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Mental Illness Overview

Dispelling the Fear of Care-Giving

Monday, 09 August 2010 14:55 Last Updated on Wednesday, 18 August 2010 09:15 Written by Michele Howe

Tips and information for people that need to care for a loved one with a mental or physical condition. How to take care of someone without forgetting to take care of yourself, the caregiver. Written by Michele Howe. Watch Michele Howe's video interview at HealthyPlace Mental Health TV Show.

How Proactive Planning Can Make a Difference in Care-Giving

"People who are considering care-giving often make one primary mistake, they do not look forward enough in the process. What today is considered as minor aid can quickly escalate into constant, twenty-four hour a day care."

Dr. Christopher A. Foetisch, orthopedic surgeon

When forty-nine-year-old Renee lost her job earlier in the year, she was stunned. Immediately, she began sending out resumes. Getting a job became her job. For seven months, she landed only a few interviews despite her advanced degree and experience. Renee wondered if she'd lose her home, her credit rating, and savings in one fell swoop. Then Renee's mom called and her fretting took an entirely different turn.

Several years earlier, Renee had answered the call to move in and care for with her ailing and then increasingly frail eighty-year-old mother. That arrangement lasted about nine months. No sooner had Renee agreed to sell her home and join households to care for her mother, than her mom changed her mind. Renee's mother decided she didn't want anyone living with her even though she needed outside assistance. Renee tried to reason with her elderly parent, tried accommodating her in every way possible, because Renee knew it was only a matter of time before her mom's health would deteriorate to a point where it would be dangerous for her to live alone. So after much discussion that had led nowhere, Renee moved into an apartment and eventually purchased another home for her and her children.

Life went on pretty smoothly with Renee transporting her mom to appointments, doing her shopping for her, and making certain her mother's home was well maintained. Renee wondered if perhaps her mom might actually realize her wish to stay in her home until she passed away. Renee herself certainly preferred living in her own home.

Then Renee lost her job. Suddenly, her mother decided the perfect solution was for Renee to move back in with her again. Things would be different this time, her mom promised. I've changed, she told Renee. Renee wasn't so sure; then again with the housing and job market so shaky, this might be the their best option.

Having recalled the strain of living with her mom caused Renee to think proactively on both small and large matters. She also recognized that even though her mom was giving lip service to wanting Renee back to care for her, her mom was infinitely fickle and today's enthusiasm could very well die a sudden death once Renee settled in and the routine of daily life took over. Minute issues as how to tie the garbage bag properly or how to load the dishwasher were just a couple of irritants that had so upset Renee's mom the first time around.

Weighing the pros and cons carefully, Renee decided to take pen to paper and begin listing areas were problematic for her mom as well as any differences in living arrangements that had caused upset for her aging mom. While making such a list was semi-depressing, Renee knew it was necessary. Once she got started, fresh questions and concerns arose too. Renee realized her mom was far less physically able to move and live safely than a few years earlier and with this deterioration, how would it affect her ability to go to work each day?

Certainly Renee had questions to get answered and challenges to overcome, but she also had the wisdom of hindsight and a clearer understanding of what it meant to enter someone else's home (even at their request) and merge two households. It wouldn't be easy; care taking is never that. But Renee's goal wasn't ease or comfort...it was taking care of someone close to her. It was a living out of that principle; treat others in the way you would want to be treated. Easy to accomplish? Rarely. Right to do. Always.

The three aspects of care giving

Emotional Considerations:

Realize the parent you once knew and loved might be gone forever and be willing to grieve the loss of that relationship even while a parent is still alive.
Be prepared to take control of important decision-making regarding all aspects of care even when met with some resistance by the person in need.
Make peace with the fact that not all extended family members will step-up to assist in the way you might want and expect.

Spiritual Considerations:

Before you enter into a care-giving situation enlist the support of friends and family who will commit to pray for you and those under your care.
Learn how to share your faith and life perspectives without receiving the appropriate responses back from the person you are caring for.
Be ready to journey along with your patient as they face their mortality and be prepared to listen and respond to their concerns.

Physical Considerations:

Take good personal care of yourself as the primary caregiver by eating right, getting enough sleep and exercising daily.
Make use of professional care-giving agencies that can offer practical assistance with hygiene, dressing, and meal support.
Understand your personal limits before you reach them by scheduling away time regularly to recharge yourself mentally and physically.

Sidebar: Care-giving from a physician's perspective.

Dr. Christopher A. Foetisch, orthopedic surgeon, Toledo, OH, offers the following observations from both a clinician's standpoint and having served as a caregiver personally.

Providing care for a sick individual almost always requires more time and resources than most people realize.
Realize that the level of care can quickly change from minor to constant 24/7-hour care.
Caregivers need to ask themselves if they are "mentally tough enough" to help with bathing, bathroom, medications and possibly dressing changes or tubes and IV lines.
Before an individual becomes overwhelmed, decide ahead of time when the need for another arrangement will be required such as transfer to a nursing home or hospice facility.
Plan for unexpected expenses to arise from a variety of sources.
When caregivers begin feeling frustrated, anxious, or depressed note these as warning signs that the situation must be promptly addressed and responsibilities reduced.
No one individual should assume the caregiver role without some form of backup, even for a short period of time.

About the author:

Michele Howe Michele is the author of ten books for women and has published over 1200 articles, reviews, and curriculum to more than 100 different publications. Her articles and reviews have been published in Good Housekeeping, Redbook, Christianity Today, Focus on the Family and many other publications. Michele's newest title, Still Going It Alone, was released last year. After having undergone four shoulder surgeries, Michele saw the need for an upcoming women's inspirational health-related book co-authored with her orthopedic surgeon, titled, Burdens Do a Body Good: Meeting Life's Challenges with Strength (and Soul). Michele also writes a parenting column at bizmoms.com. Read more about Michele at http://michelehowe.wordpress.com/.

Click here to watch Michele Howe's video interview at HealthyPlace Mental Health TV Show.

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Mental Illness Overview Table of Contents

Tuesday, 06 January 2009 22:29 Last Updated on Friday, 08 July 2011 09:00 Written by HealthyPlace.com Staff Writer

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Use of Illegal Drugs During Pregnancy

Tuesday, 06 January 2009 21:19 Last Updated on Friday, 08 July 2011 09:12

Learn how taking hallucinogens, opioids, amphetamines, or marijuana during pregnancy can affect you or your baby.

Use of illicit drugs (particularly opioids) during pregnancy can cause complications during pregnancy and serious problems in the developing fetus and the newborn. For pregnant women, injecting illicit drugs increases the risk of infections that can affect or be transmitted to the fetus. These infections include hepatitis and sexually transmitted diseases (including AIDS). Also, when pregnant women take illicit drugs, growth of the fetus is more likely to be inadequate, and premature births are more common.

Babies born to mothers who use cocaine often have problems, but whether cocaine is the cause of those problems is unclear. For example, the cause may be cigarette smoking, use of other illicit drugs, deficient prenatal care, or poverty.

Hallucinogens, such as methylenedioxymethamphetamine (MDMA, or Ecstasy), rohypnol, ketamine, methamphetamine (DESOXYN), and LSD (lysergic acid diethylamide) may, depending on the drug, lead to an increased incidence of spontaneous miscarriage, premature delivery, or fetal/neonatal withdrawal syndrome.

Opioids: Opioids, such as heroin, methadone (DOLOPHINE), and morphine (MS CONTIN, ORAMORPH), readily cross the placenta. Consequently, the fetus may become addicted to them and may have withdrawal symptoms 6 hours to 8 days after birth. However, use of opioids rarely results in birth defects. Use of opioids during pregnancy increases the risk of complications during pregnancy, such as miscarriage, abnormal presentation of the baby, and preterm delivery. Babies of heroin users are more likely to be small.

Amphetamines: Use of amphetamines during pregnancy may result in birth defects, especially of the heart.

Marijuana: Whether use of marijuana during pregnancy can harm the fetus is unclear. The main component of marijuana, tetrahydrocannabinol, can cross the placenta and thus may affect the fetus. However, marijuana does not appear to increase the risk of birth defects or to slow the growth of the fetus. Marijuana does not cause behavioral problems in the newborn unless it is used heavily during pregnancy.

Source:

Merck Manual (last reviewed May 2007)

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Psychiatric Medications and Breastfeeding

Tuesday, 06 January 2009 21:29 Last Updated on Friday, 08 July 2011 09:11

Is it safe to take psychiatric medications such as antianxiety drugs, antidepressants, and antipsychotic drugs while breastfeeding?

Some drugs require a doctor's supervision during their use. Taking them safely while breastfeeding may require adjusting the dose, limiting the length of time the drug is used, or timing when the drug is taken in relation to breastfeeding. Most antianxiety drugs, antidepressants, and antipsychotic drugs require a doctor's supervision, even though they are unlikely to cause significant problems in the baby. However, these drugs stay in the body a long time. During the first few months of life, babies may have difficulty eliminating the drugs, and the drugs may affect the baby's nervous system. For example, the antianxiety drug diazepam (VALIUM, DIASTAT (a benzodiazepine) causes lethargy, drowsiness, and weight loss in breastfed babies. Babies eliminate phenobarbital (LUMINAL) (an anticonvulsant and a barbiturate) slowly, so this drug may cause excessive drowsiness. Because of these effects, doctors reduce the dose of benzodiazepines and barbiturates as well as monitor their use by women who are breastfeeding.

Impact of Taking Illegal Drugs or Alcohol While Breastfeeding

Some drugs should not be taken by mothers who are breastfeeding. They include amphetamines, and illicit drugs such as cocaine, heroin, and phencyclidine (PCP).

If women who are breastfeeding must take a drug that may harm the baby, they must stop breastfeeding. But they can resume breastfeeding after they stop taking the drug. While taking the drug, women can maintain their milk supply by pumping breast milk, which is then discarded.

Women who smoke should not breastfeed within 2 hours of smoking and should never smoke in the presence of their baby whether they are breastfeeding or not. Smoking reduces milk production and interferes with normal weight gain in the baby.

Alcohol consumed in large amounts can make the baby drowsy and cause profuse sweating. The baby's length may not increase normally, and the baby may gain excess weight.

Sources:

Merck Manual (last reviewed May 2007)
Mayo Clinic website, Antidepressants: Are they safe during pregnancy?, Dec. 2007

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Effects of Taking Psychiatric Medications During Pregnancy

Tuesday, 06 January 2009 21:05 Last Updated on Friday, 08 July 2011 09:11 Written by HealthyPlace.com Staff Writer

Are psychiatric medications safe during pregnancy and breastfeeding? Detailed information on taking antidepressants, antipsychotics, mood stabilizers, antianxiety medications during pregnancy and breastfeeding.

According to the Merck Manual, more than 90% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy. The Merck Manual says "in general, drugs, unless absolutely necessary, should not be used during pregnancy because many can harm the fetus. About 2 to 3% of all birth defects result from the use of drugs other than alcohol."

Sometimes drugs are essential for the health of the pregnant woman and the fetus. For instance, a British Medical Journal article on antipsychotics during pregnancy reports "Withholding antipsychotic treatment may expose mother and fetus to more harm than benefit as, in addition to behavioural disturbance which may put both at risk, physiological changes associated with psychosis could affect fetoplacental integrity and development of the central nervous system."

In such cases, a woman should talk with her doctor or other health care practitioner about the risks and benefits of taking psychiatric medications. Before taking any drug (including over-the-counter drugs) or dietary supplement (including medicinal herbs), a pregnant woman should consult her health care practitioner. A health care practitioner may recommend that a woman take certain vitamins and minerals during pregnancy.

The Merck Manual states: "Most antidepressants appear to be relatively safe when used during pregnancy." If you take antidepressants throughout pregnancy or during the last trimester, The Mayo Clinic website states: "your baby may experience temporary withdrawal symptoms - such as jitters or irritability - at birth."

Psychiatric Medications That May Cause Problems During Pregnancy
Type	Examples	Problems
Antianxiety drug	Diazepam (Valium)	When the drug is taken late in pregnancy, depression, irritability, shaking, and exaggerated reflexes in the newborn. Benzodiazepines (Xanax) are also associated with prenatal syndrome, including feeding problems, hypothermia, and deficiency in baby's muscle tone.
Antidepressant drug
SSRI Antidepressants	Citalopram (Celexa), Fluoxetine (Prozac, Sarafem), Sertraline (Zoloft)	Associated with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn, or PPHN) when taken during the last half of pregnancy. Considered an option during pregnancy. Paroxetine (Paxil) should be avoided during pregnancy as it's associated with with fetal heart defects when taken during the first three months of pregnancy.
Tricyclic Antidepressants	Amitriptyline, Nortriptyline (Pamelor)	Suggested risk of limb malformation in early studies, but not confirmed with newer studies. Considered an option during pregnancy.
MOAI Antidepressants	Phenelzine (Nardil), Tranylcypromine (Parnate)	May cause a severe increase in blood pressure that triggers a stroke and should be avoided during pregnancy.
Other	Bupropion (Wellbutrin)	No established risks during pregnancy. Considered an option during pregnancy.
Anticonvulsants	Carbamazepine (Tegretol)	Some risk of birth defects. Bleeding problems in the newborn, which can be prevented if pregnant women take vitamin K by mouth every day for a month before delivery or if the newborn is given an injection of vitamin K soon after birth
	Phenobarbital (Luminal)	Same as those for carbamazepine.
	Phenytoin (Dilantin)	Same as those for carbamazepine.
	Trimethadione (Tridione)	Increased risk of miscarriage in the woman. High (70%) risk of birth defects, including a cleft palate and defects of the heart, face, skull, hands, or abdominal organs
	Valproate (Deparene)	Some (1%) risk of birth defects, including a cleft palate and defects of the heart, face, skull, spine, or limbs
Mood-stabilizing drug	Lithium (Lithane, Lithonate)	Birth defects (mainly of the heart), lethargy, reduced muscle tone, poor feeding, underactivity of the thyroid gland, and nephrogenic diabetes insipidus in the newborn
Atypical Antipsychotic drug	olanzapine (Zyprexa), quetiapine (Seroquel)	Possibility of low birth weight; premature births. Concerns have been raised that olanzapine in particular tends to be associated with significant weight gain. Theoretically, during pregnancy this could be associated with an increased incidence of outcomes, including increased rates for birth defects such as neural tube defects and an increased risk of obstetric complications. (there's very little data on atypical antipsychotic medication use during pregnancy)

Again, a strong reminder, not to take anything on this page as medical advice. It is extremely important for you to discuss the issue of taking psychiatric medications during pregnancy with your doctor. The medical standard in deciding whether or not to administer psychiatric medication during pregnancy is the risks and benefits of taking the drugs during pregnancy must be weighed carefully on a case-by-case basis. Work with your doctor to make an informed choice that gives you and your baby the best chance for long-term health.

(more articles on taking various types of psychiatric medications while pregnant or nursing)