helen kim, md director, hcmc mother baby program and hennepin women’s mental health program...

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Helen Kim, MD Director, HCMC Mother Baby Program and Hennepin Womens Mental Health Program Department of Psychiatry Hennepin County Medical Center www.mnwomensprogram.org helen.kim@hcmed.org Minding the mother and restoring natural rhythms to support the mother-baby relationship Slide 2 Outline I.Definitions: mind, mindsight, mentalizing II.What interferes with mindsight? III.Psychiatric illness as brain/mind disorders that include disruptions in energy and biological rhythms IV.The role of psychiatrists and medication V.Functional or integrative medicine as a lens to interpret mind/body symptoms Slide 3 Mission: To support families by strengthening the emotional health and parenting capacity of mothers Slide 4 Mission: To support families by strengthening the emotional health and parenting capacity MINDSIGHT of mothers Slide 5 MIND Slide 6 Definition of Mind by Daniel Siegel, MD Mind: an embodied and relational process that regulates the flow of energy and information. An emergent process that arises from energy and information flow within you and between you and others Slide 7 Mindsight the ability to reflect on the mind or mental states of oneself and others. emerges from within attachment relationships that foster such processes. essential in healthy relationships a learnable skill I am sad vs I feel sad Slide 8 Mindsight is a kind of focused attention that allows us to see the internal workings of our own minds. It helps us to be aware of our mental processes without being swept away by them, enables us to get ourselves off the autopilot of ingrained behaviors and habitual responses, and moves us beyond the reactive emotional loops we all have a tendency to get trapped in The focusing skills that are part of mindsight make it possible to see what is inside, to accept it, and in the accepting to let it go, and, finally, to transform it. Dan Siegel, MD Slide 9 Mindsight -- seeing the mind 1) Insight into oneself 2) Empathy for others 3) Integration within you and your nervous system and between you and others Intepersonal Neurobiology -- the study of mindsight Slide 10 Mentalize To be aware of mental states (desires, needs, feelings, reasons, beliefs) that drive reactions and behaviors of ourselves and others To feel and think about feeling at the same time A psychological skill that allows one to understand the internal state of oneself and another Occurs on intellectual/conscious level Occurs on a gut/intuitive level An old idea --- Descartes, Theory of Mind, Fonagy (mentalizing in the context of attachment relationship, Arietta Slade (mentalizing in context of parenting; reflective functioning) Slide 11 Mindsight - noun Mentalize - verb Nonjudmental curiosity, acceptance, compassion Mindfulness of the mind of self and others; Mind mindedness, reflective functioning, psychological mindedness Empathy for self and others Slide 12 Mentalizing as a Compass for Treatment Jon G. Allen, PhD, Efrain Bleiberg, MD, and Tobias Haslam-Hopwood, PsyD, The Menninger Clinic http://www.menningerclinic.com/education/clinical- resources/mentalizing Mentalizing as conceptual compass to help patients understand how staff approach treatment Shared understanding and shared goals as foundation for sense of were in this together Slide 13 Why is mentalizing important? Self-awareness: to reflect on and communicate our feelings/thoughts Self-agency: Understanding that behavior doesnt just happen but is based on mental states. I am responsible for my behavior Self-regulation: I feel angry vs I am angry I am not my feelings Relationships: feeling felt by another provides sense of connectedness/security; promotes understanding, intimacy Finding meaning from suffering and hope Resilience Mentalizing as a Compass for Treatment Jon G. Allen, Slide 14 Why is mindsight or mentalizing important? Responsibility Regulation Relationships Resilience Slide 15 "The whole idea of thinking about thinking is that we learn about ourselves through being understood by other people. Babies learn about their feelings by having their feelings understood by someone else." ~ David Wallin David Wallin Slide 16 Slide 17 What interferes with mentalizing? Strong emotions: shame, anger, fear ---> flight/fight/freeze Defense strategies: repression, denial, avoidance, suppression Apathy/indifference: I dont care whats in my mind or yours Psychiatric illness: depression, anxiety, substance use, mania, psychosis Slide 18 Psychiatric illness as disruptions in biological rhythms and energy Maternal depression or anxiety inhibit mindsight and/or the ability to mentalize disrupt biological rhythms and energy Stabilizing a mothers biological rhythms is essential before she can synchronize with her babys rhythms. Parents as brain scientists or curators of the mind: Compassionate stance Non-judgmental curiosity Awe and wonder Slide 19 Depression is the number one complication of childbirth (Wisner, NEJM 2001) Perinatal Depression: 10% in general population 25% in high risk groups Perinatal Anxiety: 7-10% Gestational Diabetes: 5% pregnancies Slide 20 Kessler RC, et al. J Affect Disorders 1993;29:85-96 Women have 1.5-2.5 x rate of depression vs. men Lifetime prevalence: 21.3% women and 12.7% men Slide 21 Psychosis Slide 22 50% of women with PPD have depressive symptoms during pregnancy Slide 23 Risks of Untreated Depression/Anxiety Poor self care, nutrition, and prenatal compliance. Increased smoking, alcohol, drugs Increased ob/neonatal complications, such as preterm delivery Increased attachment and behavioral problems More pediatric visits for behavioral problems and injuries Slide 24 Maternal Depression and Risk to Early Parenting Children 0-3 years old are most vulnerable to risks of maternal depression due to rapid brain development and sole reliance on caregiver Slide 25 Childrens Defense Fund of Minnesota. (2011). Zero to Three Research to Policy: Maternal Depression and Early Childhood. www.cdf-mn.org Maternal Depression and Risk to Children Slide 26 Total annual cost of not treating 1 mother with depression = $22,647 Cost of not treating the mother = $7,211 Cost attributable to a child born to a depressed mother = $15,323 Cost of untreated maternal depression for mother and baby Wilder Research, Oct 2010 Slide 27 Slide 28 Slide 29 Slide 30 Waiting until behavior is a problem is not early detection/early intervention Psychiatric illness -- disorders of the brain/mind that can manifest in behavior changes* Mind behind the behavior as the target Early intervention starts prenatally and with parents/children Brain/Mind Science vs Behavioral Health *Thomas Insel, MD, NIMH http://www.ted.com/talks/thomas_insel_toward_a_new_understanding_of_mental_illness Slide 31 Slide 32 Are psychiatrists just prescribers and behavioral health providers? You need to see a psychiatrist = You need meds Slide 33 Slide 34 Slide 35 STRESS Slide 36 STRESS affects mind/body and ability to mentalize Difficulty sleeping Headaches, body or joint aches Poor energy Poor concentration Altered appetite Digestion problems Heart problems High blood pressure Irritability/anger/depression Slide 37 Stress, Depression and Anxiety through a Functional Medicine lens Slide 38 Slide 39 Personalized medicine that deals with primary prevention and underlying causes instead of symptoms for serious chronic disease. Based on these principles: -Biochemical individuality - Patient-centered medicine -- "patient care" vs "disease care - Web-like interconnections of physiological factors - Health as a positive vitality not merely the absence of disease What is Functional Medicine? www.functionalmedicine.org Slide 40 Slide 41 1)Hormone and neurotransmitter imbalances 2)Energy, mitochondria, and oxidative stress 3)Detoxification imbalances 4)Immune and inflammation imbalances 5)Gut and digestive health 6)Mind-body dysrhythms Some clinical imbalances underlying chronic medical conditions: Slide 42 Chronic Inflammation: the common final pathway to chronic disease Slide 43 Slide 44 Is depression an inflammatory condition? Acute inflammatory response necessary for trauma or infection Overactive immune or inflammatory response harmful: autoimmune disorders, RA, IBS, asthma, allergies, MS, celiac, thyroid Chronic inflammation drives some chronic diseases: heart disease, obesity, diabetes, and depression Pro-inflammatory cytokines cause physical and psychological symptoms (malaise, low mood, low energy, sleep disturbance) called sickness behavior which resembles depression Neurotransmitter-focused theories of depression have been limited Depressions connections to inflammation and immune dysregulation offer other treatment options Psychoneuroimmunology: the study of the CNS and immune system Slide 45 What causes chronic inflammation? Stress Toxins SAD diet Lack of exercise Hidden allergens/infections Slide 46 What do you need to thrive? Safety Sleep Healthy Foods/Healthy Digestion Light, water, air Movement Love, community, connection Purpose Slide 47 Slide 48 Sleep Slide 49 SLEEP Average sleep in 1900 --- 9 hours Study of 669 middle-aged adults found people sleep much less than they should, and even less than they think. (Am J Epi, 2006) White women 6.7 hrs/night White men 6.1 hrs/night Black women 5.9 hrs/night Black men 5.1 hrs/night Poor sleep less than wealthy. Slide 50 National Sleep Foundation Sleep in America Poll 2003: % reportingSlide 51 Slide 52 Sleep deprivation: the costs Inhibits mentalizing (mind-blindedness) Irritability Poor concentration Increased inflammation Makes you fat Increased risk of accidents Slide 53 Healthy Nutrition and Digestion Slide 54 Slide 55 Standard American Diet (SAD) High sugar High processed food -- think Twinkies nutrient poor, high calorie High in animal fats High in unhealthy fats: saturated, hydrogenated Low in fiber Low in complex carbohydrates Low in plant-based foods Slide 56 Foo