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Callovini T, Montanari S, Bardi F, Barbonetti S, Rossi S, Caso R, Mandracchia G, Margoni S, Brugnami A, Paolini M, Manfredi G, Giudice LL, Segatori D, Zanzarri A, Onori L, Calderoni C, Benini E, Marano G, Massetti M, Fiaschè F, Di Segni F, Janiri D, Simonetti A, Moccia L, Grisoni F, Ruggiero S, Bartolucci G, Biscosi M, Ferrara OM, Bernardi E, Monacelli L, Giannico AM, De Berardis D, Battisti G, Ciliberto M, Brisi C, Lisci FM, D’Onofrio AM, Restaino A, Di Benedetto L, Anesini MB, Boggio G, Specogna E, Crupi A, De Chiara E, Caroppo E, Ieritano V, Monti L, Chieffo DPR, Rinaldi L, Camardese G, Cuomo I, Brugnoli R, Kotzalidis GD, Sani G, Mazza M. Obstetric Outcomes in Women on Lithium: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:4872. [PMID: 39201016 PMCID: PMC11355283 DOI: 10.3390/jcm13164872] [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: 07/24/2024] [Revised: 08/12/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Lithium taken during pregnancy was linked in the past with increased risk for foetal/newborn malformations, but clinicians believe that it is worse for newborn children not to treat the mothers' underlying psychiatric illness. We set to review the available evidence of adverse foetal outcomes in women who received lithium treatment for some time during their pregnancy. Methods: We searched four databases and a register to seek papers reporting neonatal outcomes of women who took lithium during their pregnancy by using the appropriate terms. We adopted the PRISMA statement and used Delphi rounds among all the authors to assess eligibility and the Cochrane Risk-of-Bias tool to evaluate the RoB of the included studies. Results: We found 28 eligible studies, 10 of which met the criteria for inclusion in the meta-analysis. The studies regarded 1402 newborn babies and 2595 women exposed to lithium. Overall, the systematic review found slightly increased adverse pregnancy outcomes for women taking lithium for both the first trimester only and any time during pregnancy, while the meta-analysis found increased odds for cardiac or other malformations, preterm birth, and a large size for gestational age with lithium at any time during pregnancy. Conclusions: Women with BD planning a pregnancy should consider discontinuing lithium when euthymic; lithium use during the first trimester and at any time during pregnancy increases the odds for some adverse pregnancy outcomes. Once the pregnancy has started, there is no reason for discontinuing lithium; close foetal monitoring and regular blood lithium levels may obviate some disadvantages of lithium administration during pregnancy.
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Affiliation(s)
- Tommaso Callovini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Silvia Montanari
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesca Bardi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Barbonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Rossi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Romina Caso
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Mandracchia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Stella Margoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Brugnami
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Paolini
- Department of Psychiatry, Università Vita-Salute San Raffaele, 20132 Milan, Italy;
| | - Giovanni Manfredi
- UOC Psichiatria, Sant’Andrea University Hospital, Università La Sapienza of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Luca Lo Giudice
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Daniele Segatori
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Zanzarri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Onori
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Claudia Calderoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elisabetta Benini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Marano
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Massetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Federica Fiaschè
- ASL RM1, Presidio Ospedaliero San Filippo Neri, Servizio Psichiatrico di Diagnosi e Cura, Via Giovanni Martinotti, 20, 00135 Rome, Italy;
| | - Federica Di Segni
- ASL Roma 2, Dipartimento di Salute Mentale, Servizio Per Le Dipendenze Patologiche Distretto 7, Via dei Sestili 7, 00174 Rome, Italy;
| | - Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Flavia Grisoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Ruggiero
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giovanni Bartolucci
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Biscosi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ottavia Marianna Ferrara
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Evelina Bernardi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Leonardo Monacelli
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandro Michele Giannico
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Giulia Battisti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Michele Ciliberto
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Caterina Brisi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesco Maria Lisci
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Maria D’Onofrio
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Restaino
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Di Benedetto
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Maria Benedetta Anesini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianluca Boggio
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elettra Specogna
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Arianna Crupi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Emanuela De Chiara
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Emanuele Caroppo
- Department of Mental Health, Local Health Authority Roma 2, 00159 Rome, Italy;
| | - Valentina Ieritano
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.M.); (D.P.R.C.)
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.M.); (D.P.R.C.)
- Department Women Children and Public Health, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Lucio Rinaldi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giovanni Camardese
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ilaria Cuomo
- ASL RM1, UOC SM Distretto XIII ASL Roma 1, CSM Via Boccea 271271, 00168 Rome, Italy;
| | - Roberto Brugnoli
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marianna Mazza
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
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Sagué-Vilavella M, Solé E, Pinzón-Espinosa J, Sandra-Hernández A, Roda E, Vieta E, Roca A. Obstetric outcomes regarding the use of lithium in pregnant women with bipolar disorders: a prospective cohort study. Arch Womens Ment Health 2022; 25:729-737. [PMID: 35522327 DOI: 10.1007/s00737-022-01234-8] [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: 01/18/2022] [Accepted: 04/25/2022] [Indexed: 11/02/2022]
Abstract
Lithium is the mood stabilizer of choice for the prevention of bipolar relapse over the perinatal period. A critical issue is its safety of the mother and the developing fetus. This study aims to compare obstetric outcomes in women with bipolar disorders (BD) regarding treatment with lithium during pregnancy. We enrolled a cohort of pregnant women with BD that received care at the Perinatal Mental Health Unit of a tertiary hospital between January 2005 and March 2017. The exposed group received lithium during pregnancy, whereas the unexposed group did not. The main outcomes were obstetric complications during pregnancy, during labor and delivery, neonatal complications, and congenital malformations. Demographic and clinical data were described using measures of frequency, central tendency, and dispersion. Between-group differences were calculated with chi-square, Fisher's test, t-tests, or Mann-Whitney U test. Our cohort included 100 pregnant women with BD: 53 (53%) used lithium during pregnancy, and 47 (47%) did not. There were no significant differences in obstetric complications, neonatal complications, or congenital anomalies. Nonetheless, newborns of lithium-treated women had lower Apgar scores at 1 min (mean 8.2 ± 1.6 vs. 8.9 ± 0.6, p = 0.026) and 5 min (9.6 ± 0.8 vs. 9.9 ± 0.5, p = 0.015). Our findings do not identify worse obstetric outcomes in women with BD that take lithium during pregnancy, except for an impact on newborn Apgar scores. Lithium might be an adequate treatment for pregnant women with BD, especially for those with a high recurrence risk, and always after an individualized risk-benefit assessment.
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Affiliation(s)
- Maria Sagué-Vilavella
- Bipolar and Unipolar Disorders Unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain
| | - Eva Solé
- Institute of Neuroscience, Perinatal Mental Health Unit, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain. .,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain. .,Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Justo Pinzón-Espinosa
- Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.,Department of Mental Health, Parc Tauli University Hospital, Sabadell, Barcelona, Spain.,Department of Clinical Psychiatry, School of Medicine, University of Panama, Panama, Spain
| | - Ana Sandra-Hernández
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain.,Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.,Department of Maternal-Fetal Medicine, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain
| | - Ester Roda
- Institute of Neuroscience, Perinatal Mental Health Unit, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Unipolar Disorders Unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain.,Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Alba Roca
- Institute of Neuroscience, Perinatal Mental Health Unit, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain
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Kan ACO, Chan JKN, Wong CSM, Chen EYH, Chang WC. Psychotropic drug utilization patterns in pregnant women with bipolar disorder: A 16-year population-based cohort study. Eur Neuropsychopharmacol 2022; 57:75-85. [PMID: 35151952 DOI: 10.1016/j.euroneuro.2022.01.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/15/2022]
Abstract
Despite growing concern about reproductive safety of psychotropic drugs, there is a paucity of research assessing prenatal prescribing practices for bipolar disorder (BD). This population-based cohort study identified women aged 15-50 years with BD diagnosis, who delivered their first and singleton child between 2003 and 2018 in Hong Kong, with an aim to examine temporal trends and predictors of prenatal psychotropic drug use as well as drug utilization patterns before and during pregnancy were evaluated. Data were retrieved from territory-wide medical-record database of public healthcare services. Of 302 identified women, 202 (66.9%) and 180 (59.6%) redeemed at least 1 prescription for psychotropic drugs in 12 months pre-pregnancy and during pregnancy, respectively. Psychotropic drug treatment (OR = 16.14 [95% CI: 8.79-29.65]) and psychiatric admission (OR = 4.12 [95% CI: 1.66-10.24]) within 12 months pre-pregnancy were associated with prenatal drug use. Second-generation antipsychotic use during pregnancy increased over time, while prenatal use of lithium, anti-epileptics and first-generation-antipsychotics showed declining trend. Use of psychotropic drugs progressively decreased across pre-pregnancy and trimesters of pregnancy. Forty-two (23.3%) women received polypharmacy during pregnancy. Antidepressant use accounted for 17% of all monotherapy episodes. A significant proportion of women exposed to valproate in 12 months pre-pregnancy (27.2%) and first-trimester (16%). In conclusion, our results generally indicate trajectories of reduced psychotropic drug use across pregnancy. Deviations between real-world prescribing patterns and treatment guidelines underscore the need for comprehensive review of current clinical practices. Further research clarifying relationships of prenatal psychotropic drug exposure with maternal and fetal outcomes is warranted.
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Affiliation(s)
- Anson Chi On Kan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Joe Kwun Nam Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
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Effectiveness of patient decision aids in women considering psychotropic medication use during pregnancy: a literature review. Arch Womens Ment Health 2021; 24:569-578. [PMID: 33751206 DOI: 10.1007/s00737-021-01118-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
Women face complicated decisions regarding psychotropic medication use during pregnancy. Patient decision aids (PDAs) could be a valuable tool to assist with decision-making. The objective of this review was to evaluate the effectiveness of PDAs in this population. A systematic search of the literature was conducted using PRISMA guidelines. Three major databases were searched to identify articles published between 2006 and June 2020. Studies were included if they evaluated use of a PDA for women considering medication for mental illness during pregnancy. A total of 4629 titles were returned from the search; however, only three studies met inclusion criteria and were selected for analysis. Two were pilot randomised controlled trials in women considering antidepressant use during pregnancy, and one was a non-randomised study in women considering medication for the treatment of opioid use disorder (OUD). The PDAs had good acceptability across all three studies. The randomised trials assessed knowledge, decisional conflict, depression, and anxiety, with non-significant trends towards reduced decisional conflict and anxiety in the PDA groups. PDAs have the potential to assist women with mental illnesses to make decisions regarding medication use during pregnancy; however, current evidence is too limited to evaluate the effectiveness of PDAs for this population.
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Indirect psychiatric consultation for perinatal bipolar disorder: A scoping review. Gen Hosp Psychiatry 2021; 68:19-24. [PMID: 33271405 DOI: 10.1016/j.genhosppsych.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To synthesize the literature and develop guidance on supports needed for primary care and perinatal providers in screening, initial management, triage, and bridging treatment for perinatal bipolar disorder. METHODS We conducted a scoping review by searching six electronic databases using keywords related to perinatal bipolar disorder. We summarized descriptive statistics on settings and extracted information on care approaches. We synthesized the literature on indirect care models and extracted data on screening, follow-up, referrals, and management. RESULTS 1169 articles were retrieved. 51 articles were included after review. Most papers were reviews. Fewer addressed care in obstetric (n = 20, 39%), primary care (n = 10, 20%), and pediatric settings (n = 2, 4%). Most papers (n = 30, 59%) discussed using screening instruments for bipolar disorder. Articles were mixed on recommendations for bipolar disorder screening. CONCLUSIONS Varied strategies for structured assessment exist and are influenced by practice setting. There remains uncertainty about optimal strategies for screening and management of perinatal bipolar disorder. We recommend screening for bipolar disorder in the perinatal period in select circumstances (with depression screening, known bipolar disorder risk factors, and prior to starting antidepressants). If specialty mental health care is unavailable, we recommend enhancing usual care through integrated care strategies such as indirect consultation.
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Volkmann C, Bschor T, Köhler S. Lithium Treatment Over the Lifespan in Bipolar Disorders. Front Psychiatry 2020; 11:377. [PMID: 32457664 PMCID: PMC7221175 DOI: 10.3389/fpsyt.2020.00377] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022] Open
Abstract
Lithium has been the treatment of choice for patients with bipolar disorder (BD) for nearly 70 years. It is recommended by all relevant guidelines as a first-line treatment for maintenance therapy. In this review, we outline the current state of evidence for lithium in the treatment of BD over the lifespan. First, we summarize the evidence on efficacy in general, from relapse prevention to acute anti-manic treatment and its role in treating mood episodes with mixed features and bipolar depression. As patients are often treated for many years and different aspects have to be considered in different phases of life, we discuss the particularities of lithium in the treatment of paediatric BD, in older aged individuals and in pregnant women. Lastly, we discuss the evidence on lithium's proposed suicide-preventive effects, the dangers of rapid discontinuation and lithium's adverse effects, particularly with regard to long-term treatment.
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Affiliation(s)
- Constantin Volkmann
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tom Bschor
- Department of Psychiatry, Schlosspark Hospital Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Technical University of Dresden, Dresden, Germany
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Abstract
PURPOSE OF REVIEW Despite being recognized as a first-line treatment for bipolar disorder, there is still inconsistent use of lithium in perinatal populations. This article will review data regarding lithium use during the peripartum and provide management recommendations for general psychiatric clinicians. RECENT FINDINGS In contrast to prior data, recent studies indicate that lithium use in pregnancy is associated with either no increased malformations risk or a small increase in risk for cardiac malformations including Ebstein's anomaly. Limited data also show no significant effect on obstetric or neurodevelopmental outcomes. Data regarding infant lithium exposure via breastmilk remains limited. Lithium is currently under-prescribed and is an important treatment for women with bipolar disorder in pregnancy and the postpartum. Clinicians must weigh the risk of lithium treatment versus the risk of withholding or changing lithium treatment when managing bipolar disorder in this population.
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Poels EMP, Bijma HH, Galbally M, Bergink V. Lithium during pregnancy and after delivery: a review. Int J Bipolar Disord 2018; 6:26. [PMID: 30506447 PMCID: PMC6274637 DOI: 10.1186/s40345-018-0135-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
Abstract
Lithium is an effective treatment in pregnancy and postpartum for the prevention of relapse in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first trimester lithium exposure and an increased risk of congenital malformations. Importantly, the risk estimates from these studies are lower than previously reported. Tapering of lithium during the first trimester could be considered but should be weighed against the risks of relapse. There seems to be no association between lithium use and pregnancy or delivery related outcomes, but more research is needed to be more conclusive. When lithium is prescribed during pregnancy, lithium blood levels should be monitored more frequently than outside of pregnancy and preferably weekly in the third trimester. We recommend a high-resolution ultrasound with fetal anomaly scanning at 20 weeks. Ideally, delivery should take place in a specialised hospital where psychiatric and obstetric care for the mother is provided and neonatal evaluation and monitoring of the child can take place immediately after birth. When lithium is discontinued during pregnancy, lithium could be restarted immediately after delivery as strategy for relapse prevention postpartum. Given the very high risk of relapse in the postpartum period, a high target therapeutic lithium level is recommended. Most clinical guidelines discourage breastfeeding in women treated with lithium. It is highly important that clinicians inform and advise women about the risks and benefits of remaining on lithium in pregnancy, if possible preconceptionally. In this narrative review we provide an up-to-date overview of the literature on lithium use during pregnancy and after delivery leading to clinical recommendations.
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Affiliation(s)
- Eline M P Poels
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Hilmar H Bijma
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Megan Galbally
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - Veerle Bergink
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands. .,Department of Psychiatry and Department of Obstetrics, Gynecology and Reproductive Science, The Blavatnik Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Room L4-34, New York City, NY, 10029, USA.
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Frayne J, Nguyen T, Mok T, Hauck Y, Liira H. Lithium exposure during pregnancy: outcomes for women who attended a specialist antenatal clinic. J Psychosom Obstet Gynaecol 2018; 39:211-219. [PMID: 28617151 DOI: 10.1080/0167482x.2017.1337743] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Lithium treatment in pregnancy represents a significant dilemma for women and treating health professionals alike. The complexity of risk-benefit analysis is impacted by limited information. METHODS A cohort study of 33 women with severe mental illness, who were prescribed lithium at any time during the pregnancy, and gave birth between December 2007 and January 2015 at a specialist antenatal clinic in Western Australia. A descriptive comparison for women who continued lithium throughout pregnancy, and those who ceased on discovery of pregnancy was undertaken examining demographic, obstetric, neonatal and psychiatric variables. RESULTS Women who were prescribed lithium, irrespective of whether they continued or discontinued the medication represented a high risk group obstetrically, with high rates of smoking overall (33%) medical comorbidities (54%) and antenatal complications (88%). Preconception counseling occurred in 33% of the cohort but increased the likelihood of continuing lithium in pregnancy (p = .007). Compared to those who ceased lithium, women who remained on lithium through the pregnancy had increased rates of fetal ultrasound abnormalities such as abdominal circumference >90th % (p = .005). Psychiatric relapses through the antenatal and immediate postpartum period appeared to be due to a combination of factors. DISCUSSION Pregnant women with severe mood disorders treated with lithium are a vulnerable, high-risk obstetric population who would benefit from preconception counseling, regular antenatal care in a tertiary center, delivery with neonatal pediatric support and experienced psychiatric management.
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Affiliation(s)
- Jacqueline Frayne
- a Department of Obstetrics and Gynaecology , Women and Newborn Health Service , Subiaco , Western Australia , Australia.,b School of Medicine, Division of General Practice , University of Western Australia , Western Australia , Australia
| | - Thinh Nguyen
- c School of Medicine, Division of Psychiatry , University of Western Australia , Western Australia , Australia.,d Peel and Rockingham Kwinana Mental Health Services , Western Australia , Australia
| | - Tabitha Mok
- e Department of Psychological Medicine , Women and Newborn Health Service , Subiaco , Western Australia , Australia
| | - Yvonne Hauck
- f Department of Nursing and Midwifery Education , Women and Newborn Health Service , Subiaco , Western Australia , Australia.,g School of Nursing, Midwifery and Paramedicine , Curtin University , Perth , Western Australia , Australia
| | - Helena Liira
- b School of Medicine, Division of General Practice , University of Western Australia , Western Australia , Australia
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Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies. Lancet Psychiatry 2018; 5:644-652. [PMID: 29929874 PMCID: PMC6077091 DOI: 10.1016/s2215-0366(18)30180-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Concerns about teratogenicity and maternal and offspring complications restrict the use of lithium during pregnancy for the treatment of mood disorders. We aimed to investigate the association between in-utero lithium exposure and risk of pregnancy complications, delivery outcomes, neonatal morbidity, and congenital malformations. METHODS In this meta-analysis, primary data from pregnant women and their children from six international cohorts based in the community (Denmark, Sweden, and Ontario, Canada) and in clinics (the Netherlands, UK, and USA) were analysed. Pregnancies were eligible for analysis if the pregnancy resulted in a liveborn singleton between 1997 and 2015, if health-related information was available for both mother and infant, and if the mother had a mood disorder (bipolar disorder or major depressive disorder) or if she had been given lithium during pregnancy (at least two dispensations of lithium during pregnancy that were dispensed any time from 1 month before conception until the delivery, or a single lithium dispensation during pregnancy when there was at least one other lithium dispensation within 6 months before or after this date). Pregnancies during which the mother had been prescribed known teratogenic drugs were excluded. Pregnancies were grouped into a lithium-exposed group and a mood disorder reference group. The main outcome measures were pregnancy complications, delivery outcomes, neonatal readmission to hospital within 28 days of birth, and congenital malformations (major malformations and major cardiac malformations). Analyses were done at each site by use of a shared protocol. Adjusted odds ratios (aORs) and 95% CIs were calculated by use of logistic regression models, and site-specific prevalence rates and ORs were pooled by use of random-effects meta-analytical models. FINDINGS 22 124 eligible pregnancies were identified across the six cohorts, of which 727 pregnancies were eligible for inclusion in the lithium-exposed group (557 [77%] from register-based cohorts and 170 [23%] from clinical cohorts). Lithium exposure was not associated with any of the predefined pregnancy complications or delivery outcomes. An increased risk for neonatal readmission within 28 days of birth was seen in the lithium-exposed group compared with the reference group (pooled prevalence 27·5% [95% CI 15·8-39·1] vs 14·3% [10·4-18·2]; pooled aOR 1·62, 95% CI 1·12-2·33). Lithium exposure during the first trimester was associated with an increased risk of major malformations (pooled prevalence 7·4% [95% CI 4·0-10·7] vs 4·3% [3·7-4·8]; pooled aOR 1·71, 95% CI 1·07-2·72) but for major cardiac malformations the difference was not significant (2·1% [0·5-3·7] vs 1·6% [1·0-2·1]; pooled aOR 1·54, 95% CI 0·64-3·70). INTERPRETATION Considering both the effect sizes and the precision of the estimates in this meta-analysis, treatment decisions for pregnant women with mood disorders must weigh the potential for increased risks of lithium during pregnancy-in particular those associated with use of lithium during the first trimester-against its effectiveness at reducing relapse. FUNDING None.
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Girardi P, Brugnoli R, Manfredi G, Sani G. Lithium in Bipolar Disorder: Optimizing Therapy Using Prolonged-Release Formulations. Drugs R D 2018; 16:293-302. [PMID: 27770296 PMCID: PMC5114200 DOI: 10.1007/s40268-016-0139-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Lithium has been a gold standard in the treatment of bipolar disorder (BD) for several decades. Despite a general reduction in the use of lithium over the past several years, it is effective in the management of both manic and depressive episodes in BD and continues to be recommended as a first-line mood stabilizer. This review provides an overview of the pharmacology of lithium and highlights its clinical profile in the management of BD, focusing on the potential advantages of prolonged-release (PR) versus immediate-release (IR) formulations of lithium. A literature search using PubMed was performed to identify articles describing IR and PR lithium in BD using specific search terms like ‘lithium’, ‘prolonged-release’, ‘sustained-release’, ‘extended-release’, ‘bipolar disorder’, ‘adherence’ and ‘compliance’. Relevant pharmacodynamic and pharmacokinetic data were also included. Several clinical trials suggested that lithium is effective in the treatment of acute mania and prophylaxis of BD and reduces the risk of suicide in patients with BD; it may also be used in combination with other drugs in the treatment of bipolar depression. Treatment with lithium must be monitored to avoid lithium-associated toxicity. The prolonged PR formulation of lithium has several advantages including consistent serum lithium concentrations, fewer adverse events and improved adherence to therapy. Although direct comparative studies between PR and IR formulations of lithium are primarily limited to pharmacokinetic studies, PR formulation of lithium provides potential advantages over IR formulation and can be effectively used in the management of BD with lesser adverse events.
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Affiliation(s)
- Paolo Girardi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy. .,Psychiatric Department of Saint Andrea Hospital of Rome, Via di Grottarossa 1037, 00189, Rome, Italy. .,Centro Lucio Bini, Rome, Italy.
| | - Roberto Brugnoli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,Psychiatric Department of Saint Andrea Hospital of Rome, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Giovanni Manfredi
- Psychiatric Department of Saint Andrea Hospital of Rome, Via di Grottarossa 1037, 00189, Rome, Italy.,Centro Lucio Bini, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,Psychiatric Department of Saint Andrea Hospital of Rome, Via di Grottarossa 1037, 00189, Rome, Italy.,Centro Lucio Bini, Rome, Italy
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Leong C, Raymond C, Château D, Dahl M, Alessi-Severini S, Falk J, Bugden S, Katz A. Psychotropic Drug Use before, during, and after Pregnancy: A Population-Based Study in a Canadian Cohort (2001-2013). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:543-550. [PMID: 28545329 PMCID: PMC5546669 DOI: 10.1177/0706743717711168] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To describe the extent of increase in use and the rate of continuation versus discontinuation of psychotropic agents before, during, and after pregnancy. METHODS Rates of psychotropic use (antidepressants, anxiolytic/sedative-hypnotics, antiepileptics, antipsychotics, lithium, stimulants) among women with a hospital-recorded pregnancy outcome were assessed using databases at the Manitoba Centre for Health Policy. Rate of use was defined as ≥1 prescription over the total number of pregnancies in the 3-12 months before pregnancy, 0-3 months before pregnancy, during pregnancy, or 3 months after pregnancy. Continued use was defined as ≥2 prescriptions with gap ≤14 days. Poisson regression was used to analyze trends. RESULTS Over the study period, a psychotropic drug was used before, during, or after pregnancy in 41,923 of 224,762 pregnancies. From 2001 to 2013, psychotropic use increased 1.5-fold from 11.1% to 16.2% ( p < 0.0001) in the 3-12 months before pregnancy, 1.6-fold from 6.4% to 10.5% ( p < 0.0001) in the 3 months before pregnancy, 1.8-fold from 3.3% to 6.0% ( p < 0.0001) during pregnancy, and 1.5-fold from 6.2% to 9.5% ( p < 0.0001) in the 3 months postpartum. Among the 13,579 women who received at least 1 psychotropic agent in the 3 months prior to pregnancy, 38.5% stopped the agent prior to pregnancy and only 10.3% continued use throughout pregnancy. Continued use throughout pregnancy was higher (56.9%) among the 6693 women who received at least 2 prescriptions for a psychotropic agent and were at least 80% adherent in the 3 months prior to pregnancy. CONCLUSION The use of psychotropic agents increased over 12 years. The safety of continuing versus discontinuing these agents during pregnancy remains uncertain, but we observed a decrease in psychotropic drug use during the pregnancy period.
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Affiliation(s)
- Christine Leong
- 1 College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Colette Raymond
- 2 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Dan Château
- 2 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Matthew Dahl
- 2 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Silvia Alessi-Severini
- 1 College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Jamie Falk
- 1 College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Shawn Bugden
- 1 College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Alan Katz
- 2 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Wieck A. Prevention of bipolar episodes with lithium in the perinatal period. Br J Psychiatry 2017; 211:3-4. [PMID: 28673942 DOI: 10.1192/bjp.bp.116.193508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 11/23/2022]
Abstract
Because lithium is now recommended as the initial long-term treatment for bipolar disorder in general and has a lower teratogenic potential than originally reported, it may become more frequently prescribed in childbearing women. The article by Wesseloo et al in this issue provides helpful data and guidance for managing lithium dosing in the perinatal period.
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Affiliation(s)
- Angelika Wieck
- Argelika Wieck, Dr Med, FRCPsych, Greater Manchester Mental Health NHS Foundation Trust, Department of Psychiatry, Laureate House, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK.
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14
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Westin AA, Brekke M, Molden E, Skogvoll E, Aadal M, Spigset O. Changes in drug disposition of lithium during pregnancy: a retrospective observational study of patient data from two routine therapeutic drug monitoring services in Norway. BMJ Open 2017; 7:e015738. [PMID: 28249852 PMCID: PMC5353288 DOI: 10.1136/bmjopen-2016-015738] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Pregnancy may cause changes in drug disposition, dose requirements and clinical response. For lithium, changes in disposition during pregnancy have so far been explored in a single-dose study on 4 participants only. The aim of this study was to determine the effect of pregnancy on serum levels of lithium in a larger patient material in a naturalistic setting. DESIGN A retrospective observational study of patient data from 2 routine therapeutic drug monitoring services in Norway, linked to the Medical Birth Registry of Norway. SETTING Norway, October 1999 to December 2011. MEASUREMENTS Dose-adjusted drug concentrations of lithium during pregnancy were compared with the women's own baseline (non-pregnant) values, using a linear mixed model. RESULTS Overall, coupling 196 726 serum concentration measurements from 54 393 women to the national birth registry identified 25 serum lithium concentration analyses obtained from a total of 14 pregnancies in 13 women, and 63 baseline analyses from the same women. Dose-adjusted serum concentrations in the third trimester were significantly lower than baseline (-34%; CI -44% to -23%, p<0.001). CONCLUSIONS Pregnancy causes a clinically relevant decline in maternal lithium serum concentrations. In order to maintain stable lithium concentrations during the third trimester of pregnancy, doses generally need to be increased by 50%. Individual variability in decline implies that lithium levels should be even more closely monitored throughout pregnancy and in the puerperium than in non-pregnant women to ensure adequate dosing.
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Affiliation(s)
| | - Malin Brekke
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Eirik Skogvoll
- Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne Aadal
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
- Gildheim General Practice, Trondheim, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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Broeks SC, Thisted Horsdal H, Glejsted Ingstrup K, Gasse C. Psychopharmacological drug utilization patterns in pregnant women with bipolar disorder - A nationwide register-based study. J Affect Disord 2017; 210:158-165. [PMID: 28040641 DOI: 10.1016/j.jad.2016.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/30/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bipolar disorder is often associated with a lifetime indication for treatment with psychotropic drugs, thus pregnant women face the dilemma whether to continue treatment or not. This study describes the psychopharmacological drug utilization patterns among women with bipolar disorder from 12 months preconception to 12 months postpartum. METHODS We conducted a register-based cohort study among all Danish women aged 15-55 with a diagnosis of bipolar disorder, who gave birth to their first and singleton child between January 1997 and December 2012. Psychotropic drug use was determined by prescriptions obtained from the Danish National Prescription Registry. RESULTS We identified 336 women. The proportion of women redeeming prescriptions for any psychotropic drug decreased during pregnancy, from 54.8% in the 3 months preconception to 36.6% in the third trimester (p<0.001). Lithium dosing increased significantly during pregnancy. A total of 35 (41.2%) of the women on psychotropic monotherapy and 37 (50.0%) of the women on psychotropic polypharmacy used an antidepressant without concomitant use of a mood-stabilizer at some time during pregnancy. LIMITATIONS Only redemption of prescriptions was assessable, thus we were not able to assess compliance and discontinuation of treatment before the end of the treatment duration. There was no information on drug use during hospitalizations. CONCLUSIONS We found a decrease in the proportion of women redeeming prescriptions during pregnancy. There was a high prevalence of antidepressant use without a mood-stabilizer, potentially putting women at risk for a switch to mania - although this is still debated. This calls for further investigation.
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Affiliation(s)
- S C Broeks
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - H Thisted Horsdal
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - K Glejsted Ingstrup
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - C Gasse
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
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16
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Petersen I, McCrea RL, Sammon CJ, Osborn DPJ, Evans SJ, Cowen PJ, Freemantle N, Nazareth I. Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records. Health Technol Assess 2017; 20:1-176. [PMID: 27029490 DOI: 10.3310/hta20230] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant. OBJECTIVE(S) (1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy. DESIGN Retrospective cohort studies. SETTING Primary care. PARTICIPANTS Women treated for psychosis who became pregnant, and their children. INTERVENTIONS Treatment with antipsychotics, lithium or anticonvulsant mood stabilisers. MAIN OUTCOME MEASURES Discontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders. DATA SOURCES Clinical Practice Research Datalink database and The Health Improvement Network primary care database. RESULTS Prescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy. LIMITATIONS A few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage. CONCLUSIONS Psychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics. FUTURE WORK Future research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs. FUNDING DETAILS The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rachel L McCrea
- Department of Primary Care and Population Health, University College London, London, UK
| | - Cormac J Sammon
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Stephen J Evans
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Phillip J Cowen
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
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Stevenson F, Hamilton S, Pinfold V, Walker C, Dare CRJ, Kaur H, Lambley R, Szymczynska P, Nicolls V, Petersen I. Decisions about the use of psychotropic medication during pregnancy: a qualitative study. BMJ Open 2016; 6:e010130. [PMID: 26817641 PMCID: PMC4735167 DOI: 10.1136/bmjopen-2015-010130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To understand the perspectives of women with severe mental illness concerning the use of psychotropic medicines while pregnant. DESIGN Interviews conducted by female peer researchers with personal experience of making or considering decisions about using psychotropic medicines in pregnancy, supported by professional researchers. PARTICIPANTS 12 women who had had a baby in the past 5 years and had taken antipsychotics or mood-stabilisers for severe mental illness within the 12-month period immediately prior to that pregnancy. Recruitment to the study was via peer networks and the women interviewed came from different regions of England. SETTING Interviews were arranged in places where women felt comfortable and that accommodated their childcare needs including their home, local library and the research office. RESULTS The views expressed demonstrated complex attempts to engage with decision-making about the use of psychotropic medicines in pregnancy. In nearly all cases, the women expressed the view that healthcare professionals had access to limited information leaving women to rely on experiential and common sense evidence when making decisions about medicine taking during pregnancy. CONCLUSIONS The findings complement existing work using electronic health records by providing explanations for the discontinuation of psychotropic medicines in pregnancy. Further work is necessary to understand health professionals' perspectives on the provision of services and care to women with severe mental illness during pregnancy.
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Affiliation(s)
- Fiona Stevenson
- Department of Primary Care and Population Health, UCL, London, UK
| | | | | | | | | | | | | | - Paulina Szymczynska
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | | | - Irene Petersen
- Department of Primary Care and Population Health, UCL, London, UK
- Department of Clinical Epidemiology, Aarhus, Denmark
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Alosaimi FD, Alhabbad A, Abalhassan MF, Fallata EO, Alzain NM, Alassiry MZ, Haddad BA. Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia. Neuropsychiatr Dis Treat 2016; 12:897-907. [PMID: 27143891 PMCID: PMC4844432 DOI: 10.2147/ndt.s100405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To study the pattern of psychotropic medication use and compare this pattern between inpatient and outpatient psychiatric settings in Saudi Arabia. METHOD This cross-sectional observational study was conducted between July 2012 and June 2014 on patients seeking psychiatric advice at major hospitals in five main regions of Saudi Arabia. Male (n=651) and female (n=594) patients who signed the informed consent form and were currently or had been previously using psychotropic medications, irrespective of the patient's type of psychiatric diagnosis and duration of the disease, were included. A total of 1,246 patients were found to be suitable in the inclusion criteria of whom 464 were inpatients while 782 were outpatients. RESULTS Several studied demographic factors have shown that compared with outpatients, inpatients were more likely to be male (P=0.004), unmarried (P<0.001), have less number of children (1-3; P=0.002), unemployed (P=0.001), have a lower family income (<3,000 SR; P<0.001), live in rural communities (P<0.001), have a lower body mass index (P=0.001), and are smokers (P<0.001); however, there were no differences with regard to age or educational levels. The current frequency of use of psychotropic medications in overall patients was antipsychotics (76.6%), antidepressants (41.4%), mood stabilizers (27.9%), and antianxiety (6.2%). However, compared to outpatients, the current use of medications for inpatients was more frequent (93.8% vs 89.9%, P=0.019) with inpatients more likely to be treated with multiple medications (2.1 vs 1.8 medications). A similar trend was observed in the case of antipsychotics, high potency first-generation antipsychotics, second-generation antipsychotics, mood stabilizers, and antianxiety medicines where inpatients were more frequently treated with these medications for all psychiatric diagnoses when compared with outpatients. On the contrary, in the case of antidepressant treatment, an opposite trend was observed with more number of treated outpatients in comparison to inpatients. Among elderly patients, 75.9% received antipsychotics, mainly second-generation formulations (67.2%), whereas only 41% received antidepressants and 13.8% received mood stabilizers. CONCLUSION Based upon the present study data, it is concluded that among all the psychotropic medications, antipsychotics were heavily used and the frequency was found to be significantly high in the case of inpatients compared with outpatients. Such a practice may lead to multiple negative consequences among the Saudi psychiatric patient population. Further, extensive use of sodium valproate in the case of bipolar disorder, and also among females either in childbearing age or during pregnancy is also the cause of concern and warrants logical use. Overall, this study may help in assessing the burden of psychiatric illness within specific patient demographics and might be effectively used to strategically plan health resources allocation, generate new treatment hypothesis, or be used as a source of evidence that could further integrate other observational studies.
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Affiliation(s)
- Fahad D Alosaimi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Abdulhadi Alhabbad
- Department of Psychiatry, Prince Mohammed Medical City, Aljouf, Saudi Arabia
| | - Mohammed F Abalhassan
- Department of Medicine, Prince Sattam Bin Abdulaz University, Al-Kharj, Saudi Arabia
| | - Ebtihaj O Fallata
- Department of Psychiatry, Mental Health Hospital, Jeddah, Saudi Arabia
| | - Nasser M Alzain
- Department of Psychiatry, Al-Amal complex for Mental health, Dammam, Saudi Arabia
| | | | - Bander Abdullah Haddad
- Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard, Riyadh, Saudi Arabia
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Abstract
Perinatal mental disorders are common and can impact adversely both on maternal functioning and on foetal and neonatal outcomes. For the more severe disorders, such as schizophrenia, bipolar disorder and severe depression, medication may be needed during pregnancy and breastfeeding, and there is a growing but complex evidence based on the effects of psychotropic medication on the foetus and neonate. In addition, the neonatologist needs to be aware of the co-morbid problems that women with mental disorders are more likely to have as these may also impact on the neonate. Close liaison with family physicians and primary care where there are concerns about mental health is important to ensure maternal mental health is optimal for the mother and her infant.
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Affiliation(s)
- Hind Khalifeh
- Section of Women's Mental Health, King's College London, PO31 De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Ruth Brauer
- Section of Women's Mental Health, King's College London, PO31 De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Hilary Toulmin
- Wellcome Trust Research Training Fellow, Centre for the Developing Brain/Division of Imaging Sciences and Biomedical Engineering, King's College London-King's Health Partners, St Thomas' Hospital, London SE1 7EH, United Kingdom.
| | - Louise M Howard
- Section of Women's Mental Health, King's College London, PO31 De Crespigny Park, London SE5 8AF, United Kingdom.
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