The normalisation of disrupted attentional processing of infant distress in depressed pregnant women following Cognitive Behavioural Therapy

BACKGROUND

Maternal depression is associated with abnormal processing of infant distress. This may explain why depression disrupts maternal behaviour and ultimately child outcomes. Understanding and improving such processing, in depressed mothers as early as possible is thus important.

AIM

The focus of the current study was to investigate whether Cognitive Behavioural Therapy (CBT) normalises depressed pregnant women's abnormal attentional processing of infant distress.

METHOD

Depressed pregnant women participating in a randomised control trial completed a measure of attentional bias for infant distress before and after intervention. Women received either CBT (n=12) or usual care [UC] (n=12) between their first and last trimesters of pregnancy.

RESULTS

At baseline, depressed women in both arms showed a diminished attentional bias for infant distress compared to a non-depressed comparison group (n=51). Following intervention attentional biases of women who received CBT increased becoming comparable to non-depressed women. In contrast there was no improvement in the UC arm.

CONCLUSIONS

If replicated, the findings may suggest that CBT during pregnancy improves mother's basic processing of infant stimuli before their child is born.

LIMITATIONS

The sample size was relatively small and there was some loss to follow up between the pre and post intervention sessions.

The impact of alcohol use during pregnancy on maternal responses after birth

The aim of the study was to investigate the influence of alcohol exposure during pregnancy on a mother's responsiveness towards her infant after birth. Using longitudinal data from a subsample of 687 mother-infant dyads from a UK cohort study (Avon Longitudinal Study of Parents and Children), we investigated the influence of alcohol use during mid- and late pregnancy on observed mother-infant interactions after birth. We found that women who drank one or more glasses of alcohol a week during their mid-trimester of pregnancy were 19 % (95 % CI, 1 to 40 %; p = 0.033) more likely to show non-responsive behaviour towards their infant 12 months after birth. In contrast, we found that alcohol use during late pregnancy was not associated with later maternal responsiveness. This study adds to the growing evidence for the importance of factors during pregnancy on later maternal responsiveness. Further research is needed to replicate these findings and to examine potential mechanisms linking maternal responsiveness to alcohol use during pregnancy.

Disruption to the development of maternal responsiveness? The impact of prenatal depression on mother-infant interactions

Both prenatal and postnatal maternal depression are independently associated with an increased risk of adverse infant development. The impact of postnatal depression on infants may be mediated through the effect of depression in reducing maternal responsiveness. However, the mechanisms underlying the effect of prenatal depression are unclear. Using longitudinal data from over 900 mother-infant pairs in a UK birth cohort (ALSPAC), we found that women with high depressive symptom scores during mid pregnancy, but NOT when their infants were 8 months, had a 30% increased risk of low maternal responsiveness when the infant was 12 months compared to women with consistently low depression. This may provide a mechanism to explain the independent association between prenatal depression and poorer infant development.

Symptoms of depression during pregnancy are associated with increased systolic blood pressure responses towards infant distress

A mother's response towards her infant's distress is important for the mother-infant relationship and infant development. There is evidence that maternal responses are impaired in depressed mothers. Further understanding of how depression disrupts maternal responses is important to direct treatment strategies. There is evidence that maternal responses develop during pregnancy. Further understanding of the relationship between depression and maternal responses during pregnancy is therefore important. We have previously found that depression during pregnancy is associated with reduced attentional engagement with infant distress but is unclear whether this is an insensitive or avoidance response. In the current study, we investigated the impact of anhedonic symptoms of depression on pregnant women's autonomic response towards infant distress. We found that women experiencing anhedonic depressive symptoms during pregnancy had significantly larger systolic blood pressure responses towards infant distress (β, 1.6 mmHg, 95 % CI 0.5 to 2.6, p = 0.004) than non-depressed pregnant women. These results suggest that anhedonic symptoms during pregnancy may be associated with increased sympathetic sensitivity. This suggests that depression is not, at a sympathetic level at least, associated with insensitivity to infant distress and rather depression may be associated with an abnormally sensitive response.

The association between observed non-verbal maternal responses at 12 months and later infant development at 18 months and IQ at 4 years: a longitudinal study

BACKGROUND

An infant's early environment has an important influence on their development. For example, the sensitivity and warmth of a mother's responses towards her infant is associated with the infant's later socio-emotional development. However, it is less clear whether maternal responses are associated with the infant's later cognitive development.

METHOD

We used data from a large UK cohort study to investigate the association between non-verbal maternal responses and later infant development and IQ. Maternal responses were rated at 12 months during an observed mother-infant interaction. Infant development was assessed using the Griffiths scales at 18 months and IQ at 4 years was assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Data on the infant's developmental level at 6 months (prior to the maternal response ratings) was also available. The complete case sample comprised 732 mother-infant pairs.

RESULTS

There was evidence for an association between positive maternal responses and infant development at 18 months. After adjusting for infant developmental level at 6 months and other confounders, we found a difference of 0.25 standard deviations (coef 2.0, 95% CI (0.8-3.2), p=0.002) on the Griffiths scales between infant's whose mothers showed positive compared to neutral non-verbal responses at 12 months. However, an association between positive maternal responses and IQ at 4 years diminished following adjustment for maternal educational attainment.

CONCLUSION

The results provide evidence that positive maternal responses are associated with improved development in infants at 18 months. However, the association between maternal response and IQ at 4 years may be explained by higher educational attainment in mothers who show positive responses. Future studies are needed to explore the influence of maternal responses on different aspects of infant development as well as the role of maternal factors such as education.

Attentional processing of infant emotion during late pregnancy and mother-infant relations after birth

The mother-infant relationship has an important influence on maternal mental health and infant development. Evidence suggests that this relationship is enhanced by a mother's sensitive response towards her infant's distress. We proposed that attentional processing of infant distress may indicate individual differences in this response. Research also suggests that maternal responses develop during pregnancy. We therefore hypothesised that more sensitive attentional processing of distressed infant stimuli during late pregnancy will be associated with more successful mother-infant relationships. Healthy pregnant women were recruited through community midwives. An established computerised paradigm measured women's ability to disengage attention from distressed or non-distressed infant faces. From this paradigm, we derived an index of women's attentional bias towards infant distress. Mother-infant relationships were measured using the postpartum bonding questionnaire (PBQ). A complete case sample of 49 women completed the attentional paradigm during late pregnancy and the PBQ 3-6 months after birth. We found that women who showed greater attentional bias towards infant distress during late pregnancy reported more successful mother-infant relationships. For every 50-ms increase on our measure of attentional bias towards infant distress during late pregnancy, the odds ratio for reporting a higher PBQ score, indicative of a weaker relationship, was 0.43 (95% confidence intervals 0.23-0.81, p = 0.01). The results suggest that women's basic attentional processing of infant emotion during pregnancy influences their relationships with their infant. In the future, women's attentional processing of infant emotion could inform early strategies to promote successful mother-infant relationships in vulnerable mothers to be.

The impact of breastfeeding on mothers' attentional sensitivity towards infant distress

BACKGROUND

Maternal response towards infant distress has an important impact on infant development. In animals it is established that lactation and pup suckling plays an important role in maintaining maternal responses. Previous research suggests that breastfeeding is associated with sensitive maternal responses in human mothers. However, this may be because women who are more sensitive to their infant choose to breastfeed. The current study investigated the attentional sensitivity towards infant distress in women who went on to breast or formula feed during pregnancy as well as after birth. We hypothesised that differences in breast and formula feeding mothers would only emerge after birth once feeding had commenced.

METHOD

Women were recruited during pregnancy through community midwives as part of a longitudinal study. 51 women were seen during late pregnancy and between 3 and 6 months after birth (27 were breast and 24 were formula feeding). Sensitivity to infant distress was measured as the extent of women's attentional bias towards infant distress stimuli.

RESULTS

After birth, we found that our index of attentional bias towards infant distress was 37 ms (0.5 S.D.s) (CI; 6-69, p = 0.021) higher in breastfeeding compared to formula feeding mothers. However, mothers who went on to breastfeed did not show greater attentional bias towards infant distress already during late pregnancy.

CONCLUSIONS

Our results suggest that the act of breastfeeding may influence mothers' attentional sensitivity towards infant distress. Previous research suggests breastfeeding is indicative of sensitive parenting. The current findings may suggest a mechanism by which breastfeeding and/or associated infant interaction could contribute to this sensitivity.

Depressive symptoms in early pregnancy disrupt attentional processing of infant emotion

BACKGROUND

Growing evidence suggests that perinatal depression is associated with disrupted mother-infant interactions and poor infant outcomes. Antenatal depression may play a key role in this cycle by disrupting the development of a maternal response to infant stimuli. The current study therefore investigated the impact of depressive symptoms on the basic cognitive processing of infant stimuli at the beginning of pregnancy.

METHOD

A total of 101 women were recruited by community midwives and tested at an average gestation of 11 weeks. An established computerized paradigm measured women's ability to disengage attention from infant and adult faces displaying negative positive and neutral emotions. Depressive symptoms were measured using a computerized interview (the Clinical Interview Schedule).

RESULTS

The effect of infant emotion on women's ability to disengage from infant faces was found to be influenced by depressive symptoms. Non-depressed pregnant women took longer to disengage attention from distressed compared with non-distressed infant faces. This bias was not, however, seen in women experiencing depressive symptoms. There was a difference of -53 (s.d.=0.7) ms (95% confidence interval -90 to -14, p=0.007) between those with and without depressive symptoms in this measure of attentional bias towards distressed infant faces.

CONCLUSIONS

Our results suggest that depressive symptoms are already associated with differential attentional processing of infant emotion at the very beginning of childbearing. The findings have potential implications for our understanding of the impact of depressive symptoms during pregnancy on the developing mother-infant relationship.

Emotional sensitivity for motherhood: late pregnancy is associated with enhanced accuracy to encode emotional faces

Previous research suggests that female sex hormones can increase the sensitivity of women's emotion processing systems. The largest rises in sex hormone levels in a woman's life are from early to late pregnancy. The current study, therefore, investigated whether changes in emotion processing are seen across pregnancy. Hypervigilant emotion processing has been implicated in the aetiology of anxiety. Therefore enhanced emotion processing across pregnancy has implications for women's vulnerability to anxiety. Ability to encode facial expressions of emotion was assessed in 101 women during early pregnancy and again in 76 of these women during late pregnancy. Symptoms of anxiety were measured using a clinical interview (The CIS-R). Consistent with previous research, the presence of anxiety symptoms was associated with greater accuracy to encode faces signalling threat (fearful and angry faces). We found that women had higher accuracy scores to encode emotional expressions signalling threat or harm (fearful, angry and disgusted faces) but also a more general negative emotion (sadness) during late, compared with early, pregnancy. Enhanced ability to encode emotional faces during late pregnancy may be an evolutionary adaption to prepare women for the protective and nurturing demands of motherhood by increasing their general emotional sensitivity and their vigilance towards emotional signals of threat, aggression and contagion. However, the results also suggest that, during late pregnancy, women's emotion processing style is similar to that seen in anxiety. The results have implications for our understanding of normal pregnant women's processing of emotional cues and their vulnerability to symptoms of anxiety.

Comparison of vibration perception thresholds in individuals with diffuse upper limb pain and carpal tunnel syndrome

The study objective was to compare vibration perception and patterns of blood flow in outpatients with diffuse upper limb pain disorder (ULPD), carpal tunnel syndrome (CTS) and age and sex matched healthy controls. Vibration perception and discrimination thresholds were compared in subjects with ULPD (n=27), CTS (n=27) and healthy matched controls (n=54). Vibration measurements were taken bilaterally at three sites: (a) over the dorsum of the second and (b) fifth metacarpals and (c) the palmar aspect of the first and second metacarpals, corresponding to the innervation territories of the radial, ulnar and median nerves, respectively. Non-invasive assessments of peripheral blood flow were also performed in both limbs. When compared to healthy controls, subjects with ULPD had widespread elevation of vibration thresholds both ipsilateral and contralateral to the symptomatic limb. Subjects with CTS had similarly elevated vibration thresholds at sites both adjacent to and distant from the site of peripheral nerve injury. The responses to cold pressor testing of the upper limbs were physiologically normal in both the CTS and ULPD patient groups. Furthermore, there were no significant differences in the haemodynamic responses between the patient groups. The global elevation of vibration thresholds in subjects with both ULPD and CTS is consistent with altered central nervous system mechanisms, common to both conditions, which may be either adaptive to or maintaining the perception of pain.

Receptor pharmacology of neuroleptics

The term 'neuroleptic' originated from animal experiments--these drugs caused profound sedation and abnormal posturing as if the animal had been 'seized' (Greek 'lepsis', meaning seizure). All early neuroleptic drugs had antipsychotic actions and vice versa. Now there are drugs which are potent antipsychotics without the classic neuroleptic actions known as atypical neuroleptics.

Effect of nitric-oxide-generating system on microcirculatory blood flow in skin of patients with severe Raynaud's syndrome: a randomised trial

BACKGROUND

Patients with Raynaud's syndrome have abnormal digital vasoconstriction, which may be secondary to impaired synthesis of, or impaired sensitivity to, nitric oxide. We studied the effect on microcirculation of a nitric-oxide-generating system applied topically to the finger and forearm of healthy volunteers and patients with primary Raynaud's syndrome.

METHODS

We did a single-blind, randomised, placebo controlled, cross-over study of the microcirculatory response to topical application of a nitric-oxidegenerating gel in 20 patients with severe Raynaud's syndrome, and ten healthy volunteers. We prepared the nitric-oxide-generating system by mixing a solution of KY jelly and sodium nitrite (5% weight/volume), with a solution of KY jelly and ascorbic acid (5% weight/volume). About 0.5 mL of each solution was separately applied to the skin of the forearm (3 cm2), and then mixed with a sterile cotton bud. A similar procedure was done simultaneously on the other arm with KY jelly only (placebo). The procedure was then repeated on the finger pulps. Changes in skin microcirculatory volume and flux were measured bilaterally by infrared photoplethysmography and laser doppler fluxmetry, respectively.

FINDINGS

In the forearm, blood flow increased significantly after application of the active gel both in patients with Raynaud's syndrome (microcirculatory volume from mean area under the curve 98 [SE 14] to 1024 [130]; microcirculatory flux from 5060 [462] to 74,800 [3940]) and in healthy controls (volume from 85 [19] to 1020 [60]; flux from 4420 [435] to 84,500 [7000]). In the fingers, although baseline blood flow was lower in patients than in controls, both groups showed increases with application of active gel (volume from 1100 [194] to 3280 [672] and 2380 [441] to 6160 [1160], respectively; flux from 33,400 [4200] to 108,000 [13,600] and 52,000 [8950] to 185,000 [19,500]). Increases in blood flow with placebo gel were not significant. No adverse effects were reported.

INTERPRETATION

In primary Raynaud's syndrome, topical application of a nitric-oxide-generating system can stimulate an increase in both microcirculatory volume and flux.

Effects of pentoxifylline on human sperm parameters in vitro

PURPOSE

Pentoxifylline was tested in three raising concentrations (0.7 mM/l, 1.5 mM/l, 3.6 mM/l) on human sperm cells in vitro.

METHODS

On 143 samples, we examined drug effect on motile sperm concentration, grade of their motility, acrosome reaction and membrane status.

RESULTS

Obtained results show improvement in motile sperm concentration, as well as in the grade of progression in the majority of samples.

CONCLUSIONS

Spermatozoa membranes as well as occurrence of the acrosomal reaction were not affected by pentoxifylline.

Reflex Sympathetic Dystrophy and Repetitive Strain Injury: Temperature and Microcirculatory Changes following Mild Cold Stress

Temperature and blood flow studies were performed in the upper limbs of six patients with reflex sympathetic dystrophy (RSD), nine patients with repetitive strain injury (RSI) and 12 control subjects using thermography, laser Doppler flowmetry, infrared photoplethysmography and venous occlusion strain gauge plethysmography. The contralateral responses of the symptomatic and asymptomatic limbs were examined after being subjected, separately, to mild cold stress (20°C for 1 min). Altered thermoregulation and haemodynamics were evident in RSD. Though the pattern of response to contralateral cold challenge is similar to normal in RSI, vasodilatation and reduced vasomotion appears to be characteristic in this condition. Such changes may assist in distinguishing between RSD and RSI from other causes of chronic upper limb pain.

Influence of debrisoquine hydroxylation phenotype on the pharmacokinetics of mexiletine

Marked interindividual variation has been observed in the pharmacokinetics of the antiarrhythmic agent mexiletine. The fact that its urinary excretion is dependent on urinary pH may account, in part, for such variation. The influence that genetic differences in hepatic metabolism of the debrisoquine-type may have on mexiletine pharmacokinetics was considered in this study. The pharmacokinetics and urinary excretion of mexiletine (250 mg administered intravenously) were investigated in 5 rapid extensive metabolisers (EM), 5 slow EM and 5 poor metabolisers (PM) of debrisoquine, under conditions of controlled urinary pH. Mexiletine disposition kinetics was found to be altered in PM individuals. These subjects showed higher total area under the curve (AUC), (15.7 versus 8.16 micrograms.h.ml-1) prolonged elimination half-lives (in serum and urine) (serum: 18.5 versus 11.6 h, urine: 19.2 versus 11.7 h) and lower total clearance values compared with EM (216 versus 450 ml.min-1). In this respect, slow EM individuals generally presented intermediate values of those pharmacokinetic parameters. A higher incidence of adverse-effects was also observed among slow EM and PM subjects. It is concluded that genetic differences in mexiletine oxidation of the debrisoquine-type have an influence on its observed pharmacokinetic variability. The clinical consequences are discussed.

Lack of acipimox-digoxin interaction in patient volunteers

1. A study was carried out to find out if digoxin and acipimox interact. 2. Six elderly patients on digoxin were each given acipimox 150 mg three daily for a week, after informed consent. Digoxin and acipimox plasma concentrations and urinary excretion were measured after the first dose of acipimox and after a week of treatment. 3. Data were fitted to a one-compartment oral absorption model. Areas under the plasma concentration-time curve, plasma and renal clearances, and elimination half-life were computed. 4. There was no significant difference in digoxin plasma concentrations and kinetic parameters before and after acipimox administration. Acipimox kinetics were not affected by the concomitant ingestion of digoxin. 5. The patients' clinical condition remained stable during the study. 6. Thus there was no evidence for an adverse interaction between digoxin and acipimox in human subjects under the conditions of this study.