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Kernizan N, Forinash A, Yancey A, Kruger S, Chavan NR, Mathews K. Mood stabilizers for treatment of bipolar disorder in pregnancy and impact on neonatal outcomes. Bipolar Disord 2024. [PMID: 39175136 DOI: 10.1111/bdi.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Untreated bipolar disorder in pregnancy is associated with adverse maternal and neonatal outcomes. Despite advances in clinical management, there is concern among obstetric providers and patients about the safety of pharmacological agents for the treatment of bipolar disorder in pregnancy. Recent studies have shown atypical antipsychotics and lamotrigine to have a favorable safety profile; however, little information is published on lurasidone. OBJECTIVES The objective of this retrospective chart review was to evaluate pregnancy and neonatal outcomes in obstetric patients with bipolar disorder who are untreated, compared to those treated with lurasidone, other atypical antipsychotics, and lamotrigine at a tertiary teaching institution. METHODS This retrospective cohort study included neonates whose mothers had a diagnosis of bipolar disorder and were referred to the Maternal & Fetal Care Clinic with two documented visits after January 1, 2014, with delivery by October 31, 2017, within an SSM health-system hospital. RESULTS In this study, women with untreated bipolar disorder (not on any mood stabilizer) in pregnancy had significantly higher rates of premature delivery and low birth weight compared to women on mood stabilizers of lamotrigine, lurasidone, and other atypical antipsychotics. No difference was observed for pregnancy or neonatal outcomes between patients taking any of the mood stabilizers. CONCLUSIONS This study suggests that the use of lurasidone, other atypical antipsychotics, and lamotrigine have better neonatal outcomes than untreated bipolar disorder in pregnancy.
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Affiliation(s)
- Nalinoë Kernizan
- University Health Sciences and Pharmacy-St. Louis College of Pharmacy, St Louis, Missouri, USA
- SSM Health St. Mary's Hospital Center, St Louis, Missouri, USA
| | - Alicia Forinash
- University Health Sciences and Pharmacy-St. Louis College of Pharmacy, St Louis, Missouri, USA
- SSM Health St. Mary's Hospital Center, St Louis, Missouri, USA
| | - Abigail Yancey
- University Health Sciences and Pharmacy-St. Louis College of Pharmacy, St Louis, Missouri, USA
- SSM Health St. Mary's Hospital Center, St Louis, Missouri, USA
| | - Samuel Kruger
- College of Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
| | - Niraj R Chavan
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology & Women's Health, Saint Louis University, St Louis, Missouri, USA
| | - Katherine Mathews
- Department of Obstetrics, Gynecology & Women's Health, Saint Louis University, St Louis, Missouri, USA
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Constantino EA, LaSala MS, Bhattacharya K, Choudhry M. Predictive factors and treatment of postpartum mania: a representative case. Int Clin Psychopharmacol 2024; 39:120-122. [PMID: 37910245 DOI: 10.1097/yic.0000000000000518] [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] [Indexed: 11/03/2023]
Abstract
Postpartum mania and psychosis puts both the person giving birth and their child at significant risk, so predicting its onset and determining effective treatment is crucial. Here, a representative case is presented of a patient started on an antidepressant during her pregnancy who suffered a postpartum manic episode with psychosis. The case describes many of the risk factors and treatment issues faced by clinicians when caring for patients with these symptoms in the postpartum period. Subsequent discussion provides guidance for clinicians to help predict postpartum mania and reviews factors that may increase the risk of its onset. The evidence for psychiatric treatment is also reviewed to both prevent and treat postpartum mania and psychosis.
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Affiliation(s)
- Eduardo A Constantino
- Department of Psychiatry and Behavioral Health, Stony Brook Medicine, Stony Brook, New York, USA
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Hasser C, Ameresekere M, Girgis C, Knapp J, Shah R. Striking the Balance: Bipolar Disorder in the Perinatal Period. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:3-15. [PMID: 38694148 PMCID: PMC11058914 DOI: 10.1176/appi.focus.20230020] [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
The authors reviewed the literature, published between 2018 and 2023, on treating bipolar disorder in the perinatal period in order to summarize current treatment perspectives. Mood episodes occur during pregnancy and there are high rates of both initial onset and recurrence in the postpartum period. Bipolar disorder itself is associated with higher risks of adverse pregnancy outcomes, including gestational hypertension, hemorrhage, cesarean delivery, and small for gestational age infants. A general principle of perinatal treatment includes maintaining psychiatric stability of the pregnant person while reducing medication exposure risk to the fetus. A variety of factors can compromise psychiatric stability, including rapid discontinuation of stabilizing medications, decreased efficacy due to physiologic changes of pregnancy, and exacerbation of underlying psychiatric illness. Psychosocial interventions include optimizing sleep, increasing support, and reducing stress. The American College of Obstetricians and Gynecologists recommends against discontinuing or withholding medications solely due to pregnancy or lactation status. Individualized treatment involves a discussion of the risks of undertreated bipolar disorder weighed against the risks of individual medication choice based on available evidence regarding congenital malformations, adverse neonatal and obstetrical events, and neurodevelopmental outcomes. Valproate is not a first-line treatment due to higher risks. Data are lacking on safety for many newer medications. The authors review current safety data regarding lithium, lamotrigine, and antipsychotics, which are the most commonly used treatments for managing bipolar disorder in the perinatal period. Due to physiologic changes during pregnancy, frequent therapeutic drug monitoring and dose adjustments are required.
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Affiliation(s)
- Caitlin Hasser
- Department of Psychiatry (Hasser, Knapp, Shah) and Department of Obstetrics and Gynecology (Knapp), School of Medicine, Oregon Health & Science University, Portland, Oregon; Portland VA Health Care System, Portland, Oregon (Hasser, Shah); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston (Ameresekere); Edward Hines, Jr. VA Hospital, Hines, Illinois (Girgis); Department of Psychiatry, Stritch School of Medicine, Loyola University, Maywood, Illinois (Girgis)
| | - Maithri Ameresekere
- Department of Psychiatry (Hasser, Knapp, Shah) and Department of Obstetrics and Gynecology (Knapp), School of Medicine, Oregon Health & Science University, Portland, Oregon; Portland VA Health Care System, Portland, Oregon (Hasser, Shah); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston (Ameresekere); Edward Hines, Jr. VA Hospital, Hines, Illinois (Girgis); Department of Psychiatry, Stritch School of Medicine, Loyola University, Maywood, Illinois (Girgis)
| | - Christina Girgis
- Department of Psychiatry (Hasser, Knapp, Shah) and Department of Obstetrics and Gynecology (Knapp), School of Medicine, Oregon Health & Science University, Portland, Oregon; Portland VA Health Care System, Portland, Oregon (Hasser, Shah); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston (Ameresekere); Edward Hines, Jr. VA Hospital, Hines, Illinois (Girgis); Department of Psychiatry, Stritch School of Medicine, Loyola University, Maywood, Illinois (Girgis)
| | - Jacquelyn Knapp
- Department of Psychiatry (Hasser, Knapp, Shah) and Department of Obstetrics and Gynecology (Knapp), School of Medicine, Oregon Health & Science University, Portland, Oregon; Portland VA Health Care System, Portland, Oregon (Hasser, Shah); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston (Ameresekere); Edward Hines, Jr. VA Hospital, Hines, Illinois (Girgis); Department of Psychiatry, Stritch School of Medicine, Loyola University, Maywood, Illinois (Girgis)
| | - Riva Shah
- Department of Psychiatry (Hasser, Knapp, Shah) and Department of Obstetrics and Gynecology (Knapp), School of Medicine, Oregon Health & Science University, Portland, Oregon; Portland VA Health Care System, Portland, Oregon (Hasser, Shah); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston (Ameresekere); Edward Hines, Jr. VA Hospital, Hines, Illinois (Girgis); Department of Psychiatry, Stritch School of Medicine, Loyola University, Maywood, Illinois (Girgis)
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Sırlıer Emir B, Yıldız S, Kazğan Kılıçaslan A, Kurt O, Uğur K, Tabara MF, Aydın S. Inflammation Markers in Patients with Bipolar Disorder Who Have Committed Offenses and Their Relationship with Criminal Behavior. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1725. [PMID: 37893443 PMCID: PMC10608231 DOI: 10.3390/medicina59101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: This study aimed to examine the function of various inflammation parameters and their interactions in the pathology of Bipolar disorder (BD) and to assess whether they could be biomarkers in the relationship between criminal behavior and BD. Materials and Methods: Overall, 1029 participants, including 343 patients with BD who have committed offenses, 343 nonoffending patients with BD, and 343 healthy controls, were included in this retrospective study. Neutrophil, lymphocyte, monocyte, and platelet counts; high-density lipoprotein (HDL-c) levels; systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI), neutrophil to high-density lipoprotein ratio (NHR), lymphocyte to high-density lipoprotein ratio (LHR), monocyte to high-density lipoprotein ratio (MHR), platelet to high-density lipoprotein ratio (PHR) were measured. Results: Significant differences were observed between the groups in terms of SII, SIRI, NHR, LHR, MHR, PHR, neutrophil, and monocyte values (p < 0.001). The lymphocyte counts were significantly higher in the patients with BD who committed offenses (p = 0.04). The platelet counts were significantly lower in the patients with BD who committed offenses compared to nonoffending patients with BD (p = 0.015). The HDL-c levels were significantly lower in the patients with BD who have committed offenses than those of nonoffending patients with BD (p < 0.001). Bipolar disorder, not receiving active psychiatric treatment, having a diagnosis of bipolar manic episodes, and having low platelet and HDL values constitute a risk of involvement in crime. Conclusions: The present study emphasizes the role of systemic inflammation in the pathophysiology of patients with BD with and without criminal offenses and the relationship between inflammation and criminal behavior.
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Affiliation(s)
- Burcu Sırlıer Emir
- Department of Psychiatry, Elazığ Fethi Sekin City Hospital, 23100 Elazığ, Turkey;
| | - Sevler Yıldız
- Department of Psychiatry, Elazığ Fethi Sekin City Hospital, 23100 Elazığ, Turkey;
| | | | - Osman Kurt
- Department of Public Health, Adıyaman Provincial Health Directorate, 23100 Adıyaman, Turkey;
| | - Kerim Uğur
- Department of Psychiatry, University of Turgut Özal, 44900 Malatya, Turkey;
| | - Muhammed Fatih Tabara
- Department of Psychiatry, Elazig Mental Health and Diseases Hospital, 23100 Elazığ, Turkey;
| | - Süleyman Aydın
- Department of Biochemistry, University of Fırat, 23119 Elazığ, Turkey;
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Esposito CM, Barkin JL, Ceresa A, Nosari G, Di Paolo M, Legnani F, Cirella L, Surace T, Tagliabue I, Capuzzi E, Caldiroli A, Dakanalis A, Politi P, Clerici M, Buoli M. Are There Any Differences in Clinical and Biochemical Variables between Bipolar Patients with or without Lifetime Psychotic Symptoms? J Clin Med 2023; 12:5902. [PMID: 37762843 PMCID: PMC10531939 DOI: 10.3390/jcm12185902] [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: 08/17/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Psychotic symptoms occur in more than half of patients affected by Bipolar Disorder (BD) and are associated with an unfavorable course of the disorder. The objective of this study is to identify the differences in the clinical and biochemical parameters between bipolar patients with or without psychotic symptoms. METHODS A total of 665 inpatients were recruited. Demographic, clinical, and biochemical data related to the first day of hospitalization were obtained via a screening of the clinical charts and intranet hospital applications. The two groups identified via the lifetime presence of psychotic symptoms were compared using t tests for quantitative variables and χ2 tests for qualitative ones; binary logistic regression models were subsequently performed. RESULTS Patients with psychotic BD (compared to non-psychotic ones) showed a longer duration of hospitalization (p < 0.001), higher Young Mania Rating Scale scores (p < 0.001), lower Global Assessment of Functioning scores (p = 0.002), a less frequent history of lifetime suicide attempts (p = 0.019), less achievement of remission during the current hospitalization (p = 0.028), and a higher Neutrophile to Lymphocyte Ratio (NLR) (p = 0.006), but lower total cholesterol (p = 0.018) and triglycerides (p = 0.013). CONCLUSIONS Patients with psychotic BD have a different clinical and biochemical profile compared to their counterparts, characterized by more clinical severity, fewer metabolic alterations, and a higher grade of inflammation. Further multi-center studies have to confirm the results of this present study.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Jennifer L. Barkin
- Department of Community Medicine, School of Medicine, Mercer University, Macon, GA 31207, USA;
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Guido Nosari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Martina Di Paolo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Francesca Legnani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Luisa Cirella
- Healthcare Professionals Department, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Teresa Surace
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Ilaria Tagliabue
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, 20126 Monza, Italy;
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Massimo Clerici
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
- Department of Medicine and Surgery, University of Milano Bicocca, 20126 Monza, Italy;
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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Higgins NE, Rose MJ, Gardner TJ, Crawford JN. Perinatal Depression Treatment Guidelines for Obstetric Providers. Obstet Gynecol Clin North Am 2023; 50:589-607. [PMID: 37500219 DOI: 10.1016/j.ogc.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Perinatal depression is the occurrence of depressive symptoms during the antenatal or postnatal period with an annual incidence of 10% to 20%. The consequences of untreated perinatal depression are significant and include negative impacts on maternal health, pregnancy outcomes, and maternal-infant outcomes. The purpose of this article is to provide perinatal pharmacologic and psychological treatment information to help first-line providers more confidently manage depression in the perinatal period. Treatment strategies including medication management using risk versus risk conversations, psychotherapy, and colocated perinatal mental health clinics are discussed.
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Affiliation(s)
- Nina E Higgins
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, 2400 Tucker Avenue N.E., 1 University of New Mexico, MSC09-5030, Albuquerque, NM 87131, USA; Department of Obstetrics and Gynecology, University of New Mexico, 2400 Tucker Avenue N.E., 1, MSC09-5030, Albuquerque, NM 87131, USA.
| | - Marquette J Rose
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, 2400 Tucker Avenue N.E., 1 University of New Mexico, MSC09-5030, Albuquerque, NM 87131, USA
| | - Tamara J Gardner
- Perinatal Associates of New Mexico, 201 Cedar SE, Suite 405 Albuquerque, NM 87106, USA
| | - Jennifer N Crawford
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, 2400 Tucker Avenue N.E., 1 University of New Mexico, MSC09-5030, Albuquerque, NM 87131, USA; Department of Obstetrics and Gynecology, University of New Mexico, 2400 Tucker Avenue N.E., 1, MSC09-5030, Albuquerque, NM 87131, USA
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Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 5. Obstet Gynecol 2023; 141:1262-1288. [PMID: 37486661 DOI: 10.1097/aog.0000000000005202] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
PURPOSE To assess the evidence regarding safety and efficacy of psychiatric medications to treat mental health conditions during pregnancy and lactation. The conditions reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, and acute psychosis. For information on screening and diagnosis, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 4, "Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum" (1). TARGET POPULATION Pregnant or postpartum individuals with mental health conditions with onset that may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology and one maternal-fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on treatment and management of perinatal mental health conditions including depression, anxiety, bipolar disorders, and acute postpartum psychosis, with a focus on psychopharmacotherapy. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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Bottemanne H, Joly L, Javelot H, Ferreri F, Fossati P. Guide de prescription psychiatrique pendant la grossesse, le postpartum et l’allaitement. L'ENCEPHALE 2023:S0013-7006(22)00228-7. [PMID: 37031069 DOI: 10.1016/j.encep.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/16/2022] [Indexed: 04/09/2023]
Abstract
Perinatal psychopharmacology is an emerging specialty that is gradually developing alongside perinatal psychiatry. The management of psychiatric disorders during the perinatal period is a challenge for perinatal practitioners due to the multiple changes occurring during this crucial period. This little-known specialty still suffers from inappropriate considerations on the impact of psychotropic treatments on the mother and the infant during pregnancy and postpartum, which can promote a deficiency in perinatal psychic care. However, the risks associated with insufficient management of mental health are major, impacting both the mental and physical health of the mother and the infant. In this paper, we propose a perinatal psychopharmacology prescription guide based on available scientific evidence and international and national recommendations. We thus propose a decision-making process formalized on simple heuristics in order to help the clinician to prescribe psychotropic drugs during the perinatal period.
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Petelin DS, Kondrateva KK, Dzhibladze TA, Volel BA. [Complex therapy of psychosomatic disorders associated with the female reproductive cycle]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:14-21. [PMID: 37994883 DOI: 10.17116/jnevro202312311114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Psychosomatic disorders make a great contribution to the structure of reproductive health disorders in women. The purpose of this review was to analyze the available data on effective methods of therapy for psychosomatic disorders associated with the reproductive cycle of women - psychopharmacological, psychotherapeutic, non-drug biological, hormonal. The review summarizes the evidence in relation to the treatment of disorders such as: stress-related menstrual irregularities; premenstrual dysphoric disorder; perinatal affective disorders (especially depression); psychosomatic disorders of the involutionary period. General recommendations on the complex therapy of psychosomatic disorders associated with the menstrual cycle within the framework of an interdisciplinary team have been formed.
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Affiliation(s)
- D S Petelin
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - K K Kondrateva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T A Dzhibladze
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - B A Volel
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Mental Health Research Center, Moscow, Russia
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Millan DM, Clark CT, Sakowicz A, Grobman WA, Miller ES. Optimization of the Mood Disorder Questionnaire in identification of perinatal bipolar disorder. Am J Obstet Gynecol MFM 2023; 5:100777. [PMID: 36280148 DOI: 10.1016/j.ajogmf.2022.100777] [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: 08/12/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The recognition of bipolar disorder during the perinatal period is often challenging because birthing people most commonly present in a depressive episode. The phenotypic expression of episodes of bipolar depression is difficult to differentiate from major depressive disorder and can lead to misdiagnosis and inappropriate treatment. The Mood Disorder Questionnaire is a readily available screening tool for bipolar disorder that has been validated in previous studies for use in the general and perinatal populations. However, the discriminatory capacity of the Mood Disorder Questionnaire for perinatal people who screen positive for depression in nonpsychiatric settings is still unclear. OBJECTIVE This study aimed to evaluate the discriminatory capacity of the Mood Disorder Questionnaire to identify bipolar disorder in perinatal people who screen positive for depression on the Patient Health Questionnaire-9. STUDY DESIGN This retrospective cohort study included individuals enrolled in the Collaborative Care Model for Perinatal Depression Support Services, a collaborative care program for perinatal mental health services implemented in a quaternary care setting, from January 2017 to April 2021. All individuals completed the Mood Disorder Questionnaire and psychiatric evaluation by a licensed clinical social worker. Clinical and sociodemographic characteristics were compared between those with and without a clinical diagnosis of bipolar disorder using bivariable analyses. The discriminatory capacity and test characteristics of the Mood Disorder Questionnaire were assessed at each score cutoff using the gold standard of a psychiatric clinical evaluation for comparison. RESULTS From January 2017 to April 2021, 1510 birthing people were enrolled in the Collaborative Care Model for Perinatal Depression Support Services and included in this study. Among this group, 62 (4.1%) were diagnosed with bipolar disorder by psychiatric clinical evaluation using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria. A score of ≥7 on question 1 is often used in the general population to identify bipolar disorder, which has a 60% sensitivity and 88% specificity in our perinatal sample with an area under the receiver operating characteristic curve of 0.74 (95% confidence interval, 0.72-0.76). Lowering the threshold to ≥4 improves sensitivity to 81% and the discriminatory capacity to an area under the receiver operating characteristic curve of 0.75 (95% confidence interval, 0.70-0.80), at the expense of a reduction in specificity to 69%. CONCLUSION The administration of the Mood Disorder Questionnaire in the perinatal period can help to identify which individuals who have screened positive for depression on the Patient Health Questionnaire-9 are at risk of a bipolar or unipolar disorder. In this context, lowering the Mood Disorder Questionnaire score threshold from that used in the nonperinatal population down to 4 improves test characteristics and reduces the risk of a missed diagnosis of bipolar disorder.
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Affiliation(s)
- Danielle M Millan
- The Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Millan and Drs Clark and Miller).
| | - Crystal T Clark
- The Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Millan and Drs Clark and Miller); Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Clark and Miller)
| | - Allie Sakowicz
- Wake Forest University School of Medicine, Winston-Salem, NC (Dr Sakowicz)
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH (Dr Grobman)
| | - Emily S Miller
- The Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Millan and Drs Clark and Miller); Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Clark and Miller); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Miller)
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McIntyre RS, Alda M, Baldessarini RJ, Bauer M, Berk M, Correll CU, Fagiolini A, Fountoulakis K, Frye MA, Grunze H, Kessing LV, Miklowitz DJ, Parker G, Post RM, Swann AC, Suppes T, Vieta E, Young A, Maj M. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry 2022; 21:364-387. [PMID: 36073706 PMCID: PMC9453915 DOI: 10.1002/wps.20997] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Ross J Baldessarini
- Harvard Medical School, Boston, MA, USA
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Mailman Research Center, McLean Hospital, Belmont, MA, USA
| | - Michael Bauer
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
- Orygen, National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Kostas Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Heinz Grunze
- Allgemeinpsychiatrie Ost, Klinikum am Weissenhof, Weinsberg, Germany
- Paracelsus Medical Private University Nuremberg, Nuremberg, Germany
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Center, Psychiatric Center Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David J Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles (UCLA) Semel Institute, Los Angeles, CA, USA
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Robert M Post
- School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Alan C Swann
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Trisha Suppes
- Department of Psychiatry and Behavioural Sciences, Stanford School of Medicine and VA Palo Alto Health Care -System, Palo Alto, CA, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Postpartum Relapse in Patients with Bipolar Disorder. J Clin Med 2022; 11:jcm11143979. [PMID: 35887743 PMCID: PMC9319395 DOI: 10.3390/jcm11143979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022] Open
Abstract
Pregnancy and postpartum are vital times of greater vulnerability to suffer a decompensation of bipolar disorder (BD). Methods: A systematic literature search was performed on public electronic medical databases, following PRISMA guidelines. Studies were included if they reported postpartum relapse in patients diagnosed with BD according to Diagnosis Statistical Manual (DSM) or International Classification Disease (ICD) criteria. Results: Sixteen articles describing 6064 deliveries of 3977 women were included in the quantitative analyses. The overall risk of postpartum relapse was 36.77%. The methodology of the studies, the diagnostic criteria, the discrimination between BD type I and II, and the origin of the sample were very heterogeneous. Conclusions: the rate of postpartum bipolar relapse is very high, as it is considered to be a critical period. It is especially important to detect decompensation in this period and to evaluate mood-stabilizing treatment, given the high risk of relapse concentrated in a short period.
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Bamgbose Pederson A, Waldron E, Burnett-Zeigler I, Clark CT, Lartey L, Wisner K. Perspectives on Mental Illness Stigma Among African Immigrant Pregnant and Post-Partum Women in an Urban Setting: A Brief Report. Health Equity 2022; 6:390-396. [PMID: 35651359 PMCID: PMC9148647 DOI: 10.1089/heq.2021.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: This study assessed the perspectives of pregnant and postpartum African immigrant women on mental illness. Methods: We conducted a focus group session (n=14) among pregnant and postpartum African immigrant women in June 2020. We used an inductive driven thematic analysis to identify themes related to mental health stigma. Results: Five core themes emerged: conceptualization of mental health, community stigmatizing attitudes, biopsychosocial stressors, management of mental health, and methods to reduce stigma. Conclusion: Understanding the perspectives of pregnant African immigrant women at the intersection of their race, ethnicity, gender, and migration are necessary to improve engagement with mental health services.
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Affiliation(s)
| | - Elizabeth Waldron
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Crystal T. Clark
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lynette Lartey
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Katherine Wisner
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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14
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Singh S, Deep R. Screening for lifetime bipolarity in women with perinatal depression: Need for clinical and research attention. Indian J Psychiatry 2022; 64:217-218. [PMID: 35494319 PMCID: PMC9045349 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1373_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/19/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Swarndeep Singh
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India E-mail:
| | - Raman Deep
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India E-mail:
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15
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Zhang T, Guo L, Li R, Wang F, Yang WM, Yang JB, Cui ZQ, Zhou CH, Chen YH, Yu H, Peng ZW, Tan QR. Alterations of Plasma Lipids in Adult Women With Major Depressive Disorder and Bipolar Depression. Front Psychiatry 2022; 13:927817. [PMID: 35923457 PMCID: PMC9339614 DOI: 10.3389/fpsyt.2022.927817] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Lipidomics has been established as a potential tool for the investigation of mental diseases. However, the composition analysis and the comparison of the peripheral lipids regarding adult women with major depressive depression (MDD) or bipolar depression (BPD) has been poorly addressed. In the present study, age-matched female individuals with MDD (n = 28), BPD (n = 22) and healthy controls (HC, n = 25) were enrolled. Clinical symptoms were assessed and the plasma samples were analyzed by comprehensive lipid profiling based on liquid chromatography-mass spectrometry (LC/MS). We found that the composition of lipids was remarkably changed in the patients with MDD and BPD when compared to HC or compared to each other. Moreover, we identified diagnostic potential biomarkers comprising 20 lipids that can distinguish MDD from HC (area under the curve, AUC = 0.897) and 8 lipids that can distinguish BPD from HC (AUC = 0.784), as well as 13 lipids were identified to distinguish MDD from BPD with moderate reliability (AUC = 0.860). This study provides further understanding of abnormal lipid metabolism in adult women with MDD and BPD and may develop lipid classifiers able to effectively discriminate MDD from BPD and HC.
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Affiliation(s)
- Ting Zhang
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Lin Guo
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Rui Li
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Fei Wang
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Wen-Mao Yang
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Jia-Bin Yang
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Zhi-Quan Cui
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Cui-Hong Zhou
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yi-Huan Chen
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Huan Yu
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Zheng-Wu Peng
- Department of Psychiatry, Chang'an Hospital, Xi'an, China.,Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Qing-Rong Tan
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
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16
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Guo L, Zhang T, Li R, Cui ZQ, Du J, Yang JB, Xue F, Chen YH, Tan QR, Peng ZW. Alterations in the Plasma Lipidome of Adult Women With Bipolar Disorder: A Mass Spectrometry-Based Lipidomics Research. Front Psychiatry 2022; 13:802710. [PMID: 35386518 PMCID: PMC8978803 DOI: 10.3389/fpsyt.2022.802710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/07/2022] [Indexed: 01/21/2023] Open
Abstract
Lipidomics has become a pivotal tool in biomarker discovery for the diagnosis of psychiatric illnesses. However, the composition and quantitative analysis of peripheral lipids in female patients with bipolar disorder (BD) have been poorly addressed. In this study, plasma samples from 24 female patients with BD and 30 healthy controls (HCs) were analyzed by comprehensive lipid profiling and quantitative validation based on liquid chromatography-mass spectrometry. Clinical characteristics and a correlation between the level of lipid molecules and clinical symptoms were also observed. We found that the quantitative alterations in several lipid classes, including acylcarnitine, lysophosphatidylethanolamine, GM2, sphingomyelin, GD2, triglyceride, monogalactosyldiacylglycerol, phosphatidylinositol phosphate, phosphatidylinositol 4,5-bisphosphate, phosphatidylethanolamine, phosphatidylserine, and lysophosphatidylinositol, were remarkably upregulated or downregulated in patients with BD and were positively or negatively correlated with the severity of psychotic, affective, or mania symptoms. Meanwhile, the composition of different carbon chain lengths and degrees of fatty acid saturation for these lipid classes in BD were also different from those of HCs. Moreover, 55 lipid molecules with significant differences and correlations with the clinical parameters were observed. Finally, a plasma biomarker set comprising nine lipids was identified, and an area under the curve of 0.994 was obtained between patients with BD and the HCs. In conclusion, this study provides a further understanding of abnormal lipid metabolism in the plasma and suggests that specific lipid species can be used as complementary biomarkers for the diagnosis of BD in women.
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Affiliation(s)
- Lin Guo
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Ting Zhang
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Rui Li
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Zhi-Quan Cui
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Jing Du
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Jia-Bin Yang
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Fen Xue
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yi-Huan Chen
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Qing-Rong Tan
- Department of Psychiatry, Chang'an Hospital, Xi'an, China
| | - Zheng-Wu Peng
- Department of Psychiatry, Chang'an Hospital, Xi'an, China.,Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China
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17
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Schier de Fraga F, Wan-Dall BSL, Garcia GHDO, Pandolfo H, Sequinel AMTDS, Alvin P, Serman EJ, do Amaral VF. Antenatal screening of depressive and manic symptoms in south Brazilian childbearing women: A transversal study in advance of the pandemic scenario. PLoS One 2021; 16:e0261874. [PMID: 34962942 PMCID: PMC8714122 DOI: 10.1371/journal.pone.0261874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background The diagnosis of mood disorders (MD) during pregnancy is challenging and may bring negative consequences to the maternal-fetal binomial. The long waitlist for specialized psychiatric evaluation in Brazil contributes to the treatment omission. Almost 20.0% of women treated with antidepressants have a positive screening for bipolar disorder. Therefore, it has been recommended the investigation of depressive and bipolar disorder during prenatal care. Unfortunately, the screening for mood disorders is not a reality in Brazil and many childbearing women remain undiagnosed. The objective of this study is to observe the frequency of MD and the effectiveness of screening scales for routine use by health professionals during prenatal care in high-risk pregnancies. Methodology/Principal findings This cross-sectional study included 61 childbearing women in their second trimester who were interviewed using the Edinburgh Postnatal Depression Scale (EPDS) and the Mood Disorder Questionnaire (MDQ). The cut-off point was EPDS ≥ 13 and MDQ ≥ 7 and the SCID-5 was the gold standard diagnosis. MD were diagnosed in 24.6% of the high-risk pregnancies. EDPS was positive in 19.7% and the frequency of major depression was 8.2%. 16.4% of the childbearing women were diagnosed with bipolar disorder, while MDQ was positive in 36.1%. 11.5% of the women had EPDS and MDQ positive. EPDS sensitivity was 80.0% and specificity 92.1%, whereas MDQ presented a sensitivity of 70.0% and specificity of 70.6%. Conclusion/Significance There is a high prevalence of MD in high-risk pregnancies. The routine use of EPDS simultaneously to MDQ during antenatal care is effective and plays an important role in early diagnosis, counselling, and promotion of perinatal mental health.
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Affiliation(s)
- Fernanda Schier de Fraga
- Department of Obstetrics and Gynaecology, Health Science Sector of Federal University of Parana, Curitiba, Parana, Brazil
- * E-mail:
| | | | | | - Henrique Pandolfo
- Department of Psychiatry, Health Science Sector of Federal University of Parana, Curitiba, Parana, Brazil
| | | | - Pedro Alvin
- Department of Psychiatry, Health Science Sector of Federal University of Parana, Curitiba, Parana, Brazil
| | - Eduardo Jonson Serman
- Department of Obstetrics and Gynaecology, Health Science Sector of Federal University of Parana, Curitiba, Parana, Brazil
| | - Vivian Ferreira do Amaral
- Department of Obstetrics and Gynaecology, Health Science Sector of Federal University of Parana, Curitiba, Parana, Brazil
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18
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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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19
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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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20
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Edinoff AN, Silverblatt NS, Vervaeke HE, Horton CC, Girma E, Kaye AD, Kaye A, Kaye JS, Garcia AJ, Neuchat EE, Eubanks TN, Varrassi G, Viswanath O, Urits I. Hyperprolactinemia, Clinical Considerations, and Infertility in Women on Antipsychotic Medications. PSYCHOPHARMACOLOGY BULLETIN 2021; 51:131-148. [PMID: 34092827 PMCID: PMC8146565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Infertility, the inability to establish a clinical pregnancy after 12 months of regular unprotected sexual intercourse, is caused by a wide variety of both male and female factors. Infertility is estimated to affect between 8-12% of couples trying to conceive globally. Female factor infertility can be subdivided into the following broad categories: ovulatory dysfunction, fallopian tubal disease, uterine causes, and oocyte quality. Hyperprolactinemia causes ovulary dysfunction along with other hormonal abnormalities, such as decreased estrogen, which can lead to infertility. In this regard, antipsychotics are commonly used for both schizophrenia and bipolar disorder. The use of these medications can be associated with hyperprolactinemia and hyperprolactinemia associated infertility. Antipsychotic-induced hyperprolactinemia occurs through blockade of D2 receptors on lactotroph cells of the anterior pituitary gland. Discontinuation of the hyperprolactinemia-inducing antipsychotic is an option, but this may worsen the patient's psychosis or mood. If antipsychotics are determined to be the culprit of infertility, the degree of hyperprolactinemia symptoms, length of treatment with the antipsychotic, and risk of relapse should be assessed prior to discontinuation, reduction, or switching of antipsychotic medications. The treatment of a women's mental health and her desire to have children should always be considered as treatment may influence fertility while on the medication.
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Affiliation(s)
- Amber N Edinoff
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Nancy S Silverblatt
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Hayley E Vervaeke
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Cassidy C Horton
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Eden Girma
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Alan D Kaye
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Adam Kaye
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Jessica S Kaye
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Andrew J Garcia
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Elisa E Neuchat
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Treniece N Eubanks
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Giustino Varrassi
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Omar Viswanath
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Ivan Urits
- Amber N. Edinoff, Nancy S. Silverblatt, Eden Girma, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine. Hayley E. Vervaeke, Cassidy C, Horton, Louisiana State University Shreveport School of Medicine. Alan D. Kaye, Treniece N. Eubanks, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam Kaye, Jessica S. Kaye, Andrew J. Garcia, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Elisa E. Neuchat, Department of Biological Sciences, Florida International University, Miami, FL. Giustino Varrassi, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Omar Viswanath, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Ivan Urits, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA; Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
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21
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Indirect psychiatric consultation for perinatal bipolar disorder: A scoping review. Gen Hosp Psychiatry 2021; 68:19-24. [PMID: 33271405 DOI: 10.1016/j.genhosppsych.2020.11.011] [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] [Received: 09/07/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To synthesize the literature and develop guidance on supports needed for primary care and perinatal providers in screening, initial management, triage, and bridging treatment for perinatal bipolar disorder. METHODS We conducted a scoping review by searching six electronic databases using keywords related to perinatal bipolar disorder. We summarized descriptive statistics on settings and extracted information on care approaches. We synthesized the literature on indirect care models and extracted data on screening, follow-up, referrals, and management. RESULTS 1169 articles were retrieved. 51 articles were included after review. Most papers were reviews. Fewer addressed care in obstetric (n = 20, 39%), primary care (n = 10, 20%), and pediatric settings (n = 2, 4%). Most papers (n = 30, 59%) discussed using screening instruments for bipolar disorder. Articles were mixed on recommendations for bipolar disorder screening. CONCLUSIONS Varied strategies for structured assessment exist and are influenced by practice setting. There remains uncertainty about optimal strategies for screening and management of perinatal bipolar disorder. We recommend screening for bipolar disorder in the perinatal period in select circumstances (with depression screening, known bipolar disorder risk factors, and prior to starting antidepressants). If specialty mental health care is unavailable, we recommend enhancing usual care through integrated care strategies such as indirect consultation.
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22
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Levenberg K, Hajnal A, George DR, Saunders EFH. Prolonged functional cerebral asymmetry as a consequence of dysfunctional parvocellular paraventricular hypothalamic nucleus signaling: An integrative model for the pathophysiology of bipolar disorder. Med Hypotheses 2020; 146:110433. [PMID: 33317848 DOI: 10.1016/j.mehy.2020.110433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/14/2020] [Accepted: 11/24/2020] [Indexed: 01/09/2023]
Abstract
Approximately 45 million people worldwide are diagnosed with bipolar disorder (BD). While there are many known risk factors and models of the pathologic processes influencing BD, the exact neurologic underpinnings of BD are unknown. We attempt to integrate the existing literature and create a unifying hypothesis regarding the pathophysiology of BD with the hope that a concrete model may potentially facilitate more specific diagnosis, prevention, and treatment of BD in the future. We hypothesize that dysfunctional signaling from the parvocellular neurons of the paraventricular hypothalamic nucleus (PVN) results in the clinical presentation of BD. Functional damage to this nucleus and its signaling pathways may be mediated by myriad factors (e.g. immune dysregulation and auto-immune processes, polygenetic variation, dysfunctional interhemispheric connections, and impaired or overactivated hypothalamic axes) which could help explain the wide variety of clinical presentations along the BD spectrum. The neurons of the PVN regulate ultradian rhythms, which are observed in cyclic variations in healthy individuals, and mediate changes in functional hemispheric lateralization. Theoretically, dysfunctional PVN signaling results in prolonged functional hemispheric dominance. In this model, prolonged right hemispheric dominance leads to depressive symptoms, whereas left hemispheric dominance correlated to the clinical picture of mania. Subsequently, physiologic processes that increase signaling through the PVN (hypothalamic-pituitaryadrenal axis, hypothalamic- pituitary-gonadal axis, and hypothalamic-pituitary-thyroid axis activity, suprachiasmatic nucleus pathways) as well as, neuro-endocrine induced excito-toxicity, auto-immune and inflammatory flairs may induce mood episodes in susceptible individuals. Potentially, ultradian rhythms slowing with age, in combination with changes in hypothalamic axes and maturation of neural circuitry, accounts for BD clinically presenting more frequently in young adulthood than later in life.
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Affiliation(s)
- Kate Levenberg
- College of Medicine, Penn State University College of Medicine, State College, USA.
| | - Andras Hajnal
- Neural & Behavioral Sciences, Penn State University College of Medicine, State College, USA
| | - Daniel R George
- Department of Humanities, Penn State University College of Medicine, Hershey, USA
| | - Erika F H Saunders
- Psychiatry and Behavioral Health, Penn State University College of Medicine, State College, USA
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23
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Zorkina Y, Abramova O, Ushakova V, Morozova A, Zubkov E, Valikhov M, Melnikov P, Majouga A, Chekhonin V. Nano Carrier Drug Delivery Systems for the Treatment of Neuropsychiatric Disorders: Advantages and Limitations. Molecules 2020; 25:E5294. [PMID: 33202839 PMCID: PMC7697162 DOI: 10.3390/molecules25225294] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
Neuropsychiatric diseases are one of the main causes of disability, affecting millions of people. Various drugs are used for its treatment, although no effective therapy has been found yet. The blood brain barrier (BBB) significantly complicates drugs delivery to the target cells in the brain tissues. One of the problem-solving methods is the usage of nanocontainer systems. In this review we summarized the data about nanoparticles drug delivery systems and their application for the treatment of neuropsychiatric disorders. Firstly, we described and characterized types of nanocarriers: inorganic nanoparticles, polymeric and lipid nanocarriers, their advantages and disadvantages. We discussed ways to interact with nerve tissue and methods of BBB penetration. We provided a summary of nanotechnology-based pharmacotherapy of schizophrenia, bipolar disorder, depression, anxiety disorder and Alzheimer's disease, where development of nanocontainer drugs derives the most active. We described various experimental drugs for the treatment of Alzheimer's disease that include vector nanocontainers targeted on β-amyloid or tau-protein. Integrally, nanoparticles can substantially improve the drug delivery as its implication can increase BBB permeability, the pharmacodynamics and bioavailability of applied drugs. Thus, nanotechnology is anticipated to overcome the limitations of existing pharmacotherapy of psychiatric disorders and to effectively combine various treatment modalities in that direction.
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Affiliation(s)
- Yana Zorkina
- Department Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, 119034 Moscow, Russia; (O.A.); (V.U.); (A.M.); (E.Z.); (M.V.); (P.M.); (V.C.)
- Healthcare Department, Mental-Health Clinic No. 1 Named after N.A. Alexeev of Moscow, 117152 Moscow, Russia
| | - Olga Abramova
- Department Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, 119034 Moscow, Russia; (O.A.); (V.U.); (A.M.); (E.Z.); (M.V.); (P.M.); (V.C.)
| | - Valeriya Ushakova
- Department Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, 119034 Moscow, Russia; (O.A.); (V.U.); (A.M.); (E.Z.); (M.V.); (P.M.); (V.C.)
- Department of Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
| | - Anna Morozova
- Department Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, 119034 Moscow, Russia; (O.A.); (V.U.); (A.M.); (E.Z.); (M.V.); (P.M.); (V.C.)
- Healthcare Department, Mental-Health Clinic No. 1 Named after N.A. Alexeev of Moscow, 117152 Moscow, Russia
| | - Eugene Zubkov
- Department Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, 119034 Moscow, Russia; (O.A.); (V.U.); (A.M.); (E.Z.); (M.V.); (P.M.); (V.C.)
| | - Marat Valikhov
- Department Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, 119034 Moscow, Russia; (O.A.); (V.U.); (A.M.); (E.Z.); (M.V.); (P.M.); (V.C.)
| | - Pavel Melnikov
- Department Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, 119034 Moscow, Russia; (O.A.); (V.U.); (A.M.); (E.Z.); (M.V.); (P.M.); (V.C.)
| | - Alexander Majouga
- D. Mendeleev University of Chemical Technology of Russia, 125047 Moscow, Russia;
| | - Vladimir Chekhonin
- Department Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, 119034 Moscow, Russia; (O.A.); (V.U.); (A.M.); (E.Z.); (M.V.); (P.M.); (V.C.)
- Department of Medical Nanobiotechnology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
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24
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Abstract
Optimal dose management of psychotropic drugs during the perinatal period reduces the risk for recurrence of mood episodes in women with Bipolar Disorder. Physiological changes during pregnancy are associated with decreases in the plasma concentrations of the majority of mood stabilizing medications. Regular symptom and drug concentration monitoring for lithium and anticonvulsants with reflexive dose adjustment improves the probability of sustained symptom remission across pregnancy. The elimination clearance trajectory across pregnancy for psychotropics dictates the frequency of laboratory monitoring and dose adjustment. The literature on the pharmacokinetics of lithium, lamotrigine, carbamazepine and atypical antipsychotics during pregnancy and postpartum are reviewed, recommendations for symptom and laboratory monitoring are proposed and recommendations for dose adjustments are presented.
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Affiliation(s)
- Crystal T Clark
- Department of Psychiatry and Behavioral Sciences, Department of Obstetrics and Gynecology, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University, United States.
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25
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Betcher HK, Wisner KL. Psychotropic Treatment During Pregnancy: Research Synthesis and Clinical Care Principles. J Womens Health (Larchmt) 2019; 29:310-318. [PMID: 31800350 DOI: 10.1089/jwh.2019.7781] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Psychiatric illnesses are common in women of childbearing age. The perinatal period is a particularly high-risk time for depression, bipolar, and anxiety disorders. Methods: The scope of the public health problem of perinatal mental disorders is discussed followed by an examination of the specific research methods utilized for the study of birth and developmental outcomes associated with maternal mental illness and its treatment. The evidence on exposure to common psychotropics during pregnancy and breastfeeding is reviewed. Results: Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitor medications are not associated with higher rates of birth defects or long-term changes in mental development after adjustment for confounding factors associated with underlying psychiatric illness. Lithium exposure is associated with an increased risk for fetal cardiac malformations, but this risk is lower than previously thought (absolute risk of Ebstein's anomaly 6/1,000). Antipsychotics, other than risperidone and potentially paliperidone, have not been associated with an increase in birth defects; olanzapine and quetiapine have been linked with an elevated risk of gestational diabetes. Due to the dramatic physiological changes of pregnancy and enhanced hepatic metabolism, drug doses may need to be adjusted during pregnancy to sustain efficacy. Untreated maternal psychiatric illness also carries substantial risks for the mother, fetus, infant, and family. Conclusions: The goal of perinatal mental health treatment is to optimally provide pharmacotherapy to mitigate the somatic and psychosocial burdens of maternal psychiatric disorders. Regular symptom monitoring during pregnancy and postpartum and medication dose adjustments to sustain efficacy constitutes good practice.
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Affiliation(s)
- Hannah K Betcher
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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26
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Abstract
PURPOSE OF REVIEW Despite being recognized as a first-line treatment for bipolar disorder, there is still inconsistent use of lithium in perinatal populations. This article will review data regarding lithium use during the peripartum and provide management recommendations for general psychiatric clinicians. RECENT FINDINGS In contrast to prior data, recent studies indicate that lithium use in pregnancy is associated with either no increased malformations risk or a small increase in risk for cardiac malformations including Ebstein's anomaly. Limited data also show no significant effect on obstetric or neurodevelopmental outcomes. Data regarding infant lithium exposure via breastmilk remains limited. Lithium is currently under-prescribed and is an important treatment for women with bipolar disorder in pregnancy and the postpartum. Clinicians must weigh the risk of lithium treatment versus the risk of withholding or changing lithium treatment when managing bipolar disorder in this population.
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27
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Favini A, Homitsky S. Psychotropic Medications for Bipolar Disorder in Pregnancy. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190808-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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A practical guide to the use of psychotropic medications during pregnancy and lactation. Arch Psychiatr Nurs 2019; 33:254-266. [PMID: 31227078 DOI: 10.1016/j.apnu.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022]
Abstract
The use of psychotropic medications during the perinatal period is often met with fear and discomfort on the part of both clinicians and patients. There is a great deal of misinformation about the risks of medication use during pregnancy and lactation. The risk of untreated or undertreated mental illness during this time is an important consideration when making treatment recommendations. This paper serves as a practical guide for clinicians who may be treating patients with psychotropic medication during the perinatal period. A heuristic tool for making treatment decisions will be introduced, and coverage of specific psychiatric disorders and medication classes will be provided.
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29
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Abstract
Purpose of review Antipsychotics are frequently prescribed to women of childbearing age and are increasingly prescribed during pregnancy. A small, but growing, body of research on implications for pregnancy and infant outcomes is available to inform the risks and benefits of in utero exposure to antipsychotics. This review examines the existing published research on the use of common typical and atypical antipsychotics in pregnancy and the implications for pregnancy and infant outcomes. Recent findings The majority of studies do not show associations with major malformations and antipsychotic use in pregnancy, with the possible exception of risperidone. There is concern that atypical antipsychotics may be associated with gestational diabetes. Metabolic changes during pregnancy may necessitate dose adjustments. Summary In general, it is recommended that women who need to take an antipsychotic during pregnancy continue the antipsychotic that has been most effective for symptom remission. Further study on risperidone is needed to better understand its association with malformations and it is not considered a first-line agent for use during pregnancy.
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Affiliation(s)
- Hannah K Betcher
- Department of Psychiatry, Northwestern University Feinberg School of Medicine 676 N. St. Clair St. Ste 1000, Chicago, IL 60611, USA.,Mayo Clinic, Rochester, MN, USA
| | - Catalina Montiel
- Department of Psychiatry, Northwestern University Feinberg School of Medicine 676 N. St. Clair St. Ste 1000, Chicago, IL 60611, USA
| | - Crystal T Clark
- Department of Psychiatry, Northwestern University Feinberg School of Medicine 676 N. St. Clair St. Ste 1000, Chicago, IL 60611, USA.,Department of Obstetrics and Gynecology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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