Prenatal Alcohol Exposure: A Clinician's Guide

474 Pages·1921·6.361 MB·English

by  Mansfield Mela

PRENATAL
ALCOHOL
EXPOSURE
A Clinician’s Guide
Mansfield Mela, MBBS, M.Sc.Psych.
Mela_Final.indd 1 11/20/2020 1:41:40 PM
PRENATAL ALCOHOL EXPOSURE
A Clinician’s Guide

PRENATAL ALCOHOL EXPOSURE
A Clinician’s Guide
by

Mansfield Mela, MBBS, M.Sc.Psych.
Director, Centre for Forensic Behavioral Science and Justice Studies
Professor, Department of Psychiatry, University of Saskatchewan
Diagnostic Research Lead, Canada FASD Research Network
Forensic Psychiatrist, Regional Psychiatric Centre
Saskatoon, Canada
Note: The author has worked to ensure that all information in this book is accurate
at the time of publication and consistent with general psychiatric and medical
standards, and that information concerning drug dosages, schedules, and routes of
administration is accurate at the time of publication and consistent with standards set
by the U.S. Food and Drug Administration and the general medical community. As
medical research and practice continue to advance, however, therapeutic standards
may change. Moreover, specific situations may require a specific therapeutic
response not included in this book. For these reasons and because human and
mechanical errors sometimes occur, we recommend that readers follow the advice of
physicians directly involved in their care or the care of a member of their family.
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represent the policies and opinions of American Psychiatric Association Publishing
or the American Psychiatric Association.
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Copyright © 2021 American Psychiatric Association Publishing
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First Edition
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Library of Congress Cataloging-in-Publication Data
Names: Mela, Mansfield, author. | American Psychiatric Association Publishing,
publisher.
Title: Prenatal alcohol exposure : a clinician's guide / by Mansfield Mela.
Description: First edition. | Washington, DC : American Psychiatric Association
Publishing, [2021] | Includes bibliographical references and index.
Identifiers: LCCN 2020048844 (print) | LCCN 2020048845 (ebook) | ISBN
9781615372393 (paperback ; alk. paper) | ISBN 9781615373697 (ebook)
Subjects: MESH: Fetal Alcohol Spectrum Disorders—psychology | Prenatal
Exposure Delayed Effects | Mental Disorders—diagnosis | Mental
Disorders—therapy
Classification: LCC RG629.F45 (print) | LCC RG629.F45 (ebook) | NLM WQ
211 | DDC 618.3/26861—dc23
LC record available at https://lccn.loc.gov/2020048844
LC ebook record available at https://lccn.loc.gov/2020048845
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xix
PART I
History and Epidemiology
1
History of Fetal Alcohol Spectrum Disorder
and Mental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3
Prenatal Exposure to Multiple
Psychoactive Substances . . . . . . . . . . . . . . . . . . . . . . . 29
PART II
Etiology
4
Understanding Etiological Mechanisms . . . . . . . . 59
5
Neurocognitive Mechanisms . . . . . . . . . . . . . . . . . . . 79
PART III
Presentation
6
Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . .93
7
Mental Disorder Manifestation of Fetal
Alcohol Spectrum Disorder . . . . . . . . . . . . . . . . . . . .127
8
Profile of Associated Mental Disorders . . . . . . . . .139
PART IV
Assessment and Diagnosis
9
Neuroimaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
10
Psychological Testing . . . . . . . . . . . . . . . . . . . . . . . . .169
11
Laboratory Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
12
Diagnostic Nosology . . . . . . . . . . . . . . . . . . . . . . . . . .201
PARTV
Treatment
13
Pharmacological Intervention . . . . . . . . . . . . . . . . .227
14
Psychological Treatment . . . . . . . . . . . . . . . . . . . . . .245
15
Critical Success Factors . . . . . . . . . . . . . . . . . . . . . . . .271
PARTVI
Special Populations
16
Special issues in Children and Adolescents
(the Young) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291
17
Special Issues in the Elderly . . . . . . . . . . . . . . . . . . .313
18
Special Issues in Forensic Mental Health . . . . . . .325
19
The Emergency Room . . . . . . . . . . . . . . . . . . . . . . . .353
PARTVII
Systems of Care
20
Clinical Relevance of Fetal Alcohol Spectrum
Disorder in the Mental Health System . . . . . . . . .369
21
Future of the Interface of Prenatal Alcohol
Exposure and Mental Disorder . . . . . . . . . . . . . . . .403
Appendix: Abbreviations . . . . . . . . . . . . . . . . . . . . . .421
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .423

Preface
This book provides clinically relevant information for mental health ex-
perts, but it goes beyond that to provide sufficient content to improve cli-
nicians’ level of comfort with information to which they have not hitherto
been exposed. Clinicians in this context include professionals in the medi-
cal, mental, educational, vocational, legal and correctional, child welfare,
and others in the health and social services sectors who encounter individ-
uals with a hidden disability. The scope and course content of curricula
needed to equip professionals are usually informed by the requisite skills
and experience for optimum clinical care. Professionals require essential
training to appropriately support patients who navigate the mental health
system because of the consequences of prenatal alcohol exposure (PAE).
Because curricula have only recently begun to incorporate this material, a
text providing basic as well as advanced information is necessary. This book
is significant because its content is useful for professional training across
many mental health disciplines. It covers information missing from curric-
ula about the long-term effects of PAE (fetal alcohol spectrum disorder
[“FASD 101”]) and includes clinical information on the mental disorders
relevant to FASD. Given the burgeoning research and knowledge in this
area, the text also updates, synthesizes, and consolidates current informa-
tion into one source. Even seasoned mental health professionals well versed
in the research data can use this information to become better educated and
informed on the intersecting mental health consequences of PAE.
Because a large number of individuals with neurobehavioral disorder
associated with PAE/FASD also manifest overlapping features of mental
disorders or have additional mental disorder diagnoses, advocating for a
separate system that addresses their specific needs has lasting implications
and benefits. Acknowledging the realities of life, educating and training
mental health professionals to adapt their practices to recognize these needs
ix