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NICE clinical guideline 45
Antenatal and postnatal mental health: clinical management and service
guidance
Ordering information
You can download the following documents from www.nice.org.uk/CG045
· The NICE guideline (this document) ­ all the recommendations.
· A quick reference guide ­ a summary of the recommendations for
healthcare professionals.
· `Understanding NICE guidance' ­ information for patients and carers.
· The full guideline ­ all the recommendations, details of how they were
developed, and summaries of the evidence they were based on.…read more

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Contents
Introduction ......................................................................................................4
Patient-centred care.........................................................................................5
Key priorities for implementation......................................................................6
1 Guidance ................................................................................................10
1.1 Principles of care for all women with mental disorders during
pregnancy and the postnatal period 10
1.2 Prediction, detection and initial management of mental disorders 12
1.3 Prevention of mental disorders 15
1.4 Care of women with a mental disorder during pregnancy and the
postnatal period 16
1.5 The organisation of services 36
2 Notes on the scope of the guidance .......................................................37
3 Implementation .......................................................................................38
4 Research recommendations ...................................................................39
4.…read more

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Introduction
This guideline makes recommendations for the prediction, detection and
treatment of mental disorders in women during pregnancy and the postnatal
period (up to 1 year after delivery). It includes advice on the care of women
with an existing mental disorder who are planning a pregnancy, and on the
organisation of mental health services.…read more

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Patient-centred care
Treatment and care should take into account the woman's individual needs
and preferences. Women with mental disorders during pregnancy or the
postnatal period should have the opportunity to make informed decisions
about their care and treatment in partnership with their healthcare
professionals. If women do not have the capacity to make decisions,
healthcare professionals should follow the Department of Health guidelines ­
`Reference guide to consent for examination or treatment' (2001) (available
from www.dh.gov.uk).…read more

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Key priorities for implementation
Prediction and detection
· At a woman's first contact with services in both the antenatal and the
postnatal periods, healthcare professionals (including midwives,
obstetricians, health visitors and GPs) should ask questions about:
- past or present severe mental illness including schizophrenia,
bipolar disorder, psychosis in the postnatal period and severe
depression
- previous treatment by a psychiatrist/specialist mental health
team including inpatient care
- a family history of perinatal mental illness.…read more

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Psychological treatments
· Women requiring psychological treatment should be seen for treatment
normally within 1 month of initial assessment, and no longer than 3
months afterwards. This is because of the lower threshold for access to
psychological therapies during pregnancy and the postnatal period
arising from the changing risk­benefit ratio for psychotropic medication
at this time.…read more

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Management of depression
· When choosing an antidepressant for pregnant or breastfeeding
women, prescribers should, while bearing in mind that the safety of
these drugs is not well understood, take into account that:
- tricyclic antidepressants, such as amitriptyline, imipramine
and nortriptyline, have lower known risks during pregnancy
than other antidepressants
- most tricyclic antidepressants have a higher fatal toxicity
index than selective serotonin reuptake inhibitors (SSRIs)
- fluoxetine is the SSRI with the lowest known risk during
pregnancy
- imipramine, nortriptyline and sertraline are…read more

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Organisation of care
· Clinical networks should be established for perinatal mental health
services, managed by a coordinating board of healthcare professionals,
commissioners, managers, and service users and carers.…read more

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Guidance
The following guidance is based on the best available evidence. The full
guideline (www.nice.org.uk/CG045fullguideline) gives details of the methods
and the evidence used to develop the guidance (see section 5 for details).
1.1 Principles of care for all women with mental
disorders during pregnancy and the postnatal period
1.1.…read more

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