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Okayasu H, Yasui-Furukori N, Shimoda K. A pregnant woman who experienced auditory hallucinations concurrent with hyperemesis gravidarum: A case report. Neuropsychopharmacol Rep 2021; 41:548-550. [PMID: 34472727 PMCID: PMC8698677 DOI: 10.1002/npr2.12206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022] Open
Abstract
We report the case of a pregnant woman who experienced auditory hallucinations only while suffering from hyperemesis gravidarum. To the best of our knowledge, the present report is the first report of a case of obvious auditory hallucinations and hyperemesis gravidarum at the same time in a pregnant woman who had not been diagnosed with any psychiatric disorder. The patient was a 24‐year‐old pregnant woman with no history of psychiatric disorder. Two years prior to this admission, she became pregnant for the first time, and she was admitted to an obstetrics clinic due to severe hyperemesis gravidarum. She developed mild auditory hallucinations at the same time. After she gave birth, the auditory hallucinations disappeared. When she was 24 years old, she became pregnant again. She suffered from severe hyperemesis gravidarum from the early stage of pregnancy. At 20 weeks of pregnancy, she visited the Department of Psychiatry of our hospital for a detailed psychiatric evaluation and treatment because her moderate auditory hallucinations had relapsed. We administered an antipsychotic agent, perospirone, to treat the auditory hallucinations, which disappeared, although the hyperemesis gravidarum persisted until childbirth. After childbirth, perospirone treatment was discontinued, and her auditory hallucinations did not relapse. The auditory hallucinations may have occurred as a result of complicated biological and psychosocial factors. Physicians should carefully evaluate psychotic symptoms, such as auditory hallucinations, not only during the postpartum period but also throughout the course of pregnancy. The present report is the first report of a case of obvious auditory hallucinations and hyperemesis gravidarum at the same time in a pregnant woman who had not been diagnosed with any psychiatric disorder. We administered an antipsychotic agent, perospirone, to treat the auditory hallucinations, which disappeared, although the hyperemesis gravidarum persisted until childbirth. After childbirth, perospirone treatment was discontinued, and her auditory hallucinations did not relapse.
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Affiliation(s)
- Hiroaki Okayasu
- Department of Psychiatry, Dokkyo Medical University, Mibu, Japan
| | | | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University, Mibu, Japan
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Beck CT. Perinatal Mood and Anxiety Disorders: Research and Implications for Nursing Care. Nurs Womens Health 2021; 25:e8-e53. [PMID: 34099430 DOI: 10.1016/j.nwh.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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53
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Perinatal depression. Int Anesthesiol Clin 2021; 59:45-51. [PMID: 34001697 DOI: 10.1097/aia.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
ABSTRACT Despite extensive research, the etiology behind postpartum depression (PPD) remains a mystery. Experts have theorized about various potential risk factors, including hormonal fluctuations, genetics, prior history of depression, low socioeconomic status, adolescent pregnancy, and certain personality traits. This article provides foundational information about PPD, reviewing the risk factors for and the consequences of this mood disorder. Postpartum blues and postpartum psychosis are briefly discussed for context, although they differ from PPD. Screening and treatment options are explained, and nursing implications for practice are presented.
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Affiliation(s)
- Barbara Marie Alba
- Barbara Marie Alba is the director of nursing for maternal-child health services at New York-Presbyterian Hospital, New York City. Contact author: . The author and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the author is available at www.ajnonline.com
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Koukopoulos A, Mazza C, De Chiara L, Sani G, Simonetti A, Kotzalidis GD, Armani G, Callovini G, Bonito M, Parmigiani G, Ferracuti S, Somerville S, Roma P, Angeletti G. Psychometric Properties of the Perinatal Anxiety Screening Scale Administered to Italian Women in the Perinatal Period. Front Psychiatry 2021; 12:684579. [PMID: 34239465 PMCID: PMC8257936 DOI: 10.3389/fpsyt.2021.684579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/25/2021] [Indexed: 12/04/2022] Open
Abstract
Literature stressed the importance of using valid, reliable measures to assess anxiety in the perinatal period, like the self-rated Perinatal Anxiety Screening Scale (PASS). We aimed to examine the psychometric properties of the Italian PASS version in a sample of Italian women undergoing mental health screening during their third trimester of pregnancy and its diagnostic accuracy in a control perinatal sample of psychiatric outpatients. Sample comprised 289 women aged 33.17 ± 5.08, range 19-46 years, undergoing fetal monitoring during their third trimester of pregnancy, with 49 of them retested 6 months postpartum. Controls were 60 antenatal or postnatal psychiatric outpatients aged 35.71 ± 5.02, range 22-50 years. Groups were assessed through identical self- and clinician-rating scales. Confirmatory Factor Analysis (CFA), Principal Component Analysis (PCA), Pearson's correlations and receiver operating characteristic were conducted for PASS. PCA and CPA confirmed four-factor structure with slight differences from the original version. Construct validity and test-retest reliability were supported. Cut-off was 26. The PASS correlated with principal anxiety scales. Despite small sample size, findings confirm reliability and validity of the Italian PASS version in assessing anxiety symptoms in the perinatal period. Its incorporation in perinatal care will improve future mother and child psychological health.
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Affiliation(s)
- Alexia Koukopoulos
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Lucio Bini Centre, Rome, Italy
| | - Cristina Mazza
- Department of Neuroscience, Imaging and Clinical Sciences G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Lavinia De Chiara
- Lucio Bini Centre, Rome, Italy
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Gabriele Sani
- Institute of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessio Simonetti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Lucio Bini Centre, Rome, Italy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Georgios D. Kotzalidis
- Lucio Bini Centre, Rome, Italy
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Giulia Armani
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
- APC Associazione di Psicologia Cognitiva, Rome, Italy
| | - Gemma Callovini
- Lucio Bini Centre, Rome, Italy
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, “San Camillo de Lellis” National Health System Hospital, Rieti, Italy
| | - Marco Bonito
- Dipartimento Materno Infantile, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Giovanna Parmigiani
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Susanne Somerville
- Department of Psychological Medicine, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Paolo Roma
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Gloria Angeletti
- Lucio Bini Centre, Rome, Italy
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
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Nard N, Moulier V, Januel D, Guillin O, Rothärmel M. [Electroconvulsive therapy during the perinatal period: Representations of mental health professionals]. Encephale 2021; 47:445-451. [PMID: 34148646 DOI: 10.1016/j.encep.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/17/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Psychiatric disorders are common in peripartum and are associated with adverse outcomes for mother and fetus. Electroconvulsive therapy (ECT) is one of the most effective and safe options to treat severe mental illness, including during the perinatal period. Nevertheless, it remains underutilized during this period, possibly due to negative representations. Research has been carried out on the representations and attitudes of caregivers towards ECT, but the specificities of these attitudes during peripartum have not been explored. OBJECTIVES We aimed to assess the attitudes towards ECT during the peripartum among psychiatrists, nurses, social workers and psychologists. The primary objective was to compare the score of favorability for ECT during peripartum according to the profession. The secondary objective was to highlight other factors involved in the favorability for ECT in peripartum. METHODS We investigated mental health professionals' attitudes sending by e-mail an anonymous questionnaire in five hospitals in France. The questionnaire was composed of demographic details, one scale about the attitudes towards ECT (the Questionnaire on Attitudes and Knowledge of ECT (QuAKE)) used in several studies; in this questionnaire, a specific part for perinatal period has been added for our study, both using a Likert scale. The completion time for this online questionnaire was approximately 5 to 7minutes. A score of favorability for ECT in general and in peripartum was established for each participant. These scores represented the percentage of positive responses to favorable items and of negative responses to unfavorable items towards ECT. Comparison of the QuAKE answers with a sample of English caregivers in 2001 has been determined with χ2 tests. A Bonferroni correction was applied due to the large number of tests performed. Factors involved in the favorability for ECT have been studied with Pearson correlation, Kruskall-Wallis and Wilcoxon tests. RESULTS Two hundred and twenty one professionals (80 psychiatrists, 78 nurses, 19 social workers and 44 psychologists) were included in the study. Their answers to the QuAKE questionnaire were comparable or more favorable to ECT than the English sample answered in 2001. The perinatal part of questionnaire had a good internal consistency (Cronbach coefficient: 0,91). Participants were less favorable to ECT in perinatal period (favorability score: 44.2) than in general (63.6). They more often responded « uncertain » to the perinatal questionnaire (44,9 % against 18.4 % for the ECT in general; W=19931,5; P<0,001). The favorability for ECT in general and during peripartum were statistically associated with profession (psychiatrists were more favorable), specific training and experience in ECT. Gender, perinatal specialization, age, and the number of years in professional service were not associated with favorability for ECT in general and during peripartum in this study. CONCLUSIONS In this study, we have found that profession, training and experience in ECT are linked to the attitudes towards ECT, including in the perinatal period. It is necessary to inform professionals about the possibility of prescribing ECT in the perinatal period by training them in the specificities of pregnancy.
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Affiliation(s)
- Noémie Nard
- Service Hospitalo-Universitaire, centre hospitalier du Rouvray, 4, rue Paul Eluard, 76300 Sotteville-lès-Rouen, France; Faculté de médecine, université de Normandie, 22, boulevard Gambetta, 76000 Rouen, France
| | - Virginie Moulier
- Service Hospitalo-Universitaire, centre hospitalier du Rouvray, 4, rue Paul Eluard, 76300 Sotteville-lès-Rouen, France; EPS Ville-Evrard, unité de Recherche Clinique, 202, avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France
| | - Dominique Januel
- EPS Ville-Evrard, unité de Recherche Clinique, 202, avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France
| | - Olivier Guillin
- Service Hospitalo-Universitaire, centre hospitalier du Rouvray, 4, rue Paul Eluard, 76300 Sotteville-lès-Rouen, France; Faculté de médecine, université de Normandie, 22, boulevard Gambetta, 76000 Rouen, France; CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - Maud Rothärmel
- Service Hospitalo-Universitaire, centre hospitalier du Rouvray, 4, rue Paul Eluard, 76300 Sotteville-lès-Rouen, France; CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France.
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Kohlhoff J, Cibralic S, Tooke S, Hickinbotham R, Knox C, Roach V, Barnett B. Health professional perspectives on an antenatal mental health screening program in a private hospital. Aust N Z J Obstet Gynaecol 2021; 61:891-897. [PMID: 34121178 DOI: 10.1111/ajo.13394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/11/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal mental ill-health is a global health priority. Mental health screening during pregnancy is a routine part of clinical practice in many public hospital obstetric services across Australia, but implementation in the private hospital system has lagged. AIMS This study explored health professionals' perspectives on the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. MATERIALS AND METHODS Nine midwives and three medical specialists participated in focus groups or individual interviews; key themes were determined using thematic qualitative analysis. RESULTS Five major themes and three sub-themes were identified: immediate benefits to women (identifying women at risk; referrals to support services; supporting and educating women); enhanced overall quality of care at the hospital; the dilemma of partners attending; factors that make the program successful; and recommendations for improvement. CONCLUSIONS Results will inform the implementation of antenatal mental health screening programs at other private hospitals across Australia.
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Affiliation(s)
- Jane Kohlhoff
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Karitane, Sydney, New South Wales, Australia
| | - Sara Cibralic
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah Tooke
- The Mater Hospital, Sydney, New South Wales, Australia
| | - Rachael Hickinbotham
- North Shore Private Hospital and the Mater Hospital, Sydney, New South Wales, Australia
| | | | - Vijay Roach
- North Shore Private Hospital and the Mater Hospital, Sydney, New South Wales, Australia
| | - Bryanne Barnett
- Gidget Foundation Australia, Sydney, New South Wales, Australia
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58
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Beck CT. Perinatal Mood and Anxiety Disorders: Research and Implications for Nursing Care. J Obstet Gynecol Neonatal Nurs 2021; 50:e1-e46. [PMID: 34099348 DOI: 10.1016/j.jogn.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Goedde D, Zidack A, Li YH, Arkava D, Mullette E, Mullowney Y, Brant JM. Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination. J Am Psychiatr Nurses Assoc 2021; 27:123-133. [PMID: 31898913 DOI: 10.1177/1078390319897311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression. AIMS: The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences. METHOD: A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale. Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness. A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service. RESULTS: The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit. Patients taking three or more psychiatric medications attended more OBMHC visits. Trend analysis indicated that women with the highest levels of depression had the best response to the intervention. Three qualitative themes emerged: Safe Place, Mental/Emotional Stability, and Integrated Personalized Approach. Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care. CONCLUSION: OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service. Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms. The longevity of this clinic's experience serves as a role model for other centers to replicate this successful integrated model of care.
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Affiliation(s)
- Diane Goedde
- Diane Goedde, MSN, APRN, Billings Clinic, Billings, MT, USA
| | - Astri Zidack
- Astri Zidack, EdD, LCPC, CRC, Billings Clinic, Billings, MT, USA
| | - Ya-Huei Li
- Ya-Huei Li, PhD, Billings Clinic, Billings, MT, USA
| | - Diane Arkava
- Diane Arkava, MSW, LCSW, Billings Clinic, Billings, MT, USA
| | | | | | - Jeannine M Brant
- Jeannine M. Brant, PhD, APRN AOCN, FAAN, Billings Clinic, Billings, MT, USA
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Perry A, Gordon-Smith K, Jones L, Jones I. Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review. Brain Sci 2021; 11:brainsci11010047. [PMID: 33406713 PMCID: PMC7824357 DOI: 10.3390/brainsci11010047] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 11/16/2022] Open
Abstract
Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1–2 in every 1000 deliveries. These episodes typically present as acute mania or depression with psychosis within the first few weeks of childbirth, which, as life-threatening psychiatric emergencies, can have a significant adverse impact on the mother, baby and wider family. The nosological status of postpartum psychosis remains contentious; however, evidence indicates most episodes to be manifestations of bipolar disorder and a vulnerability to a puerperal trigger. While childbirth appears to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum psychosis occurs are poorly understood. This review examines the current evidence with respect to potential aetiology and childbirth-related triggers of postpartum psychosis. Findings to date have implicated neurobiological factors, such as hormones, immunological dysregulation, circadian rhythm disruption and genetics, to be important in the pathogenesis of this disorder. Prediction models, informed by prospective cohort studies of high-risk women, are required to identify those at greatest risk of postpartum psychosis.
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Affiliation(s)
- Amy Perry
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
- Correspondence:
| | - Katherine Gordon-Smith
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
| | - Lisa Jones
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
| | - Ian Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK;
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61
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Thippeswamy H, Davies W. A new molecular risk pathway for postpartum mood disorders: clues from steroid sulfatase-deficient individuals. Arch Womens Ment Health 2021; 24:391-401. [PMID: 33219387 PMCID: PMC8116278 DOI: 10.1007/s00737-020-01093-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022]
Abstract
Postpartum mood disorders develop shortly after childbirth in a significant proportion of women. These conditions are associated with a range of symptoms including abnormally high or low mood, irritability, cognitive disorganisation, disrupted sleep, hallucinations/delusions, and occasionally suicidal or infanticidal ideation; if not treated promptly, they can substantially impact upon the mother's health, mother-infant bonding, and family dynamics. The biological precipitants of such disorders remain unclear, although large changes in maternal immune and hormonal physiology following childbirth are likely to play a role. Pharmacological therapies for postpartum mood disorders can be effective, but may be associated with side effects, concerns relating to breastfeeding, and teratogenicity risks when used prophylactically. Furthermore, most of the drugs that are used to treat postpartum mood disorders are the same ones that are used to treat mood episodes during non-postpartum periods. A better understanding of the biological factors predisposing to postpartum mood disorders would allow for rational drug development, and the identification of predictive biomarkers to ensure that 'at risk' mothers receive earlier and more effective clinical management. We describe new findings relating to the role of the enzyme steroid sulfatase in maternal postpartum behavioural processes, and discuss how these point to a novel molecular risk pathway underlying postpartum mood disorders. Specifically, we suggest that aberrant steroid hormone-dependent regulation of neuronal calcium influx via extracellular matrix proteins and membrane receptors involved in responding to the cell's microenvironment might be important. Testing of this hypothesis might identify novel therapeutic targets and predictive biomarkers.
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Affiliation(s)
- Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - William Davies
- Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK. .,School of Psychology, Cardiff University, Tower Building, 70, Park Place, Cardiff, CF10 3AT, UK. .,Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK.
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Barkin JL, Beals L, Bridges CC, Ezeamama A, Serati M, Buoli M, Erickson A, Chapman M, Bloch JR. Maternal Functioning and Depression Scores Improve Significantly With Participation in Visiting Moms® Program. J Am Psychiatr Nurses Assoc 2021; 27:54-63. [PMID: 31561726 DOI: 10.1177/1078390319877444] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND: Postpartum depression is the most common complication of childbearing can affect the entire family unit. Health professionals must strive to identify and develop effective, feasible solutions for women during this critical period. AIMS: To determine whether postpartum maternal functioning (as measured by the Barkin Index of Maternal Functioning) and depression symptoms (as measured by the Patient Health Questionnaire-9) were improved after participation in the Visiting Moms program. METHOD: Paired data were collected from women at program intake and after completion of the Visiting Moms program. Visiting Moms provides services through eastern and central Massachusetts and was designed to support new mothers throughout the infant's first year of life. The study population was composed of adult women living in the Jewish Family and Children's Services geographic catchment area, who enrolled in Visiting Moms between January 1, 2013, and December 31, 2015. Descriptive statistics were calculated for all 402 women enrolled in this timeframe. Utilizing a pretest/posttest design, paired t tests were performed for the Barkin Index of Maternal Functioning (n = 149) and for the Patient Health Questionnaire-9 (n = 156), where women had complete scores at both intake and completion, to determine the program's potential impact on depressive symptoms and functional status. RESULTS: Functioning and depression scores were significantly improved after participation in the program. CONCLUSIONS: Visiting moms, and similar programs, aimed at delivery of enhanced social support, may be effective in promoting mental and emotional wellness among new mothers who are require additional support in the postpartum period.
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Affiliation(s)
| | - Laura Beals
- Laura Beals, PhD, Jewish Family & Children's Service, Waltham, MA, USA
| | | | - Amara Ezeamama
- Amara Ezeamama, PhD, Michigan State University, East Lansing, MI, USA
| | - Marta Serati
- Marta Serati, MD, ASST Rhodense, Rho, Milan, Italy
| | | | - Amber Erickson
- Amber Erickson, MPH, Georgia Department of Public Health, North Central Health District, Macon, GA, USA
| | - Megan Chapman
- Megan Chapman, BSN, RN, Georgia Department of Public Health, North Central Health District, Macon, GA, USA
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Bider EN, Coker JL. Postpartum psychosis and SARS-CoV-2 infection: is there a correlation? Arch Womens Ment Health 2021; 24:1051-1054. [PMID: 34085138 PMCID: PMC8175096 DOI: 10.1007/s00737-021-01150-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has had a negative impact on mental health. Cases of psychosis associated with SARS-CoV-2 infection have been noted. The Women's Mental Health Program at the University of Arkansas for Medical Sciences determined four-fold increase from data from the last 5 years. We propose that the pandemic should be considered a risk factor for postpartum psychosis. Providers should emphasize sleep hygiene and monitor carefully for psychosis in postpartum women.
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Affiliation(s)
- Erin N. Bider
- grid.241054.60000 0004 4687 1637Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205 USA
| | - Jessica L. Coker
- grid.241054.60000 0004 4687 1637Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205 USA ,grid.241054.60000 0004 4687 1637Departments of Psychiatry and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR USA
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Pradeepkumar PC, Hamza A, Ragesh G, Ganjekar S, Thippeswamy H, Chandra PS, Desai G. Psychological Distress, Coping and Perceived Social Support Among Partners of Women with Postpartum Onset Severe Mental Illness (SMI) Admitted to a Mother-Baby Unit. Indian J Psychol Med 2020; 42:535-539. [PMID: 33354079 PMCID: PMC7735251 DOI: 10.1177/0253717620958162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The presence of a severe mental illness in the mother during the postpartum period may impact the whole family and specifically have an effect on the health of the spouse. The current study aimed to assess psychological distress, coping, and perceived social support of spouses of women with postpartum onset severe mental illness. METHODOLOGY A cross-sectional descriptive research design was used, and 30 spouses of the women admitted to the mother-baby unit (MBU) for psychiatric inpatient care were included in the study. The assessments included sociodemographic details, Kessler psychological distress scale (K10), brief coping orientation to problems experienced scale (brief COPE), and Zimets' multidimensional scale of perceived social support. RESULTS Around 50% of the spouses experienced severe psychological distress. Nearly 40% of spouses reported poor coping and 56.7% of spouses had moderate social support from family and friends. CONCLUSION The findings indicate the need to address distress and coping in spouses of women with postpartum onset SMI.
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Affiliation(s)
- PC Pradeepkumar
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ameer Hamza
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - G Ragesh
- Institute of Mental Health and Neurosciences, Govt Medical College Campus, Kozhikode, Kerala, India
| | - Sundarnag Ganjekar
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Harish Thippeswamy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Prabha S Chandra
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Geetha Desai
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Forde R, Peters S, Wittkowski A. Recovery from postpartum psychosis: a systematic review and metasynthesis of women's and families' experiences. Arch Womens Ment Health 2020; 23:597-612. [PMID: 32020314 PMCID: PMC7497301 DOI: 10.1007/s00737-020-01025-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/26/2020] [Indexed: 01/20/2023]
Abstract
Postpartum psychosis is a serious disorder that can result in adverse consequences for the mother and baby. It is important that we understand the experiences of women, to develop effective interventions during this critical period. The aim of this systematic review was to conduct a metasynthesis of qualitative research exploring women's experiences of postpartum psychosis and factors involved in recovery from the perspective of women and family members. A comprehensive literature search of five databases was conducted and the findings were appraised and synthesised, following a thematic synthesis approach. Fifteen studies, capturing the views of 103 women and 42 family members, met the inclusion criteria. Four main themes incorporating 13 subthemes were identified following synthesis: (1) Experiencing the unspeakable, (2) Loss and disruption, (3) Realigning old self and new self and the integrative theme of (4) Social context. The findings offer new insight into the unique experience of postpartum psychosis and demonstrate that recovery does not follow a linear path. To improve clinical outcomes, a more integrative and individualised approach is needed which incorporates long-term psychological and psychosocial support, and considers the needs of the family. Further areas for staff training, service development and future research are highlighted.
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Affiliation(s)
- R Forde
- Divison of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S Peters
- Divison of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - A Wittkowski
- Divison of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Zaydlin M, Tamargo C. Organic vs Stimulant-Induced Psychosis in the Peripartum Period. Cureus 2020; 12:e10718. [PMID: 33145126 PMCID: PMC7598219 DOI: 10.7759/cureus.10718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This is the case of a 30-year-old pregnant female who presented to the medical emergency department with signs and symptoms consistent with a psychotic episode. At the time of presentation, the patient was noted to have paranoia and delusions focused on her current pregnancy. On further evaluation in the emergency department, the patient’s urine toxicology was found to be positive for methamphetamines. Following medical clearance, the patient was admitted for acute inpatient psychiatric stabilization. During hospitalization, her psychosis rapidly resolved with only the use of two emergency treatment injections containing antipsychotic medication. This case presents an interesting differential diagnosis between a brief psychotic disorder with peripartum onset and a substance-induced psychosis, and allows for further discussion in the differentiation and clinical treatment of these diagnoses.
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Asselmann E, Kunas SL, Wittchen HU, Martini J. Maternal personality, social support, and changes in depressive, anxiety, and stress symptoms during pregnancy and after delivery: A prospective-longitudinal study. PLoS One 2020; 15:e0237609. [PMID: 32833975 PMCID: PMC7446870 DOI: 10.1371/journal.pone.0237609] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background The role of maternal personality and perceived social support for peripartum changes in psychopathological symptoms remains unresolved. Methods In a regional-epidemiological sample of 306 women, depressive, anxiety, and stress symptoms were assessed three times during pregnancy and three times after delivery with the 21-item version of the Depression Anxiety Stress Scale. In pregnancy, the Big Five personality traits and perceived social support were assessed with the short version of the Big Five Inventory and the Social Support Questionnaire. Results Multilevel analyses revealed that depressive (b = -0.055) and stress (b = -0.047) symptoms decreased from early to late pregnancy. After delivery, anxiety symptoms were lower (two months postpartum: b = -0.193; four/ 16 months postpartum: b = -0.274), but stress symptoms were higher (two months postpartum: b = 0.468; four/ 16 months postpartum: b = 0.320) than during pregnancy. Across the peripartum period, more conscientious and more extraverted women experienced lower depressive and stress symptoms (b = -0.147 to -0.177), and more emotionally stable women experienced lower depressive, anxiety, and stress symptoms (b = -0.294 to -0.415). More emotionally stable women more strongly increased in anxiety during pregnancy (b = 0.019), and more extraverted women less strongly increased in depression after delivery (b = -0.010). Moreover, peripartum depressive, anxiety, and stress symptoms were lower in women with higher perceived social support (b = -0.225 to -0.308). Conclusions Less emotionally stable, less conscientious, and less extraverted women and women with lower perceived social support seem to be at increased risk for peripartum psychopathological symptoms and might thus particularly profit from targeted prevention.
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Affiliation(s)
- Eva Asselmann
- Department of Psychology, Faculty of Life Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- * E-mail:
| | - Stefanie L. Kunas
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians Universität, Munich, Germany
| | - Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Abstract
BACKGROUND Psychotic episodes in the postpartum period are life-threatening psychiatric emergencies, requiring urgent medical attention and admission to a psychiatric hospital. AREAS OF UNCERTAINTY Although the postpartum psychosis (PPP) is the most severe psychiatric disorder associated with parturition, there is little information about what interventions are most effective. Because there are no specific guidelines for the treatment of PPP, the aim of the present review was to examine the available evidence regarding the treatment of PPP. DATA SOURCES The PubMed database was searched based on the title and the abstract, using the key words "postpartum psychosis," "postpartum psychosis antipsychotics," "postpartum psychosis treatment," and "postpartum psychosis pharmacotherapy," for both interventional and observational, irrespective of language. RESULTS A number of 14 publications met the study criteria, including case reports and case series. The antipsychotics (APs) use included both first generation APs, such as haloperidol and chlorpromazine, and second generation APs, mainly, olanzapine, quetiapine, and risperidone. The most frequently used AP was olanzapine. Olanzapine and quetiapine seem to be the most acceptable during breastfeeding. Proposed treatment algorithms for the successful management of PPP are discussed. CONCLUSIONS The existing studies to date do not allow to draw a definitive conclusion regarding which treatment is the most effective or the most adequate. Existing evidence suggests that APs alone or in combination are responsible for sustained remission and that treated PPP has a higher pace of improvement of the mental status, with a rapid discharge from the hospital. Clinical studies to compare the efficacy and safety of different APs in the PPP are needed to provide guidance on treatment interventions.
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Zhang W, Liu H, Silenzio VMB, Qiu P, Gong W. Machine Learning Models for the Prediction of Postpartum Depression: Application and Comparison Based on a Cohort Study. JMIR Med Inform 2020; 8:e15516. [PMID: 32352387 PMCID: PMC7226048 DOI: 10.2196/15516] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/15/2019] [Accepted: 02/01/2020] [Indexed: 12/13/2022] Open
Abstract
Background Postpartum depression (PPD) is a serious public health problem. Building a predictive model for PPD using data during pregnancy can facilitate earlier identification and intervention. Objective The aims of this study are to compare the effects of four different machine learning models using data during pregnancy to predict PPD and explore which factors in the model are the most important for PPD prediction. Methods Information on the pregnancy period from a cohort of 508 women, including demographics, social environmental factors, and mental health, was used as predictors in the models. The Edinburgh Postnatal Depression Scale score within 42 days after delivery was used as the outcome indicator. Using two feature selection methods (expert consultation and random forest-based filter feature selection [FFS-RF]) and two algorithms (support vector machine [SVM] and random forest [RF]), we developed four different machine learning PPD prediction models and compared their prediction effects. Results There was no significant difference in the effectiveness of the two feature selection methods in terms of model prediction performance, but 10 fewer factors were selected with the FFS-RF than with the expert consultation method. The model based on SVM and FFS-RF had the best prediction effects (sensitivity=0.69, area under the curve=0.78). In the feature importance ranking output by the RF algorithm, psychological elasticity, depression during the third trimester, and income level were the most important predictors. Conclusions In contrast to the expert consultation method, FFS-RF was important in dimension reduction. When the sample size is small, the SVM algorithm is suitable for predicting PPD. In the prevention of PPD, more attention should be paid to the psychological resilience of mothers.
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Affiliation(s)
- Weina Zhang
- XiangYa School of Public Health, Central South University, Changsha, China
| | - Han Liu
- Sanofi Global Research and Design Operations Center, Chengdu, China
| | - Vincent Michael Bernard Silenzio
- Urban-Global Public Health, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Newark, NJ, United States
| | - Peiyuan Qiu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Wenjie Gong
- XiangYa School of Public Health, Central South University, Changsha, China
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Sharma V, Sharma P, Sharma S. Managing bipolar disorder during pregnancy and the postpartum period: a critical review of current practice. Expert Rev Neurother 2020; 20:373-383. [PMID: 32172610 DOI: 10.1080/14737175.2020.1743684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Despite increased interest in the pharmacotherapy of bipolar disorder during pregnancy and the postpartum period, management of the disorder during these critical periods in a woman's life remains challenging.Areas covered: The authors review the effect of pregnancy and the postpartum period on the course of bipolar disorder, describe adverse pregnancy and birth outcomes, and discuss the pharmacotherapy of bipolar disorder during and after pregnancy.Expert opinion: When treating women with bipolar disorder of childbearing age, clinicians should consider the possibility of pregnancy. Pre-conception counseling should be an integral part of the overall plan to manage bipolar disorder during and after pregnancy. Peripartum management of bipolar disorder is challenging and requires balancing of risks associated with the use of drugs and the potentially deleterious effects of untreated bipolar disorder on the fetus/child. Formulation of personalized treatment requires knowledge of both current (episode type, symptom severity, psychiatric comorbidity, and safety concerns) and historical (episode frequency, response to drugs and psychotherapy, and the effect of reproductive events including pregnancy and postpartum period) factors. Close monitoring is essential for early detection and management of mood episodes. Routine safety assessments are necessary to identify women at risk of harming themselves or the newborn.
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Affiliation(s)
- Verinder Sharma
- Departments of Psychiatry and Obstetrics & Gynecology, University of Western Ontario, London, Canada.,Parkwood Institute Mental Health, London, Canada
| | - Priya Sharma
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Canada
| | - Sapna Sharma
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Canada
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Perry A, Gordon-Smith K, Di Florio A, Fraser C, Craddock N, Jones L, Jones I. Adverse childhood experiences and postpartum depression in bipolar disorder. J Affect Disord 2020; 263:661-666. [PMID: 31744744 DOI: 10.1016/j.jad.2019.11.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/24/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Women are particularly vulnerable to recurrence of bipolar disorder (BD) following childbirth. Risk of postpartum psychosis (PP) is especially high, but postpartum depression (PPD) is also common. Adverse childhood experiences (ACEs) have not been associated with PP, but have been associated with PPD in non-bipolar samples. The relationship between ACEs and PPD within BD remains to be investigated. Here, we examined this association in a large, well-defined sample of women with BD. METHODS Participants were 575 parous women with DSM-IV BD. Lifetime psychopathology, including perinatal, was assessed via semi-structured interview and case-notes. ACEs, assessed via self-report and case-notes, were compared between women with lifetime PPD (n = 368) and those without a lifetime history of perinatal mood episodes (n = 207). RESULTS In univariate analysis exposure to 3 or more ACEs, and to childhood abuse specifically, was significantly associated with PPD (p = 0.026 and 0.041 respectively), but this did not remain significant after adjusting for lifetime number of episodes of depression and parity. Post-hoc analysis revealed more frequent episodes of depression to be associated with both a history of 3 or more ACEs and of childhood abuse. LIMITATIONS Limited range of ACEs assessed and potential recall bias. CONCLUSIONS Increased frequency of ACEs and particularly childhood abuse was associated with more frequent lifetime episodes of depression, but not specifically episodes with postpartum onset. Understanding factors that mediate the pathway between ACEs and PPD in BD has implications for risk prediction of PPD.
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Affiliation(s)
- Amy Perry
- Psychological Medicine, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK
| | | | - Arianna Di Florio
- Institute of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Christine Fraser
- Institute of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Nick Craddock
- Institute of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Lisa Jones
- Psychological Medicine, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK..
| | - Ian Jones
- Institute of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
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Nielsen T, Bernson D, Terplan M, Wakeman SE, Yule AM, Mehta PK, Bharel M, Diop H, Taveras EM, Wilens TE, Schiff DM. Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery. Addiction 2020; 115:291-301. [PMID: 31692133 PMCID: PMC7066531 DOI: 10.1111/add.14825] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/29/2019] [Accepted: 09/03/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Opioid-related overdose is increasingly linked to pregnancy-associated deaths, but factors associated with postpartum overdose are unknown. We aimed to estimate the strength of the association between maternal and infant characteristics and postpartum opioid-related overdose. DESIGN Retrospective cohort study using a linked, population-level data set. SETTING Massachusetts, United States. CONCLUSION Among women who delivered live infants in Massachusetts, USA between 2012 and 2014, maternal diagnosis of OUD, prior non-fatal overdose, infant diagnosis of NAS and high unscheduled health-care utilization appeared to be positively associated with postpartum opioid overdose. However, more than half of postpartum overdoses in that period were to women without a diagnosis of OUD. Engagement in methadone or buprenorphine treatment in the month prior to delivery was not sufficient to reduce the odds of postpartum overdose. PARTICIPANTS Women who delivered one or more live births from 2012 to 2014 (n = 174 517). MEASUREMENTS The primary outcome was opioid-related overdose in the postpartum year. We used multivariable logistic regression to explore the independent associations of maternal (demographics, substance use, pregnancy) and infant [gestational age, birthweight, neonatal abstinence syndrome (NAS)] characteristics with postpartum opioid overdose. Findings were stratified by maternal opioid use disorder (OUD) diagnosis. FINDINGS There were 189 deliveries to women who experienced ≥ 1 opioid overdose in the first year postpartum (11 of 10 000 deliveries). Among women with postpartum opioid overdose, 46.6% had an OUD diagnosis within 12 months before delivery. In our adjusted model, maternal diagnosis of OUD [adjusted odds ratio (aOR) = 3.61, 95% confidence interval (CI) = 1.73-7.51] and prior non-fatal overdose (aOR = 2.40, 95% CI = 1.11-5.17) were most strongly associated with postpartum overdose. After stratifying by OUD status, infant diagnosis of NAS (OUD+ aOR = 2.03, 95% CI = 1.26-3.27; OUD- aOR = 2.79, 95% CI = 1.12-6.93) and high unscheduled health-care utilization (OUD+ aOR = 2.27, 95% CI = 1.38-3.73; OUD- aOR = 2.11, 95% CI = 1.24-3.58) were positively associated with postpartum overdose in both groups.
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Affiliation(s)
- Timothy Nielsen
- Massachusetts Department of Public Health, 250 Washington St, Boston, Massachusetts, 02108,Child Population and Translational Health Research, University of Sydney, Randwick, New South Wales 2031, Australia
| | - Dana Bernson
- Massachusetts Department of Public Health, 250 Washington St, Boston, Massachusetts, 02108
| | - Mishka Terplan
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, 1101 E. Marshall St, Richmond, Virginia, 23298
| | - Sarah E. Wakeman
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts, 02114
| | - Amy M. Yule
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts, 02114
| | - Pooja K. Mehta
- Center for Healthcare Value and Equity, Department of Obstetrics and Gynecology, and Program in Health Policy and Systems Management, Schools of Medicine and Public Health, Louisiana State University Health Sciences Center, 2020 Gravier St, New Orleans, Lousiana, 70112
| | - Monica Bharel
- Massachusetts Department of Public Health, 250 Washington St, Boston, Massachusetts, 02108
| | - Hafsatou Diop
- Massachusetts Department of Public Health, 250 Washington St, Boston, Massachusetts, 02108
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
| | - Timothy E. Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts, 02114
| | - Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
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Maguire J, McCormack C, Mitchell A, Monk C. Neurobiology of maternal mental illness. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:97-116. [PMID: 32736761 DOI: 10.1016/b978-0-444-64239-4.00005-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This chapter provides an overview of current research discoveries beginning to uncover the neurobiology of maternal mental illness. Results are described according to standard diagnostic categories (specifically, perinatal depression, perinatal anxiety and OCD, postpartum psychosis and bipolar disorder, and trauma and posttraumatic stress disorder), yet we aim to put this approach in context with the introduction of a classification model for psychiatric research, the research domain criteria, gaining traction in basic and clinical translational fields. We first review a new area of study, the neuroplasticity of the pregnant and postpartum brain, as work here has relevance for understanding the pathophysiology of mental disorders and may provide clues to changes in brain functioning that are related to compromised parenting in the context of postpartum depression. We next provide background information on neuroendocrine and immune changes during pregnancy and, to a lesser extent, the postpartum period, as alterations in these systems are significantly implicated in underlying neurobiology of mental illness for peripartum women. Our discussion of the major mental illnesses for pregnant and postpartum women includes neuroendocrine changes, neuroinflammation, and neurotransmitter alterations, as well as circuit dysfunction. Overall, remarkable progress has been made in identifying variations in neurobiology (and related systems) involved in maternal mental illness; yet, it is clear that, as classified with standard diagnostic systems, these are heterogeneous disorders and there is individual variability in the alterations in neurobiology for the same illness.
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Affiliation(s)
- Jamie Maguire
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
| | - Clare McCormack
- Center for Science and Society, Columbia University, New York, NY, United States
| | - Anika Mitchell
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States.
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74
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Forde R, Peters S, Wittkowski A. Psychological interventions for managing postpartum psychosis: a qualitative analysis of women's and family members' experiences and preferences. BMC Psychiatry 2019; 19:411. [PMID: 31856785 PMCID: PMC6923990 DOI: 10.1186/s12888-019-2378-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/27/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Postpartum psychosis is a rare, yet severe disorder, in which early identification and immediate intervention are crucial. Despite recommendations for psychological input, little is known about the types of psychological intervention reported to be helpful. The aim of this study was to explore the experiences, needs and preferences for psychological intervention from the perspective of women with postpartum psychosis and from the perspective of family members. METHODS Thirteen women and eight family members, including partners were interviewed. The data from these semi-structured interviews were audio-recorded, transcribed and inductively analysed using thematic analysis. RESULTS Twelve subthemes were identified and then organised around three main themes: 1) Seeking safety and containment, 2) Recognising and responding to the psychological impact and 3) Planning for the future. These themes highlight the temporal element of recovery from postpartum psychosis, because women's psychological needs and preferences changed over time. Emphasis was initially placed on ensuring safety, followed by a need to connect, process and adjust to their experiences. Additional needs were reported by women and family when planning for the future, including managing the fear of relapse and help to reach a decision about future pregnancies. CONCLUSION The results illustrate a range of areas in which psychological intervention could be delivered to facilitate and enhance recovery. Further research is needed to develop meaningful and effective psychological interventions and to investigate the most appropriate timing for this to be offered.
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Affiliation(s)
- R Forde
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - A Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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75
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Davies W. An Analysis of Cellular Communication Network Factor Proteins as Candidate Mediators of Postpartum Psychosis Risk. Front Psychiatry 2019; 10:876. [PMID: 31849729 PMCID: PMC6901936 DOI: 10.3389/fpsyt.2019.00876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/06/2019] [Indexed: 12/21/2022] Open
Abstract
Postpartum (or puerperal) psychosis (PP) is a severe psychiatric condition associated with hallucinations, delusions, cognitive disorganization, and mood problems, which affects approximately 1-2 out of every 1,000 mothers shortly after childbirth. While the risk factors for, and co-morbidities of, PP are relatively well-defined, currently, the pathophysiology underlying the disorder is very poorly-specified. Here, I argue, on the basis of multiple lines of new evidence, that altered expression of the Cellular Communication Network (CCN) factor proteins (and of the heterodimerizing CCN2 and CCN3 proteins in particular), may be associated with, and possibly causal for, increased PP risk. Future preclinical and clinical studies should aim to test this hypothesis as empirical support for it would provide much-needed clues regarding the biological substrates of PP, and could point to predictive biomarkers for the condition.
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Affiliation(s)
- William Davies
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
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76
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Bauer AE, Liu X, Byrne EM, Sullivan PF, Wray NR, Agerbo E, Nyegaard M, Grove J, Musliner KL, Ingstrup KG, Johannsen BMW, Mægbæk ML, Wang Y, Nordentoft M, Mors O, Børglum AD, Werge T, Hougaard DM, Mortensen PB, Munk-Olsen T, Meltzer-Brody S. Genetic risk scores for major psychiatric disorders and the risk of postpartum psychiatric disorders. Transl Psychiatry 2019; 9:288. [PMID: 31712652 PMCID: PMC6848186 DOI: 10.1038/s41398-019-0629-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/18/2019] [Accepted: 07/30/2019] [Indexed: 12/17/2022] Open
Abstract
Postpartum psychiatric disorders are heritable, but how genetic liability varies by other significant risk factors is unknown. We aimed to (1) estimate associations of genetic risk scores (GRS) for major depression (MD), bipolar disorder (BD), and schizophrenia (SCZ) with postpartum psychiatric disorders, (2) examine differences by prior psychiatric history, and (3) compare genetic and familial risk of postpartum psychiatric disorders. We conducted a nested case-control study based on Danish population-based registers of all women in the iPSYCH2012 cohort who had given birth before December 31, 2015 (n = 8850). Cases were women with a diagnosed psychiatric disorder or a filled psychotropic prescription within one year after delivery (n = 5829 cases, 3021 controls). Association analyses were conducted between GRS calculated from Psychiatric Genomics Consortium discovery meta-analyses for MD, BD, and SCZ and case-control status of a postpartum psychiatric disorder. Parental psychiatric history was associated with postpartum psychiatric disorders among women with previous psychiatric history (OR, 1.14; 95% CI 1.02-1.28) but not without psychiatric history (OR, 1.08; 95% CI: 0.81-1.43). GRS for MD was associated with an increased risk of postpartum psychiatric disorders in both women with (OR, 1.44; 95% CI: 1.19-1.74) and without (OR, 1.88; 95% CI: 1.26-2.81) personal psychiatric history. SCZ GRS was only minimally associated with postpartum disorders and BD GRS was not. Results suggest GRS of lifetime psychiatric illness can be applied to the postpartum period, which may provide clues about distinct environmental or genetic elements of postpartum psychiatric disorders and ultimately help identify vulnerable groups.
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Affiliation(s)
- Anna E Bauer
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Xiaoqin Liu
- NCRR - National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Enda M Byrne
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Patrick F Sullivan
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Naomi R Wray
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - Esben Agerbo
- NCRR - National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Mette Nyegaard
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- iSEQ, Center for Integrative Sequencing and, Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Jakob Grove
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- iSEQ, Center for Integrative Sequencing and, Center for Genomics and Personalized Medicine, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Katherine L Musliner
- NCRR - National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Katja G Ingstrup
- NCRR - National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Benedicte M W Johannsen
- NCRR - National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Merete L Mægbæk
- NCRR - National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Yunpeng Wang
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
- Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, Oslo, Norway
| | - Merete Nordentoft
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Mental Health Centre Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Aarhus, Denmark
| | - Anders D Børglum
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- iSEQ, Center for Integrative Sequencing and, Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Thomas Werge
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
| | - David M Hougaard
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Danish Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Preben Bo Mortensen
- NCRR - National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
- iSEQ, Center for Integrative Sequencing and, Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Trine Munk-Olsen
- NCRR - National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Shorey S, Chee CYI, Ng ED, Lau Y, Dennis CL, Chan YH. Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 1): Randomized Controlled Trial. J Med Internet Res 2019; 21:e12410. [PMID: 31469084 PMCID: PMC6744221 DOI: 10.2196/12410] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/19/2019] [Accepted: 07/28/2019] [Indexed: 01/19/2023] Open
Abstract
Background The frenzy of postbirth events often takes a toll on mothers’ mental well-being, leaving them susceptible to postpartum psychological disorders such as postnatal depression (PND). Social support has been found to be effective in restoring the emotional well-being of new mothers. Therefore, mothers need to be supported during the crucial postpartum period to buffer the negative after effects of childbirth and to promote healthier maternal well-being. Objective This study aimed to evaluate the effectiveness of a technology-based peer-support intervention program (PIP) on maternal outcomes during the early postpartum period. Methods A randomized, parallel-armed controlled trial was conducted. The study recruited 138 mothers (69 in intervention group, 69 in control group) at risk of PND from a tertiary hospital in Singapore. To support these mothers, 20 peer volunteers were recruited by word of mouth and trained by a psychiatrist in social support skills before the intervention commenced. The 4-week–long intervention included a weekly follow-up with a peer volunteer through phone calls or text messages. The intervention group received peer support in addition to the standard care offered by the hospital. The control group only received postnatal standard care. Maternal outcomes (PND, postnatal anxiety [PNA], loneliness, and perceived social support) were measured with reliable and valid instruments. Data were collected immediately postpartum, at 1 month postpartum and at 3 months postpartum. The general linear model was used to compare the groups for postpartum percentage changes in the outcome variables at first and third months, and the linear mixed model was used to compare the trend over the study period. Results There was a statistically significant difference in Edinburgh Postnatal Depression Scale scores (d=–2.11; 95% CI −4.0 to −0.3; P=.03) between the intervention and control groups at 3 months postpartum after adjusting for covariates. The intervention group had a significant change over time compared with the control group. Conclusions The technology-based PIP was found to be effective in reducing the risk of PND among new mothers and showed a generally positive trend in reducing PNA and loneliness and increasing perceived social support. This study highlights the importance of training paraprofessionals to provide needed support for new mothers postpartum. A further long-term evaluation of the PIP on maternal and family outcomes and its cost-effectiveness is needed to inform clinical practices. Trial Registration ISRCTN Registry ISRCTN14864807; https://www.isrctn.com/ISRCTN14864807 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.9416
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School Of Medicine, National University of Singapore, Singapore, Singapore
| | - Cornelia Yin Ing Chee
- Department of Psychological Medicine, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School Of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School Of Medicine, National University of Singapore, Singapore, Singapore
| | - Cindy-Lee Dennis
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yiong Huak Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School Of Medicine, National University of Singapore, Singapore, Singapore
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78
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Sihre HK, Simons AM, Gill P, Lindenmeyer A, Fazil Q. Women's experiences of severe postnatal psychiatric illness: a systematic review protocol. Syst Rev 2019; 8:173. [PMID: 31315663 PMCID: PMC6637608 DOI: 10.1186/s13643-019-1085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/02/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Super diversity has become a twenty-first-century phenomena in the UK. The Five Year Forward View Plan for Mental Health commits to improving access to Perinatal Mental Health services for all new mothers. Existing research indicates various postnatal mental illness aetiologies, traditional practices and beliefs, which are important to explore during medical consultation to achieve a collaborative relationship between the patient and clinician. The study of severe postnatal psychiatric illnesses is well established in the quantitative literature; however, the subjective experiences of mothers with severe psychiatric illnesses after childbirth have been given little attention. The aim of this systematic review is to synthesise the small body of qualitative findings, which will achieve a deeper understanding of mothers' experiences and understandings. This integration of qualitative data is invaluable in facilitating culturally competent strategies in Western settings and informing future research. METHODS/DESIGN This protocol proposes a systematic review of qualitative literature of severe postnatal psychiatric illnesses, using a meta-ethnography approach following the PRISMA-P guidelines. A comprehensive search strategy will be developed to undertake a systematic search via online databases to identify eligible articles. Studies will be considered for eligibility if they include mothers aged 18 and over who have been diagnosed with a severe psychiatric illness during the postnatal period; present primary data on women's illness experiences; use qualitative methods. Titles and abstracts will be screened by the primary reviewer to identify potential papers. Two independent reviewers will access and read texts in full and agree on the final list of included studies. Discrepancies will be resolved via consultation with a third independent reviewer. The final list of included studies for review will be methodologically appraised by two independent reviewers using the Critical Appraisal Skills Programme. This systematic review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42018093674. DISCUSSION To date, no systematic review following a meta-ethnographic approach on qualitative explorations of mothers worldwide diagnosed with severe postnatal psychiatric illnesses has been conducted. An amalgamation of this information enables a deeper understanding of how severe postnatal psychiatric illnesses manifests across cultures. This information is useful when devising culturally competent care. SYSTEMATIC REVIEW REGISTRATION CRD42018093674.
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Affiliation(s)
- Harpreet Kaur Sihre
- Institute of Applied Health Research, University of Birmingham, Birmingham, Edgbaston B15 2TT UK
| | - Anne-Marie Simons
- Birmingham and Solihull Mental Health Foundation Trust, The Barberry, Birmingham, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Antje Lindenmeyer
- Institute of Applied Health Research, University of Birmingham, Birmingham, Edgbaston B15 2TT UK
| | - Qulsom Fazil
- Institute of Applied Health Research, University of Birmingham, Birmingham, Edgbaston B15 2TT UK
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79
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Naito T, Chin J, Lin J, Shah PJ, Lomiguen CM. Postpartum psychosis in a non-native language-speaking patient: A perspective on language barriers and cultural competency. Gen Psychiatr 2019; 32:e100077. [PMID: 31360910 PMCID: PMC6629379 DOI: 10.1136/gpsych-2019-100077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/05/2019] [Accepted: 05/15/2019] [Indexed: 12/21/2022] Open
Abstract
Postpartum psychosis is a condition characterised by rapid onset of psychotic symptoms several weeks after childbirth. Outside of its timing and descriptions of psychotic features, minimal research exists due to its relative rarity (1 to 2 per 1000 births in the USA), with greater emphasis on postpartum sadness and depression. With the existing literature, cultural differences and language barriers previously have not been taken into consideration as there are no documented cases of postpartum psychosis in a non–English-speaking patient. Correctly differentiating postpartum psychosis from other postpartum psychiatric disorders requires adeptly evaluating for the presence of psychotic symptoms with in-depth history taking. Here, we present a case of postpartum psychosis in a Japanese-speaking only patient, with an associated clinical course and culturally appropriate approach to treatment. A review of postpartum psychosis and language/cultural considerations are also discussed, with attention on the Japanese concept of ‘Satogaeri bunben’.
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Affiliation(s)
- Tatsuhiko Naito
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Justin Chin
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Jun Lin
- Primary Care, Touro College of Osteopathic Medicine, New York City, New York, USA
| | - Pritesh J Shah
- Psychiatry, Holy Name Medical Center, Teaneck, New Jersey, USA
| | - Christine M Lomiguen
- Basic Sciences, Lake Erie College of Osteopathic Medicine, Erie, Pennslyvannia, USA
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80
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Aktar E, Qu J, Lawrence PJ, Tollenaar MS, Elzinga BM, Bögels SM. Fetal and Infant Outcomes in the Offspring of Parents With Perinatal Mental Disorders: Earliest Influences. Front Psychiatry 2019; 10:391. [PMID: 31316398 PMCID: PMC6610252 DOI: 10.3389/fpsyt.2019.00391] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/17/2019] [Indexed: 12/16/2022] Open
Abstract
Mental illness is highly prevalent and runs in families. Mental disorders are considered to enhance the risk for the development of psychopathology in the offspring. This heightened risk is related to the separate and joint effects of inherited genetic vulnerabilities for psychopathology and environmental influences. The early years of life are suggested to be a key developmental phase in the intergenerational psychopathology transmission. Available evidence supports the idea that early exposure to parental psychopathology, during the pregnancy and first postpartum year, may be related to child psychological functioning beyond the postpartum period, up to adulthood years. This not only highlights the importance of intervening early to break the chain of intergenerational transmission of psychopathology but also raises the question of whether early interventions targeting parental mental disorders in this period may alleviate these prolonged adverse effects in the infant offspring. The current article focuses on the specific risk of psychopathology conveyed from mentally ill parents to the offspring during the pregnancy and first postpartum year. We first present a summary of the available evidence on the associations of parental perinatal mental illness with infant psychological outcomes at the behavioral, biological, and neurophysiological levels. Next, we address the effects of early interventions and discuss whether these may mitigate the early intergenerational transmission of risk for psychopathology. The summarized evidence supports the idea that psychopathology-related changes in parents' behavior and physiology in the perinatal period are related to behavioral, biological, and neurophysiological correlates of infant psychological functioning in this period. These alterations may constitute risk for later development of child and/or adult forms of psychopathology and thus for intergenerational transmission. Targeting psychopathology or mother-infant interactions in isolation in the postnatal period may not be sufficient to improve outcomes, whereas interventions targeting both maternal psychopathology and mother-infant interactions seem promising in alleviating the risk of early transmission.
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Affiliation(s)
- Evin Aktar
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Jin Qu
- Department of Psychology, Clarion University of Pennsylvania, Clarion, PA, United States
| | - Peter J Lawrence
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Marieke S Tollenaar
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Bernet M Elzinga
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
- Developmental Psychology, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
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81
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Warselius P, Cnattingius S, Li J, Wei D, Valdimarsdottir UA, Kosidou K, Reutfors J, Olsen J, Vestergaard M, Obel C, László KD. Maternal bereavement shortly before or during pregnancy and risk of postpartum psychotic illness: a population-based study from Denmark and Sweden. Clin Epidemiol 2019; 11:285-298. [PMID: 31118817 PMCID: PMC6500870 DOI: 10.2147/clep.s195741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/27/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose: Postpartum psychosis is a rare but severe complication following childbirth, with unknown etiology. This study investigated whether the death of a close family member — a source of severe stress — the year before or during pregnancy was associated with an increased risk of psychotic illness in the postpartum period among women without and with a history of psychiatric disorder. Methods: We studied live births in Denmark during 1978–2008 and births in Sweden during 1973–2006 (n=5,246,978). Information on death of women’s relatives and partners and sociodemographic, health-, and pregnancy-related factors was obtained through linkage with nationwide registries. Results: The death of a close relative the year before or during pregnancy was not associated with psychotic illness during the first 90 days postpartum among women without (adjusted HR 1.02, 95% CI 0.76–1.37) or with a history of psychiatric disorder (HR 0.96, 95% CI 0.74–1.25). Similarly, there was no association between bereavement and risk of postpartum psychosis according to the timing of the loss (the year before or during pregnancy), the relative’s cause of death (natural or unnatural), or the woman’s relationship to the deceased (parent/sibling or partner/older child). Conclusions: Death of a close relative, one of the most severe sources of stress, before or during pregnancy was not associated with postpartum psychosis. Therefore, these data do not support the hypothesis that severely stressful life events, such as bereavement around the time of pregnancy, are associated with postpartum psychosis.
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Affiliation(s)
- Pauline Warselius
- Department of Medicine Solna, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Sven Cnattingius
- Department of Medicine Solna, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Dang Wei
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Anna Valdimarsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kyriaki Kosidou
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County's Health Care District, Stockholm, Sweden
| | - Johan Reutfors
- Department of Medicine Solna, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA
| | - Mogens Vestergaard
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Research Unit and Section for General Practice, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Carsten Obel
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Research Unit and Section for General Practice, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Krisztina D László
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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82
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Heinisch C, Galeris MG, Gabler S, Simen S, Junge-Hoffmeister J, Fößel J, Spangler G. Mothers With Postpartum Psychiatric Disorders: Proposal for an Adapted Method to Assess Maternal Sensitivity in Interaction With the Child. Front Psychiatry 2019; 10:471. [PMID: 31396110 PMCID: PMC6661973 DOI: 10.3389/fpsyt.2019.00471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/13/2019] [Indexed: 01/14/2023] Open
Abstract
About 15% of mothers suffer from postpartum psychiatric disorders, such as depression, anxiety, or psychosis. Numerous studies have shown maternal caregiving behavior to be negatively affected under these circumstances. The current study sets out to shed light on specific caregiving behaviors of affected mothers in the context of parental mental illness at an early stage. There are several methods to assess maternal caregiving behavior in terms of sensitivity. However, all of them have limitations regarding the peculiarities of mothers with postpartum disorders, that is, changes in affect regulation, and the early onset of the disorder postpartum. With the current study, we provide an adapted method to assess maternal sensitivity based on methods recently approved in attachment research. Two groups of mothers, who were either healthy or had different postpartum disorders, were recorded on video during interactions with their infants. Behaviors were rated regarding responsiveness, promptness, appropriateness, intrusiveness, and positive and negative affect. A first analysis revealed an increased number of deficits on all subscales in mothers with postpartum psychiatric disorders as compared to healthy mothers. Depressive mothers with a single diagnosis had lower scores in responsiveness, promptness, and appropriateness and higher scores on intrusiveness as compared to those in healthy mothers. Here, maternal behavior appears more parent-centered, whereas affect seemed to be relatively unharmed. Moreover, as compared to healthy mothers, mothers with comorbid depression and anxiety symptomatology achieved lower scores on responsiveness, appropriateness, and positive affect and higher scores on intrusiveness and negative affect. It is suggested, that increased deficits are related to the severity of illness in mothers with comorbidities. Results on promptness indicate that these mothers are still capable of maintaining higher vigilance to infant cues. Variance in maternal behavior was relatively high in clinical mothers, showing that some of them are well capable of behaving in a sensitive manner toward their child. One strength of our adapted method is that particular aspects of sensitive parent-child interactions are assessed separately. This may shed light on specific behavior patterns of different postpartum psychiatric disorders, which may in turn relate to specific child outcomes. The manual is open for usage, while reliability testing is required.
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Affiliation(s)
- Christine Heinisch
- Developmental and Educational Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Mirijam-Griseldis Galeris
- Developmental and Educational Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Paediatric Psychiatry, Psychotherapy and Psychosomatics, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Sandra Gabler
- Developmental and Educational Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Susanne Simen
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg Süd, Nürnberg, Germany
| | - Juliane Junge-Hoffmeister
- Klinik für Psychotherapie und Psychosomatik des Universitätsklinikums Carl Gustav Carus der Technischen Universität Dresden, Dresden, Germany
| | - Judith Fößel
- Developmental and Educational Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Gottfried Spangler
- Developmental and Educational Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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83
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Barba-Müller E, Craddock S, Carmona S, Hoekzema E. Brain plasticity in pregnancy and the postpartum period: links to maternal caregiving and mental health. Arch Womens Ment Health 2019; 22:289-299. [PMID: 30008085 PMCID: PMC6440938 DOI: 10.1007/s00737-018-0889-z] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/02/2018] [Indexed: 12/16/2022]
Abstract
Pregnancy and the postpartum period involve numerous physiological adaptations that enable the development and survival of the offspring. A distinct neural plasticity characterizes the female brain during this period, and dynamic structural and functional changes take place that accompany fundamental behavioral adaptations, stimulating the female to progress from an individual with self-directed needs to being responsible for the care of another life. While many animal studies detail these modifications, an emerging body of research reveals the existence of reproduction-related brain plasticity in human mothers too. Additionally, associations with aspects of maternal caregiving point to adaptive changes that benefit a woman's transition to motherhood. However, the dynamic changes that affect a woman's brain are not merely adaptive, and they likely confer a vulnerability for the development of mental disorders. Here, we review the changes in brain structure and function that a woman undergoes during the peripartum period, outlining associations between these neural alterations and different aspects of maternal care. We additionally discuss peripartum mood disorders and postpartum psychosis, and review the neuroimaging studies that investigate the neural bases of these conditions.
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Affiliation(s)
- Erika Barba-Müller
- Brain and Development Research Center, Leiden University, Leiden, the Netherlands ,Leiden Institute for Brain and Cognition, Leiden, the Netherlands ,University Institute of Mental Health Vidal i Barraquer, Ramon Llull University, Barcelona, Spain
| | - Sinéad Craddock
- Brain and Development Research Center, Leiden University, Leiden, the Netherlands ,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Susanna Carmona
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain ,Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain ,Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Elseline Hoekzema
- Brain and Development Research Center, Leiden University, Leiden, the Netherlands. .,Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
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84
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Scrandis DA. Antidepressant use in breastfeeding women. Nurse Pract 2018; 43:18-21. [PMID: 30234822 DOI: 10.1097/01.npr.0000545001.45758.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Debra A Scrandis
- Debra A. Scrandis is an associate professor at the University of Maryland School of Nursing, Baltimore, Md
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85
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Levey EJ, Zhong QY, Rondon MB, Sanchez S, Li J, Williams MA, Gelaye B. The psychometric properties of the 16-item version of the Prodromal Questionnaire (PQ-16) as a screening instrument for perinatal psychosis. Arch Womens Ment Health 2018; 21:563-572. [PMID: 29560530 PMCID: PMC6558519 DOI: 10.1007/s00737-018-0833-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
Abstract
Psychiatric illness can pose serious risks to pregnant and postpartum women and their infants. There is a need for screening tools that can identify women at risk for postpartum psychosis, the most dangerous perinatal psychiatric illness. This study used exploratory factor analysis (EFA) and Rasch item response theory (IRT) models to evaluate the psychometric properties and construct validity of the Spanish language version of the 16-item Prodromal Questionnaire (PQ-16) as a screening tool for psychosis in a population of pregnant Peruvian women. The EFA yielded a four-factor model, which accounted for 44% of the variance. Factor 1, representing "unstable sense of self," accounted for 22.1% of the total variance; factor 2, representing "ideas of reference/paranoia," for 8.4%; factor 3, representing "sensitivity to sensory experiences," accounted for 7.2%; and factor 4, possibly representing negative symptoms, accounted for 6.3%. Rasch IRT analysis found that all of the items fit the model. These findings support the construct validity of the PQ-16 in this pregnant Peruvian population. Also, further research is needed to establish definitive psychiatric diagnoses to determine the predictive power of the PQ-16 as a screening tool.
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Affiliation(s)
- Elizabeth J Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, 151 Merrimac St, 4th Floor, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
- Institute for Juvenile Research, University of Illinois College of Medicine, Chicago, IL, 60608, USA.
| | - Qiu-Yue Zhong
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | | | - Sixto Sanchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bizu Gelaye
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
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86
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Davies W. SULFATION PATHWAYS: The steroid sulfate axis and its relationship to maternal behaviour and mental health. J Mol Endocrinol 2018; 61:T199-T210. [PMID: 29440314 DOI: 10.1530/jme-17-0219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/16/2017] [Indexed: 12/14/2022]
Abstract
Steroid hormones can exist in functionally dissociable sulfated and non-sulfated (free) forms and can exert profound effects on numerous aspects of mammalian physiology; the ratio of free-to-sulfated steroids is governed by the antagonistic actions of steroid sulfatase (STS) and sulfotransferase (SULT) enzymes. Here, I examine evidence from human and animal model studies, which suggests that STS and its major substrate (dehydroepiandrosterone sulfate, DHEAS) and product (DHEA) can influence brain function, behaviour and mental health, before summarising how the activity of this axis varies throughout mammalian pregnancy and the postpartum period. I then consider how the steroid sulfate axis might impact upon normal maternal behaviour and how its dysfunction might contribute towards risk of postpartum psychiatric illness. Understanding the biological substrates underlying normal and abnormal maternal behaviour will be important for maximising the wellbeing of new mothers and their offspring.
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Affiliation(s)
- William Davies
- School of PsychologyCardiff University, Cardiff, UK
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical NeurosciencesSchool of Medicine, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Research InstituteCardiff University, Cardiff, UK
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Rundgren S, Brus O, Båve U, Landén M, Lundberg J, Nordanskog P, Nordenskjöld A. Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group. J Affect Disord 2018; 235:258-264. [PMID: 29660641 DOI: 10.1016/j.jad.2018.04.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Electroconvulsive therapy (ECT) is used to treat postpartum depression and psychosis based on clinical experience and small observational studies. AIMS The primary aim was to test the hypothesis that the response rate to ECT for depression and psychosis is higher during the postpartum period than outside this period. The secondary aim was to identify predictors of a response to ECT during the postpartum period. MATERIALS AND METHODS Cases with postpartum depression and/or psychosis received ECT within 6 months of delivery. A matched comparison group with depression and/or psychosis (not within the postpartum period) was identified from the Swedish National Quality Register for ECT. The improvement 1 week after ECT was classified according to the Clinical Global Impressions Scale - Improvement scale (CGI-I) as responder (CGI-I score 1-2) or non-responder (CGI-I score 3-7). RESULTS 185 cases and 185 comparison group subjects were included (46% with psychosis in each groups). More cases (87.0%) than comparison group subjects (73.5%) responded to ECT (p = 0.001). Adjusted binary regression analysis revealed that more severe symptoms prior to treatment were the only statistically significant predictor of response. LIMITATIONS There was no control group without ECT treatment. CONCLUSION The response rate of those with postpartum depression and/or psychosis to ECT was high. The response rate of patients with psychosis or depression was higher during the postpartum period than outside it. This study supports the use of ECT for severe forms of postpartum depression and/or psychosis.
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Affiliation(s)
- Sara Rundgren
- School of Medical Sciences, University Health Care Research Centre, Örebro University, S-702 82 Örebro, Sweden
| | - Ole Brus
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ullvi Båve
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Johan Lundberg
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden
| | - Pia Nordanskog
- Faculty of Health Sciences, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden; Department of Psychiatry, Region Östergötland, Linköping, Sweden
| | - Axel Nordenskjöld
- School of Medical Sciences, University Health Care Research Centre, Örebro University, S-702 82 Örebro, Sweden.
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88
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Alluvala SA, Aziz N, Tumkur A, Boorugu HK. One-Year Follow-Up of Women with Severe Acute Maternal Morbidity (SAMM): A Cohort Study. J Obstet Gynaecol India 2018; 69:211-217. [PMID: 31178635 DOI: 10.1007/s13224-018-1157-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/11/2018] [Indexed: 11/28/2022] Open
Abstract
Background Some women experience unforeseen complications during pregnancy and childbirth, which may be life threatening; their survival depends on intensive support and timely interventions. The aim of this study was to assess the long-term prevalence of adverse health conditions and their impact on quality of life in women who had severe acute maternal morbidity (SAMM). Methods This is a prospective cohort study comprising 43 women with SAMM during 2015 (exposure group) and 43 women who had an uneventful pregnancy and delivery (non-exposure group) during the same study period. Those who consented were given an additional follow-up date for free medical health check at 1 year. Results The incidence of SAMM during study period was 8.6/1000 births. There were five deaths in the exposure group. Adverse health events were seen in 30 (78.94%) out of 38 survivors. Abnormal lipid profile, thrombocytopenia, cardiac diastolic dysfunction, amenorrhoea, Sheehan and Asherman syndrome were major findings in the exposed group. Four (10.52%) women required re-admission, and eight (20.05%) required additional procedures to confirm screening abnormalities. The exposure group had higher mean scores on the EPDS scale, incidence of suicidal thoughts and poorer performance in the WHOQOL BREF psychological domain. Conclusion Health programmes need to focus on maternal health, provide medical treatment and psychological support for a longer duration than the traditional 6 weeks postpartum in women who experience SAMM.
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Affiliation(s)
- Shobha A Alluvala
- 1Department of Obstetrics, Fernandez Hospital, 4-1-1230, Bogulkunta, Abids, Hyderabad, 500001 India
| | - Nuzhat Aziz
- 1Department of Obstetrics, Fernandez Hospital, 4-1-1230, Bogulkunta, Abids, Hyderabad, 500001 India
| | - Ashwin Tumkur
- 2Consultant Interventional Cardiologist, Fernandez Hospital, 4-1-1230, Bogulkunta, Abids, Hyderabad, 500001 India
| | - Hari K Boorugu
- 3Consultant Physician, Fernandez Hospital, 4-1-1230, Bogulkunta, Abids, Hyderabad, 500001 India
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89
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Ramsauer B, Achtergarde S. Mothers with acute and chronic postpartum psychoses and impact on the mother-infant interaction. Schizophr Res 2018; 197:45-58. [PMID: 29496331 DOI: 10.1016/j.schres.2018.02.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 01/27/2018] [Accepted: 02/18/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Maternal postpartum psychoses pose a serious risk to the mother-infant interaction. It is unclear how different subtypes of postpartum psychosis, including acute and chronic, might differentially affect the mother-infant interaction. METHOD A systematic search of electronic journal databases was performed. RESULTS This systematic review yielded 17 studies with adequate overall study quality. They focused on child custody and involvement of social services as indirect indicators of the mother-infant interaction, observed mother-infant interactions as direct indicators, or potential transitional mechanisms, including memory processing, mind-mindedness, and affect recognition, that may partially explain the effects of psychotic disorders. An acute onset of psychosis during the postpartum period (de novo or relapse) was typically related to better mother-infant interactions. Mothers with schizophrenia have the highest risk of child displacement, and interventions by social services were more likely. However, mothers with postpartum schizophrenia did not exhibit more harm to the child or self-harm than mothers with postpartum depression. Heterogeneity of methodology, case definitions, and assessments characterized the studies; hence, they were not pooled. CONCLUSIONS In addition to evaluating social risk factors in patients with acute onset and chronic psychoses during the postpartum period, negative preconceptions about motherhood and schizophrenia have to be carefully examined. Clinical research on postpartum psychoses should consider the onset criteria, prevalence of self-harm or harm to the child, significance of specific (e.g., religious) delusions and expressed hostility toward the child. More studies on the impact of first-onset (de novo) postpartum psychoses on the mother-infant interaction are needed.
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Affiliation(s)
- Brigitte Ramsauer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Muenster, Germany
| | - Sandra Achtergarde
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Muenster, Germany.
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Holt L, Sellwood W, Slade P. Birth experiences, trauma responses and self-concept in postpartum psychotic-like experiences. Schizophr Res 2018; 197:531-538. [PMID: 29402582 DOI: 10.1016/j.schres.2017.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/07/2017] [Accepted: 12/26/2017] [Indexed: 11/20/2022]
Abstract
The frequency of psychotic-like experiences (PLEs) amongst new mothers is beginning to be explored but the mechanisms underlying such experiences are yet to be understood. First time mothers (N=10,000) receiving maternity care via the UK National Health Service were contacted postnatally via Emma's Diary, an online resource for mothers. Measures assessed birth experience, trauma appraisals, post-traumatic stress symptoms, adjustment to motherhood, self-concept clarity and PLEs (in the form of hallucinations and delusions). There was a 13.9% response rate (N=1393) and 1303 participants reported experiencing at least one PLE (93.5%). Three competing nested path models were analysed. A more negative birth experience directly predicted delusions, but not hallucinations. Trauma appraisals and poorer adjustment to motherhood indirectly predicted PLEs, via disturbed self-concept clarity. Post-traumatic stress symptoms directly predicted the occurrence of all PLEs. PLEs in first time mothers may be more common than previously thought. A key new understanding is that where new mothers have experienced birth as traumatic and are struggling with adjustment to their new role, this can link to disturbances in a coherent sense of self (self-concept clarity) and be an important predictor of PLEs. Understanding the development of PLEs in new mothers may be helpful in postnatal care, as would public health interventions aimed at reducing the sense of abnormality or stigma surrounding such experiences.
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Affiliation(s)
- Lyndsey Holt
- Mersey Care NHS Foundation Trust, Park Lodge CMHT, Orphan Drive, Liverpool L6 7UN, UK.
| | - William Sellwood
- Division of Health Research, University of Lancaster, Bailrigg LA1 4YW, UK.
| | - Pauline Slade
- Institute of Psychology, Health & Society, University of Liverpool, Brownlow Hill, Liverpool LG9 3GB, UK.
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Shorey S, Chee C, Chong YS, Ng ED, Lau Y, Dennis CL. Evaluation of Technology-Based Peer Support Intervention Program for Preventing Postnatal Depression: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e81. [PMID: 29540338 PMCID: PMC5874437 DOI: 10.2196/resprot.9416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/05/2018] [Accepted: 01/23/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Multiple international agencies, including the World Health Organization and the International Monetary Fund, have emphasized the importance of maternal mental health for optimal child health and development. Adequate social support is vital for the most vulnerable to postpartum mood disorders. Hence, an urgent need for sustainable social support programs to aid mothers ease into their new parenting role exists. OBJECTIVE This study protocol aims to examine the effectiveness of a technology-based peer support intervention program among mothers at risk for postnatal depression in the early postpartum period. METHODS A randomized controlled 2-group pretest and repeated posttest experimental design will be used. The study will recruit 118 mothers from the postnatal wards of a tertiary public hospital in Singapore. Eligible mothers will be randomly allocated to receive either the peer support intervention program or routine perinatal care from the hospital. Peer volunteers will be mothers who have experienced self-reported depression and will be receiving face-to-face training to support new mothers at risk of depression. Outcome measures include postnatal depression, anxiety, loneliness, and social support. Data will be collected at immediate postnatal period (day of discharge from the hospital), at fourth week and twelfth week post childbirth. RESULTS The recruitment and training of peer support volunteers (N=20) ended in June 2017, whereas recruitment of study participants commenced in July 2017 and is still ongoing. The current recruitment for new mothers stands at 73, with 36 in the control group and 37 in the intervention group. Data collection is projected to be completed by May 2018. CONCLUSIONS This study will identify a potentially effective and clinically useful method to prevent postnatal depression in new mothers, which is the top cause of maternal morbidity. Receiving social support from others who share similar experiences may enhance the positive parenting experiences of mothers, which in turn can improve the psychosocial well-being of the mothers, tighten mother-child bond, and enhance overall family dynamics for mothers and infants. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number ISRCTN14864807; http://www.isrctn.com/ISRCTN14864807 (Archived by WebCite at http://www.webcitation.org/6xtBNvBTX).
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Affiliation(s)
| | | | | | | | - Ying Lau
- National University of Singapore, Singapore, Singapore
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Upadhyay RP, Chowdhury R, Aslyeh Salehi, Sarkar K, Singh SK, Sinha B, Pawar A, Rajalakshmi AK, Kumar A. Postpartum depression in India: a systematic review and meta-analysis. Bull World Health Organ 2017; 95:706-717C. [PMID: 29147043 PMCID: PMC5689195 DOI: 10.2471/blt.17.192237] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To provide an estimate of the burden of postpartum depression in Indian mothers and investigate some risk factors for the condition. METHODS We searched PubMed®, Google Scholar and Embase® databases for articles published from year 2000 up to 31 March 2016 on the prevalence of postpartum depression in Indian mothers. The search used subject headings and keywords with no language restrictions. Quality was assessed via the Newcastle-Ottawa quality assessment scale. We performed the meta-analysis using a random effects model. Subgroup analysis and meta-regression was done for heterogeneity and the Egger test was used to assess publication bias. FINDINGS Thirty-eight studies involving 20 043 women were analysed. Studies had a high degree of heterogeneity (I2 = 96.8%) and there was evidence of publication bias (Egger bias = 2.58; 95% confidence interval, CI: 0.83-4.33). The overall pooled estimate of the prevalence of postpartum depression was 22% (95% CI: 19-25). The pooled prevalence was 19% (95% CI: 17-22) when excluding 8 studies reporting postpartum depression within 2 weeks of delivery. Small, but non-significant differences in pooled prevalence were found by mother's age, geographical location and study setting. Reported risk factors for postpartum depression included financial difficulties, presence of domestic violence, past history of psychiatric illness in mother, marital conflict, lack of support from husband and birth of a female baby. CONCLUSION The review shows a high prevalence of postpartum depression in Indian mothers. More resources need to be allocated for capacity-building in maternal mental health care in India.
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Affiliation(s)
- Ravi Prakash Upadhyay
- Department of Community Medicine, Room 517, 5th floor, College Building, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | | | - Aslyeh Salehi
- School of Health and Human Sciences, Southern Cross University, Queensland, Australia
| | - Kaushik Sarkar
- Directorate of National Vector Borne Disease Control Programme, New Delhi, India
| | - Sunil Kumar Singh
- Department of Community Medicine, Room 517, 5th floor, College Building, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | - Bireshwar Sinha
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Aditya Pawar
- Department of Psychiatry, Drexel University College of Medicine, Philadelphia, United States of America
| | | | - Amardeep Kumar
- Department of Psychiatry, Patna Medical College, Patna, Bihar, India
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