1 / 21

Establishing an integrated perinatal care program for substance-dependent young mothers

Implementing an integrated program for substance-dependent young mothers, focusing on methamphetamine-related issues, neonatal abstinence syndromes, and psychiatric care strategies.

christopherturner
Download Presentation

Establishing an integrated perinatal care program for substance-dependent young mothers

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Establishing an integrated perinatal care program for substance-dependent young mothers Ulrich Zimmermann Dept. of Psychiatry and Psychotherapy

  2. Methamphetamine seizures in Germany

  3. In-patient treatment of newborns due to methamphetamin use of their mothers (n=160) (N) Dinger et al. ZGN 2017

  4. Prevalence of neonatal abstinence syndromes in Saxony ‰

  5. Neonatal risk factors • pretermdelivery ( < week 37): 32% = 4 x moreprevalent • lowbirthweight (< 10th percentile): 24% = 3 x moreprevalent • smallheadcircumference (<10th percentile): 23% = 3 x moreprevalent Preliminarydata on birth defects • Central nervous (e.g., hemorrhage, PVL): 26% (vs. 3%) • Cardial (VSD, foramen ovale, cardiomyopathy): 12% (vs. 1%) • Urogenital (obstructive, ureterdysgenesis , renal): 9% (vs. 0,2%)

  6. Gynaecology Paedia-trics Psych-iatry Youth welfareoffice publiccounsellingagencies

  7. Elements of psychiatric out-patient care • Frequentcounsellingwithpsychiatrist, ifnecessarydaily • Diagnosticworkupofpsychiatricandsomaticcomorbidity (includingbloodchemistry, ECG, maybe MRI) • Developaims: abstinence vs. reduceduse, in- vs. out-patient setting • Negotiateinclusionoffriends, relatives, authorities in treatment plan • Establishproofofabstinencebyrandomurinetestsfor illegal substances. Ifnecessary, breathalcoholtestsandurineethylglucuronide • Methamphetamin-specificgrouppsychoeducation/ CBT bypsychologist • Sociotherapybysocialworker • Cooperationwithmunicipalcouncellingcenters

  8. Group psychotherapy and psychoeducation • Open groupsof 2-5 patients, 50 minutesonce per week • Treatment manualfor 16 groupsessions(elementsofcognitivebehavioraltherapy, motivational interviewingandpsychoeducation) including: • Analysis ofaddiction-specificbehavioralpatterns • Developdiscrepanciesbetweencurrentsituationandpursuedgoals • Handling ofcraving, drugcues, high-risksocialencounters • Role-play practisinghowtorejectofferstoconsume • Identifyandavoidseeminglyharmlessdecisions • Home-worktoapplylearntissuestoown personal situation • Planningaheadto handle violationsofabstinece Clinical Treatment Guidelines for Alcohol and Drug Clinicians. Fitzroy, Victoria: Turning Point Alcohol and Drug Centre Inc.) Translated and adapted by Silke Behrendt, Ph.D.

  9. 45 parents in psychiatric out-patient care Fathers/ alcohol 4 Fathers/ crystal Mothers/ crystal 5 Mothers/ alcohol 4 27 5 Mothers/ other illegal drugs(4 cannabis, 1 cocaine)

  10. Retention rate MAR 2016 – MAY 2017 discontinued 7 First contact(45) 3 pregnant, 33 mothers, 9 fathers Attended > 2 appointments(36) 4 Complex psychiatric outpatient care (26) Counsellingwithpsychiatrist (26) Urine drugtesting In-patient:detox(6)rehab(1) Psycho-pharmaco-logy(7) Antidepressants (2)ADHS (2)Disulfiram (3) Group therapy(13) Individual psycho-therapy(7) Goes tocounsellingcenter (n=7) Socialworker(16) 9 Discontinued: 20 (44% of 45) Ongoing treatment: 17 (38% of 45) Sucessfully comple-ted: 8 (18% of 45)

  11. Duration of psychiatric outpatient treatment > 12 months < 1 month 10 - 12 months 21 % (9) 7 - 9 months 23 % (10) 1 - 3 months 25 % (11) 4 - 6 months

  12. Where do the newborns stay? 2015: n=33 children born to mothers abusing crystal Verbleib von Kindern nach maternalem Methamphetamin-Abusus in 2015 (N = 33). FamilieNetz 2016 (unveröff.) 2016: n=26 children born to mothers abusing crystal Verbleib von Kindern nach maternalem Methamphetamin-Abusus in 2016 (N = 18). FamilieNetz 2016 (unveröff.)

  13. Zimmermann (Guest-editor, Dresden): Editorial to special issue Wodarz et al. (Regensburg): Evidence-based guidelines for the pharmacological management of acute methamphetamine-related disorders/ toxicity Härtel-Petri et al. (Bayreuth): Evidence-based guidelines for the pharmacologic management of methamphetamine dependence, relapse-prevention, chronic methamphetamine-related, and comorbid psychiatric disorders Dinger et al. (Dresden): Methamphetamine consumption during pregnancy – effect on child health Scherbaum, Schifano und Bonnet (Essen): New psychoactive substances (NPS) – a challenge for the drug treatment system

  14. Häufigkeit Methamphetaminkonsum während der Schwangerschaft in Sachsen (nach Regierungsbezirken)

  15. Zeitpunkt der ersten Vorsorgeuntersuchung (%)  Frauen mit Crystalkonsum (Universitätskinderklinik Dresden, N = 160)  Alle sächsischen Schwangeren (Jahr 2014, N = 35.124) Dinger et al. ZGN 2017 (accepted) Projektgeschäftsstelle Qualitätssicherung bei der SLÄK, QS Geburtshilfe 2014, Dresden 2015.

  16. Gestationsalter der Neugeborenen (%) SSW

  17. Gestationsalter der Neugeborenen (%) Frügeborenenrate = 32 % weeks

  18. Geburtsgewicht der Neugeborenen Rate an Neugeborenen mit Untergewicht = 24,2 %

  19. Kopfumfang der Neugeborenen Rate an zu kleinem Kopfumfang = 22 %

  20. Symptome der Neugeborenen %

More Related