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The Royal College of Psychiatrists Improving the lives of people with mental illness

Antenatal and Postnatal Mental Health: The NICE Guideline on Clinical Management and Service Guidance

National Collaborating Centre for Mental Health (NCCMH)


Price: £35.00

College members' price: £31.50

Published: Oct 2007

Format: Paperback + free CD-ROM

Number of pages: 369

ISBN: 9781854334541

Antenatal and Postnatal Mental Health: The NICE Guideline on Clinical Management and Service Guidance

This guideline, commissioned by the National Institute for Health and Clinical Excellence (NICE), covers the care and treatment of women with mental health problems during pregnancy and the first postnatal year. This includes depression, anxiety disorders, and severe mental illnesses such as bipolar disorder and schizophrenia.

The impact of mental disorders on women, their infants and other members of their family can be greater during pregnancy and the postnatal period than at any other time. It is therefore of great importance that any problem is recognised and managed quickly and safely. The guideline sets out clear recommendations, based on the best available evidence, for healthcare staff on how to work with pregnant and breastfeeding women to significantly improve their treatment and care.

This book brings together all of the evidence that led to the recommendations in the guideline. It provides an overview of how mental health problems manifest during pregnancy and post-natally and covers prediction and detection, prevention, and psychological and pharmacological interventions for specific disorders, including balancing the risks and benefits of drug treatment during pregnancy and while breastfeeding. The guideline also encompasses the organisation of perinatal mental health services, making it the first of its kind to fully integrate the clinical and service aspects of care into a single volume. The book is illustrated by women’s experiences of mental health problems, treatment and services.

“One in seven women will have some kind of psychological problem during the antenatal and postnatal periods and it is absolutely vital that healthcare professionals, including midwives and health visitors, are able to identify those women who are at risk of developing a mental health problem during pregnancy and after giving birth. This guideline is an indispensable tool to aid professionals in that endeavour."
- Dr Gwyneth Lewis, National Clinical Lead for Maternal Health and Maternity Services and Director of the Maternal Deaths Enquiry for CEMACH


NICE Mental Health Guidelines

These guidelines from the National Institute for Health and Clinical Excellence (NICE) set out clear recommendations, based on the best available evidence, for health care professionals on how to work with and implement physical, psychological and service-level interventions for people with various mental health conditions.

The book contains the full guidelines that cannot be obtained in print anywhere else. It brings together all of the evidence that led to the recommendations made, detailed explanations of the methodology behind their preparation, plus an overview of the condition covering detection, diagnosis and assessment, and the full range of treatment and care approaches.

The accompanying free CD-ROM contains all the data used as evidence, including:

  • Included and excluded studies.
  • Profile tables that summarise both the quality of the evidence and the results of the evidence synthesis.
  • All meta-analytical data, presented as forest plots.
  • Detailed information about how to use and interpret forest plots.

Full Contents

Guideline Development Group Membership

 

1. EXECUTIVE SUMMARY

1.1 Principles of care for all women with mental disorders during pregnancy and the postnatal period

1.2 Prediction, detection and initial management of mental disorders

1.3 Prevention of mental disorders

1.4 Care of women with a mental disorder during pregnancy and the postnatal period

1.5 The organisation of services

1.6 Research recommendations

 

2. INTRODUCTION

2.1 National guidelines

2.2 The national antenatal and postnatal mental health guideline

2.3 The structure of this guideline

 

3. METHODS USED TO DEVELOP THIS GUIDELINE

3.1 Overview

3.2 The scope

3.3 The Guideline Development Group

3.4 Clinical questions

3.5 Systematic clinical literature review

3.6 Health economics review strategies

3.7 Stakeholder contributions

3.8 Testimonies from women with mental disorders in the antenatal and postnatal period

3.9 Validation of this guideline

 

4. ANTENATAL AND POSTNATAL MENTAL HEALTH: POPULATION, DISORDERS AND SERVICES

4.1 Scope of the guideline

4.2 Mental disorders during pregnancy and the postnatal period

4.3 Incidence and prevalence of perinatal disorders

4.4 Aetiology of antenatal and postnatal mental disorders

4.5 Consequences of mental disorder during pregnancy and the postnatal period

4.6 Treatment in the NHS

4.7 The economic burden of mental disorders in the antenatal and postnatal period

4.8 Explaining risk to women: helping patients to make decisions about treatment

 

5. THE PREDICTION AND DETECTION OF MENTAL ILLNESS DURING PREGNANCY AND THE POSTNATAL PERIOD

5.1 Introduction

5.2 Prediction – risk factors for the onset of mental disorder during pregnancy and the postnatal period

5.3 Methods for predicting mental disorder during pregnancy and the postnatal period

5.4 Methods for detecting mental disorder during pregnancy and the postnatal period

5.5 Referral pathways

 

6. PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS

6.1 Introduction

6.2 Issues in research into psychological treatments

6.3 Definitions of psychological and psychosocial interventions

6.4 Overview of clinical review

6.5 Review of treatments aimed at preventing the development of mental disorders during the antenatal and postnatal periods for women with existing risk factors

6.6 Health economics evidence on psychological and psychosocial interventions aimed at preventing the development of depression during the antenatal and postnatal periods in women with identified psychosocial risk factors and/or sub-threshold depressive symptoms

6.7 Clinical practice and research recommendations

6.8 Review of treatments aimed at preventing the development of mental disorders during the antenatal and postnatal periods for women with no identified risk factors

6.9 Review of non-pharmacological treatments for depression in the postnatal period

6.10 Health economics evidence on psychosocial interventions for treatment of depression in the postnatal period

6.11 Focusing on the infant: intervening in the mother-infant interaction or measuring child-related outcomes

6.12 Broader psychosocial interventions and other treatments

6.13 Treatments for women with disorders other than depression

 

7. THE PHARMACOLOGICAL TREATMENT OF MENTAL DISORDERS IN PREGNANT AND BREASTFEEDING WOMEN

7.1 Introduction

7.2 Risk associated with specific drugs in pregnancy and the postnatal period

7.3 The pharmacological treatment of mental disorder during pregnancy and the postnatal period – review of available studies

7.4 Prescribing psychotropic medication to pregnant and breastfeeding women

7.5 The pharmacological treatment of specific mental disorders during pregnancy and the postnatal period – adaptation of existing guidelines

 

8. THE ORGANISATION OF PERINATAL MENTAL HEALTH SERVICES

8.1 Introduction

8.2 The current structure of services

8.3 Estimating the need for services

8.4 The functions of services for women, their partners and carers in the antenatal and postnatal period

8.5 The structure of perinatal mental health services

8.6 Implementing the managed network model: service recommendations

8.7 Research recommendation

 

9. Appendices

10. References

11. Abbreviations

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