Background:
Women of reproductive age have a high prevalence of mental and behavioral disorders, especially depression and anxiety.  Due to gender specific concerns such as pregnancy and lactation this is a population that often benefits from specialized and customized care.  However, general psychiatry residency programs often do not have the resources to include in depth training in perinatal psychiatric issues for residents.  Residents often express interest in learning more about aspects of perinatal psychiatry. We developed the WMH fellowship for interested psychiatrists, specifically geared towards clinical, educational, and scholarly experiences in perinatal psychiatry.

Description:
The pathway will include clinical rotations, regular meetings, and a research or scholarly project.  It can also include teaching activities or projects.  The pathway can be completed in the third and fourth year of residency.

Goals and Objectives:
The overall goal of this pathway is to develop the knowledge base and clinical skills of general psychiatry residents in assessment and treatment of psychiatric symptoms during pregnancy, postpartum, and in women wishing to conceive.

After participating in this pathway, residents will be able to:

  • Discuss the influence of the female reproductive cycle on psychiatric disorders.
  • Demonstrate knowledge of changes in pharmacokinetics and pharmacodynamics of psychotropic medications during pregnancy and postpartum, and incorporate this knowledge into patient care.
  • Describe potential effects and risks of in utero exposure to psychotropic medications on the fetus and newborn.
  • Discuss the implications of maternal psychiatric disorders during pregnancy and postpartum for pregnancy and child outcomes.
  • Provide information to patients, family members, and other healthcare providers about risks of medications and about the risks of stopping or not taking psychotropic medication during pregnancy and/or lactation.
  • Incorporate knowledge about evidence-based psychotherapies, other non-pharmacologic interventions, and complementary and alternative therapies into discussions with patients and into treatment plans for pregnant and postpartum women.
  • Display appreciation of, knowledge about, and the ability to manage psychological responses to pregnancy and pregnancy-related complications such as infertility and perinatal loss.
  • Demonstrate sound clinical reasoning and the ability to weigh risks of treatments and of maternal mental illness, patient preferences, and alternative treatment approaches in specific clinical situations.
  • Critically appraise the literature and the evidence base related to psychiatric practice during pregnancy and postpartum.

Clinical rotations:
MICC – The Maternal and Infant Care Clinic provides obstetric and gynecological care to women with high-risk pregnancies throughout pregnancy and the postpartum period. The psychiatry resident assigned to this clinic spends half a day per week providing consultation to clinic providers, who include obstetrician-gynecologists, neonatologists, and midwives, and working very closely with the two clinic social workers. The resident provides psychiatric evaluation and treatment for women with a wide range of mental health issues in pregnancy and postpartum, including depression, anxiety, bipolar disorder, and psychotic disorders.

Perinatal psychiatry clinic – Located at UWMC Roosevelt, this clinic provides psychiatric consultation and ongoing care to women with mental health issues during pregnancy, postpartum and pre-conception.

Pathway meetings:
Quarterly pathway meetings will include discussions of cases, recent literature, and ongoing projects. They will be interdisciplinary and include faculty / residents / providers from Obstetrics, Pediatric and Family Medicine. We will also invite speakers from the community. Examples include speakers from King County’s home visiting nurse program and Child Protective Services.

Perinatal Psychiatry Research/Scholarly/Education Projects:
Residents in this pathway will have the opportunity to participate in research projects, write review articles, and/or develop curricula and educational materials for trainees, other healthcare professionals, and patients.

Examples of completed projects include:

  • Developing online educational modules regarding postpartum psychiatric disorders for NICU nurses.
  • Developing patient education material regarding antidepressants in pregnancy / lactation
  • Review article regarding anxiolytics in pregnancy and lactation
  • Article describing postpartum depression screening in the NICU.

Other possible projects include but are not limited to:

  • Preparing annotations for articles relevant to perinatal psychiatry for the APM (Academy of Psychosomatic Medicine) website.
  • Developing educational materials and information sheets for patients.

Criteria for Area of Distinction:

  • Completion of at least one clinical rotation listed above
  • Regular attendance at pathway meetings
  • Completion of either an educational or research project

For further information contact:
Deborah Cowley, MD
dcowley@uw.edu
Amritha Bhat, MD
amritha@uw.edu