were abused. Many women I have worked with have been able to have a sexual relationship with someone where they were very 'detached' or cut off from their feelings but it was when they become involved in a serious relationship that the sexual relationship triggered anxiety, flashbacks or depression. For some women the thoughts of being pregnant and going through labour are terrifying women may fear feeling out of control or are terrified of being examined or touched. These fears can trigger intense anxiety or flashbacks. Many survivors of childhood abuse also worry about their ability to be a parent will they be too over-protective of a child Or they worry about not being able...

Going back to school Classes to take

In order to prepare yourself for labor, you may want to consider taking some birthing classes to find out about breathing, relaxation, and massage techniques that help alleviate the fear, anxiety, and pain associated with labor. Today, a great majority of first-time expectant parents attend childbirth classes. Childbirth education has dramatically changed the average woman's experience of labor and delivery. Today's birthing experience is a far cry from the middle part of the last century, when women were knocked out with anesthesia for the delivery and the expectant father's only job was to pace around the waiting room like Ricky Ricardo anticipating the arrival of Little Ricky. Most contemporary childbirth education classes teach a combination of some of these techniques. The greatest benefit of childbirth classes is probably the opportunity they provide to find out what to anticipate during labor, because a little information goes a long way in reducing anxiety and fear about the...

2 Natural Course Of Bipolar Disorder In Pregnancy

Although there are no systematic data on the effects of untreated manic, depressive, or mixed states on fetal development in patients with bipolar disorder, systematic studies have shown that other forms ofpsychopathol-ogy during pregnancy are associated with adverse effects on offspring. Maternal depression during pregnancy has been associated with preterm delivery and low birthweight (21,22) and anxiety in pregnancy has been associated with an increased risk of both preterm delivery (23) and behavioral problems in early childhood (24,25). Rodent and primate research has shown a link between maternal antenatal stress and persistent impaired behavioral adjustment and emotional reactivity in offspring that is accompanied by changes in hypothalamic-pituitary-adrenal axis functioning (24,26). Thus, it is possible that episodes of mania or bipolar depression during pregnancy could have long-term deleterious effects on the infant. The risks of the impact on the fetus of a woman who...

21111 Barbiturates as sedativehypnotic agents

Barbiturates were the most important hypnotics on the market, prior to the introduction of the benzodiazepines. Today, only phenobarbitone (ph nobarbital) is still in regular use. Recommendation. Phenobarbitone is not recommended as a hypnotic during pregnancy. Sedating antihistamines such as diphenhydramine (see Chapters 2,2 and 2.4) or benzodiazepines are preferred for the treatment of sleeping disorders. Short-term use of phenobaititone Is not an Indication for a termination of pregnancy, and does not require specific prenatal diagnostic procedures. Observation of the neonate for withdrawal symptoms or adaptation problems for at least 2 days is recommended when barbiturates have been used up to delivery.

21113 Zaleplon Zolpidem and zopiclone

Zaleplon, Zolpidem, zopiclone, and eszopiclone are newer drugs with sedative-hypnotic properties, which have an agonistic effect on central benzodiazepine receptors. Chemically, they are not related to benzodiazepines. They usually have a short halflife. A prospective controlled study on 40 first-trimester zopiclone-exposed women found no increased rate of major malformations (Diav-Citrin 1999). There was a normal outcome among 18 Zolpidem-exposed pregnancies (e.g. Wilton 1998). Data for zaleplon and eszopiclone are insufficient to assess the safety in pregnancy. Recommendation. These drugs should not be prescribed for pregnant women. Their inadvertent use is not grounds for termination of pregnancy. Detailed fetal ultrasonography may be considered after first-trimester exposure. The drugs of first choice for sleeping disorders are sedating antihistamines and benzodiazepines.

21116 Other sedativehypnotic drugs

Clomethiazol, melperone, promethazine, scopolamine, and tryptophane should not be prescribed to pregnant women with sleeping disorders. Inadvertent use of these drugs during pregnancy Is not grounds for termination of pregnancy, or for invasive diagnostic procedures. The drugs of first choice for sleeping disorders are sedating antihistamines such as diphenhydramine, valerian, or benzodiazepines.

And Kidney also become deficient Use GB41 on the right side and TE5 on the left side obtain Deqi and leave the needles

When the uterus is contracting, I needle the Penetrating Vessel PC-6 on the right side and SP-4 on the left side, as well as LU-7 and KI-6 to ease the abdominal pain and calm any anxiety in the patient. This treatment was really helpful in Vicki's case and I was able to treat her again 3 days later, when I added further points, BL-17 and 23, to tonify and build up her Blood and Kidney energy. On this occasion I used moxa on the points. I treated the Girdle Vessel points GB-41 on right side and TE-5 on the left side, PC-6 on the right side and LR-3 on the left side. After obtaining Deqi, I left the needles in for 45 minutes. The aim of the treatment was to calm her anxiety and move her Qi. I finished treatment by tonifying BL-23 and KI-6 to nourish her Yin.

Where Should Your Baby Sleep

As your baby grows, you may want to let her share a room with another child or move her to a room of her own. Your decision will depend on practical questions and the space in your home. Unless you are planning to continue sharing your room with the baby, it's usually easier to move her to her permanent room if you do it during the first six to nine months. After that, separation anxiety may make it harder for your baby to sleep alone until she is about two years old.

Nightmares Monsters in the Night

Nightmares are as inevitable a part of childhood as skinned knees. How early they start is unknown, but children describe dreams as soon as they can talk. In young children, they generally are thought to reflect psychological tasks or conflicts that are a normal part of growing up, such as separation anxiety or competing desires to be in control and to please parents. Preschoolers typically have nightmares about monsters or wild animals, which are thought to represent the child's aggressive urges.

11 Treatment Guidelines

Women who are breast-feeding and are on medications must be made aware that all psychotropics, including antidepressants as well as mood stabilizers and benzodiazepines, are secreted in the breast milk at varying concentrations (116). Although consideration of the mood stabilizer may be based on the patient's clinical status and past response, regardless of breast-feeding status, it is important to consider the effect to exposed infants if lactation is a concern (144). Both valproate and car-bamazepine are considered compatible with breast-feeding by the AAP, although in general the recommendations made by the AAP and

Healthy Adaptations To New Media

Rather than rationally analyzing how young people consume New Media in the contexts oftheir larger lives, culture warriors imagine the most objectionable images must be driving adolescents to act in the worst ways. However, Kaiser Family Foundation's study of 2,000 American youth, Generation M Media in the Lives of 8 to 18-Year-Olds, though suffused with an undertone of anxiety, nonetheless suggests young people are successfully integrating modern media into their lives without descending into wastage and mayhem. Kaiser begins by noting the ubiquitous use of modern media by young people

2164 Injectable anesthetics

Ketamine (Ketalar) is a fast-acting anesthetic agent that has a good analgesic effect and little effect on respiration. There are no epidemiologic studies in man evaluating its possible effects on fetal development. Due to its enhancement of sympathomimetic sensitivity. ketamine administration can be associated with marked cardiovascular effects such as increased heart rate and blood pressure. Ketamine increases the uterine tone and the frequency of uterine contractions in a dose-related fashion (Krissel 1994). High doses may depress fetal functions and hence distort fetal monitoring during parturition (Baraka 1990, Reich 1989). Use of ketamine during cesarean section has in several cases led to clinically important panic disorders, which restricts its use during birth. In addition, neonatal behavioral alterations, including reduction in sucking.

Timing Of The First Ultrasound Scan

The timing of the first trimester scan is important. If carried out too early is will lead to inconclusive results and increased anxiety. Some units in the United Kingdom do not offer ultrasound scans to women in the first trimester until after 7 weeks' gestation. Such a policy sets a dangerous precedent as one cannot rely on the last menstrual period to determine whether a woman should undergo a scan or not, not to mention the fact that many ectopic pregnancies present before this gestation. In a recent study, women with lower abdominal pain and a history of ectopic pregnancy presented at a mean gestation of 20 days 1

Indications For Prenatal Cytogenetic Diagnosis

The criteria for determining at what age to offer amniocentesis were derived largely from several surveys (61,62). Most centers in the United States now offer amniocentesis to women who will be over 35 at the time of delivery. However, this cutoff reflects the age at which the risks for the procedure are balanced by the risks of finding an abnormality. Increasing numbers of younger patients request amniocentesis because of maternal anxiety. Table 5-1 lists estimated maternal age-specific risks for trisomy 21 and other chromosome anomalies. It has been estimated by Hook and colleagues that 30 of trisomy 21, 68 of trisomy 18, and 43 of trisomy 13 fetuses are lost during the first half of pregnancy. This accounts for the greater detection rate of chromosome abnormalities at prenatal diagnosis (CVS and amniocentesis) than at term (63).

Getting to know your new baby bondingattachment

As well as issues that you bring to the relationship, there are also factors to do with the baby. If your baby is born healthy and a good size, begins to feed quite easily and sleeps a lot, you are much more likely to feel relaxed and able to respond to your baby and in turn feel that you are making a reasonable start at being a mother. However, if the baby seems to come out screaming or doesn't seem to want to feed, you are more likely to feel anxious, miss the signs that the baby is giving you and start to feel scared and uncertain about your ability to look after the baby. Feeling close to the baby is going to be hampered by feeling overwhelmed by the needs of the baby. Should your baby be in an incubator, you may find it much more difficult to obtain the closeness with the baby and to manage your fears about what is happening to him. You will be encouraged, however, to feed your baby and hold him as much as is possible.

The role of the acupuncturist

Face, brow and shoulder presentation are all self-explanatory terms that you may hear used to describe abnormal head-first deliveries, and they are described briefly here for information. They all carry complications and are sometimes hard to diagnose when the midwife or doctor palpates. You may see these diagnoses written in the notes, or your patient may be admitted to hospital because of them. As an acupuncturist, there is little you can do to treat these conditions directly, but you can of course help to relieve any anxiety and stress they might cause to the mother. It is also important that you are familiar with the terminology so that you have a greater understanding of what is happening in a complicated labour. In all cases, even if complications are not previously diagnosed, labour would begin normally. You would therefore use the same acupuncture treatments as for a normal delivery. You are most likely to become aware that there is a problem following the midwife's vaginal...

Is There Help Available

In KK hospital, a mental wellness service has been set up to help grieving mothers cope with their pregnancy loss better. Comprising of a psychiatrist, psychologist and a medical social worker, it aims to provide a holistic approach to grieving mothers. There is even a support group known as the Perinatal Depression and Anxiety Support and Education Group set up. More information can be obtained through our hotline at ( + 652) 6394 3739.

Clinical Features Postpartum Blues

During the first week after the birth of a child, many women experience a brief period of affective instability, commonly referred to as postpartum blues or the baby blues. Depending on the criteria used to diagnose the blues, it appears that about 50 -85 of women experience the blues (Kennerly and Gath 1989 Pitt 1973). Given the high prevalence of this type of mood disturbance, it may be more accurate to consider the blues a normal experience associated with childbirth rather than a psychiatric disorder. Women with postpartum blues report a variety of symptoms, including a rapidly fluctuating mood, tearfulness, irritability, and anxiety (Kennerly and Gath 1989). These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within 2 weeks of delivery. However, some women with more severe blues may go on to develop PPD (Beck 1996 Henshaw et al. 2004).

Problems of Special Concern

About 1 in 750 babies born in the United States has fetal alcohol syndrome (FAS), the most severe form of damage. These children generally are small and may have small heads, delayed development, specific birth defects, poor motor skills, poor memory and language comprehension skills, an inability to understand concepts such as time or money, and behavioral problems such as impulsiveness and anxiety.

Postpartum Depression

Anxiety symptoms may be prominent in this population, and women may present with generalized anxiety, panic disorder, or hypochondriasis (Hendrick et al. 2000 Ross et al. 2003 Wenzel et al. 2003). In one study, 30 of women diagnosed with PPD also met criteria for an anxiety disorder, most commonly generalized anxiety disorder (Nonacs and Cohen 2001). Although comorbid obsessive-compulsive disorder is not common, women with PPD frequently experience intrusive, obsessive ruminations (Wisner et al. 1999). These obsessions frequently involve the child and often are violent in nature (e.g., thoughts about smothering the infant, dropping the baby down the stairs, or throwing the child out the window). It is important to note that these thoughts are ego-dys-tonic women are very distressed by these thoughts and appear to go out of their way to ensure their child's safety. In contrast to

FollowUp Activities in Msafp Screen Positive Patients

Counseling and follow-up should be offered and implemented as soon as possible after a patient is alerted to a screen-positive result, because of the anxiety that such a report often provokes (see Psychological Impact of Prenatal Screening below). Whereas amniocentesis with subsequent AFAFP testing remains the best diagnostic procedure, less invasive ultrasound examinations are now frequently the follow-up procedure of choice. The procedures outlined here may be offered to patients coincidentally.

New Toy for Time Away from Home

To make going to the hospital for treatment or an overnight stay less anxiety-filled, buy a small toy and wrap it up before your day of departure. Give it to your child once you arrive the excitement of opening a gift will be fun, and the new toy will hold her attention while registering or waiting for the doctor or nurse. When packing to go to the hospital, pack some items to make your child's stay more comfortable. It's fine to bring your child's own nightgown or pajamas. Make sure they are short-sleeved so that they don't need to be rolled up for blood pressure checks, intravenous lines, or blood tests. Sometimes after surgery, your child will need to wear a hospital gown so doctors have better access to what they need to see and examine, but his own bathrobe will give him something warm and familiar to wear. For young children, it is helpful to bring a doll or stuffed animal, especially one with arms and legs like a teddy bear. When someone comes in to check vital signs, like...

44 Treatment for Alcohol Withdrawal Symptoms

Alcohol-dependent women who suddenly cease drinking may experience withdrawal symptoms that could be threatening to the mother, particularly if she has a history of withdrawal delirium or seizures. An additional concern is that alcohol withdrawal may also cause fetal distress. If a woman is experiencing alcohol withdrawal symptoms, inpatient detoxification is recommended. Most programs treat alcohol withdrawal in pregnant women with benzodiazepines. Benzodiazepines were previously thought to increase birth defects however, recent studies have not supported this claim. Pooled data from cohort studies show no association between brief fetal exposure to benzodiazepines and the risk of major malformations or oral cleft (31,32). However, benzodiaz-epines can cause neonatal hypotonia, hypothermia, and mild neonatal respiratory distress when taken in late pregnancy or around the time of delivery (33).

5 Maternal Marijuana

In recent years, the concentration of the major psychopharmaco-logically active component of cannabis, tetrahydrocannabinol (THC), has increased, as have reports of adverse effects. The increase in THC is a result of plant selection and cultivation changes (38). Short-term adverse effects of marijuana use include memory and learning problems, distorted perception, and difficulty with problem solving. Psychiatric symptoms associated with marijuana use include anxiety, depression, paranoia, and psychosis (39,40).

So what is puerperal psychosis

Again, this is a condition that usually develops very rapidly after the baby is born. It may initially look like just the normal emotional struggles after having a baby. The mother may seem very anxious or agitated or tearful but, rather than subsiding, usually these symptoms escalate very rapidly. There are many different ways that these problems may present but quite quickly it becomes clear to those around the mother that her mental state is quite severely affected.What may start off as a fairly trivial anxiety about the baby may rapidly develop into an unshakeable delusion. For example, an initial concern about the baby's features may develop into an idea that the baby is a devil.The symptoms can be very varied but usually there is an initial 'manic' or excitable phase. The mother's ideas may be racing, her

8 Maternal Opioid

Heroin is processed from morphine, a naturally occurring opiate extracted from poppy plants. It is sold illegally, often tied in the ends of small balloons. Common street names for heroin include smack, dope, H, China white, black tar, and junk. Heroin can be smoked, sniffed, or injected intravenously or intramuscularly. After an injection, the user experiences euphoria, relaxation, warmth, and an absence of anxiety. Because the duration of action is 4-6 h (72), users tend to use it two to three times a day. The signs of heroin use include drowsiness, itching, pinpoint pupils, loss of appetite, slowed breathing, and constipation. Death in chronic intravenous heroin users is often the result of overdose. Heroin users are also at risk for developing collapsed veins, endocarditis, abscesses, cellulitis, HIV, AIDS, and hepatitis (73). The hallmarks of opiate dependence are tolerance and withdrawal upon cessation. Some women use heroin in combination with prescription opioid medications to...

21117 Psychoanaleptic drugs

Bonnot O, Vollset SE, Godet PF et al. Maternal exposure to lorazepam and anal atresia in newborns results from a hypothesis-generating study of benzodiazepines and malformations. Psychopharmacol 2001 21 456-8. IJolovich LR. Addis A. Hegis Vaillancourl et al. Benzodiazepine use in pregnancy and major malformations or oral cleft meta-analysis of cohort and case-control stud ies. Br Med ) 1998 317 839-43. Eros E, Czeizel AE, Hockenbauer M el al. A population-based case-control study of nitrazepam, medazepam, tofisopam, alprazolam and clonazepam treatment during pregnancy. Eur Obstet Gynecol Reprod Biol 2002 101 147-54. Hostetter A, Stowe ZN. Strader JR et al Dose of selective serotonin reuptake inhibitors across pregnancy clinical implications. Depress Anxiety 2000 11 51-7. Iqbal MM, Sobhan T. Ryals T. Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatric Services 2002 53 39-49. Lin AE, Peller AJ, Westgate M-N et al. Clonazepam use in...

Depressive Symptoms During Pregnancy

Regardless of illness history, the emergence of depressive symptoms during pregnancy significantly increases the likelihood of PPD, and depression during pregnancy remains one of the most robust predictors of postpartum illness (Beck 2001 O'Hara 1986 O'Hara et al. 1984). One study demonstrated that women who were depressed at 18 weeks of gestation had a threefold greater risk of PPD than women who were euthymic during pregnancy (Heron et al. 2004). For women who were depressed at 32 weeks, the risk was sixfold higher. This study also demonstrated that anxiety during pregnancy significantly increases the risk of PPD.

184 exercise and lactation

Physical activity at any stage of the life cycle is associated with a decreased prevalence of cardiovascular disease, colon cancer, type 2 diabetes, and overweight, and it decreases mortality rates from all causes. Specifically in lactation, regular activity improves cardiovascular fitness, plasma lipid levels, and insulin response 14 . Regular activity also has the potential to benefit psychosocial well-being in lactation, such as improving self-esteem and reducing depression and anxiety. Other potential benefits include promotion of body weight regulation and optimizing bone health. Engagement in regular activity by the mother may also encourage the same in her offspring, promoting a healthy lifestyle and body weight management for the entire family.

What does it feel like

Often post-natal sadness manifests itself as extreme anxiety, particularly about the baby or about some aspect of the birth or the mother's labour or recovery. Jenny, whose story was in the last chapter, became preoccupied with Hannah's milk intake to the detriment of everything else. Clearly, for many women these issues are very real but if you become preoccupied with your labour difficulties to a point where you can't get on with your life with the baby, then perhaps there are problems to be looked at in more depth.

The Impetus to Lower the FPR

Screen-positive results cause anxiety (178-181) for both the patient and provider (3,174). In a survey assessing provider and patient response to maternal serum screening, half of the physicians responding cited the high screen-positive rate as the aspect they most wanted to change (174). The same majority of physicians also wanted the detection From a public health perspective, the cost of follow-up services must be in balance or in proportion to the cost of care related to the disorder. In screening for fetal Down syndrome, the usual panel of follow-up services includes genetic counseling, an ultrasound examination perhaps in the context of an amniocentesis procedure, karyotyping, and further counseling about the result or further services. Because most screen-positive reports are false-positives (Table 5), there is an economic opportunity to invest in a better front-end screening procedure and recover the cost from the reduction in volume of follow-up services (Table 6). The...

Prophylactic Interventions

Women are at lower risk for puerperal illness while others appear to be at higher risk for puerperal decompensation and are candidates for some type of prophylactic intervention. All women, regardless of illness history, should be monitored for mood symptoms during the postpartum period. Women with pregravid histories of a mood or anxiety disorder are clearly at higher risk and should be closely monitored for recurrent symptoms during the postpar-tum period. Women with histories of recurrent major depression or those who have experienced depressive symptoms during pregnancy may also benefit from antidepressant prophylaxis. Although a less aggressive, wait and see approach is appropriate for women with no history of postpartum psychiatric illness, women at highest risk for postpartum affective illness those with bipolar disorder or histories of postpartum psychiatric illness deserve not only close monitoring but also specific prophylactic measures.

Getting help with postnatal problems Admitting that something is wrong

For many women it takes a while to acknowledge that there is a problem. There is often the feeling that 'Well, I just need a good night's sleep'and everything will be OK. It may be that you are so consumed with anxiety about how the baby is doing or so preoccupied with trying to sort out a 'routine' for the baby that you fail to notice that you are crying every few moments.

Explanation Of Condition

Some degree of emotional lability and anxiety during pregnancy is normal. Sleep deprivation is common. However this needs to be differentiated from depressive and anxiety disorders occurring during this period5. Most first-onset conditions are mild depressive and anxiety disorders, and the cause is commonly psychosocial6 - depressive and anxiety disorders - obsessive compulsive disorder Common psychosocial factors associated with mild antenatal depressive and anxiety symptoms are9 Any depression or anxiety during pregnancy that is unrecognised and untreated increases the risk of suicide during the last trimester4.

171 Antenatal Psychiatric Disorders 209

Persistent anxiety and depressive symptoms affect the woman's general health and satisfaction with pregnancy. The increased production of maternal and fetal cortisol in these patients may also be associated with increased uterine artery resistance which may result in11,12 Mild to moderate depressive and anxiety symptoms are the most frequent psychiatric problems in pregnancy and may be managed in primary care Anxiety management techniques may be useful in anxious women Discuss methods of support for labour pain to reduce anxiety Increased anxiety and agitation

195cultural perspectives of postpartum depression

Horowitz and colleagues 22 conducted focus groups with mothers between 2 and 4 months after delivery in nine different countries the United States, Australia, Finland, Guyana, India, Italy, Korea, Sweden, and Taiwan. How mothers described their postpartum depressive symptoms was remarkably similar across these countries. Common cognitive symptoms reported included poor concentration, worry, and indecisiveness. The most frequently cited emotional symptoms were anger, irritability, depression, sadness, guilt, anxiety, loneliness, fear, inadequacy, and tearfulness.

196postpartum depression risk factors

Results of individual studies in which predictors of this crippling mood disorder were investigated have been summarized in four meta-analyses 23-25 . In Beck's 23 meta-analyses the following risk factors for postpartum depression were significant prenatal depression, self-esteem, child care stress, life stress, social support, prenatal anxiety, maternity blues, marital satisfaction, history of previous depression, infant temperament, marital status, socioeconomic status, and unplanned unwanted pregnancy. Prenatal depression was one of the strongest risk factors. O'Hara and Swain's 24 and Robertson's et al. 25 metaanalyses corroborated the predictors identified by Beck 23 . The strongest predictors of postpartum depression reported by O'Hara and Swain 24 were psychopathology history and psychologic disturbance during the prenatal period, poor marital relationship, low social support, and life stressors. In the most recent meta-analysis, Robertson et al. 25 also reported that the...

199effects of postpartum depression on child development

Whose mothers had not experienced postpartum depression. Halligan et al. 41 recently published findings from their longitudinal study. Thirteen-year-olds whose mothers had suffered from postpartum depression were at an increased risk for depression if their mothers had later episodes of depression following the postpartum period. Anxiety disorders in these adolescents were increased in the group whose mothers had been postpartum depressed regardless of whether their mothers had suffered from subsequent depressive episodes.

487 Recommendations classical anticonvulsants

Antiepileptic therapy with the barbiturates, clonazepam and ethosux-imide should be considered problematic during breastfeeding. If treatment is unavoidable, the decision to breastfeed should be made individually, and the infant should be observed for symptoms such as weak suck, vomiting, and tiredness. Where there is a suspicion of side effects, the concentration in the infant's serum should be determined and a decision taken regarding whether formula should be added to reduce drug transfer via mother's milk, or the baby should be weaned. Anticonvulsive combination therapy with barbiturates, clonazepam or ethosuximide is not compatible with breastfeeding.

493 Selective serotonin reuptake inhibitors

Up to 94 of fluoxetine and its active metabolite norfluoxetine is bound to plasma protein. The half-life of fluoxetine is 4 days that of norfluoxetine is 7 days. The M P ratio is 0.25. Experience with 16 mother-baby pairs in two studies showed that the relative dosage of fluoxetine plus norfluoxetine taken in by the breastfed baby was, on average, 6.5 , with a maximum of 17 . The children were unremarkable (Yoshida 1998A, Taddio 1996, Burch 1992). Another case report described an infant with screaming attacks, watery stools, and increasing vomiting, whose symptoms disappeared when he changed to artificial feeding. When he was put to breast again, the symptoms reappeared (Lester 1993). The mother took 20 mg fluoxetine daily. A relative dosage of around 8 , including norfluoxetine, was calculated. Therapeutic concentrations (340 ng 1 fluoxetine and 208 ig l norfluoxetine), such as would be expected in an adult taking 20 mg, were found in the serum of the 10-week-old baby. In an...

1915antidepressants and breastfeeding

The clinicians of breastfeeding women diagnosed with postpartum depression must consider the different treatment options for their patients including antidepressants, hormonal therapy, or psychotherapy. In situations where the postpartum depression requires antidepressants, the safety of the nursing infant must be considered. Antidepressants taken during breastfeeding can induce adverse symptoms in the infant. The antidepressants that have been particularly problematic are nefazodone 102 , citalo-pram 103 , doxepin 104, 105 , and fluoxetine 106, 107 . Given the negative infant outcomes associated with maternal antidepressant therapies, the US Food and Drug Administration (FDA) has not approved any antidepressant for use during lactation 49 . Alternatively, depression during the postpartum period can impair maternal-infant interactions 108 , which in turn negatively affect infant cognitive development 109 , emotional development 109 , anxiety, and self-esteem 110 . In some cases, the...

The role of the midwife

For many women, the midwife will be the first port of call after the birth for support, information and advice. The midwife is well placed to monitor the physical and mental well-being of both mother and baby, help with the establishment of feeding, whether breast or bottle, help give the new mother confidence, offer general health education and ensure that the mother's recovery is progressing well. The midwife will make daily observations, which will include assessing whether the mother is getting adequate sleep and rest. This is considered a priority, as lack of sleep can quickly lead to anxiety and depression. Other observations she makes will include

Other People Can Drive You Crazy

We realize these people usually have only good intentions when they tell you how their sister's pregnancy ended badly, or about the trouble a friend of a friend had. They don't realize that they're increasing your anxiety. Don't pay attention. Try to politely smile and ignore them. Tell them you really don't want to hear this story right now. If you have any real problems or concerns, talk them over with your practitioner.

Mental Illness in Postpartum Women Spectrum of Psychiatric Conditions

The treatment of mental illness during lactation represents a complicated clinical situation that involves the health and well-being of at least two individuals, the mother and the child. The question regarding use of medications during lactation is one of relative safety that must consider both the safety of available therapies and the impact of maternal illness. Numerous laboratory and clinical investigations have demonstrated that maternal depression, anxiety, and stress can produce a wide spectrum of adverse effects on the offspring. Coyne 1990), delayed motor development (Galler et al. 2000), poor interpersonal interactions (Jameson et al. 1997), lower self-esteem (Downey and Coyne 1990), more fear and anxiety (LyonsRuth et al. 2000), greater aggression (Jameson et al. 1997), and insecure and disorganized attachment behaviors (Martins and Gaffan 2000). Long-term investigations have demonstrated increased emotional instability, suicidal behavior, and behavioral problems in...

72 Preschool Children

In this example, the increasing severity and chronicity ofJoan's symptoms and problematic parenting style was mirrored by the development of symptoms in her daughter, including sleep problems, tantrums, and difficulties in toilet training. Recent research also shows this correlation between severity and chronicity of maternal symptoms with more child symptoms in the preschool years, even when demographic risk factors were controlled for (e.g., ref. 133). Preschool-aged children may exhibit behaviors that mirror the ill parent's symptoms, including lethargy or anxiety, which may be expressed as phobias and fears. Additionally, if the child's environment (including mother and other caregivers) has not provided enough cognitive stimulation (57), preschool-aged children may demonstrate cognitive and motor delays (89,113).

Clinical Decision Making

Egorizations that often do not reflect the current literature and as such are of limited utility in treatment planning. Instead, the discrepancy between the published data and these guidelines establishes an arena of discrepant opinions that potentially invites increased medicolegal liability and increased clinician and patient anxiety. An ethical question warrants consideration Should the infants of women with mental illness and the women themselves be deprived of the potential benefits of breast-feeding secondary to their mental illness

Do men get morning sickness too

Although the physical symptoms highlighted above should be common only to women, it may be that partners too experience unpleasant thoughts and feelings in early pregnancy. The early pregnancy does impact far less on the father partner and probably he is going to be less troubled now by worries about becoming a parent. However, some may find themselves anxious and confused.Where perhaps this is not understood as 'anxiety', this may result in physical symptoms in the partner. As we have said in relation to women we cannot be sure that all of the physical symptoms of morning sickness are generated hormonally, therefore, worries in the partner may lead to feelings of nausea, headaches and pains, and so on. More often than not, anxiety can lead to behavioural changes or what Psychologists might call 'acting out'. The news of a pregnancy may lead the partner to increase alcohol or drug use. He might stay out more, stay at work later or be more argumentative. Relationships are often...

Maternal Physiological Responses To Exercise In Pregnancy

The physiologic purpose of this state of hyperventilation in pregnancy is to reduce arterial pCO2 while the arterial pH is maintained at 7.44. This mild maternal alkalosis facilitates placental gas exchange. The combined alterations could be reduced or compromised, primarily during strenuous exercise, and result in a lower oxygen reserve.

197 phenomenology of postpartum depression

Loss of control is the basic problem women grapple with when suffering from postpartum depression 29 . Mothers try to resolve this loss of control in a four-stage process as outlined in Fig. 19.1 29, 30 . In the first stage, mothers are bombarded with horrifying anxiety, relentless obsessive thoughts, and difficulty concentrating. In the second stage, women feel that their normal selves are gone. The women describe feeling unreal, like they were just robots going through the motions caring for their infants. In this stage, women often isolate themselves and may begin to contemplate harming themselves. The third stage involves women strategizing ways to survive postpartum depression, including battling the health care system to get appropriate mental health treatment, prayer, and seeking solace in postpartum depression support groups. In the final stage, women finally regain control of their thoughts and emotions as their depression lifts. During this transition period, mothers...

Addictive Disorders

Laegried L, Olegard R and Walstrom JNC 1989 Teratogenic effects of benzodiazepine use during pregnancy. The Journal of Pediatrics, 114(1) 126-131 11. Teixeira JMA, Fisk NM and Glover V 1999 Association between maternal anxiety in pregnancy and increased uterine artery resistance index cohort based study. British Medical Journal, 318 153-157 12. O'Connor TG, Heron J, Golding G, Beverdige M and Glover V 2002 Maternal antenatal anxiety and children's behavioural emotional problems at 4 years Report from the Avon Longitudinal Study of Parents and Children. British Journal of Psychiatry, 180 502-508

Cosmetic Lies About Girls

Even if America's New Girl is healthier, saner, safer, happier, and dramatically more accomplished by nearly every major index, do subtler psychological trends show she's sicker today Let us get to the sexuality-centered issue of modern worries about girls' attitudes body image. In Courtney Martin's unhappy world, crushing anxiety about inadequate bodies is what the large majority of girls and young women 11 wake up in the morning to walk around all day resisting go to bed sad and hopeless about (emphasis hers). This sort of anxiety supports traditionalists' views that females are too fragile to assume larger roles in society and should be confined safely to the kitchen. Teens and 'tweens are perhaps open to altering or branding their bodies than adults, Quart continues. Utterly false. The American Society for Aesthetic Plastic Surgery's statistics show (Table 8.5) that girls under age 19 obtain fewer than 2 percent of all cosmetic procedures, a declining number, and even these mostly...

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