Concurrent Health Issues
Topics
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Women Veterans have a high rate of chronic medical conditions, many of which require ongoing treatment with medications.
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As part of routine medical care, all women should be assessed for chronic and acute disease conditions known to impact women’s general health and well being as well as their reproductive health. Optimal management includes appropriate prevention counseling, testing, treatment, and coordination of care among primary and specialty care providers.
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Mental Health Conditions
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General Principles
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Normal physiological hormonal transitions that occur during a woman’s life cycle may increase her vulnerability to mental health disorders or exacerbate existing mental health disorders.
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Reproductive events including the menstrual cycle, pregnancy, lactation, and the postpartum period may affect management decisions.
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Screen for mental health conditions in all women of childbearing age by asking about family history of mental health conditions (i.e. psychosis, depression, psychotic or affective disorders). Ask about mood disorders, personal history of depression, other psychiatric conditions and interpersonal violence.
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VA requires that providers screen all Veterans for military sexual trauma (MST) as part of the mental health assessment. Screening questions:
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While you were in the military, did you receive uninvited and unwanted sexual attention, such as touching, cornering, pressure for sexual favors, or verbal remarks?
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While you were in the military, did someone ever use force or threat of force to have sexual contact with you against your will?
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Women at risk should receive a formal psychiatric assessment.
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Appropriate contraception should be offered to women who do not desire pregnancy.
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If a Veteran requires immediate assistance with a mental health issue, confidential support is available 24 hours a day, 7 days a week, 365 days a year through the Veterans Crisis Line (1-800-273-8255 and Press 1).
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Counsel on Increased Risk With Pregnancy
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For patients with a mental health diagnosis, consider a referral to a mental health specialist if they are not already connected to a mental health provider.
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There are several very effective methods for the treatment of a wide range of mental health disorders.
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Preconception care should be provided collaboratively with the mental health provider and primary care provider and ob/gyn involved when needed.
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Treatment is provided during pregnancy when the risk to the mother and fetus from the disorder outweighs the risk of the intervention.
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Patients with similar illness histories may make different decisions regarding treatment during pregnancy when presented with the risks and benefits of medication treatment and other available therapies.
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No decision is risk-free.
- Risks of untreated psychiatric illness during pregnancy include:
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Relapse or exacerbation of symptoms.
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Higher rates of C-section, preterm birth, low birth weight, being small for gestational age.
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Additional risks with pregnancy may occur with co-existing relationship difficulties, financial strain, and interpersonal violence.
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Screening for past and current interpersonal violence, including Military Sexual Trauma (MST), is indicated for all patients. Support for these issues should be made available (See Resources).
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Non-Pharmacologic Treatment
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Condition Specific Risks and Medication Management
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