Umylny Polina, German Miguelina, Lantiere Alexa
Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY.
Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY.
Curr Probl Pediatr Adolesc Health Care. 2017 Oct;47(10):254-266. doi: 10.1016/j.cppeds.2017.08.003. Epub 2017 Sep 18.
Postpartum psychiatric disorders represent a significant public health problem that has not been readily addressed, particularly in the primary care setting. As maternal mood and anxiety difficulties are associated with a number of adverse outcomes for the mother, her offspring and the family system, addressing these concerns during the perinatal period is of critical importance. Although researchers and clinicians have become increasingly aware of the problem, postpartum mood and anxiety disorders (PMADs) remain widely unrecognized and poorly understood by both patients and providers. As pediatric primary care providers encounter mothers repeatedly throughout the postpartum period, the pediatric clinician has the unique opportunity to intervene with mothers suffering from mental illness. Given the potentially devastating impact of PMADs across multiple domains, the purpose of this article is to provide guidelines for pediatric clinicians to better manage maternal mental illness within the primary care pediatric setting. As such, we review the categories and prevalence of PMADs and provide strategies for responding to a positive PMADs screen or concerns raised during surveillance of the mother-infant-dyad. In addition, we offer a summary of the literature on evidence-based treatments for PMADs to allow pediatricians to guide the parents of their patients towards the most effective interventions. Finally, we provide an overview of alternative treatment models that can facilitate the screening and treatment of behavioral health concerns within the primary care setting.
产后精神障碍是一个尚未得到充分解决的重大公共卫生问题，尤其是在初级保健环境中。由于产妇的情绪和焦虑问题会给母亲、其子女以及家庭系统带来许多不良后果，因此在围产期解决这些问题至关重要。尽管研究人员和临床医生越来越意识到这个问题，但产后情绪和焦虑障碍（PMADs）在患者和医疗服务提供者中仍然普遍未被认识和理解。由于儿科初级保健提供者在产后期间会多次接触母亲，儿科临床医生有独特的机会对患有精神疾病的母亲进行干预。鉴于PMADs在多个领域可能产生的毁灭性影响，本文旨在为儿科临床医生提供指导方针，以便在儿科初级保健环境中更好地管理产妇的精神疾病。因此，我们回顾了PMADs的类别和患病率，并提供应对PMADs筛查呈阳性或在母婴二元组监测期间提出的问题的策略。此外，我们总结了关于PMADs循证治疗的文献，以便儿科医生指导其患者的父母采取最有效的干预措施。最后，我们概述了替代治疗模式，这些模式可以促进初级保健环境中行为健康问题的筛查和治疗。
