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

Establishing an integrated perinatal care program for substance-dependent young mothers. Ulrich Zimmermann Dept. of Psychiatry and Psychotherapy. Methamphetamine seizures in Germany. In-patient treatment of newborns due to methamphetamin use of their mothers (n=160). (N).

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

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  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 %

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