The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale

BACKGROUND

Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.

METHOD

Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.

RESULTS

Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01).

CONCLUSIONS

Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.

A naturalistic comparison of clozapine, risperidone, and olanzapine in the treatment of bipolar disorder

BACKGROUND

Our purpose was to evaluate the overall efficacy and tolerability of novel antipsychotic medications for patients with bipolar disorder type I.

METHOD

A retrospective study of the Massachusetts General Hospital Bipolar Clinic database was carried out to identify 50 consecutive treatment trials in patients with DSM-IV bipolar disorder type I who had received adjunctive treatment with risperidone, olanzapine, or clozapine, along with standard mood stabilizers. The treatment charts of those patients (N = 42) were reviewed for details of adverse effects, tolerability, and efficacy of medication.

RESULTS

Overall results indicated equivalent efficacy in novel antipsychotic treatments according to change in Clinical Global Impressions scale score. Levels of extrapyramidal symptoms were similar in all groups and occurred in 12/42 patients (28.6%). Prolactin-related side effects were not observed in any patients. There were no cases of affective switch or worsening of mania. Substantial weight gain of more than 10 lb (4.5 kg) was significantly greater in patients treated with olanzapine.

CONCLUSION

These results suggest that the efficacy and tolerability of risperidone, olanzapine, and clozapine are similar in patients with bipolar disorder. One major differentiation factor of these drugs appears to be weight gain, particularly between olanzapine and risperidone. This may, in part, also be related to the need to use mood-stabilizing agents, like lithium or divalproex sodium, which may potentiate the weight-gain effect of novel antipsychotics.

Comorbidity of attention deficit hyperactivity disorder with early- and late-onset bipolar disorder

OBJECTIVE

The relationship between attention deficit hyperactivity disorder (ADHD) and earlier age at onset of affective illness was examined in probands with a history of bipolar disorder.

METHOD

The authors assessed 56 adult bipolar subjects. Those with a history of childhood ADHD (N=8) were age and sex matched with bipolar subjects without a history of childhood ADHD (N=8).

RESULTS

The age at onset of the first affective episode was lower for the subjects with bipolar disorder and a history of childhood ADHD (mean=12.1 years, SD=4.6) than for those without a history of childhood ADHD (mean=20. 0 years, SD=11.3).

CONCLUSIONS

ADHD in children of bipolar probands might identify children at highest risk for development of bipolar disorder.

Weight gain associated with use of psychotropic medications

Weight gain is associated with the use of many psychotropic medications, including lithium, valproic acid, and several conventional and newer antipsychotics. Patients asked to select from among several comparable drugs often choose the one least likely to cause weight gain, even if the drug is less effective or has other troublesome adverse effects. For many patients, weight gain is so intolerable that they discontinue treatment. Patients who continue treatment are at risk for clinically significant weight gain that can progress to obesity. Even after patients stop taking the drug, weight gained during therapy may be difficult to lose. Thus, the best approach is to attempt to prevent weight gain when feasible, possibly through pretreatment dietary counseling and judicious drug selection, and to intervene as soon as weight gain becomes evident.

Does feminism serve a protective function against eating disorders?

ABSTRACT Two hundred seventeen women completed the Kinsey Sexual Orientation Scale, the Feminist Identity Scale, and three questionnaires that measured eating attitudes and behaviors. Lesbian participants were significantly more likely than heterosexual participants to work actively to improve the status of women, and they were less likely than heterosexuals to report attitudes and behaviors that are associated with eating disorders. Older women were more committed to feminist activism than younger women. Although feminist identity scores did not directly predict eating attitudes and behaviors, evidence suggests that feminism may serve a protective function against eating disorders in lesbians.