Mother-to-Infant Bonding in Women With a Bipolar Spectrum Disorder

Mother-infant interaction and infant development in women at risk of postpartum psychosis with and without a postpartum relapse

BACKGROUND

This study aimed to investigate mother-infant interaction and infant development in women at-risk of postpartum psychosis (PP), with and without a postpartum relapse.

METHODS

103 women (and their offspring) were included, 43 at-risk-of-PP because of a diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 60 with no current/previous mental illness or family history of PP. Of the at-risk women, 18 developed a psychiatric relapse within 4 weeks after delivery (AR-unwell), while 25 remained symptom-free (AR-well). Mother-infant interaction was assessed using the CARE-Index at 8 weeks' and 12 months' postpartum and infant development using the Bayley-III at 12 months' postpartum.

RESULTS

Women at-risk-of-PP as a group, regardless of whether they developed a psychiatric relapse within 4 weeks after delivery, had less synchronous mother-infant interactions and had infants with less optimal cognitive, language, motor and socio-emotional development than healthy controls. In particular, boys of at-risk women had the lowest scores in cognitive, language and motor development and in mother-infant interaction, while girls of the at-risk women had the lowest scores in socio-emotional development. The synchrony in the dyad predicted infant cognitive and language development. There was no evidence for a difference in mother-infant interaction nor in infant development between the AR-unwell and AR-well groups.

CONCLUSIONS

These results suggest that, while there is a lack of evidence that an early postpartum relapse in women at-risk-of-PP could represent a risk for the infant per se, maternal risk for PP may be associated with less optimal mother-infant interaction and infant development.

Neurodevelopment in school-aged children after intrauterine exposure to antipsychotics

OBJECTIVE

Antipsychotics are increasingly prescribed in pregnancy, yet little is known about potential long-term developmental effects on children. In this study, we investigated the effect of prenatal antipsychotic exposure on neurodevelopmental functioning in school-aged children.

METHODS

We performed a cross-sectional neurodevelopmental assessment of 91 children aged 6-14 years whose mothers had severe mental illness and were either exposed or unexposed to antipsychotic medication during pregnancy. Neurodevelopmental outcomes were assessed using validated neurodevelopmental assessment instruments to examine the child's IQ and global cognitive functioning, and the presence of any psychiatric disorders and/or learning problems in the child was assessed by parental report.

RESULTS

No statistically significant associations were found between antipsychotic exposure during pregnancy and either adverse neurodevelopmental outcomes (IQ, neuropsychological function), likelihood of psychiatric diagnosis, or learning problems based on parental report. Analyses were likely limited in power to detect subtler differences in neurodevelopmental functioning because of small sample size and heterogeneity of the sample.

CONCLUSIONS

In this exploratory cohort study, intrauterine exposure to antipsychotics was not associated with any adverse effect on IQ or neurodevelopmental functioning in a cohort of school-aged children (6-14 years).

Mother-Infant Bonding in Patients with Bipolar Disorder

INTRODUCTION

The quality of mother-infant bonding might play a role in future psychopathologies of the infant. The present study aims to compare the mother-infant bonding in mothers with remitted bipolar disorder (BD) and healthy mothers.

METHODS

We included 51 mothers who have bipolar disorder in remission and 53 healthy mothers during postpartum one-year period. All participants were interviewed with Structured Clinical Interview for DSM-IV (SCID-IV). Young Mania Rating Scale and the Hamilton Depression Rating Scale were given to the patient group to evaluate depressive and manic symptoms. Mother-infant bonding in both groups were evaluated with the Postpartum Bonding Questionnaire (PBQ).

RESULTS

There was no significant difference in PBQ scores between the bipolar group and the control group. Age was negatively correlated with PBQ scores in the patient group.

CONCLUSION

Women with bipolar disorder can develop healthy bonding patterns with their babies, during remission.

Being parent is associated with suicidal history in people with serious mental illness enrolled in psychiatric rehabilitation

Parenting is a central life experience that could promote recovery in people with Serious Mental Illness (SMI). It could also be challenging for parents with SMI and result in poor recovery-related outcomes. Parenting is often overlooked in psychiatric rehabilitation. The objectives of the present study were to identify the characteristics and needs for care of mothers and fathers with SMI enrolled in a multicentric non-selected psychiatric rehabilitation SMI sample. We consecutively recruited 1436 outpatients from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). The evaluation included standardized scales for clinical severity, psychosocial function, quality of life and satisfaction with life, wellbeing, personal recovery and a broad cognitive battery. We found that parenting was associated to suicidal history in mothers and fathers with SMI. In the multivariate analysis, being mother was best explained by insight (p < 0.015, adjusted OR = 0.76 [0.59-0.90]), current age (p < 0.001, aOR = 1.13 [1.07-1.21]), education level (p = 0.008; aOR = 0.12 [0.02-0.53]) and family accommodation (p = 0.046, aOR = 0.19 [0.03-0.84]). Being father was best explained by suicidal history (p = 0.005, aOR = 3.85 [1.51-10.10]), marital status (in relationship, p < 0.001; aOR = 7.81 [2.73-23.84]), satisfaction with family relationships (p = 0.032, aOR = 1.22 [1.02-1.47]) and current age (p < 0.001, aOR = 1.16 [1.10-1.23]). In short, parenting was associated to increased history of suicide attempt in mothers and fathers with SMI. Mothers and fathers with SMI may have unique treatment needs relating to parenting and recovery-related outcomes. The implementation of interventions supporting the needs of parents with SMI in psychiatric rehabilitation services could improve parent and children outcomes.