Perinatal Psychiatry Masterclass for senior trainees resources

Speakers: Dr Clare Dolman, Dr Lucinda Green and Dr Liz McDonald

Intended learning objectives

At the end of day 1 participants will be able to:

1. understand the different approaches to development and delivery of PMH services within the different nations.
2. describe the range of factors that can affect a woman’s mental health in the perinatal period and her experience of pregnancy and parenting.
3. summarise, formulate and communicate assessments to enable women, families and professionals to understand the factors which have contributed to her mental health problems, associated risks and/or her risk of developing a perinatal mental illness.
4. demonstrate an awareness of the barriers to care for women in the perinatal period
5. understand the factors influencing women’s decision-making around pregnancy and childbirth
6. recognise how healthcare professionals can improve the experience of women and families receiving perinatal mental healthcare
7. recognise the effect of a woman’s perinatal mental illness on her partner.

Recommend reading

1. Perinatal Mental Health Services - CR232 (rcpsych.ac.uk)
2. Scotland:https://www.pmhn.scot.nhs.uk/delivering-effective-services/delivering-effective-services-report/
3. Scottish care pathways
4. England care pathways
5. Wales: together-for-mental-health-delivery-plan-2019-to-2022.pdf (gov.wales)
6. Ireland:https://www.hse.ie/eng/services/list/4/mental-health-services/specialist-perinatal-mental-health/specialist-perinatal-mental-health-services-model-of-care-2017.pdf
7. Darwin, Z., Domoney, J.,Iles, J. et al. Involving and supporting partners and other family members in specialist perinatal mental health services. NHS England (2021) https://www.england.nhs.uk/wp-content/uploads/2021/03/Good-practice-guide-March-2021.pdf
8. PMH Partners Ambition FAQs. PMH Partners Ambition FAQ - National Perinatal Mental Health Workspace - FutureNHS Collaboration Platform
9. NHS England (2016) The Five Year Forward View for Mental Health
10. NHS England (2019) The NHS Long Term Plan
11. Lever Taylor, B., Billings, J., Morant, N., Bick, D., & Johnson, S. (2019). Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England. BMJ Open, 9(7):e030208.
12. Dolman, C., Jones, I., & Howard, L. M. (2013). Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Archives of women's mental health, 16(3), 173–196
13. Ruffell, B., Smith, D.M. & Wittkowski, A J. (2019) The Experiences of Male Partners of Women with Postnatal Mental Health Problems: A Systematic Review and Thematic
    

Speakers: Dr Lucinda Green and Dr Liz McDonald

Intended learning objectives

At the end of day 2 participants will be able to:

1. understand the course of depression, OCD, schizophrenia, BPAD and Post-partum psychosis within the perinatal context
2. understand how to organise and chair a perinatal mental health pre-birth planning meeting to ensure that the woman, her partner and other family members and the relevant professionals have a shared understanding of any concerns, needs and risks as well as the woman and family’s strengths.
3. develop effective perinatal mental health care plans collaboratively with women, partners, other carers and professionals.

Recommend reading

1. Di Florio A &Jones IR. (2019) Postpartum Depression. BMJ Best Practice. 4.
2. Bergink, V., Rasgon, N., & Wisner, K. L. (2016). Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood. The American journal of psychiatry, 173(12), 1179–1188.
3. Challacombe, F. L., Bavetta, M., & De Giorgio, S. (2019). Intrusive thoughts in perinatal obsessive-compulsive disorder. BMJ (Clinical research ed.), 367, l6574.
4. Dazzan P. (2021). Schizophrenia during pregnancy. Current opinion in psychiatry, 34(3), 238–244.
5. Forde R, Peters S, Wittkowski A. Recovery from postpartum psychosis: a systematic review and metasynthesis of women's and families' experiences [published online ahead of print, 2020 Feb 4]. Arch Womens Ment Health. 2020;10.1007/s00737-020-01025-z
6. Howard, L. M., & Khalifeh, H. (2020). Perinatal mental health: a review of progress and challenges. World psychiatry : official journal of the World Psychiatric Association (WPA), 19(3), 313–327.
7. Perry, A., Gordon-Smith, K., Jones, L., & Jones, I. (2021). Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review. Brain sciences, 11(1), 47.
8. Pre-Birth Planning: Best Practice Toolkit for Perinatal Mental Health Services (2019) Pan-London Perinatal Mental Health Networks. https://www.healthylondon.org/wp-content/uploads/2019/01/Pre-birth-planning-guidance-for-Perinatal-Mental-Health-Networks.pdf

Speakers: Dr Angelika Wieck, Prof Ian Jones, Dr Lucinda Green and Dr Liz McDonald

Intended learning objectives

At the end of day 3 participants will be able to:

1. describe the factors highlighted in child serious case reviews which can affect children’s safety and wellbeing and increase the risk of abuse and neglect
2. recognise how perinatal mental health services, working effectively in partnership with a range of professionals, can ensure child safeguarding concerns are identified early and that effective care, treatment and support for women and families can reduce the risk of harm to infants and children
3. be familiar with currently available evidence on the reproductive safety of the main psychotropic drugs, resources that provide high quality evidence updates and current influential prescribing guidance.

Recommend reading

1. Department for Education (2018). Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children. London: HM Government
2. Department for Education (2020) Complexity and challenge: a triennial analysis of serious case reviews 2014-2017. London: Department for Education.
3. LARA-VP - Linking Abuse and Recovery through Advocacy for Victims and Perpetrators – A resource to help mental health professionals identify and respond to Domestic Violence and Abuse. (www.kcl.ac.uk/psychology-systems-sciences/research/lara-vp-download-form )
4. Howard, L. M., Oram, S., Galley, H., Trevillion, K., & Feder, G. (2013). Domestic violence and perinatal mental disorders: a systematic review and meta- analysis. PLoS medicine, 10(5), e1001452
5. Hahn, C. K., Gilmore, A. K., Aguayo, R. O., & Rheingold, A. A. (2018). Perinatal Intimate Partner Violence. Obstetrics and gynecology clinics of North America, 45(3), 535–547
6. McAllister-Williams, R. H., Baldwin, D. S., Cantwell, R. et al (2017). British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum. Journal of psychopharmacology (Oxford, England), 31(5), 519–552.
7. National Institute for Health and Care Excellence (2014). Antenatal and Postnatal Mental Health - Clinical Management and Service Guidance. Clinical Guideline 192.
8. MHRA: Valproate use by women and girls (2018). www.gov.uk/guidance/valproate-use-by-women-and-girls
9. Pre-conception advice: Best Practice Toolkit for Perinatal Mental Health Service (2019) Pan-London Perinatal Mental Health Networks. www.healthylondon.org/wp-content/uploads/2019/05/Pre-conception-advice-Best-Practice-Toolkit-for-Perinatal-Mental-Health-Services.pdf
10. Delivering preconception care to women of childbearing age with serious mental illness - https://www.tommys.org/pregnancy-information/health-professionals/free-pregnancy-resources/guide-delivering-preconception-care

Speakers: Dr Angelika Wieck, Professor Ian Jones, Dr Maddalena Miele and Dr Emily Finch

Mandatory reading: These papers will be made available on the webpage. They must be read with the letter from Dr Wieck and Professor Jones before the session.

• Grigoriadis et al. Pregnancy and Delivery Outcomes Following Benzodiazepine Exposure: A Systematic Review and Meta-analysis. Can J Psychiatry. 2020 Dec;65(12):821-834. doi: 10.1177/0706743720904860
• With supplement
• Maternal Use of Specific Antidepressant Medications During Early Pregnancy and the Risk of Selected Birth Defects. Anderson et al. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2020.2453

Intended learning objectives

At the end of day 4 participants will be able to:

1. understand the kinds of methodological problems that hamper research into the reproductive safety of psychotropic drugs and be able to take these into account when interpreting peer-reviewed publications
2. be able to apply current evidence and general principles for the pharmacological management of pregnant and breastfeeding women to clinical scenarios.
3. understand the keyways in which perinatal mental health problems can affect the ability of women to interact with their infant
4. demonstrate a basic knowledge of the current clinical approaches to assessing parent-infant relationships
5. outline the determinants of a sensitive parent-infant interaction
6. understand the issues encountered in measuring how common substance misuse in pregnancy is.
7. explore ways to identify substance misuse in pregnancy
8. understand what interventions are available to reduce the harm from substance misuse in pregnancy.

Recommend reading

1. P.O. Svanberg , J. Barlow & W. Tigbe (2013) The Parent–Infant Interaction Observation Scale: reliability and validity of a screening tool, Journal of Reproductive and Infant Psychology, 31:1, 5-14.
2. Stein A, Pearson RM, Goodman SH, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800‐1819.
3. Clinical Guidelines on Drug Misuse and Dependence Update 2017 Independent Expert Working Group (2017) Drug misuse and dependence: UK guidelines on clinical management. London: Department of Health – page 220 pregnancy section

Speakers: Dr Roch Cantwell, Dr Lucinda Green and Dr Liz McDonald

Intended learning objectives

At the end of day 5 participants will be able to:

1. Describe the factors highlighted in child serious case reviews which can affect children’s safety and wellbeing and increase the risk of abuse and neglect.
2. Recognise how perinatal mental health services, working effectively in partnership with a range of professionals, can ensure child safeguarding concerns are identified early and that effective care, treatment and support for women and families can reduce the risk of harm to infants and children.
3. Describe the epidemiology of self-harm and suicide in the perinatal period.
4. Describe the distinctive clinical features of maternal suicide.

5. Recognise risk in relation to maternal suicide and apply this to clinical assessment.

Recommend reading

1. Department for Education (2018). Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children. London: HM Government
2. Department for Education (2020) Complexity and challenge: a triennial analysis of serious case reviews 2014-2017. London: Department for Education.
3. Department for Education (2022) Learning for the future: final analysis of Serious Case Reviews, 2017-19. London: Department for Education.
4. Cantwell R, Knight M, Oates M, Shakespeare J on behalf of the MBRRACE-UK mental health chapter writing group (2015) Lessons on maternal mental health. In Knight M, Tuffnel D, Kenyon S, Shakespeare J, Gray R, Kyrinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care – Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-13. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2015: p22-41.
5. Cantwell R, Youd E and Knight M on behalf of the MBRRACE-UK mental health chapter-writing group (2018) Messages for mental health. In Knight M, Bunch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014- 16. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2018: p42-60
6. Cairns A, Kenyon S, Patel R, Bunch K and Knight M on behalf of the MBRRACE-UK mental health chapter-writing group. In Knight M, Bunch K, Patel R, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care Core Report - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2022: pp 10-15.