1
|
Kobylski LA, Arakelian MH, Freeman MP, Gaw ML, Cohen LS, Vanderkruik R. Barriers to care and treatment experiences among individuals with postpartum psychosis. Arch Womens Ment Health 2024; 27:637-647. [PMID: 38396143 DOI: 10.1007/s00737-024-01447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Postpartum psychosis (PP) is a severe psychiatric disorder affecting 1-2 per 1,000 deliveries. Prompt access to healthcare and timely initiation of treatment are crucial to minimizing harm and improving outcomes. This analysis seeks to fill gaps in knowledge surrounding barriers to care and treatment experiences among this population. METHODS Participants were individuals with histories of PP who enrolled in the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3). The MGHP3 Healthcare Access Survey, a cross-sectional questionnaire, assesses barriers to care, treatment-seeking behaviors, and experiences with treatment. Descriptive statistics were utilized to describe sample characteristics. RESULTS 139 participants provided 146 episode-specific survey responses. Lack of available services was cited as the greatest barrier to care for PP. Among those who sought treatment, obstetric providers (34.5%) and emergency medical professionals (29.4%) were the most common initial points of contact. 82.2% of the respondents went to an emergency room or crisis center during their episode(s). Most (61.8%) reported being given insufficient information to manage their PP. Approximately half of participants were hospitalized (55.5%), the majority of whom had no access to their infant during hospitalization (70.4%). Of those breastfeeding or pumping at admission, 31.3% were not given access to a breast pump. 44.4% dealt with delivery-related medical issues during their hospitalization. CONCLUSION This report is the first of its kind to assess key public health domains among individuals with PP. Findings point to several directions for future research and clinical practice to improve treatment timeliness and quality, potentially improving long-term outcomes related to this serious illness.
Collapse
Affiliation(s)
- Lauren A Kobylski
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychological & Brain Sciences, George Washington University, Washington, DC, USA.
| | - Miranda H Arakelian
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Marlene P Freeman
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret L Gaw
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Lee S Cohen
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Vanderkruik
- Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
2
|
Thela L, Paruk S, Bhengu B, Chiliza B. Psychiatric emergencies during pregnancy and puerperium in low - And middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 94:102478. [PMID: 38401484 DOI: 10.1016/j.bpobgyn.2024.102478] [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] [Received: 10/01/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
Pregnancy and puerperium are critical points in women's health, and various psychiatric emergencies may worsen or manifest (for the first time) during this period. In the presence of a psychiatric emergency, the pregnancy and puerperium outcomes may be compromised. In addition to the mother being at risk, the health of the fetus and the newborn may also be compromised if the psychiatric emergency is not managed appropriately. Early detection and collaborative approaches between mental health practitioners and obstetricians are of utmost importance in women who are at risk and those living with psychiatric illnesses during pregnancy and puerperium. Practitioners should also ensure that women with impaired capacity due to psychiatric disease are treated in a non-judgmental and respectful manner, even if their autonomies have been overridden.
Collapse
Affiliation(s)
- Lindokuhle Thela
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa.
| | - Saeeda Paruk
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| | - Busisiwe Bhengu
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| | - Bonginkosi Chiliza
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| |
Collapse
|
3
|
Connors MH, Gibbs J, Large MM, Halligan PW. Delusions in postpartum Psychosis: Implications for cognitive theories. Cortex 2024; 177:194-208. [PMID: 38875734 DOI: 10.1016/j.cortex.2024.04.018] [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: 12/16/2023] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 06/16/2024]
Abstract
Postpartum psychosis is a rare but serious condition that can affect women after childbirth. We present a case study of an individual with no comorbidities or psychiatric history who developed postpartum psychosis characterised by prominent misidentification delusions whilst admitted to hospital. The woman recovered quickly with medication and showed no evidence of relapse over the following three years. Whilst still symptomatic and after recovery, the patient was able to provide a detailed description of her experiences. Contemporaneous interviews and observations during her hospital admission and a subsequent detailed retrospective account provide a unique, comprehensive window into her experience of these time-limited delusions. Her case reveals important insights including the triggers for her misidentification delusions, the role of social and contextual influences on delusional beliefs, and her recall of active involvement in evaluating and discarding delusional hypotheses. These insights highlight the complexity of delusional beliefs, challenge existing theories of delusions, and help inform broader theories of belief formation.
Collapse
Affiliation(s)
- Michael H Connors
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia; Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia; Eastern Suburbs Mental Health Service, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Jessica Gibbs
- Eastern Suburbs Mental Health Service, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Matthew M Large
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia; Eastern Suburbs Mental Health Service, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Peter W Halligan
- School of Psychology, Cardiff University, Cardiff, Wales, United Kingdom
| |
Collapse
|
4
|
Maxwell D, Leat SR, Gallegos T, Praetorius RT. Sacred space: a qualitative interpretive meta-synthesis of women's experiences of supportive birthing environments. BMC Pregnancy Childbirth 2024; 24:372. [PMID: 38750419 PMCID: PMC11097458 DOI: 10.1186/s12884-024-06544-6] [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] [Received: 11/06/2023] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In the United States there are roughly three million births a year, ranging from cesarean to natural births. A major aspect of the birthing process is related to the healing environment, and how that helps or harms healing for the mother and child. Using the theoretical framework, Theory of Supportive Care Settings (TSCS), this study aimed to explore what is necessary to have a safe and sacred healing environment for mothers. METHOD This study utilized an updated Qualitative Interpretive Meta-synthesis (QIMS) design called QIMS-DTT [deductive theory testing] to answer the research question, What are mother's experiences of environmental factors contributing to a supportive birthing environment within healthcare settings? RESULTS Key terms were run through multiple databases, which resulted in 5,688 articles. After title and abstract screening, 43 were left for full-text, 12 were excluded, leaving 31 to be included in the final QIMS. Five main themes emerged from analysis: 1) Service in the environment, 2) Recognizing oneself within the birthing space, 3) Creating connections with support systems, 4) Being welcomed into the birthing space, and 5) Feeling safe within the birthing environment. CONCLUSIONS Providing a warm and welcoming birth space is crucial for people who give birth to have positive experiences. Providing spaces where the person can feel safe and supported allows them to find empowerment in the situation where they have limited control.
Collapse
Affiliation(s)
| | | | - Toni Gallegos
- The University of Texas at Arlington, Arlington, TX, USA
| | | |
Collapse
|
5
|
Feingold SB, Lewis BM. The criminalization of women with postpartum psychosis: "a call for action" for judicial change. Arch Womens Ment Health 2024:10.1007/s00737-024-01461-1. [PMID: 38652323 DOI: 10.1007/s00737-024-01461-1] [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] [Received: 05/05/2023] [Accepted: 03/23/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To prevent the incarceration and influence outcomes when criminal culpability is linked to postpartum psychosis. METHODS Infanticide, neonaticide and filicide are most often linked with postpartum psychosis, which affects 1-2 women per 1,000 births or 4,000 women each year in the United States. Multiple genetic, hormonal and psychosocial factors surrounding childbirth result in a 1 to 4% risk of infanticide in women with postpartum psychosis. The authors seek to increase awareness of postpartum psychosis and postpartum depression in state legislatures. Others are working to have it recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a specific illness. Specific postpartum legislation for those charged with crimes related to maternal mental illness is necessary. RESULTS In Illinois, the very first criminal law in the nation recognizing the pernicious effects of this illness went into effect in 2018. The authors and others are attempting to cause similar or broader legislation to be brought in other states. Several women have been released from extended incarceration utilizing this law. CONCLUSIONS This temporary mental illness can lead to tragic outcomes when hospitalization and crisis intervention is delayed or the illness is misdiagnosed. The legal/judicial system has not utilized the growing body of scientific developments that medical researchers have discovered in recent decades. The lack of a unique diagnostic classification in the DSM and the lack of postpartum criminal laws, lead to mentally ill mothers in the U.S. receiving excessively harsh sentences when prosecuted, evidenced both in trial and sentencing.
Collapse
Affiliation(s)
- Susan Benjamin Feingold
- Advisory Council for Postpartum Support International, 1038 N. Crosby, Chicago, 60610, IL, US.
| | - Barry M Lewis
- National Association of Criminal Defense Lawyers, 205 N. Michigan Avenue, Suite 810, Chicago, 60610, IL, US
| |
Collapse
|
6
|
Sharma V. Shifting the paradigm in how we assess and treat perinatal psychopathology. Arch Womens Ment Health 2024:10.1007/s00737-024-01453-1. [PMID: 38459990 DOI: 10.1007/s00737-024-01453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
Both syndromic and subsyndromal episodes of psychiatric disorders are common during and after pregnancy and are associated with adverse consequences for the mother and her baby. Despite remarkable opportunities for the detection of at-risk women, the prevention and treatment of peripartum recurrences of psychiatric disorders remain a challenge for physicians, and allied professionals This brief report discusses the importance of subsyndromal symptoms and offers suggestions to improve the assessment, diagnosis, and treatment of perinatal psychiatric disorders.
Collapse
Affiliation(s)
- Verinder Sharma
- Department of Psychiatry, Western University, London, ON, Canada.
- Department of Obstetrics & Gynecology, Western University, London, ON, Canada.
- Parkwood Institute Mental Health, St. Joseph's Health Care, London, ON, Canada.
| |
Collapse
|
7
|
Kępińska AP, Robakis TK, Humphreys K, Liu X, Kahn RS, Munk-Olsen T, Bergink V, Mahjani B. Familial risk of postpartum psychosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.07.20.23292910. [PMID: 37546727 PMCID: PMC10402213 DOI: 10.1101/2023.07.20.23292910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Objective Postpartum psychosis, a mood disorder triggered by childbirth, is one of the most severe psychiatric conditions, with high risks of suicide and infanticide if untreated. While it is evident that genetic factors play a crucial role in disorder risk, the exact extent of their importance is yet to be determined. Methods This cohort study consisted of 1,648,759 women from the Swedish nationwide registers, of whom 2,514 (0.15%) experienced postpartum psychosis within three months of their first-ever childbirth. We estimated the relative recurrence risk of postpartum psychosis for female full siblings and cousins as a measure of familial, genetic, and environmental risk. Results Relative recurrence risk of postpartum psychosis in full siblings was 10.69 (95% CI=6.60-16.26) when adjusted for year of and age at childbirth. Although cousins showed an elevated relative recurrence risk, these results did not reach statistical significance (1.78, 95% CI=0.70-3.62). Despite the higher familial risk of postpartum psychosis among full siblings, the absolute risk for women with an affected sibling is relatively low, estimated at 1.55% within the entire population. Conclusions The observed increased risk of postpartum psychosis in full siblings suggests both genetic and shared environmental influences. However, the lack of significant results in cousins hampers a definitive distinction between these factors. Furthermore, despite increased relative recurrence risk in siblings, their overall likelihood of developing postpartum psychosis remains low. Our study underscores the need for further research to better understand the intricate interplay of genetics and environment in the development of postpartum psychosis.
Collapse
Affiliation(s)
- Adrianna P. Kępińska
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thalia K. Robakis
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoqin Liu
- Department of Clinical Research, Research Unit Children and Adolescent Psychiatry, University of Southern Denmark, Denmark
| | - René S. Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Trine Munk-Olsen
- Department of Clinical Research, Research Unit Children and Adolescent Psychiatry, University of Southern Denmark, Denmark
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Behrang Mahjani
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm
| |
Collapse
|
8
|
Rimvall MK, Jeppesen P. The problem of overestimating the value of self-report measures of psychotic experiences. Psychiatry Res 2024; 333:115769. [PMID: 38335778 DOI: 10.1016/j.psychres.2024.115769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital- Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark.
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital- Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Perry A, Gordon-Smith K, Lewis KJS, Di Florio A, Craddock N, Jones L, Jones I. Perinatal sleep disruption and postpartum psychosis in bipolar disorder: Findings from the UK BDRN Pregnancy Study. J Affect Disord 2024; 346:21-27. [PMID: 37940050 DOI: 10.1016/j.jad.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Women with bipolar disorder (BD) are at high risk of postpartum psychosis (PP). The factors that increase risk of PP among women with BD are not fully understood. Here, we examine whether sleep disruption in the perinatal period (poor sleep quality in late pregnancy and sleep deprivation related to childbirth) is associated with PP in a longitudinal study of pregnant women with BD. METHODS Participants were 76 pregnant women with lifetime DSM-5 bipolar I disorder or schizoaffective-BD, followed from week 12 of pregnancy to 12 weeks postpartum. Demographics and lifetime psychopathology were assessed at baseline via semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry). Psychopathology and sleep disruption within the current perinatal period were assessed in the third trimester and at 12 weeks postpartum. Data were supplemented by clinician questionnaires and case-note review. RESULTS After controlling for prophylactic use of mood stabilising medication, the loss of at least one complete night of sleep across labour/delivery was associated with five times the odds of experiencing PP compared to no or less than one night of sleep loss across labour/delivery (OR 5.19, 95 % CI 1.45-18.54; p = 0.011). Sleep quality in late pregnancy was not associated with PP, and perinatal sleep disruption was not associated with postpartum depression. LIMITATIONS Lack of objective measures of sleep factors. CONCLUSIONS In the context of other aetiological factors, severe sleep loss associated with childbirth/the immediate postpartum may act as a final trigger of PP. These findings could have important clinical implications for risk prediction and prevention of PP.
Collapse
Affiliation(s)
- A Perry
- Psychological Medicine, University of Worcester, UK
| | | | - K J S Lewis
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK; Department of Psychiatry, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| | - A Di Florio
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - N Craddock
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - L Jones
- Psychological Medicine, University of Worcester, UK
| | - I Jones
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| |
Collapse
|
11
|
Vogel JP, Jung J, Lavin T, Simpson G, Kluwgant D, Abalos E, Diaz V, Downe S, Filippi V, Gallos I, Galadanci H, Katageri G, Homer CSE, Hofmeyr GJ, Liabsuetrakul T, Morhason-Bello IO, Osoti A, Souza JP, Thakar R, Thangaratinam S, Oladapo OT. Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward. Lancet Glob Health 2024; 12:e317-e330. [PMID: 38070535 PMCID: PMC10805007 DOI: 10.1016/s2214-109x(23)00454-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 01/22/2024]
Abstract
Over the past three decades, substantial progress has been made in reducing maternal mortality worldwide. However, the historical focus on mortality reduction has been accompanied by comparative neglect of labour and birth complications that can emerge or persist months or years postnatally. This paper addresses these overlooked conditions, arguing that their absence from the global health agenda and national action plans has led to the misconception that they are uncommon or unimportant. The historical limitation of postnatal care services to the 6 weeks after birth is also a contributing factor. We reviewed epidemiological data on medium-term and long-term complications arising from labour and childbirth beyond 6 weeks, along with high-quality clinical guidelines for their prevention, identification, and treatment. We explore the complex interplay of human evolution, maternal physiology, and inherent predispositions that contribute to these complications. We offer actionable recommendations to change the current trajectories of these neglected conditions and help achieve the targets of Sustainable Development Goal 3. This paper is the third in a Series of four papers about maternal health in the perinatal period and beyond.
Collapse
Affiliation(s)
- Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia.
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Tina Lavin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Grace Simpson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Dvora Kluwgant
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Virginia Diaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Soo Downe
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ioannis Gallos
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
| | - Geetanjali Katageri
- S Nijalingappa Medical College and HSK Hospital & Research Centre, Bagalkot, India
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Tippawan Liabsuetrakul
- Department of Epidemiology and Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Imran O Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences and Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Alfred Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Olufemi T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
12
|
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.
Collapse
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)
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Michalczyk J, Miłosz A, Soroka E. Postpartum Psychosis: A Review of Risk Factors, Clinical Picture, Management, Prevention, and Psychosocial Determinants. Med Sci Monit 2023; 29:e942520. [PMID: 38155489 PMCID: PMC10759251 DOI: 10.12659/msm.942520] [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] [Received: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 12/30/2023] Open
Abstract
Postpartum psychosis is rare, but is a serious clinical and social problem. On its own, it is not included in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) or ICD-10 (International Statistical Classification of Diseases and Related Health Problems) as a disease entity, and current diagnostic criteria equate it with other psychoses. This poses a serious legal problem and makes it difficult to classify. The disorder is caused by a complex combination of biological, environmental, and cultural factors. The exact pathophysiological mechanisms of postpartum psychosis remain very poorly understood. There is a need for further research and increased knowledge of the medical sector in the prevention and early detection of psychosis to prevent stigmatization of female patients during a psychiatric episode. It is necessary to regulate its position in the DSM5 and ICD-10. Attention should be paid to the social education of expectant mothers and their families. This article aims to review the current status of risk factors, prevention, and management of postpartum psychosis.
Collapse
Affiliation(s)
- Justyna Michalczyk
- II Department of Psychiatry and Psychiatric Rehabilitation, Student Scientific Association, Faculty of Medicine, Medical University of Lublin, Lublin, Poland
| | - Agata Miłosz
- II Department of Psychiatry and Psychiatric Rehabilitation, Student Scientific Association, Faculty of Medicine, Medical University of Lublin, Lublin, Poland
| | - Ewelina Soroka
- II Department of Psychiatry and Psychiatric Rehabilitation, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
15
|
Gorman-Sandler E, Wood G, Cloude N, Frambes N, Brennen H, Robertson B, Hollis F. Mitochondrial might: powering the peripartum for risk and resilience. Front Behav Neurosci 2023; 17:1286811. [PMID: 38187925 PMCID: PMC10767224 DOI: 10.3389/fnbeh.2023.1286811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/01/2023] [Indexed: 01/09/2024] Open
Abstract
The peripartum period, characterized by dynamic hormonal shifts and physiological adaptations, has been recognized as a potentially vulnerable period for the development of mood disorders such as postpartum depression (PPD). Stress is a well-established risk factor for developing PPD and is known to modulate mitochondrial function. While primarily known for their role in energy production, mitochondria also influence processes such as stress regulation, steroid hormone synthesis, glucocorticoid response, GABA metabolism, and immune modulation - all of which are crucial for healthy pregnancy and relevant to PPD pathology. While mitochondrial function has been implicated in other psychiatric illnesses, its role in peripartum stress and mental health remains largely unexplored, especially in relation to the brain. In this review, we first provide an overview of mitochondrial involvement in processes implicated in peripartum mood disorders, underscoring their potential role in mediating pathology. We then discuss clinical and preclinical studies of mitochondria in the context of peripartum stress and mental health, emphasizing the need for better understanding of this relationship. Finally, we propose mitochondria as biological mediators of resilience to peripartum mood disorders.
Collapse
Affiliation(s)
- Erin Gorman-Sandler
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
- Columbia VA Healthcare System, Columbia, SC, United States
| | - Gabrielle Wood
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Nazharee Cloude
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Noelle Frambes
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Hannah Brennen
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Breanna Robertson
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Fiona Hollis
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
- Columbia VA Healthcare System, Columbia, SC, United States
- USC Institute for Cardiovascular Disease Research, Columbia, SC, United States
| |
Collapse
|
16
|
Carr C, Borges D, Lewis K, Heron J, Wilson S, Broome MR, Jones I, Di Florio A, Morales-Muñoz I. Sleep and Postpartum Psychosis: A Narrative Review of the Existing Literature. J Clin Med 2023; 12:7550. [PMID: 38137618 PMCID: PMC10744103 DOI: 10.3390/jcm12247550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Sleep problems are extremely common during the postpartum period. The role of sleep in the development of postpartum psychosis (PP) is, however, still under-researched. This narrative review aims to (1) provide a summary of the existing evidence for the associations between sleep problems and PP, (2) discuss the relevant risk factors associated with sleep problems and PP, and (3) suggest future lines of research in this area. Some of the existing literature suggests an association between sleep problems, specifically insomnia, sleep loss and sleep disruption during pregnancy and postpartum, and PP, with the most relevant risk factors including history of bipolar disorder and time of delivery. However, it is still unclear whether the previously mentioned sleep problems are a symptom of, or a trigger for PP. Thus, further research is needed to identify the specific role of sleep problems in PP, using longitudinal designs and more objective measures of sleep. This will allow appropriate detection, intervention and support for women experiencing and/or at risk for PP.
Collapse
Affiliation(s)
- Camilla Carr
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (C.C.); (D.B.)
| | - Daniela Borges
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (C.C.); (D.B.)
- Coventry and Warwickshire Partnership NHS Trust, Coventry CV6 6NY, UK
| | - Katie Lewis
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff CF24 4HQ, UK
| | - Jessica Heron
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (C.C.); (D.B.)
- Action on Postpartum Psychosis, Swansea SA3 9BT, UK
| | - Sally Wilson
- Action on Postpartum Psychosis, Swansea SA3 9BT, UK
| | - Matthew R. Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (C.C.); (D.B.)
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, UK
| | - Ian Jones
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff CF24 4HQ, UK
| | - Arianna Di Florio
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff CF24 4HQ, UK
| | - Isabel Morales-Muñoz
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (C.C.); (D.B.)
| |
Collapse
|
17
|
Yang JMK, Vaiphei K, Siliya M, Mkandawire T, Dolman C, Heron J, Wilson S, Yaresheemi S, Kitney D, Bailey L, Apsey C, Liwimbi O, Stewart R, Thippeswamy H, Jones I, Chorwe-Sungani G, Chandra P, Di Florio A. Postpartum psychosis: a public involvement perspective across three continents. Arch Womens Ment Health 2023; 26:831-837. [PMID: 37615717 PMCID: PMC10632256 DOI: 10.1007/s00737-023-01347-8] [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] [Received: 03/24/2023] [Accepted: 07/01/2023] [Indexed: 08/25/2023]
Abstract
Postpartum psychosis is a psychiatric emergency that is currently not represented in diagnostic systems, to the detriment of people with lived experience. Engaging with stakeholders offers an important avenue to improve clinical practice and make research more impactful, by providing perspectives based on first-hand, expert experience. There is a paucity of reports on stakeholders' engagement in psychiatry. Activities have thus far been limited to Western countries and there are few reports on postpartum psychosis. We report the results of public involvement activities (in the form of discussion groups) with key stakeholders in India, Malawi and the UK. These discussions centred around the clinical picture of postpartum psychosis and the terminologies used to describe these episodes. Seven major areas were highlighted: how postpartum psychosis is handled within services, common symptoms and characteristics, impact of episode, barriers to care, non-medical approaches, terminology and research areas of interest. According to the discussions, postpartum psychosis presents similarly across countries, although there are differences in access to services, approaches to mental health and terminologies used within and across countries. With this understanding comes the foundation for cross-cultural assessment, service improvement and a stakeholder-informed research agenda.
Collapse
Affiliation(s)
- Jessica Mei Kay Yang
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Kimneihat Vaiphei
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | | | | | - Clare Dolman
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Bipolar UK, 32 Cubitt Street, London, UK
| | - Jessica Heron
- Action on Postpartum Psychosis, Institute of Mental Health, University of Birmingham, Birmingham, UK
| | - Sally Wilson
- Action on Postpartum Psychosis, PO Box 137, Swansea, UK
| | - Shivanand Yaresheemi
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Danielle Kitney
- National Centre for Mental Health, Cardiff University, Cardiff, UK
| | - Leah Bailey
- National Centre for Mental Health, Cardiff University, Cardiff, UK
| | - Chloe Apsey
- National Centre for Mental Health, Cardiff University, Cardiff, UK
| | | | - Robert Stewart
- Division of Psychiatry, University of Edinburgh, Scotland, UK
| | - Harish Thippeswamy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Ian Jones
- National Centre for Mental Health, Cardiff University, Cardiff, UK
| | | | - Prabha Chandra
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Arianna Di Florio
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
| |
Collapse
|
18
|
Mongan D, Lynch J, Anderson J, Robinson L, Mulholland C. Perinatal mental healthcare in Northern Ireland: challenges and opportunities. Ir J Psychol Med 2023; 40:601-606. [PMID: 34839853 DOI: 10.1017/ipm.2021.71] [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] [Indexed: 11/06/2022]
Abstract
Perinatal mental health is a vital component of public mental health. The perinatal period represents the time in a woman's life when she is at the highest risk of developing new-onset psychiatric disorders or relapse of an existing mental illness. Optimisation of maternal mental health in the perinatal period is associated with both short- and long-term benefits not only for the mother, but also for her infant and family. However, perinatal mental health service provision remains variable across the world. At present in Northern Ireland, 80% of women do not have access to specialist community perinatal mental health services, and without access to a mother and baby unit, mothers who require a psychiatric admission in the postnatal period are separated from their baby. However, following successful campaigns, funding for development of specialist perinatal mental health community teams has recently been approved. In this article, we discuss the importance of perinatal mental health from a public health perspective and explore challenges and opportunities in the ongoing journey of specialist service development in Northern Ireland.
Collapse
Affiliation(s)
- D Mongan
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Lynch
- Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - J Anderson
- Northern Health and Social Care Trust, Antrim, Northern Ireland
| | - L Robinson
- Independent Researcher, Northern Ireland
| | - C Mulholland
- Northern Health and Social Care Trust, Antrim, Northern Ireland
- School of Medicine, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|
19
|
Fekih-Romdhane F, El Hadathy D, González-Nuevo C, Malaeb D, Barakat H, Hallit S. Development and preliminary validation of the Postpartum Psychotic Experiences Scale (PPES). Psychiatry Res 2023; 329:115543. [PMID: 37839316 DOI: 10.1016/j.psychres.2023.115543] [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: 08/16/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
Despite the emerging research interest in postpartum psychotic experiences, there is still a lack of measures for specifically measuring this construct. The contribution of this paper is to design and validate a novel self-report measure, the Postpartum Psychotic Experiences Scale (PPES), to screen for attenuated psychotic symptoms during postpartum. This cross-sectional study was conducted from September 2022 until June 2023, enrolling 438 women 4-6 weeks after delivery. Starting from an initial pool of 22 items, both Exploratory Factor Analysis and Confirmatory Factor Analysis suggested that remaining 15 items loaded on one factor (α = 0.95). The PPES showed good convergent validity with the Prodromal Questionnaire-Brief scale (correlations >0.8) and good concurrent validity with postpartum depression and anxiety scales. A PPSE score of 8.5 (sensitivity=85.2%, specificity=78.6%) was defined as the optimal cutoff point. At this cutoff, 47% of participating women were considered at possible risk for postpartum psychosis. This study provides, for the first time, a specific self-report measure to assess postpartum PEs reliably and validly. We hope that the PPES will facilitate routine screening for PEs after childbirth among women who are predisposed to developing postpartum psychosis.
Collapse
Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, Manouba 2010 Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Diane El Hadathy
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | | | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Habib Barakat
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon; Department of Obstetrics and Gynecology, Notre Dame des Secours University Hospital Center, Street 93, Byblos 3, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon; Psychology Department, College of Humanities, Effat University, Jeddah 21478, Saudi Arabia; Applied Science Research Center, Applied Science Private University, Amman, Jordan; Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| |
Collapse
|
20
|
Beck CT, Twomey T. Posttraumatic Growth after Postpartum Psychosis. MCN Am J Matern Child Nurs 2023; 48:303-311. [PMID: 37589921 DOI: 10.1097/nmc.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
PURPOSE To explore positive changes in women's beliefs, emotions, and behaviors following their struggles with postpartum psychosis. STUDY DESIGN AND METHODS This is a descriptive qualitative study of women who experienced posttraumatic growth after postpartum psychosis. We recruited participants from postings on three Facebook groups. Participants sent their stories of posttraumatic growth after postpartum psychosis via email attachment. We used the following five domains from Tedeschi and Calhoun's (2004) posttraumatic growth model to guide our deductive content analysis: Relating to Others, Personal Strength, Appreciation of Life, New Possibilities, and Spiritual and Existential Change . RESULTS Thirteen women participated. Relating to Others was the posttraumatic growth domain most often described by the participants followed in order of frequency by Personal Strength, Appreciation of Life, New Possibilities , and Spiritual and Existential Change . Partners and family members' support was instrumental in recovery from postpartum psychosis. CLINICAL IMPLICATIONS When considering the total sample, participants experienced all five domains of posttraumatic growth after postpartum psychosis though not every individual experienced growth in all five domains. Interventions can be tailored to meet the needs of women depending on which phase of recovery from postpartum psychosis women are in, acute, early recovery, or advanced recovery. Advanced recovery is the most appropriate phase to discuss the possibility of posttraumatic growth with women. Such discussion should be done with caution and sensitivity as not all women experience positive growth, and it can be harmful to frame this in a way that indicates or encourages expectation.
Collapse
|
21
|
Pearce G, Bell L, Pezaro S, Reinhold E. Childbearing with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6957. [PMID: 37887695 PMCID: PMC10606623 DOI: 10.3390/ijerph20206957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023]
Abstract
One in 20 births could be affected by hypermobile Ehlers-Danlos syndrome or Hypermobility Spectrum Disorders (hEDS/HSD); however, these are under-diagnosed and lacking research. This study aimed to examine outcomes and complications in people childbearing with hEDS/HSD. A large online international survey was completed by women with experience in childbearing and a diagnosis of hEDS/HSD (N = 947, total pregnancies = 1338). Data were collected on demographics, pregnancy and birth outcomes and complications. Participants reported pregnancies in the UK (N = 771), USA (N = 364), Australia (N = 106), Canada (N = 60), New Zealand (N = 23) and Ireland (N = 14). Incidences were higher in people with hEDS/HSD than typically found in the general population for pre-eclampsia, eclampsia, pre-term rupture of membranes, pre-term birth, antepartum haemorrhage, postpartum haemorrhage, hyperemesis gravidarum, shoulder dystocia, caesarean wound infection, postpartum psychosis, post-traumatic stress disorder, precipitate labour and being born before arrival at place of birth. This potential for increased risk related to maternal and neonatal outcomes and complications highlights the importance of diagnosis and appropriate care considerations for childbearing people with hEDS/HSD. Recommendations include updating healthcare guidance to include awareness of these possible complications and outcomes and including hEDS/HSD in initial screening questionnaires of perinatal care to ensure appropriate consultation and monitoring can take place from the start.
Collapse
Affiliation(s)
- Gemma Pearce
- Research Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (L.B.); (S.P.)
| | - Lauren Bell
- Research Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (L.B.); (S.P.)
- Coventry City Council, Coventry CV1 2GN, UK
| | - Sally Pezaro
- Research Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (L.B.); (S.P.)
| | - Emma Reinhold
- Patient and Public Involvement and Medical Advisor, Coventry University, Coventry CV1 5FB, UK;
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Duran S, Vural G. Problems Experienced by the Mothers in Post-Cesarean Period: A Narrative Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:2036-2041. [PMID: 37899917 PMCID: PMC10612559 DOI: 10.18502/ijph.v52i10.13841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/19/2023] [Indexed: 10/31/2023]
Abstract
Cesarean delivery rates have been increasing which leads to a rise the problems experienced. After cesarean deliveries important problems for the mother and baby may be seen. The most common problems in the mothers after cesarean delivery are; bleeding, infection, fatigue, sleep disorders, breast problems, self-care issues, and sense of inadequacy in care of the newborn. The method used in this study was narrative review. A literature review was conducted by searching the materials published in databases including Web of Science, PubMed, Google Scholar search engine and, the WHO website. Pain, maternal death, breastfeeding problems, worsened sleep quality and comfort, anxiety, delayed recovery, prolonged hospitalization and infection rates in the cesarean deliveries are higher than in vaginal deliveries. Nurses can facilitate adaptation to the role of motherhood and prevent risky situations by evaluating mothers' care needs and providing proper interventions and support. Nurses should not only focus on the physical care needs of the mother and baby; they should also ensure the physical and psychosocial adaptation of family members in the face of role changes.
Collapse
Affiliation(s)
- Serpil Duran
- Department of Nursing, Faculty of Health Sciences, Cyprus International University, Nicosia, Turkish Republic of North Cyprus
| | - Gülşen Vural
- Department of Medical Services and Techniques, Vocational School of Health Services, Atılım University, Ankara, Turkey
| |
Collapse
|
24
|
Baldaçara L, Leite VDS, Teles ALS, da Silva AG. Puerperal psychosis: an update. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S125. [PMID: 37556644 PMCID: PMC10411698 DOI: 10.1590/1806-9282.2023s125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/18/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Leonardo Baldaçara
- Associação Brasileira de Psiquiatria – Rio de Janeiro (RJ), Brazil
- Universidade Federal do Tocantins – Palmas (TO), Brazil
| | - Verônica da Silveira Leite
- Associação Brasileira de Psiquiatria – Rio de Janeiro (RJ), Brazil
- Universidade Federal do Tocantins – Palmas (TO), Brazil
| | - Ana Luiza Silva Teles
- Associação Brasileira de Psiquiatria – Rio de Janeiro (RJ), Brazil
- Centro Universitário de Brasília – Brasília (DF), Brazil
| | - Antônio Geraldo da Silva
- Associação Brasileira de Psiquiatria – Rio de Janeiro (RJ), Brazil
- Universidade Federal de Minas Gerais – Belo Horizonte (MG), Brazil
| |
Collapse
|
25
|
Harrison S, Pilkington V, Li Y, Quigley MA, Alderdice F. Disparities in who is asked about their perinatal mental health: an analysis of cross-sectional data from consecutive national maternity surveys. BMC Pregnancy Childbirth 2023; 23:263. [PMID: 37101310 PMCID: PMC10132923 DOI: 10.1186/s12884-023-05518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The perinatal period is a vulnerable time, with one in five women experiencing mental health problems. Antenatal and postnatal appointments are key contact points for identifying women in need of support. Since 2014, the UK National Institute for Health and Care Excellence (NICE) has recommended that all women be asked about their mental health at their antenatal booking appointment and early in the postnatal period. The aim of this study was to assess the proportions of women who reported being asked about their mental health during the perinatal period across consecutive national maternity surveys (NMS) in England and to evaluate sociodemographic disparities in who was asked. METHODS Secondary analysis was performed on cross-sectional data from the NMS in 2014-2020. In each survey, women reported whether they had been asked about their mental health antenatally (during their booking appointment) and postnatally (up to six months after giving birth). The proportions of women in each survey who reported being asked about their mental health were calculated and compared according to key sociodemographic characteristics and across survey years. Logistic regression was conducted to identify disparities in who was asked. RESULTS The proportion of women who reported being asked about their mental health antenatally increased from 80.3% (95%CI:79.0-81.5) in 2014 to 83.4% (95%CI:82.1-84.7) in 2020, yet the proportion of women who reported being asked postnatally fell from 88.2% (95%CI:87.1-89.3) in 2014 to 73.7% (95%CI:72.2-75.2) in 2020. Ethnic minority women (aOR range:0.20 ~ 0.67) were less likely to report being asked about their mental health antenatally and postnatally across all surveys compared to White women. Women living in less socioeconomically advantaged areas (aOR range:0.65 ~ 0.75) and women living without or separately from a partner (aOR range:0.61 ~ 0.73) were also less likely to report being asked about their mental health, although there was less consistency in these disparities across the antenatal and postnatal periods and across surveys. CONCLUSIONS Despite NICE recommendations, many women are still not asked about their mental health during the perinatal period, particularly after giving birth. Women from ethnic minority backgrounds are less likely to be asked and these disparities have persisted over time.
Collapse
Affiliation(s)
- Sian Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Victoria Pilkington
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Oxford University Clinical Academic Graduate School, Oxford, UK
| | - Yangmei Li
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
26
|
Grussu P, Jorizzo GJ, Alderdice F, Quatraro RM. Preventing, Mitigating, and Treating Women's Perinatal Mental Health Problems during the COVID-19 Pandemic: A Scoping Review of Reviews with a Qualitative Narrative Synthesis. Behav Sci (Basel) 2023; 13:bs13050358. [PMID: 37232595 DOI: 10.3390/bs13050358] [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: 02/19/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
Meeting the mental health needs of perinatal women during the COVID-19 pandemic is a serious concern. This scoping review looks at how to prevent, mitigate or treat the mental health problems faced by women during a pandemic, and lays out suggestions for further research. Interventions for women with pre-existing mental health problems or health problems that develop during the perinatal period are included. The literature in English published in 2020-2021 is explored. Hand searches were conducted in PubMed and PsychINFO using the terms COVID-19, perinatal mental health and review. A total of 13 systematic and scoping reviews and meta-analyses were included. This scoping review shows that every woman should be assessed for mental health issues at every stage of her pregnancy and postpartum, with particular attention to women with a history of mental health problems. In the COVID-19 era, efforts should be focused on reducing the magnitude of stress and a perceived sense of lack of control experienced by perinatal women. Helpful instructions for women with perinatal mental health problems include mindfulness, distress tolerance skills, relaxation exercises, and interpersonal relationship building skills. Further longitudinal multicenter cohort studies could help improve the current knowledge. Promoting perinatal resilience and fostering positive coping skills, mitigating perinatal mental health problems, screening all prenatal and postpartum women for affective disorders, and using telehealth services appear to be indispensable resources. In future, governments and research agencies will need to pay greater attention to the trade-offs of reducing the spread of the virus through lockdowns, physical distancing, and quarantine measures and developing policies to mitigate the mental health impact on perinatal women.
Collapse
Affiliation(s)
- Pietro Grussu
- Consultorio Familiare, South Padua District, Azienda ULSS 6 Euganea, Veneto Region, National Health Service, 35042 Este, Italy
| | - Gianfranco J Jorizzo
- Prenatal Medicine, Azienda ULSS 6 Euganea, Veneto Region, National Health Service, 35131 Padova, Italy
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- School of Nursing and Midwifery, Queens University Belfast, Belfast BT9 7BL, UK
| | | |
Collapse
|
27
|
Reilly TJ, Roberts E, Sagnay De La Bastida VC, McGuire P, Dazzan P, Cullen AE. Systematic review of the association between adverse life events and the onset and relapse of postpartum psychosis. Front Psychiatry 2023; 14:1154557. [PMID: 37139317 PMCID: PMC10149966 DOI: 10.3389/fpsyt.2023.1154557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/16/2023] [Indexed: 05/05/2023] Open
Abstract
Postpartum psychosis is defined as a psychotic episode occurring within 4 to 6 weeks of childbirth. While there is robust evidence that adverse life events are associated with the onset and relapse of psychosis outside the postpartum period, the extent to which these contribute to postpartum psychosis is less clear. This systematic review examined whether adverse life events are associated with an increased likelihood of developing postpartum psychosis or subsequent relapse in women diagnosed with postpartum psychosis. The following databases were searched from inception to June 2021: MEDLINE, EMBASE, PsycInfo. Study level data were extracted including setting, number of participants, type of adverse event, and differences between groups. A modified version of the Newcastle-Ottawa Quality Assessments Scale was used to assess risk of bias. In total, 1933 records were identified, of which 17 met the inclusion criteria, comprising nine case-control studies and eight cohort studies. Most studies (16/17) examined the association between adverse life events and the onset of postpartum psychosis, with only in which the outcome was relapse of psychosis. Overall, there were 63 different measures of adversity examined (most of which were examined in a single study only) and 87 associations between these measures and postpartum psychosis tested across the studies. In terms of statistically significant associations with onset/relapse of postpartum psychosis, 15 (17%) were positive (i.e., the adverse event increased the risk of onset/relapse), 4 (5%) were negative, and 68 (78%) were not statistically significant. Our review highlights the diversity of risk factors examined in this field, with few attempts at replication, hence limiting the ability to conclude that any single risk factor is robustly associated with the onset of postpartum psychosis. Further large-scale studies, that attempt to replicate earlier studies, are urgently needed to determine whether adverse life events play a role in the onset and exacerbation of postpartum psychosis. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=260592], identifier [CRD42021260592].
Collapse
Affiliation(s)
- Thomas J. Reilly
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Emma Roberts
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | - Philip McGuire
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Alexis E. Cullen
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
28
|
Albers SM, Wen T, Monk C, Logue TC, D'Alton ME, Booker WA, Friedman AM. Postpartum psychosis during delivery hospitalizations and postpartum readmissions, 2016-2019. Am J Obstet Gynecol MFM 2023; 5:100905. [PMID: 36775196 DOI: 10.1016/j.ajogmf.2023.100905] [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: 12/15/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Up-to-date data on population-level risk factors for postpartum psychosis is limited, although increasing substance use disorders, psychiatric disorders, autoimmune disorders, and other medical comorbidities in the obstetrical population may be contributing to the increased baseline risk of postpartum psychosis. OBJECTIVE This study aimed to determine trends in and risk factors for postpartum psychosis during delivery hospitalizations and postpartum readmissions. STUDY DESIGN Analyzing the 2016-2019 Nationwide Readmission Database, this repeated cross-sectional study identified diagnoses of postpartum psychosis during delivery hospitalizations and postpartum readmissions within 60 days of discharge. The relationship among demographic, clinical, and hospital-level factors present at delivery and postpartum psychosis was analyzed with logistic regression models with adjusted odds ratios with 95% confidence intervals as measures of association. Separate models were created for postpartum psychosis diagnoses at delivery and during postpartum readmission. Temporal trends in diagnoses were analyzed with Joinpoint regression to determine the average annual percent change with 95% confidence intervals. RESULTS Of 12,334,506 deliveries in the analysis, 13,894 (1.1 per 1000) had a diagnosis of postpartum psychosis during the delivery hospitalization, and 7128 (0.6 per 1000) had a 60-day postpartum readmission with postpartum psychosis. Readmissions with postpartum psychosis increased significantly during the study period (P=.046). Most readmissions with a postpartum psychosis diagnosis occurred in 0 to 10 days (43% of readmissions) or 11 to 20 days (18% of readmissions) after discharge. Clinical factors with the highest adjusted odds for postpartum psychosis readmission included delivery postpartum psychosis (adjusted odds ratio, 5.8; 95% confidence interval, 4.2-8.0), depression disorder (adjusted odds ratio, 3.7; 95% confidence interval, 3.3-4.2), bipolar spectrum disorder (odds ratio, 2.9; 95% confidence interval, 2.3-3.5), and schizophrenia spectrum disorder (adjusted odds ratio, 2.9; 95% confidence interval, 2.1-4.0). In models analyzing postpartum psychosis diagnoses at delivery, risk factors associated with the highest odds included anxiety disorder (adjusted odds ratio, 3.9; 95% confidence interval, 3.5-4.2), schizophrenia spectrum disorder (adjusted odds ratio, 2.5; 95% confidence interval, 1.9-3.4), bipolar disorder (adjusted odds ratio, 1.8; 95% confidence interval, 1.6-2.1), stillbirth (odds ratio, 3.6; 95% confidence interval, 3.1-4.2), and substance use disorder (odds ratio, 1.7; 95% confidence interval, 1.6-1.9). In addition, chronic conditions, such as pregestational diabetes mellitus, obesity, and substance use, were associated with delivery and readmission postpartum psychosis. CONCLUSION This study determined that postpartum psychosis is increasing during postpartum readmissions and is associated with a wide range of obstetrical and medical comorbidities. Close follow-up care after delivery for other medical and obstetrical diagnoses may represent an opportunity to identify postpartum psychiatric conditions, including postpartum psychosis.
Collapse
Affiliation(s)
- Saundra M Albers
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Dr Wen)
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman); New York State Psychiatric Institute, New York, NY (Dr Monk)
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman).
| |
Collapse
|
29
|
Cohen LS, Vanderkruik R, Arakelian M, Church TR, Dunk MM, Freeman MP. Establishment of the MGH Postpartum Psychosis Project: MGHP3. PLoS One 2023; 18:e0281133. [PMID: 36758024 PMCID: PMC9910633 DOI: 10.1371/journal.pone.0281133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/13/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE Postpartum psychosis (PP) is a severe psychiatric disorder, with incomplete consensus on definition and diagnostic criteria. The Massachusetts General Hospital Postpartum Psychosis Project (MGHP3) was established to better ascertain the phenomenology of PP in a large cohort of diverse women spanning a wide geographical range (primarily in the US), including time of onset, symptom patterns, and associated comorbidities, psychiatric diagnoses pre- and post- the episode of PP, and also to identify genomic and clinical predictors of PP. This report describes the methods of MGHP3 and provides a status update. METHOD Data are collected from women who experienced PP within 6 months of childbirth and who provided this information within ten years of the study interview. Subject data are gathered during a one-time structured clinical interview conducted by phone, which includes administration of the Mini International Neuropsychiatric Interview for Psychotic Disorders Studies (Version 7.0.2), the MGHP3© Questionnaire, and other information including lifetime mental health history and use of psychiatric medications both prior to the episode of PP and during the subsequent time period prior to study interview. Subjects also provide a saliva sample to be processed for genomic analyses; a neuroimaging assessment is also conducted for a subset of participants. RESULTS As of July 1, 2022, 311 subjects from 44 states and 7 countries were enrolled in MGHP3. Recruitment sources include social media, online advertisements, physician referral, community outreach, and partnership with PP advocacy groups. CONCLUSIONS The rigorous phenotyping, genetic sampling, and neuroimaging studies in this sample of women with histories of PP will contribute to better understanding of this serious illness. Findings from MGHP3 can catalyze ongoing discussions in the field regarding proper nosologic classification of PP as well as relevant treatment implications.
Collapse
Affiliation(s)
- Lee S. Cohen
- Department of Psychiatry, Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Rachel Vanderkruik
- Department of Psychiatry, Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Miranda Arakelian
- Department of Psychiatry, Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Taylor R. Church
- Department of Psychiatry, Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Madison M. Dunk
- Department of Psychiatry, Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Marlene P. Freeman
- Department of Psychiatry, Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
30
|
Roxburgh E, Morant N, Dolman C, Johnson S, Taylor BL. Experiences of Mental Health Care Among Women Treated for Postpartum Psychosis in England: A Qualitative Study. Community Ment Health J 2023; 59:243-252. [PMID: 35900686 PMCID: PMC9859833 DOI: 10.1007/s10597-022-01002-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/17/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
Postpartum psychosis has been found to affect 0.89-2.6 per 1000 women. Onset is typically rapid and severe. Early recognition and appropriate treatment are crucial for a good prognosis. Our aim in this study was to understand women's experiences of mental health care and services for psychosis in the postnatal period. Semi-structured interviews were conducted with 12 women who reported being treated for postpartum psychosis. Findings were analysed thematically. Women reported that healthcare professionals across maternity and mental health services often lacked awareness and knowledge of postpartum psychosis and did not always keep them or their partners/families informed, supported, and involved. Women wanted better collaboration between and within services, and more efficient, appropriate, and timely care. They valued inpatient services that could meet their needs, favouring Mother and Baby Units over general psychiatric wards. Early Intervention in Psychosis services and specialist perinatal community mental health teams were also well liked.
Collapse
Affiliation(s)
- Emily Roxburgh
- Kingston iCope, Camden & Islington NHS Foundation Trust, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Clare Dolman
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.
| | - Billie Lever Taylor
- Division of Psychiatry, University College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
31
|
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.
Collapse
|
32
|
Sharma V, Mazmanian D, Palagini L, Bramante A. Postpartum psychosis: Revisiting the phenomenology, nosology, and treatment. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
33
|
Karalexi MA, Eberhard-Gran M, Valdimarsdóttir UA, Karlsson H, Munk-Olsen T, Skalkidou A. Perinatal mental health: how nordic data sources have contributed to existing evidence and future avenues to explore. Nord J Psychiatry 2022; 76:423-432. [PMID: 35057712 DOI: 10.1080/08039488.2021.1998616] [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: 10/19/2022]
Abstract
PURPOSE Perinatal mental health disorders affect a significant number of women with debilitating and potentially life-threatening consequences. Researchers in Nordic countries have access to high quality, population-based data sources and the possibility to link data, and are thus uniquely positioned to fill current evidence gaps. We aimed to review how Nordic studies have contributed to existing evidence on perinatal mental health. METHODS We summarized examples of published evidence on perinatal mental health derived from large population-based longitudinal and register-based data from Denmark, Finland, Iceland, Norway and Sweden. RESULTS Nordic datasets, such as the Danish National Birth Cohort, the FinnBrain Birth Cohort Study, the Icelandic SAGA cohort, the Norwegian MoBa and ABC studies, as well as the Swedish BASIC and Mom2B studies facilitate the study of prevalence of perinatal mental disorders, and further provide opportunity to prospectively test etiological hypotheses, yielding comprehensive suggestions about the underlying causal mechanisms. The large sample size, extensive follow-up, multiple measurement points, large geographic coverage, biological sampling and the possibility to link data to national registries renders them unique. The use of novel approaches, such as the digital phenotyping data in the novel application-based Mom2B cohort recording even voice qualities and digital phenotyping, or the Danish study design paralleling a natural experiment are considered strengths of such research. CONCLUSIONS Nordic data sources have contributed substantially to the existing evidence, and can guide future work focused on the study of background, genetic and environmental factors to ultimately define vulnerable groups at risk for psychiatric disorders following childbirth.
Collapse
Affiliation(s)
- Maria A Karalexi
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Unnur Anna Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Hasse Karlsson
- Department of Psychiatry and Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Trine Munk-Olsen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alkistis Skalkidou
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
34
|
Ford H, Griffith S, Warren N, Swayne A, Blum S, Butzkueven H, O'Brien TJ, Velakoulis D, Kulkarni J, Monif M. Psychiatric manifestations of autoimmune encephalitis. Autoimmun Rev 2022; 21:103145. [PMID: 35840036 DOI: 10.1016/j.autrev.2022.103145] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 12/21/2022]
Abstract
Autoimmune encephalitis is increasingly recognized as a cause of psychiatric symptoms. A wide spectrum of psychiatric manifestations have been described which may precede, follow or occur independently of neurologic features. Patients typically respond to immunotherapy, however diagnosis is challenging due to phenotypic heterogeneity. The aim of this review is to provide an overview of the psychiatric features associated with encephalitis mediated by autoantibodies targeting neuronal cell-surface antigens and describe indicators of potential immunopathology underlying psychiatric manifestations.
Collapse
Affiliation(s)
- Hannah Ford
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Sarah Griffith
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Monash University, Melbourne, Vic, Australia
| | - Nicola Warren
- School of Medicine, University of Queensland, Brisbane, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Adrew Swayne
- School of Medicine, University of Queensland, Brisbane, Australia; Princess Alexandra Hospital, Department of Neurology, Brisbane, Queensland, Australia
| | - Stefan Blum
- School of Medicine, University of Queensland, Brisbane, Australia; Princess Alexandra Hospital, Department of Neurology, Brisbane, Queensland, Australia
| | - Helmut Butzkueven
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Monash University, Melbourne, Vic, Australia
| | - Terence J O'Brien
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Monash University, Melbourne, Vic, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Vic, Australia
| | - Jayashri Kulkarni
- Department of Psychiatry, Alfred Hospital, Melbourne, Vic, Australia; Department of Psychiatry, Monash University, Melbourne, Vic, Australia
| | - Mastura Monif
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Neuroscience, Monash University, Melbourne, Vic, Australia.
| |
Collapse
|
35
|
Hosseini MS, Jahanshahlou F, Mahmoodpoor A, Sanaie S, Naseri A, Kuchaki Rafsanjani M, Seyedi-Sahebari S, Vaez-Gharamaleki Y, ZehiSaadat M, Rahmanpour D. Pregnancy, peripartum, and COVID-19: An updated literature review. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
36
|
Culbert KM, Thakkar KN, Klump KL. Risk for midlife psychosis in women: critical gaps and opportunities in exploring perimenopause and ovarian hormones as mechanisms of risk. Psychol Med 2022; 52:1612-1620. [PMID: 35582864 PMCID: PMC9743981 DOI: 10.1017/s0033291722001143] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Women show a heightened risk for psychosis in midlife that is not observed in men. The menopausal transition (i.e. perimenopause) and accompanying changes in ovarian hormones are theorized to account for this midlife increase in risk. This narrative review aims to empirically examine these theories by reviewing studies of midlife and perimenopausal psychosis risk in women and potential ovarian hormone mechanisms of effects. Clinical and pre-clinical studies examining the effects of midlife age, menopausal stage, and ovarian hormones across adulthood on psychosis risk were identified. Synthesis of this body of work revealed that the peak ages of midlife psychosis risk in women overlap with the age range of key menopausal stages (especially the perimenopausal transition), although studies directly assessing menopausal stage are lacking. Studies examining ovarian hormone effects have almost exclusively focused on earlier developmental stages and events (e.g. pregnancy, the menstrual cycle) and show increases in psychotic symptoms in women and female rats during periods of lower estradiol levels. Estrogen treatment also tends to enhance the effects of neuroleptics in females across species at various reproductive phases. Initial data are promising in suggesting a role for menopausal stage and ovarian hormones in psychosis risk. However, critical gaps in our knowledge base remain, as there is a tendency to rely on indirect and proxy measures of menopausal status and hormones. Opportunities for future research are discussed with the goal of increasing research in this critical area of women's health.
Collapse
Affiliation(s)
| | - Katharine N. Thakkar
- Department of Psychology, Michigan State University, East Lansing, MI
- Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, MI
| |
Collapse
|
37
|
Shaffron M, Watkins E. Behavioral Health in Obstetrics and Gynecology. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
38
|
Choenni V, Kok R, Verhulst FC, van Lier MHM, Lambregtse-van den Berg MP. The Dutch Infant Caregiving Assessment Scales: Psychometric properties in mothers with and without a severe psychiatric disorder. Int J Methods Psychiatr Res 2022; 31:e1902. [PMID: 35088917 PMCID: PMC9159692 DOI: 10.1002/mpr.1902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/02/2021] [Accepted: 12/07/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study examines the psychometric properties of the Dutch adaptation of the Infant Caregiving Assessment Scales (INCAS). This standardized observation procedure is the first to assess both emotional and instrumental caregiving skills of mothers with a severe psychiatric disorder, during the postpartum period. METHODS Mothers with and without a severe psychiatric disorder (N = 123) were observed at home at the infant age of 6 weeks during daily caregiving; changing a diaper, bathing, dressing, and feeding. Recordings of observations were coded independently by trained coders, blind for group membership. Subsequently, the component structure, internal consistency, interrater reliability, and concurrent validity of the INCAS were examined. RESULTS Principal component analysis largely confirmed the two a priori defined caregiving domains. The internal consistencies of the emotional and instrumental domains were deemed excellent and good, respectively. The interrater reliability was substantial for the emotional domain and moderate for the instrumental domain. Furthermore, evidence for good concurrent validity of the emotional domain was found. Lastly, significant correlations were found between specific instrumental caregiving skills and maternal neuropsychological functioning. CONCLUSION Psychometric findings support the INCAS as a comprehensive and reliable instrument for standardized assessment of caregiving by mothers with a severe psychiatric disorder.
Collapse
Affiliation(s)
- Vandhana Choenni
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
| | - Rianne Kok
- Department of Psychology, Education, & Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Monique H M van Lier
- Department of the Parnassia Psychiatric Institute, Youz, Center for Youth Mental Healthcare, The Hague, The Netherlands
| | - Mijke P Lambregtse-van den Berg
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
39
|
Syam A, Qasim M, Iskandar I, Kadir A. Cortisol, Prolactin, and Breastmilk Volume; A Promising Pattern for Reducing Postpartum Depression. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Research shows postnatal depression and shorter breastfeeding are consistently related, but their causal effect remains debatable. To reduce the impact of mental disorders in the perinatal period, lactation may give a significant neuroendocrine effect.
AIM: This study aimed to examine hormonal patterns and estimated breastmilk volume of mothers with depression.
MATERIALS AND METHODS: This study was conducted during the three-trimester to 6-week postnatal period. It involved 60 pregnant women from South Sulawesi, Indonesia. Analysis of variance with repeated measures was used to compare and review fluctuations and effect sizes of cortisol, prolactin, and breastmilk volume of mothers with depression symptoms.
RESULTS: The mean cortisol levels rose in the 4th week and decreased in the 6th week in both groups. There was no substantial difference in the cortisol levels between these periods (p = 0.534; p = 0.553; and p = 0.660), but the prolactin levels continuously increased by 2 weeks and substantially progressed in the 4th and 6th weeks (p < 0.028, p < 0.009), respectively. There was no positive association between cortisol and prolactin levels (p = 0.384). The breastmilk volume was higher every week only in mothers without depression and it slightly decreased in other categories. This study emphasized the prolactin’s protective effect size on a stressful environment characterized by high cortisol; a significant rise in prolactin levels occurred in the 2nd and 4th weeks of postnatal, marking the higher lactation.
CONCLUSIONS: Breastfeeding hormones may provide protection against postpartum depression in moms. It is critical to establish a history of prior trauma in nursing mothers in order to facilitate diagnosis and proper care.
Collapse
|
40
|
Abstract
PURPOSE OF REVIEW Psychiatric illnesses are very prevalent in the United States and impact women and men differently. In this review, we will explore some gender differences in the expression of psychopathology, discuss the most common serious mental illnesses (SMI) affecting women, and review treatment options according to specific life stages. We hope to raise awareness of these issues and consequently improve outcomes for women with serious mental illness. RECENT FINDINGS SMI have different rates and are manifested differently in women and men because of biological, psychological, social, and cultural factors. Some SMI are more prevalent in women whereas others uniquely affect them during particular life stages. Even in disorders that have a similar prevalence in men and women or are more prevalent in men, the presentation, course, management, and repercussions can vary significantly between the two genders. Medical and psychiatric comorbidities, which directly influence treatment, prognosis, and disability, are more common in women. SUMMARY Several differences in the gender expression of SMI have not yet been fully described. It is important to become familiar with important characteristics of SMI in women, including biological determinants, treatment differences, and psychosocial aspects. Recognizing gender biases, cultural considerations, and adaptive responses can help identify women at risk, promote early recognition of symptoms, and prompt interventions that may lead to improved outcomes.
Collapse
Affiliation(s)
- Marcela Almeida
- Harvard Medical School, Boston
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Sun J Fletcher
- Harvard Medical School, Boston
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| |
Collapse
|
41
|
Dye C, Lenz KM, Leuner B. Immune System Alterations and Postpartum Mental Illness: Evidence From Basic and Clinical Research. Front Glob Womens Health 2022; 2:758748. [PMID: 35224544 PMCID: PMC8866762 DOI: 10.3389/fgwh.2021.758748] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/29/2021] [Indexed: 01/13/2023] Open
Abstract
The postpartum period is a time associated with high rates of depression and anxiety as well as greater risk for psychosis in some women. A growing number of studies point to aberrations in immune system function as contributing to postpartum mental illness. Here we review evidence from both clinical and animal models suggesting an immune component to postpartum depression, postpartum anxiety, and postpartum psychosis. Thus far, clinical data primarily highlights changes in peripheral cytokine signaling in disease etiology, while animal models have begun to provide insight into the immune environment of the maternal brain and how central inflammation may also be contributing to postpartum mental illnesses. Further research investigating peripheral and central immune function, along with neural and endocrine interactions, will be important in successfully developing novel prevention and treatment strategies for these serious disorders that impact a large portion of new mothers.
Collapse
Affiliation(s)
- Courtney Dye
- Neuroscience Graduate Program, The Ohio State University, Columbus, OH, United States
| | - Kathryn M. Lenz
- Department of Psychology, The Ohio State University, Columbus, OH, United States
- Department of Neuroscience, The Ohio State University, Columbus, OH, United States
- Institute of Behavioral Medicine Research, The Ohio State University, Columbus, OH, United States
| | - Benedetta Leuner
- Department of Psychology, The Ohio State University, Columbus, OH, United States
- Department of Neuroscience, The Ohio State University, Columbus, OH, United States
- *Correspondence: Benedetta Leuner
| |
Collapse
|
42
|
Gribble KD, Bewley S, Bartick MC, Mathisen R, Walker S, Gamble J, Bergman NJ, Gupta A, Hocking JJ, Dahlen HG. Effective Communication About Pregnancy, Birth, Lactation, Breastfeeding and Newborn Care: The Importance of Sexed Language. Front Glob Womens Health 2022; 3:818856. [PMID: 35224545 PMCID: PMC8864964 DOI: 10.3389/fgwh.2022.818856] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/10/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Karleen D. Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
- *Correspondence: Karleen D. Gribble
| | - Susan Bewley
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Melissa C. Bartick
- Mount Auburn Hospital, Cambridge, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI Solutions, Hanoi, Vietnam
| | - Shawn Walker
- Department of Women and Children's Health, King's College London, London, United Kingdom
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jenny Gamble
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Centre for Health Care Research, Coventry University, Coventry, United Kingdom
| | - Nils J. Bergman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arun Gupta
- Breastfeeding Promotion Network of India, New Delhi, India
| | - Jennifer J. Hocking
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, VIC, Australia
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| |
Collapse
|
43
|
Nguyen HTT, Do LTK, Pham HTT, Hoang AP, Truong HT, Nguyen HTH. The symptoms of postpartum depression observed by family members: A pilot study. Front Psychiatry 2022; 13:897175. [PMID: 36311518 PMCID: PMC9606679 DOI: 10.3389/fpsyt.2022.897175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Postpartum Depression (PPD) is a burden on women's mental health after delivery, predominantly occurring in the 1st year. PPD poses a threat to the mother's life and affects the quality of childcare. Early detection by family members of depressive symptoms is critical. This study aimed to examine the role of family members in reporting depressive symptoms of PPD among new mothers. A cross-sectional study was conducted, where 56 family members were asked to report depressive symptoms observed in new mothers. At the same time, the new mothers were also screened for PPD using the Edinburgh Postpartum Depression Scale (EPDS). Binary logistic regression was performed. Depressive symptoms of new mothers reported by family members, including emotional and behavioral disturbance, being under stress, high anxiety, isolation, changing lifestyle, and inability to take care of their children, were found as predictors of PPD.
Collapse
Affiliation(s)
| | - Ly Thi Kim Do
- General Surgical Department, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Huong Thi Thu Pham
- Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam.,School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,National Institute of Mental Health, Bach Mai Hospital, Hanoi, Vietnam
| | - Anh Phuong Hoang
- College of Health Sciences, VinUniversity, Hanoi, Vietnam.,Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Hoa Thi Truong
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
| | | |
Collapse
|
44
|
Kalra H, Tran T, Romero L, Chandra P, Fisher J. Burden of severe maternal peripartum mental disorders in low- and middle-income countries: a systematic review. Arch Womens Ment Health 2022; 25:267-275. [PMID: 35061103 PMCID: PMC8921056 DOI: 10.1007/s00737-021-01201-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/26/2021] [Indexed: 11/27/2022]
Abstract
Peripartum severe mental disorders (PSMDs) encompass schizophrenia, affective psychosis, and psychotic and non-psychotic forms of bipolar disorders. PSMDs are well documented in high-income countries. However, much less is known about the prevalence of PSMDs in low- and middle-income countries (LMICs). The aim was to review the available literature systematically and estimate the prevalence of PSMDs among women in LMICs. We searched the Ovid MEDLINE, Embase, PsycINFO, CINAHL and Maternity and Infant Care databases systematically from the date of inception to Dec 31, 2020, for English-language publications with data on the prevalence of PSMDs among women in World Bank-defined LMICs. Selection of studies, extraction of data and assessment of study quality were each undertaken independently by at least two of the investigators. A total of five studies (completed in three countries spanning two continents) met the inclusion criteria. Five studies reported cumulative incidence of postpartum psychosis (ranging from 1.1 to 16.7 per 1000 births). We found no studies on the prevalence of severe mental disorder during pregnancy in these settings. Marked heterogeneity in methodology precluded meta-analysis. These findings indicate that PSMDs occur at a similar prevalence in low- and middle-income to high-income countries. However overall, there is a paucity of high-quality evidence from these settings. There is a need for rigorous studies with standardized methods to increase knowledge of the nature, prevalence, and determinants of PSMDs among women in resource-constrained LMICs to inform policies, service development, program planning and health professional training.
Collapse
Affiliation(s)
- Harish Kalra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Ballarat Rural Clinical School, University of Notre Dame Australia, Sydney, Australia. .,Grampians Area Mental Health Services, Ballarat, VIC, Australia.
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred Hospital, Melbourne, VIC Australia
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
45
|
Nguyen HTT, Hoang AP, Do LTK, Schiffer S, Nguyen HTH. The Rate and Risk Factors of Postpartum Depression in Vietnam From 2010 to 2020: A Literature Review. Front Psychol 2021; 12:731306. [PMID: 34777111 PMCID: PMC8578872 DOI: 10.3389/fpsyg.2021.731306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Postpartum depression (PPD) is commonly seen in women after birth and can lead to adverse effects on both the health of mothers and child(ren) development. In Vietnam, there have been a number of studies examining the rate and risk factors of PPD, but none has provided a systematic review. Aim: This current literature review aims to summarize and synthesize the current state of knowledge of studies conducted in Vietnam to provide a comprehensive understanding of the PPD phenomena during the last 10 years. Data Sources: A literature search was conducted relying on the most common online databases—MEDLINE/PubMed, ScienceDirect, and Google Scholar, which included articles if they (i) examined prevalence or risk factors of PPD; (ii) were conducted among Vietnamese participants using either quantitative, qualitative, or mixed-method, and (iii) were published from 2010 to 2020. After the filtering process, 18 articles were eligible to be reviewed. Results: Research studies in Vietnam on PPD are conducted among women at and after 1-month delivery. The rate of PPD reported in Vietnam among mothers at postnatal time points from 1 to 12 months ranged from 8.2 to 48.1%. Risk factors can be clustered into three groups: personal factors, family factors, and environmental factors. Recommendation: Further research studies should focus on examining PPD at an earlier stage within the first month after birth. The investigation of risk factors in a comprehensive manner for Vietnamese mothers would also be recommended.
Collapse
Affiliation(s)
| | - Anh Phuong Hoang
- College of Health Sciences, Vin University, Hanoi, Vietnam.,Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Ly Thi Kim Do
- 47B General Surgery Department, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | | | | |
Collapse
|
46
|
Perry A, Gordon-Smith K, Di Florio A, Craddock N, Jones L, Jones I. Mood episodes in pregnancy and risk of postpartum recurrence in bipolar disorder: The Bipolar Disorder Research Network Pregnancy Study. J Affect Disord 2021; 294:714-722. [PMID: 34343930 DOI: 10.1016/j.jad.2021.07.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Women with bipolar disorder (BD) are at high risk of mania/psychosis following childbirth. The risk factors for these episodes remain poorly understood and prospective studies are rare. Here, we examine whether mood episodes occurring within pregnancy predict postpartum recurrence in women with BD using a prospective design. METHOD 128 women with DSM-5 BD were followed from week 12 of pregnancy (baseline) to 12-weeks postpartum. Semi-structured interviews, supplemented by clinician questionnaires and case-note review, assessed lifetime psychiatric history at baseline, and perinatal psychopathology at two follow-up assessments: third-trimester of pregnancy and 12-weeks postpartum. RESULTS Postpartum follow-up data were obtained for 124/128 (97%) women [98 bipolar I disorder/schizoaffective-BD (BD-I/SA-BD group) and 26 bipolar II disorder/other specified BD and related disorder (BD-II/BD-OS group)]. Perinatal recurrence was high in both diagnostic groups (57% and 62% respectively). Women with BD-I/SA-BD were significantly more likely to experience mania/psychosis within 6 weeks postpartum (23%, n=22/96) compared to those with BD-II/BD-NOS (4%, n=1/25; p=0.042). In BD-I/SA-BD, mania/psychosis in pregnancy significantly elevated risk of mania/psychosis postpartum compared to remaining well (RR 7.0, p<0.001) and experiencing non-psychotic depression in pregnancy (RR 3.18, p=0.023) Limitations: Predominantly United Kingdom White sample and limited BD-II/BD-OS sample size. CONCLUSIONS Women with BD are at high risk of recurrence during pregnancy and the postpartum. Over and above risk conferred by a history of BD-I/SA-BD, mania/psychosis during pregnancy further increased risk of postpartum mania/psychosis in this high-risk group. These data may have important implications for prediction and management of severe postpartum recurrence of BD.
Collapse
Affiliation(s)
- Amy Perry
- Psychological Medicine, University of Worcester, Henwick Grove, Worcester WR2 6AJ, UK
| | | | - Arianna Di Florio
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Nick Craddock
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Lisa Jones
- Psychological Medicine, University of Worcester, Henwick Grove, Worcester WR2 6AJ, UK
| | - Ian Jones
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| |
Collapse
|
47
|
Jefferies D, Schmied V, Sheehan A, Duff M. The river of postnatal psychosis: A qualitative study of women's experiences and meanings. Midwifery 2021; 103:103165. [PMID: 34666259 DOI: 10.1016/j.midw.2021.103165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This paper reports findings from a study about women's experience of postpartum psychosis which affects 1-2 women in 1000 in the first four to six weeks following childbirth. Previous research reports many women are relucent to disclose symptoms of mental ill health to healthcare professionals, although they are most likely to discuss symptoms and concerns with a health professional known to them. DESIGN A qualitative interpretive study using semi-structured interviews. PARTICIPANTS Ten women in Australia who had recovered from postpartum psychosis in the last ten years were interviewed. DATA ANALYSIS Data were analysed thematically by three researchers to enhance trustworthiness. RESULTS The women described their overall experience as traumatic and described what they saw as contributing factors such as a previous history of mental illness or a significant life event that was present before or during pregnancy; the women described how they made meaning of the symptoms they experienced, such as a lack of sleep or changes in their thoughts or behaviours; and the difficulties they experienced during recovery. The women also identified novel ways to support themselves and each other as they recovered. CONCLUSION AND IMPLICATIONS FOR PRACTICE Midwives require further education to recognise the symptoms of postpartum psychosis, to ask further probing questions to identify postpartum psychosis in its early stages and to support women as they recover from this illness.
Collapse
Affiliation(s)
- Diana Jefferies
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751, Australia.
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751, Australia.
| | - Athena Sheehan
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751, Australia.
| | - Margaret Duff
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751, Australia.
| |
Collapse
|
48
|
Leppers I, Veth CPM, de Waardt DA, Migchels H, Traa MJ. Perinatal mental health around the world: priorities for research and service development in The Netherlands. BJPsych Int 2021. [DOI: 10.1192/bji.2021.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Netherlands has an unique system of perinatal and postpartum healthcare. Pregnancy care is delivered predominantly by primary care midwives and childbirth services predominantly involve hospital care. The first week postpartum, all women receive daily care from maternity nurses. In addition, hospitals and out-patient clinics offer perinatal mental healthcare. More specifically, ‘POP care’ (psychiatry, obstetrics and paediatrics) was developed to promote multidisciplinary collaboration in this regard. Although clinical practices and government initiatives to improve pregnancy-related mental healthcare work well, they have yet to be fully described and evaluated. The current COVID-19 pandemic has an impact on health services and perinatal mental health.
Collapse
|
49
|
Abstract
Postpartum psychosis (PPP) is a serious disorder that is associated with maternal and infant morbidity and mortality, yet it is denied a diagnostic classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM). PPP was included in the DSMI (1952) and the DSMII (1968). It was removed from DSMIII (1980). The purpose of this article is to review the history of postpartum psychosis in the DSM and provide the mechanism and research that argues for the inclusion of postpartum psychosis as a separate diagnostic entity in the DSM. This work describes a proposal to the DSMV committee in 2020 for inclusion of PPP as a unique diagnosis based on the cognitive disorganization that accompanies psychotic symptoms. The proposal for inclusion provides the required criteria such as a rationale for the proposed change and evidence that PPP is distinct from other disorders. Validators are described. Reliability studies and benefits of inclusion are provided. We were unable to gain consensus on the presence of cognitive impairment for all postpartum psychotic episodes. The committee opined that we did not demonstrate proof that PPP is a distinct diagnosis. However, the committee acknowledged that the current "specifier" may be insufficient, and thus the option favored by the committee is that it could be added to Sect. 3 of the DSM, "Conditions for Further Study." In the next proposal, we suggest that the unique temporal relationship of symptom onset to childbirth deserves consideration as unique criteria for diagnostic distinction of PPP.
Collapse
Affiliation(s)
- Margaret Spinelli
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 710 West 168th Street Neuro 12, Women's Program, NY, 10032, New York, USA.
| |
Collapse
|
50
|
Okayasu H, Yasui-Furukori N, Shimoda K. A pregnant woman who experienced auditory hallucinations concurrent with hyperemesis gravidarum: A case report. Neuropsychopharmacol Rep 2021; 41:548-550. [PMID: 34472727 PMCID: PMC8698677 DOI: 10.1002/npr2.12206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022] Open
Abstract
We report the case of a pregnant woman who experienced auditory hallucinations only while suffering from hyperemesis gravidarum. To the best of our knowledge, the present report is the first report of a case of obvious auditory hallucinations and hyperemesis gravidarum at the same time in a pregnant woman who had not been diagnosed with any psychiatric disorder. The patient was a 24‐year‐old pregnant woman with no history of psychiatric disorder. Two years prior to this admission, she became pregnant for the first time, and she was admitted to an obstetrics clinic due to severe hyperemesis gravidarum. She developed mild auditory hallucinations at the same time. After she gave birth, the auditory hallucinations disappeared. When she was 24 years old, she became pregnant again. She suffered from severe hyperemesis gravidarum from the early stage of pregnancy. At 20 weeks of pregnancy, she visited the Department of Psychiatry of our hospital for a detailed psychiatric evaluation and treatment because her moderate auditory hallucinations had relapsed. We administered an antipsychotic agent, perospirone, to treat the auditory hallucinations, which disappeared, although the hyperemesis gravidarum persisted until childbirth. After childbirth, perospirone treatment was discontinued, and her auditory hallucinations did not relapse. The auditory hallucinations may have occurred as a result of complicated biological and psychosocial factors. Physicians should carefully evaluate psychotic symptoms, such as auditory hallucinations, not only during the postpartum period but also throughout the course of pregnancy. The present report is the first report of a case of obvious auditory hallucinations and hyperemesis gravidarum at the same time in a pregnant woman who had not been diagnosed with any psychiatric disorder. We administered an antipsychotic agent, perospirone, to treat the auditory hallucinations, which disappeared, although the hyperemesis gravidarum persisted until childbirth. After childbirth, perospirone treatment was discontinued, and her auditory hallucinations did not relapse.
Collapse
Affiliation(s)
- Hiroaki Okayasu
- Department of Psychiatry, Dokkyo Medical University, Mibu, Japan
| | | | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University, Mibu, Japan
| |
Collapse
|