1
|
Slavin MN, West BS, Schreiber-Gregory D, Levin FR, Wingood G, Martino S, Tzilos Wernette G, Black C, El-Bassel N. Correlates of Unmet Need for Modern Contraception Among Reproductive-Aged Women Involved in New York City Criminal Legal Systems. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:132-142. [PMID: 38404679 PMCID: PMC10890951 DOI: 10.1089/whr.2023.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/27/2024]
Abstract
Introduction The population of women involved in criminal legal systems (WICL), a majority of whom are reproductive-aged, has risen steadily in the United States. They contend with numerous barriers to sexual and reproductive health services resulting in high rates of unmet need for contraception and unintended pregnancy. Materials and Methods This study included 132 non-pregnancy seeking reproductive-aged WICL enrolled in the baseline assessment of the HIV prevention intervention, "Women on the Road to Health" (WORTH). A multivariate generalized linear logistic regression model with robust estimation examined effects of past 6-month intimate partner violence (IPV; sexual and physical/injurious), past 3-month substance use (binge drinking, cannabis, other illegal drug use), and lifetime mental health diagnoses (anxiety, depression, bipolar disorder) on women's unmet need for modern contraception, adjusting for significant demographic and socioeconomic factors. Results Women who were younger in age (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.63-0.88) and reporting lifetime diagnoses of anxiety disorders (OR: 13.64; 95% CI: 2.71-68.34) were significantly more likely to meet the criteria for unmet need for modern contraception. Women with a regular gynecologist (OR: 0.11; 95% CI: 0.01-0.86) reporting lifetime diagnoses of bipolar disorder and past 6-month sexual IPV histories (OR: 0.04; 95% CI: 0.002-0.86) were significantly less likely to meet the criteria for unmet need for modern contraception. Conclusions Distinct mental health diagnoses and experiences of IPV may uniquely impact unmet need for modern contraception among WICL. These findings emphasize the need for a more nuanced comprehension of these relationships to deliver comprehensive and holistic health services that address the intersecting needs of this population. Trial registration: ClinicalTrials.gov NCT01784809. Registered 6 February 2013.
Collapse
Affiliation(s)
- Melissa N. Slavin
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, New Jersey, USA
| | - Brooke S. West
- Social Intervention Group, Columbia School Social Work, Columbia University, New York, New York, USA
| | | | - Frances R. Levin
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Golfo Tzilos Wernette
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Chermaine Black
- Social Intervention Group, Columbia School Social Work, Columbia University, New York, New York, USA
| | - Nabila El-Bassel
- Social Intervention Group, Columbia School Social Work, Columbia University, New York, New York, USA
| |
Collapse
|
2
|
Sibanyoni AU, Joubert M, Naidu K. Are female bipolar patients of reproductive age aware of the teratogenic risk of sodium valproate? A qualitative study. S Afr J Psychiatr 2022; 28:1719. [PMID: 35169512 PMCID: PMC8831931 DOI: 10.4102/sajpsychiatry.v28i0.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/06/2021] [Indexed: 11/03/2022] Open
Abstract
Background Sodium valproate is considered the most teratogenic of all anticonvulsant drugs. Internationally, new regulations require women to sign risk assessment forms if initiated on it. Aim This study aimed to explore patients’ awareness of the teratogenic risk of sodium valproate. Setting Weskoppies Psychiatric Hospital, Tshwane, Gauteng. Methods We conducted a qualitative study comprising 23 semi-structured interviews with female bipolar patients of reproductive age at a tertiary psychiatric hospital in South Africa. Results Patient psychoeducation and self-education is improving as many patients were aware of the risk of teratogenicity of sodium valproate either by being educated or by searching online after developing an interest. Our study identified the need for female patients to be educated about contraceptive use when starting on sodium valproate to avoid pregnancy. Conclusion Our study shows that patients are becoming more aware of the teratogenic risk of sodium valproate. This suggests that consultations focusing on the issues of conception and the use of sodium valproate in women of childbearing potential has improved.
Collapse
Affiliation(s)
- Amanda U. Sibanyoni
- Department of Psychiatry, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Marinda Joubert
- Department of Psychiatry, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Kalaivani Naidu
- Department of Psychiatry, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
3
|
Zatloff JP, von Esenwein SA, Philip Z, Ward MC. Navigating a Complex Health System: the Perceptions of Psychiatric Residents in Addressing Sexual and Reproductive Health of Women with Severe Mental Illness. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:403-407. [PMID: 32086796 DOI: 10.1007/s40596-020-01197-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 02/04/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study's purpose was to examine attitudes and perceptions of resident psychiatrists regarding the sexual and reproductive health needs of their female patients with severe mental illness. The three aims were to investigate resident psychiatrists' (1) perceptions regarding the importance of providing sexual and reproductive health services to female patients in the outpatient behavioral health setting, (2) current engagement in providing sexual and reproductive health services to their female patients, and (3) perceived barriers and facilitators to addressing sexual and reproductive health in this vulnerable patient population. METHODS Fifteen resident psychiatrists were recruited from the behavioral health clinic at a safety-net public sector hospital for a structured interview. Interviews were recorded, transcribed, and then coded using MAXQDA© software. RESULTS Resident psychiatrists recognized the importance of addressing sexual and reproductive health with their female patients and recognized their hypothetical ability to provide sexual and reproductive health counseling and services based on their training and resources. However, residents reported rarely providing these services, mostly addressing sexual and reproductive health only when necessitated by medication changes. Perceived barriers included lack of training or knowledge, discomfort, and limited appointment time. CONCLUSIONS Resident psychiatrists perceive a need to address sexual and reproductive health with their female patients with serious mental illness but lack the confidence and resources to do so. Directed education and clear institutional guidelines are necessary to equip the next generation of psychiatrists with the tools needed to address the sexual and reproductive health needs of women with serious mental illness.
Collapse
|
4
|
Zengin Eroglu M, Lus MG. Impulsivity, Unplanned Pregnancies, and Contraception Among Women with Bipolar Disorder. Neuropsychiatr Dis Treat 2020; 16:407-414. [PMID: 32103960 PMCID: PMC7012326 DOI: 10.2147/ndt.s238887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/16/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Impulsivity is one of the principal symptoms of bipolar and related disorders (BD). Unsafe sex and unplanned pregnancies are serious problems in clinical practice. The aim of this study was to investigate impulsivity levels, contraception methods, and levels of planned pregnancies among women with bipolar and related disorders (WBD). METHODS Fifty-eight euthymic women with BD (bipolar disorder type I, II, or other) were matched by education levels with a control group of 59 healthy women. Data about their demographic, clinical-Barratt Impulsiveness Scale (BIS-11), Hamilton Depression Rating Scale, and Young Mania Rating Scale scores-and reproductive health features were obtained and compared between the groups. RESULTS No difference was found regarding BIS-11 (total, nonplanning, motor, and attentional subscales) scores between the WBD and control groups. The overall rate of contraception use was higher in WBD (96.6%), but they generally preferred "traditional" methods (i.e., withdrawal and calendar). The total rate of unplanned pregnancies in WBD was 49.52%. Rate of unplanned pregnancies in WBD was significantly different from women without bipolar disorder (49.52% vs 15.04%). DISCUSSION Levels of impulsivity in euthymic WBD under treatment were similar to those of healthy women in the control sample. WBD paid attention to contraception although they usually used traditional methods. The findings indicate that most WBD use contraception, yet the contraception is potentially ineffective especially if WBD have more unplanned pregnancies. The provision of an effective contraception method in WBD is suggested for all clinicians, in order to prevent sexually transmitted diseases and unplanned pregnancies, and thus protect the health of both mother and fetus.
Collapse
Affiliation(s)
- Meliha Zengin Eroglu
- Haydarpasa Numune Training and Research Hospital, Department of Psychiatry, Uskudar-Istanbul 34668, Turkey
| | - Melek Gözde Lus
- Department of Child and Adolescent Psychiatry, Haydarpasa Numune Training and Research Hospital, Uskudar-Istanbul 34668, Turkey
| |
Collapse
|
5
|
Perera C, Patterson S, Bruxner G. 'Conceivably Neglected' - Are prescribers sufficiently aware of the risks of prescribing sodium valproate to women with mental illness? Australas Psychiatry 2019; 27:125-128. [PMID: 30763123 DOI: 10.1177/1039856219828175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe prescription of sodium valproate (SV) for bipolar mood disorder to potentially child-bearing women within one public mental health service and describe risks of fetal exposure, and safe prescribing practices among psychiatrists. METHODS A 24-month retrospective chart review with descriptive analysis; narrative review of literature and guidelines. RESULTS Review of 383 charts demonstrated prescription of valproate to 20% of 98 women aged 15-45, with little evidence of advice regarding risk and contraception. Robust evidence of teratogenic and neurodevelopmental risk underpins increased regulation, and recommendations that valproate not be prescribed to this cohort. CONCLUSIONS The significant risks associated with SV oblige all prescribers to proactively access authoritative guidelines such as those published by the Centre of Perinatal Excellence.
Collapse
Affiliation(s)
- Charana Perera
- Advanced trainee, Royal Australian and New Zealand College of Psychiatrists, Redcliffe-Caboolture Mental Health Service, Metro-North Mental Health Service, Brisbane, QLD, and; University of Queensland, Brisbane, QLD, Australia
| | - Sue Patterson
- Principal Research Fellow, Metro-North Mental Health Service, Brisbane, QLD, and; University of Queensland, Brisbane, QLD, Australia
| | - George Bruxner
- Consultant Psychiatrist and staff specialist, Fellow Royal Australian and New Zealand College of Psychiatrists, Redcliffe-Caboolture Mental Health Service, Metro-North Mental Health Service, Brisbane, QLD, Australia
| |
Collapse
|
6
|
Posada Correa AM, Andrade Carrillo RA, Suarez Vega DC, Gómez Cano S, Agudelo Arango LG, Tabares Builes LF, Agudelo García ÁM, Uribe Villa E, Aguirre-Acevedo DC, López-Jaramillo C. Sexual and Reproductive Health in Patients with Schizophrenia and Bipolar Disorder. ACTA ACUST UNITED AC 2018; 49:15-22. [PMID: 32081203 DOI: 10.1016/j.rcp.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/05/2018] [Accepted: 04/13/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION People with schizophrenia and bipolar disorder (BD) have a high risk of unwanted pregnancies and abortions, due to their condition of vulnerability or hypersexuality (common in BD). This is associated with difficulty in planning their actions and lack of sex education and counselling by medical personnel, and can lead to adverse obstetric outcomes and inability to care adequately for their children. OBJECTIVE To describe the characteristics in terms of sexual and reproductive health, and the use of contraception and counselling in psychiatric consultations, in a sample of patients with BD and schizophrenia in Medellin, Colombia. METHODS Observational cross-sectional study. We included the 160 participants from the clinical trial, "The effects of a multimodal intervention programme in patients with bipolar disorder and schizophrenia", who were recruited from the mood and psychosis disorders group clinic at Hospital Universitario de San Vicente Fundación in Medellin. They were contacted by phone by a third-year psychiatry resident, who applied a survey about the characteristics of their sex life, contraception and reproduction. RESULTS Almost all of the patients with schizophrenia were single, had no undergraduate studies and were unemployed. No significant differences were found regarding the age of starting sexual relations when comparing by diagnosis and gender. Almost all patients with schizophrenia and almost half of the patients with BD reported not having an active sexual life. Almost all of those who admitted to having an active sexual life claimed to always use contraception; in the BD group, only 48.8% of single women admitted to using contraception and a little over half of men stated that they used a condom when having sex. A quarter of the pregnancies were unplanned. Although the majority of the patients stated that they had never received information about family planning in the consultations with their psychiatrist, 57.4% of the patients with BD and 78.8% of those who had schizophrenia, considered themselves to be well informed on the subject. CONCLUSIONS Patients with mental illness have cognitive and behavioural alterations that affect their sexual and reproductive lives. Psychiatrists should therefore address this issue, to ensure education in areas such as contraception, family planning and sexually transmitted diseases and help safeguard the safety and quality of life of their patients.
Collapse
Affiliation(s)
- Ana María Posada Correa
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Sujey Gómez Cano
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Ángela María Agudelo García
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Esteban Uribe Villa
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Carlos López-Jaramillo
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| |
Collapse
|
7
|
Macaluso M, Zackula R, Bowman C, Bourne C, Sweet D. Residents Perceive Limited Education on Family Planning and Contraception for Patients with Severe and Persistent Mental Illness. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:189-196. [PMID: 28940136 DOI: 10.1007/s40596-017-0806-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The primary goal of this study was to assess perceived adequacy of training by residents from multiple specialties on contraceptive prescribing and family planning for patients with severe and persistent mental illness (SPMI). Secondary goals included the following: (1) explore resident knowledge, attitudes, and behavior towards patients with SPMI and (2) identify barriers to meeting the reproductive health needs of patients with SPMI. METHODS The target population was 44,237 residents from four medical specialties. Participants were from a stratified, self-selected sample. Program coordinators were asked to forward a survey link to residents. Consenting residents were provided access to a questionnaire via a secure, web-based application (REDCap). The survey assessed resident education on the reproductive health needs of patients with SPMI and included demographics (age, gender, year of residency, and specialty), perceived adequacy of training, knowledge, and attitudes, and barriers regarding contraception and family planning. Responses were summarized with frequency and compared by medical specialty. RESULTS A total of 768 residents consented: 49% female, 20% male, and 31% did not indicate their gender; 19% were first year residents, 21% second year residents, 21% third year residents, 8% fourth year residents, and 30% did not indicate their year of training. By specialty, 30.6% of residents were from family medicine programs (n = 235), 10.8% were from internal medicine programs (n = 83), 18.1% were from OBGYN programs (n = 139), and 10.4% were from psychiatry programs (n = 80); 231 (30.1%) did not indicate specialty. Regarding training, 60% of residents disagreed or strongly disagreed that they had proper training on prescribing contraceptives for patients with SPMI (363 of 599). Sixty two percent of residents disagreed or strongly disagreed that they had proper training about family planning for patients with SPMI (368/599). Over 83% of residents surveyed (405/486) would prescribe contraception for patients with SPMI if they had adequate training. CONCLUSIONS Results indicate the need for curricular change on the reproductive health needs of patients with SPMI.
Collapse
Affiliation(s)
| | - Rosey Zackula
- Kansas University School of Medicine-Wichita, Wichita, KS, USA
| | | | | | - Donna Sweet
- Kansas University School of Medicine-Wichita, Wichita, KS, USA
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW The aim of this paper is to evaluate recent literature on valproic acid (VPA) in women and girls of childbearing age and to emphasize new findings. RECENT FINDINGS Recent research confirms VPAs teratogenicity and risk of hormone disruption. VPA exposure in utero increases the risk for a variety of major congenital malformations (MCMs), reduced IQ and behavioral problems. In girls and women, VPA increases the risk of hormone abnormalities, obesity, and polycystic ovarian syndrome (PCOS). Despite guidelines recommending caution, VPA use continues to be prescribed to reproductive-aged women and girls. Despite significant and well-documented risk, adherence to guidelines in VPA use in reproductive-aged girls and women remains low.
Collapse
Affiliation(s)
- Dorothy Gotlib
- Michigan Medicine, Department of Psychiatry, Ann Arbor, MI, USA.
| | - Rachel Ramaswamy
- Department of Psychiatry and Behavioral Neurosciences, Loyola University, Tampa, FL, USA
| | | | - Alana DeRiggi
- Michigan Medicine, Department of Psychiatry, Ann Arbor, MI, USA
| | - Michelle Riba
- Michigan Medicine, Department of Psychiatry, Ann Arbor, MI, USA
| |
Collapse
|
9
|
Abstract
Individuals with bipolar spectrum disorders experience higher morbidity and mortality rates relative to the general population because of increased commission of dangerous behaviors. Despite this impact, little is known about the overall rates of risk-taking behaviors in patients currently being treated for such illness. This study examined the frequency of a variety of risk-taking behaviors in 100 adults with bipolar spectrum disorders in an active outpatient psychiatric treatment. It was found that 70% of individuals assessed reported at least one risk-taking behavior over the preceding 7 days. Implications for assessment and intervention are discussed.
Collapse
|
10
|
Pagano HP, Zapata LB, Berry-Bibee EN, Nanda K, Curtis KM. Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review. Contraception 2016; 94:641-649. [PMID: 27364100 PMCID: PMC10994544 DOI: 10.1016/j.contraception.2016.06.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Women with depressive or bipolar disorders are at an increased risk for unintended pregnancy. OBJECTIVE To examine the safety of hormonal contraception among women with depressive and bipolar disorders. METHODS We searched for articles published through January 2016 on the safety of using any hormonal contraceptive method among women with depressive or bipolar disorders, including those who had been diagnosed clinically or scored above threshold levels on a validated screening instrument. Outcomes included changes in symptoms, hospitalization, suicide and modifications in medication regimens such as increase or decrease in dosage or changes in type of drug. RESULTS Of 2376 articles, 6 met the inclusion criteria. Of three studies that examined women clinically diagnosed with depressive or bipolar disorder, one found that oral contraceptives (OCs) did not significantly change mood across the menstrual cycle among women with bipolar disorder, whereas mood did significantly change across the menstrual cycle among women not using OCs; one found no significant differences in the frequency of psychiatric hospitalizations among women with bipolar disorder who used depot medroxyprogesterone acetate (DMPA), intrauterine devices (IUDs) or sterilization; and one found no increase in depression scale scores among women with depression using and not using OCs, for both those treated with fluoxetine and those receiving placebo. Of three studies that examined women who met a threshold for depression on a screening instrument, one found that adolescent girls using combined OCs (COCs) had significantly improved depression scores after 3 months compared with placebo, one found that OC users had similar odds of no longer being depressed at follow-up compared with nonusers, and one found that COC users were less frequently classified as depressed over 11 months than IUD users. CONCLUSIONS Limited evidence from six studies found that OC, levonorgestrel-releasing IUD and DMPA use among women with depressive or bipolar disorders was not associated with worse clinical course of disease compared with no hormonal method use.
Collapse
Affiliation(s)
- H Pamela Pagano
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA 30341, USA.
| | - Lauren B Zapata
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA 30341, USA
| | - Erin N Berry-Bibee
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA 30341, USA
| | | | - Kathryn M Curtis
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA 30341, USA
| |
Collapse
|
11
|
Marengo E, Martino DJ, Igoa A, Scápola M, Fassi G, Baamonde MU, Strejilevich SA. Unplanned pregnancies and reproductive health among women with bipolar disorder. J Affect Disord 2015; 178:201-5. [PMID: 25827504 DOI: 10.1016/j.jad.2015.02.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to investigate reproductive health and level of planning of pregnancies among women with bipolar disorder (BDW). METHODS 63 euthymic women, with bipolar disorder type I, II or not otherwise specified diagnosis, were included and were matched with a control group of 63 healthy women. Demographic and clinical data, structured reproductive health measures and planning level of pregnancies were obtained and compared between groups. RESULTS Lower level of planning of pregnancies and higher frequency of unplanned pregnancies were found among BDW. Women with bipolar disorder reported history of voluntary interruption of pregnancies more frequent than women from control group. Current reproductive health care showed no differences between groups. LIMITATIONS Data based on self-report of participants and retrospective nature of some collected measures may be affected by information bias. The pregnancy planning measure has not been validated in this population before. Demographic and clinical characteristics of the sample study limit generalization of these findings. CONCLUSIONS Adverse reproductive events, as unplanned pregnancies and elective interruption of pregnancies, may be more frequent among BDW. Clinician must be aware of the reproductive health during treatment of young BDW and take measures to improve better family planning access.
Collapse
Affiliation(s)
- Eliana Marengo
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
| | - Diego J Martino
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
| | - Ana Igoa
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - María Scápola
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Guillermo Fassi
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Mariana Urtueta Baamonde
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina.
| |
Collapse
|
12
|
Miller LJ, Ghadiali NY, Larusso EM, Wahlen KJ, Avni-Barron O, Mittal L, Greene JA. Bipolar disorder in women. Health Care Women Int 2014; 36:475-98. [PMID: 25315819 DOI: 10.1080/07399332.2014.962138] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article summarizes research pertinent to the clinical care of women with bipolar disorder. With bipolar disorder, female gender correlates with more depressive symptoms and different comorbidities. There is a high risk of symptom recurrence postpartum and possibly during perimenopause. Women with bipolar disorder have increased risk of sexually transmitted diseases, unplanned pregnancies, excessive weight gain, metabolic syndrome, and cardiovascular disease. Mood stabilizing medications, specific psychotherapies, and lifestyle changes can stabilize mood and improve functioning. Pharmacologic considerations include understanding interactions between mood stabilizing medications and contraceptive agents and risks and benefits of mood stabilizing medication during pregnancy and lactation.
Collapse
Affiliation(s)
- Laura J Miller
- a Department of Psychiatry, Loyola Stritch School of Medicine, Edward Hines Jr. VA Hospital , Hines , Illinois , USA
| | | | | | | | | | | | | |
Collapse
|
13
|
Bacopoulou F, Greydanus DE, Chrousos GP. Reproductive and contraceptive issues in chronically ill adolescents. EUR J CONTRACEP REPR 2012; 15:389-404. [PMID: 21091176 DOI: 10.3109/13625187.2010.532252] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To address reproductive and contraceptive issues in adolescent girls with chronic medical conditions in order to assist health-care providers when they counsel teenagers about contraceptive methods. METHODS The review is based on a literature search in Medline (1973-2010) about specific contraceptive use by adolescents with obesity, endocrine, cardiovascular, haematologic, oncologic, neurological, psychiatric, gastrointestinal, hepatobiliary, autoimmune, renal, pulmonary conditions and disabilities. The latest recommendations from the World Health Organisation for adolescents are also added. Contraceptive methods studied were combined hormonal contraceptives, progestogen-only contraceptives, and intrauterine contraceptives. RESULTS Adolescents are eligible to use any method of contraception. Contraceptive choices of chronically ill adolescents have changed over time. Given new developments in the field of adolescent sexual and reproductive health care, safe and effective forms of contraception are available for almost every adolescent with a chronic condition. When selecting a method, the nature of the medical illness and the expressed desires of the teenager must be taken into account. CONCLUSIONS Adolescents, including those with chronic conditions, are sexual beings; they are entitled to sexual and reproductive health care. Decisions on appropriate contraception must be based upon informed choice, after adequate sexual health education.
Collapse
Affiliation(s)
- Flora Bacopoulou
- Centre for Health and Prevention in Adolescence, First Department of Paediatrics, University of Athens, Children's Hospital Aghia Sophia, Athens, Greece.
| | | | | |
Collapse
|
14
|
Continuation rates and complications of intrauterine contraception in women diagnosed with bipolar disorder. Obstet Gynecol 2012; 118:1331-1336. [PMID: 22105263 DOI: 10.1097/aog.0b013e318233beae] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate continuation rates, complications, and psychiatric hospitalizations among women with bipolar disorder using levonorgestrel-releasing or copper-containing intrauterine devices (IUDs) as compared with those using depot medroxyprogesterone acetate or sterilization for birth control. METHODS Data for this cohort study were obtained from a nationwide health insurance claims database on an employed, commercially insured population. Women aged 18-44 years with a prior diagnosis of bipolar disorder (n=849) who were using the levonorgestrel intrauterine system, a copper-containing IUD, depot medroxyprogesterone acetate, or sterilization were evaluated. Outcomes included continuation rates over a 12-month interval, infectious and noninfectious complications, and hospitalizations for bipolar disorder or depression. RESULTS Women using an IUD were more likely than those using depot medroxyprogesterone acetate to continue the method for at least 12 months (copper-containing IUD, 86%; levonorgestrel intrauterine system, 87%). In comparison, only 31% of those who initiated depot medroxyprogesterone acetate received three more injections during the next year (P<.001). No significant differences were noted in infectious or noninfectious complications by contraceptive type. Finally, no differences were observed in the number of hospitalizations for bipolar disorder or depression among the four contraceptive groups. CONCLUSION More women with bipolar disorder continued using IUDs at one year than women using depot medroxyprogesterone acetate. The rates of complications and psychiatric hospitalizations were not different among women using an IUD, depot medroxyprogesterone acetate, or sterilization. LEVEL OF EVIDENCE II.
Collapse
|
15
|
Concepts of contraception for adolescent and young adult women with chronic illness and disability. Dis Mon 2012; 58:258-320. [PMID: 22510362 DOI: 10.1016/j.disamonth.2012.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sexual behavior is common in adolescents and young adults with or without chronic illness or disability, resulting in high levels of unplanned pregnancy and STDs. Individuals with chronic illness or disability should not receive suboptimal preventive health care. These individuals have a need for counseling regarding issues of sexuality and contraception. Sexually active adolescent and young adult women can be offered safe and effective contraception if they wish to avoid pregnancy. Women with chronic illnesses and disabilities who are sexually active should also be offered contraception based on their specific medical issues. Condoms are also recommended to reduce STD risks. Table 36 summarizes basic principles of contraception application for specific illnesses, which have been identified since the release of the combined OC in 1960. Clinicians should also consider the noncontraceptive benefits of this remarkable and life-changing technology that allows all reproductive age women to improve their lives, including those with chronic illnesses and disabilities.
Collapse
|
16
|
Abstract
Although depressive symptoms have been consistently associated with lower quality of life and increased disability in bipolar disorder, their relation to manic symptoms is not as clear cut. A great overlap between these outcomes complicates the understanding of how they cluster together. We used exploratory factor analysis to clarify the relation between these constructs. We consecutively recruited 320 patients with bipolar disorder, and interviewers rated the Hamilton Depression and Anxiety Rating Scales, the Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI), and the Global Assessment of Functioning (GAF). The self-rated Sheehan Disability Scale and the World Health Organization Quality of Life-BREF questionnaires were also collected. Two distinct and large dimensions emerged. Depression and anxiety, along with the self-rated scales, loaded in the first factor, whereas the YMRS, the GAF, and the CGI loaded in the second. These findings imply that evaluating self- and observer-rated outcomes may make up for a more thorough evaluation because each conveys unique illness information.
Collapse
|
17
|
Desai G, Babu GN, Chandra PS. Unplanned pregnancies leading to psychotropic exposure in women with mental illness - Findings from a perinatal psychiatry clinic. Indian J Psychiatry 2012; 54:59-63. [PMID: 22556440 PMCID: PMC3339222 DOI: 10.4103/0019-5545.94649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aims of this study were (a) to describe the sociodemographic and clinical profile of women with unplanned pregnancies and consequent exposure to psychotropic drugs, (b) to describe the nature and timing of psychotropic exposure during pregnancy among these women, and (c) to examine the outcome of decisions related to pregnancy following consultation at a perinatal psychiatric service. MATERIALS AND METHODS WOMEN ATTENDING THE PERINATAL PSYCHIATRY SERVICES REFERRED FOR ACCIDENTAL EXPOSURE TO PSYCHOTROPICS WERE ASSESSED BY STRUCTURED INTERVIEWS FOR THE FOLLOWING DETAILS: sociodemographic details, clinical details, psychotropic drug use, advice given in the clinic, and outcome related to this advice. RESULTS Fifty-three women were referred for counseling related to unplanned pregnancies and consequential psychotropic exposure. Forty-two women (79%) sought consultation in the first trimester. More than a third of the women, 19 (36%), were taking more than one psychotropic medication during the first consultation. Only 11 (20%) women had received any form of prepregnancy counseling prior to becoming pregnant. Of the 37 women who came for follow-up in the clinic, 35 (94%) of them continued the pregnancy. CONCLUSIONS Unplanned pregnancies in women with mental illness are common and result in exposure to multiple psychotropic medications during the first trimester. Majority of women did not report of having prepregnancy counseling and which needs to be an integral part of treatment and education.
Collapse
Affiliation(s)
- Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
| | | | | |
Collapse
|
18
|
Nguyen TV, Low NCP. Hormonal Treatments for Bipolar Disorder: A Review of the Literature. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jbbs.2012.21006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
19
|
Godbole K, Vehale M, Phadke S. A survey among psychiatrists regarding psychotropic drug use in reproductive age women. Asian J Psychiatr 2011; 4:272-6. [PMID: 23051161 DOI: 10.1016/j.ajp.2011.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 07/27/2011] [Accepted: 08/07/2011] [Indexed: 10/15/2022]
Abstract
We present findings of a questionnaire-based survey for practicing psychiatrists in the state of Maharashtra, India as an effort to understand challenges faced and the strategies adopted while treating women in reproductive age, especially during pregnancy. Participants were asked open-ended questions to cover pre and peri-conceptional period where use of psychotropic medication might have specific consequences. The broad areas included impact of psychiatric illness on family and reproductive health, effect of treatment on fertility or obstetric outcome, contraception, pre-pregnancy counseling and vitamin supplementation, structural and functional teratogenesis, choice of psychotropes during pregnancy, obstetric complications and pregnancy outcome and neonatal withdrawal, etc. The observations from this study bring forth various issues such as peri-conceptional care and management options during pregnancy in women on psychotropic therapy. The study reveals that not the years of clinical practice but a formal training with ongoing updates about safe prescription practices and functional effects of these drugs on the developing fetus and newborn is associated with safe prescription practice during pregnancy.
Collapse
Affiliation(s)
- Koumudi Godbole
- Department of Genetic Medicine, Deenanath Mangeshkar Hospital & Research Center, Erandawane, Pune 411004, India
| | | | | |
Collapse
|
20
|
Rapkin A, Sonalkar S. Hormonal Contraception and Mood. Contraception 2011. [DOI: 10.1002/9781444342642.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
21
|
Cacilhas AA, Magalhães PVDS, Ceresér KM, Walz JC, Weyne F, Rosa AR, Vieta E, Kapczinski F. Bipolar disorder and age-related functional impairment. BRAZILIAN JOURNAL OF PSYCHIATRY 2009; 31:354-7. [DOI: 10.1590/s1516-44462009000400012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Accepted: 07/29/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: Although bipolar disorder is a major contributor to functional impairment worldwide, an independent impact of bipolar disorder and ageing on functioning has yet to be demonstrated. The objective of the present study was to evaluate the effect of bipolar disorder on age-related functional status using matched controls as a standard. METHOD: One-hundred patients with bipolar disorder and matched controls were evaluated for disability. Age-related effects controlled for confounders were cross-sectionally evaluated. RESULTS: Patients were significantly more impaired than controls. Regression showed effects for aging in both groups. The effect, size, however, was significantly stronger in patients. CONCLUSION: Bipolar disorder was an important effect modifier of the age impact on functioning. While a longitudinal design is needed to effectively demonstrate this different impact, this study further depicts bipolar disorder as a chronic and progressively impairing illness.
Collapse
Affiliation(s)
| | | | | | | | | | - Adriane Ribeiro Rosa
- Universidade Federal do Rio Grande do Sul, Brazil; University of Barcelona, Spain
| | | | | |
Collapse
|