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Biaggi A, Hazelgrove K, Waites F, Bind RH, Lawrence AJ, Fuste M, Conroy S, Howard LM, Mehta MA, Miele M, Seneviratne G, Pawlby S, Pariante CM, Dazzan P. Mother-infant interaction and infant development in women at risk of postpartum psychosis with and without a postpartum relapse. Psychol Med 2024; 54:823-834. [PMID: 37706314 DOI: 10.1017/s0033291723002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND This study aimed to investigate mother-infant interaction and infant development in women at-risk of postpartum psychosis (PP), with and without a postpartum relapse. METHODS 103 women (and their offspring) were included, 43 at-risk-of-PP because of a diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 60 with no current/previous mental illness or family history of PP. Of the at-risk women, 18 developed a psychiatric relapse within 4 weeks after delivery (AR-unwell), while 25 remained symptom-free (AR-well). Mother-infant interaction was assessed using the CARE-Index at 8 weeks' and 12 months' postpartum and infant development using the Bayley-III at 12 months' postpartum. RESULTS Women at-risk-of-PP as a group, regardless of whether they developed a psychiatric relapse within 4 weeks after delivery, had less synchronous mother-infant interactions and had infants with less optimal cognitive, language, motor and socio-emotional development than healthy controls. In particular, boys of at-risk women had the lowest scores in cognitive, language and motor development and in mother-infant interaction, while girls of the at-risk women had the lowest scores in socio-emotional development. The synchrony in the dyad predicted infant cognitive and language development. There was no evidence for a difference in mother-infant interaction nor in infant development between the AR-unwell and AR-well groups. CONCLUSIONS These results suggest that, while there is a lack of evidence that an early postpartum relapse in women at-risk-of-PP could represent a risk for the infant per se, maternal risk for PP may be associated with less optimal mother-infant interaction and infant development.
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Affiliation(s)
- Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Freddie Waites
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Rebecca H Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Andrew J Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Montserrat Fuste
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
- Perinatal Parent-Infant Mental Health Service, Goodmayes Hospital, North East London Foundation Trust, London, IG3 8XD, UK
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Mitul A Mehta
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, SE5 8AF, UK
| | - Maddalena Miele
- Perinatal Mental Health Service, St Mary's Hospital, Imperial College London and Central North West London NHS Foundation Trust, London, W2 1PF, UK
| | - Gertrude Seneviratne
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Vanderkruik R, Kobylski LA, Dunk MM, Arakelian MH, Gaw ML, Dineen H, Kanamori M, Freeman MP, Cohen LS. The lived experiences of individuals with postpartum psychosis: A qualitative analysis. J Affect Disord 2024; 348:367-377. [PMID: 38160890 DOI: 10.1016/j.jad.2023.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/05/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
Postpartum psychosis (PP) is a severe psychiatric illness that occurs in about 1 to 2 per 1000 people in the perinatal period. To date, qualitative research investigating PP has focused on specific topics, such as treatment experiences or the impact of the illness on patients' lives and families. These studies have included small samples of women with histories of PP, often limited to certain geographical areas or treatment centers. Given the heterogeneity in presentations of PP and access to care, larger and geographically diverse samples are needed to broadly understand this complex illness. Initiated in 2018, the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3) consists of a large, international sample of those who have experienced PP. In addition to the specific aims of MGHP3, which include to better understand the phenomenology and potential genetic underpinnings of PP, this investigation invites participants to qualitatively describe their narratives of postpartum psychosis. This analysis included 130 participants who reported on 133 episodes of PP. Participants' responses to the PP narrative prompt fell under several overarching categories: 1) broad psychosocial experiences surrounding postpartum psychosis, 2) impact on the mother-baby dyad, 3) treatment experiences, and 4) recovery experiences. Our findings shed light on a range of ways in which individuals' lives are impacted by this illness, and point to areas for future research and clinical directions to improve the support and care for individuals with PP and their families.
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Affiliation(s)
- Rachel Vanderkruik
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Lauren A Kobylski
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Psychological & Brain Sciences, George Washington University, Washington, DC, United States of America
| | - Madison M Dunk
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Miranda H Arakelian
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Margaret L Gaw
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Hannah Dineen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Margaux Kanamori
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Marlene P Freeman
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lee S Cohen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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3
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Jairaj C, Seneviratne G, Bergink V, Sommer IE, Dazzan P. Postpartum Psychosis: A Proposed Treatment Algorithm. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:131-142. [PMID: 38694161 PMCID: PMC11058922 DOI: 10.1176/appi.focus.23021033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Background Postpartum psychosis (PPP) is a psychiatric emergency that generally warrants acute inpatient care. PPP is marked by the sudden onset of affective and psychotic symptoms with a rapid deterioration in mental state. Evidence suggests that PPP is a discrete disorder on the bipolar disorder spectrum with a distinct treatment profile and prognosis. Methods We conducted a PubMed database search for various terms involving PPP and its treatment and included peer-reviewed articles published in English. Objective To provide a treatment algorithm for the management of PPP based on available evidence. Results Pharmacological therapy is the mainstay of PPP management in the acute phase. Evidence points to a combination of antipsychotics and lithium in the acute treatment of PPP. Electroconvulsive therapy can offer a rapid treatment response where required. Lithium appears to have the best evidence for relapse prevention and prophylaxis in PPP. Psychoeducation is essential and psychosocial interventions used in bipolar disorder may be effective in PPP. Conclusion Early detection and prompt treatment with antipsychotics and lithium, followed by maintenance treatment with lithium, is associated with a favourable prognosis in PPP.Reprinted from J Psychopharmacol 2023; 37:960-970, with permission from Sage Journals. Copyright © 2023.
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Affiliation(s)
- Chaitra Jairaj
- South London and Maudsley NHS Foundation Trust, London, UK (Jairaj, Seneviratne); Trinity College Dublin, Dublin, Ireland (Jairaj); National Maternity Hospital, Dublin, Ireland (Jairaj); Royal College of Psychiatrists, London, UK (Seneviratne); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands (Bergink); Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Centre Groningen (UMCG), Groningen, The Netherlands (Sommer); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK (Dazzan); National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK (Dazzan)
| | - Gertrude Seneviratne
- South London and Maudsley NHS Foundation Trust, London, UK (Jairaj, Seneviratne); Trinity College Dublin, Dublin, Ireland (Jairaj); National Maternity Hospital, Dublin, Ireland (Jairaj); Royal College of Psychiatrists, London, UK (Seneviratne); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands (Bergink); Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Centre Groningen (UMCG), Groningen, The Netherlands (Sommer); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK (Dazzan); National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK (Dazzan)
| | - Veerle Bergink
- South London and Maudsley NHS Foundation Trust, London, UK (Jairaj, Seneviratne); Trinity College Dublin, Dublin, Ireland (Jairaj); National Maternity Hospital, Dublin, Ireland (Jairaj); Royal College of Psychiatrists, London, UK (Seneviratne); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands (Bergink); Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Centre Groningen (UMCG), Groningen, The Netherlands (Sommer); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK (Dazzan); National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK (Dazzan)
| | - Iris E Sommer
- South London and Maudsley NHS Foundation Trust, London, UK (Jairaj, Seneviratne); Trinity College Dublin, Dublin, Ireland (Jairaj); National Maternity Hospital, Dublin, Ireland (Jairaj); Royal College of Psychiatrists, London, UK (Seneviratne); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands (Bergink); Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Centre Groningen (UMCG), Groningen, The Netherlands (Sommer); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK (Dazzan); National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK (Dazzan)
| | - Paola Dazzan
- South London and Maudsley NHS Foundation Trust, London, UK (Jairaj, Seneviratne); Trinity College Dublin, Dublin, Ireland (Jairaj); National Maternity Hospital, Dublin, Ireland (Jairaj); Royal College of Psychiatrists, London, UK (Seneviratne); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Bergink); Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands (Bergink); Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Centre Groningen (UMCG), Groningen, The Netherlands (Sommer); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK (Dazzan); National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK (Dazzan)
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Toor R, Wiese M, Croicu C, Bhat A. Postpartum Psychosis: A Preventable Psychiatric Emergency. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:44-52. [PMID: 38694156 PMCID: PMC11058913 DOI: 10.1176/appi.focus.20230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Postpartum psychosis is the most severe psychiatric disorder associated with childbirth. Although rare, it is considered a psychiatric emergency that warrants immediate medical attention and inpatient care to ensure safety, complete diagnostic evaluation, and treatment initiation. This article describes the phenomenology of postpartum psychosis, clinical evaluation, treatment guidelines, and prevention strategies.
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Affiliation(s)
- Ramanpreet Toor
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Michelle Wiese
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Carmen Croicu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
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Pazzagli C, Buratta L, Coletti E, Mazzeschi C. Mother-to-infant bonding mediates the effects of depressive and anxious postpartum symptoms on parenting stress. J Psychosom Obstet Gynaecol 2023; 44:2264487. [PMID: 37837341 DOI: 10.1080/0167482x.2023.2264487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/24/2023] [Indexed: 10/16/2023] Open
Abstract
A number of studies have suggested close associations between maternal postpartum mental health (depressive and anxious symptoms), mother-infant bonding, and parenting stress. However, the relationship between maternal bonding and parenting stresshas hardly been explored in published literature. This cross-sectional study explored whether maternal bonding could mediate the effect of postpartum maternal mental health on parenting stress. This study assessed maternal bonding (MPAS), depressive and anxious symptoms (EPDS; STAI), and parenting stress (PSI) at 3 months postpartum in a community sample of 105 women (M (SD) = 32.60 (4.18) years old). Spearman's correlation analyses showed moderate to high correlations between these factors. The three mediation models run showed that mother's MPAS partially mitigates the effects of EPDS (b = 0.71; SE = 0.217; 95% CI = 0.290/1.136) and STAI State (b = 0.39; SE = 0.113; 95% CI = 0.178/0.625) on PSI, and totally mediated the relationship between STAI Trait and PSI (b = 0.59; SE = 0.155; 95% CI = 0.303/0.912). Maternal bonding resulted to be a relevant factor in the association between maternal mental health and parenting stress. This highlights the importance of interventions focusing on mother-infant relationship to reduce parenting stress and prevent developmental difficulties in children.
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Affiliation(s)
- Chiara Pazzagli
- Department of Dynamic and Clinical Psychology, and Health Studies - Faculty of Medicine and Psychology, Sapienza University of Rome, Roma, Italy
| | - Livia Buratta
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
| | - Elena Coletti
- Department of Dynamic and Clinical Psychology, and Health Studies - Faculty of Medicine and Psychology, Sapienza University of Rome, Roma, Italy
| | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
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6
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Abstract
BACKGROUND Postpartum psychosis (PPP) is a psychiatric emergency that generally warrants acute inpatient care. PPP is marked by the sudden onset of affective and psychotic symptoms with a rapid deterioration in mental state. Evidence suggests that PPP is a discrete disorder on the bipolar disorder spectrum with a distinct treatment profile and prognosis. METHODS We conducted a PubMed database search for various terms involving PPP and its treatment and included peer-reviewed articles published in English. OBJECTIVE To provide a treatment algorithm for the management of PPP based on available evidence. RESULTS Pharmacological therapy is the mainstay of PPP management in the acute phase. Evidence points to a combination of antipsychotics and lithium in the acute treatment of PPP. Electroconvulsive therapy can offer a rapid treatment response where required. Lithium appears to have the best evidence for relapse prevention and prophylaxis in PPP. Psychoeducation is essential and psychosocial interventions used in bipolar disorder may be effective in PPP. CONCLUSION Early detection and prompt treatment with antipsychotics and lithium, followed by maintenance treatment with lithium, is associated with a favourable prognosis in PPP.
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Affiliation(s)
- Chaitra Jairaj
- South London and Maudsley NHS Foundation Trust, London, UK
- Trinity College Dublin, Dublin, Ireland
- National Maternity Hospital, Dublin, Ireland
| | - Gertrude Seneviratne
- South London and Maudsley NHS Foundation Trust, London, UK
- Royal College of Psychiatrists, London, UK
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Iris E Sommer
- Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
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Narayan S, Kishore MT, Satyanarayana V, Bhaskarapillai B, Desai G, Chandra P. Bonding and Infants' Development and Quality of Life: A Study Among Mothers with Severe Mental Illnesses in Remission. Indian J Psychol Med 2023; 45:250-256. [PMID: 37152397 PMCID: PMC10159554 DOI: 10.1177/02537176231164732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Background Maternal mental health has specific implications for bonding and infants' mental health. However, most of the evidence comes from mothers who are either symptomatic or did not have adequate mental health support. In this context, our objective was to explore if symptom status in mothers and bonding share any significant association with the infants' development and quality of life (QOL), in case of mothers with severe mental illnesses in remission. Methods The study included 41 mother-infant dyads from the outpatient perinatal psychiatry services and the mother-baby unit of the current study center. Symptom status, self-reported bonding, mother-infant interactions, and infants' development and QOL were assessed with Clinical Global Impressions, Postpartum Bonding Questionnaire, Pediatric Infant-Parent Exam, Developmental Assessment Scales for Indian Infants, and Pediatric Quality of Life Scale, respectively. Results Most mothers had a complete recovery or minimal symptoms. Nine (22%) infants had a significant developmental delay. Atypical play-based interactions were observed in nine (22%) mothers. Self-reported bonding and bonding as evinced over play-based interactions did not significantly correlate with the QOL or development of the infants. Mothers who have recovered and are functioning well reported good bonding with their infants, though objective assessment revealed specific difficulties. Symptom severity correlated with poor physical QOL in infants. Conclusion The association between mothers' bonding and infants' mental health is domain-specific and differential than linear and robust. Infants of mothers with severe mental illnesses postpartum should be routinely monitored for mother-infant bonding, development, and quality of life.
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Affiliation(s)
- Shweta Narayan
- Dept. of Clinical Psychology, NIMHANS,
Bangalore, Karnataka, India
| | - M. Thomas Kishore
- Dept. of Clinical Psychology, NIMHANS,
Bangalore, Karnataka, India
- M. Thomas Kishore, Dept. of Clinical
Psychology, Dr MV Govindaswamy Centre, NIMHANS, Bangalore, Karnataka 560029,
India. E-mail:
| | | | | | - Geetha Desai
- Dept. of Psychiatry, NIMHANS,
Bangalore, Karnataka, India
| | - Prabha Chandra
- Dept. of Psychiatry, NIMHANS,
Bangalore, Karnataka, India
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Postpartum Psychosis: The Role of Women's Health Care Providers and the Health Care System. Obstet Gynecol Surv 2022; 77:763-777. [PMID: 36477388 DOI: 10.1097/ogx.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Importance The postpartum period is a time of high risk for serious psychiatric symptoms and hospitalization. Postpartum psychosis (PPP) is the most severe disorder that emerges during this time, with significant and wide-ranging consequences that can include suicide and infanticide. Evidence Acquisition A PubMed, MEDLINE, and PsycINFO search was completed for English-language publications about PPP, including subtopics (eg, infanticide, maternal suicide). Citations in these articles were also reviewed for relevant references. Results Although it is clear that the triggering event for PPP is childbirth, the processes by which this occurs are not fully understood, which is a critical need for being able to predict, prevent, and manage PPP. There are risk factors that contribute to PPP, and specific groups of women may be at increased risk (eg, women with bipolar disorder). Many questions and challenges remain related to the phenomenology, nosology, prevention, and treatment of PPP. However, there are changes that women's health care providers and systems can take to improve the care of women at risk of and experiencing PPP. Results Of the 1382 articles reviewed, 8 met eligibility criteria, representing 6 distinct cohorts and 726 subjects. Synthetic slings available for review were either tension-free vaginal tape (TVT) or minisling. The vast majority of studies demonstrated similar short- and long-term success rates of AFS and SS procedures utilizing a range of outcome measures. Both AFS and TVT sling had low recurrence rates in short- and long-term follow-up. However, AFS had significantly longer operative time, and longer hospital stay. Bladder perforation, on the other hand, occurred more commonly in TVT sling. Health-related quality-of-life scores, including sexual function, were similar between groups. Conclusions and Relevance Postpartum psychosis is a rare but serious condition. However, recovery is possible. Women's health care providers and systems can improve the care by better understanding the needs of women and families, offering patient-centered discussions and options for care, particularly those that promote recovery, minimize risk, and limit the interruption of the maternal-infant bond. Improving the prevention and treatment of PPP can have a broad impact for women, children, and families.
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