Antidepressants in pregnancy and breastfeeding

Copyright © 2007 Australian Prescriber Reproduced with permission from Australian Prescriber The document attached has been archived with permission from the publisher/copyright holder.Maternal depression and anxiety during pregnancy and the early years of an infant's life cause substantial problems to the mother, her infant and her family. Suicide is an ever-present risk with depression along with adverse effects on infant growth and birth weight. Balancing these risks against accumulating evidence of the effects of selective serotonin reuptake inhibitors on the fetus and infant presents a challenge to the treating doctor. Careful explanation to the woman and her partner of the risks of both the condition and the treatment, using a biological, psychological and social treatment approach, is likely to provide the most benefit.Anne Sved William

Counselling in graphics - Visual aids for distressed patients and their doctors

Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.Distressed patients present to their general practitioners with a range of information which may overwhelm both patient and doctor. This article provides visual aids which give structure to counselling sessions, providing a grounding for both patient and doctor. Case studies are presented that demosntrate the use of these aids in counselling sessions.Anne Sved-Williams; Helen Roxburg

Increasing knowledge, increasing hope for infants?

Anne Sved-William

Family therapy and infant mental health: natural partners

Article first published online: 23 JUL 2013As science identifies the importance of interplay between an infant's innate potential and the experiences of the first two years of life for life-long brain development, infant mental health as a discipline in its own right is burgeoning. Family therapists with their knowledge of systems theory are well-placed to become specialised in this field. In this article, following discussion of definitions and ‘territories’, brief descriptions of the history of attachment theory and attachment behaviours lead to summaries of current work where family therapy and infant mental health overlap. Although definitive evidence of effectiveness of family interventions remains sparse, the vital benefits of ensuring appropriate home and cultural environments for our infants through family and community interventions is likely to be demonstrated in the next decades. Earliest intervention and preventive interventions are likely to be the most rapid and the most potent.Anne Sved-William

Linking adults' problems with children's pain: Legal, ethical and clinical issues

The focus of this article is on families with both parental mental health issues and child protection concerns, a common clinical situation. Ethical dilemmas can arise from conflicting laws in a particular jurisdiction. This is evident in the State of South Australia,Australia.The issue is highlighted by examining the Mental Health Act 1993 (SA), the Children’s Protection Act 1993 (SA) and Mental Health Act 2009 (SA). In developing a family approach where a parent has a mental illness and where statutory child protection concerns exist, both the Mental Health Act and the Children’s Protection Act are needed to inform the clinical decision making for family members. Clinical, ethical, and legal issues are discussed. Two ethical models: Relational Ethics and Co-operation Despite Disagreement put forward the need for services to develop meaningful dialogue and collaborative practice. Professional codes of ethics need to address these complex, pluralistic ethical issues.Ruth Lange and Anne Sved William

Supporting mental health in the community: new systems for general practice

General practitioners (GPs) manage nearly one-third of Australians seeking help for mental health problems, and frequently express their need for consultant psychiatric support in this work. The introduction of new Medical Benefits Schedule Item Numbers 291 and 293 to provide "one-off" psychiatric assessments on referral from GPs offered the potential for providing this support, and a single point-of-entry scheme was organised to provide ease of access to appointments. The aims were to establish a single point of entry for psychiatrist assessment using Item 291, to evaluate the take-up rates of Item 291 in South Australia (SA) through this service and to evaluate the acceptability to GPs and psychiatrists of a psychiatric primary care consultation-liaison (c-l) model. Results were: 26 psychiatrists joined the project; 64 GPs referred 78 patients for assessment, providing 24% of the Australian take-up rate for Item 291, for 8% of the population; evaluation showed high approval ratings from GPs who particularly appreciated the single contact point; and positive evaluation by psychiatrists of the primary care c-l model. The conclusions were that a single contact point provided ease of access to psychiatrists for GPs; GP and psychiatrist groups evaluated Item 291 very positively; and consumer and carer evaluation are essential for further primary care c-l development.</jats:p

Primary care mental health consultation-liaison: a connecting system for private psychiatrists and general practitioners

ObjectiveThe aim of this study was to describe and evaluate a service that provides a single point-of-entry for general practitioners (GPs) wishing to refer their patients for one-off psychiatric consultations, using a new Medicare Item, number 291.MethodStatistics of all referrals made through a single access point used by GPs for referral to psychiatrists were collated, as well as data regarding psychiatrists' provision of appointments. GPs using the service were surveyed after 28 months of operation.ResultsBoth GP and psychiatrist user groups were predominantly positive about their experience of a system that provided ease of access for GPs and appropriate use of psychiatric expertise. Use of the service rose from six referrals per week to 10 per week during the survey period. Fifty-five percent of psychiatrists who joined the service continued to provide appointments on a regular basis.ConclusionA single access point for GPs to access patient appointments to private psychiatric consultants is a simple and acceptable mode of increasing access for many patients to expert assessment and management plans.Anne Sved-Williams and Jill Poulto

How acceptable are one-off consultations for consumers? Further information on Item 291

Objective: The aim of this paper is to evaluate consumer and carer views of one-off psychiatric assessments, Item 291 in the Australian Medicare system. Method: Following general practitioner referral to a psychiatrist, consumers were invited to enrol in this study and provide: demographic data; a one-off face-to-face recorded interview 6–8 weeks following psychiatric assessment; and longitudinal assessment of their mental health, using the DASS, K10 and WHOQoL (prior to psychiatric assessment, 6–8 weeks after assessment and 3–4 months later). Results: Consumer and carer enrolment were very difficult to obtain. Sufficient consumers (8) enrolled to provide meaningful qualitative data. Most had good mental health literacy, had severe and chronic mental health problems, and appreciated the opportunity to access a mental health expert and receive a management plan. Overall, GPs had appropriately informed consumers of the process. Following assessment, the GP and consumer were implementing the suggested management plan. Negative statements included instances of failure to improve, insufficient appointments with the psychiatrist, and concern with GP follow-up. Conclusion: One-off psychiatric assessments using Item 291 appear highly acceptable to referred consumers. Qualitative outcomes showed trends towards an improvement in mental health, in an appropriate target group.Anne Sved Williams, Christina Sougleris and Cate Howel

Evaluation of antenatal and postnatal support to overcome postnatal depression: a randomized, controlled trial

Article first published online: 2 APR 2007This randomized, controlled trial tested the hypothesis that women identified as more vulnerable to developing postnatal depression who attended two specific antenatal groups and one postnatal group have a reduced frequency of postnatal depression from 37 to 15 percent at 6 weeks, 12 weeks, and 6 months postpartum. A modified antenatal screening questionnaire was completed, and women identified as more vulnerable to postnatal depression were stratified by parity and randomly allocated to receive extra support groups or to a control group. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect postnatal depression. Attendance at the support groups was low, 31 percent overall. At six weeks, in the intervention group, 8 (13%) of 64 women scored high (>12) on the EPDS, compared with 11 (17%) controls. Similarly, at 12 weeks 7 (11%) of 63 versus 10 (15%) of 65 women scored higher than 12, and at 6 months, 9 (15%) of 60 versus 6 (10%) of 64 women scored higher than 12, indicating that the intervention did not reduce postnatal depression. It is possible that the method of applying the intervention, using groups separate from the standard antenatal classes, may have affected attendance. More research is required into ways of reaching and supporting women who may become depressed.Georgina E. Stamp, Anne Sved Williams, and Caroline A. Crowthe