1
|
Dodd CG, Kirk CL, Rathouz PJ, Custer J, Garrett AS, Taylor L, Rousseau JF, Claasen C, Morgan MM, Newport DJ, Wagner KD, Nemeroff CB. Comparing diagnostic criteria for posttraumatic stress disorder in a diverse sample of trauma-exposed youth. J Trauma Stress 2024. [PMID: 38565718 DOI: 10.1002/jts.23037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
Divergent conceptualization of posttraumatic stress disorder (PTSD) within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) and International Statistical Classification of Diseases and Related Health Problems (11th ed..; ICD-11) significantly confounds both research and practice. Using a diverse sample of trauma-exposed youth (N = 1,542, age range: 8-20 years), we compared these two diagnostic approaches along with an expanded version of the ICD-11 PTSD criteria that included three additional reexperiencing symptoms (ICD-11+). Within the sample, PTSD was more prevalent using the DSM-5 criteria (25.7%) compared to the ICD-11 criteria (16.0%), with moderate agreement between these diagnostic systems, κ = .57. The inclusion of additional reexperiencing symptoms (i.e., ICD-11+) reduced this discrepancy in prevalence (24.7%) and increased concordance with DSM-5 criteria, κ = .73. All three PTSD classification systems exhibited similar comorbidity rates with major depressive episode (MDE) or generalized anxiety disorder (GAD; 78.0%-83.6%). Most youths who met the DSM-5 PTSD criteria also met the criteria for ICD-11 PTSD, MDE, or GAD (88.4%), and this proportion increased when applying the ICD-11+ criteria (95.5%). Symptom-level analyses identified reexperiencing/intrusions and negative alterations in cognition and mood symptoms as primary sources of discrepancy between the DSM-5 and ICD-11 PTSD diagnostic systems. Overall, these results challenge assertions that nonspecific distress and diagnostically overlapping symptoms within DSM-5 PTSD inflate comorbidity with depressive and anxiety disorders. Further, they support the argument that the DSM-5 PTSD criteria can be refined and simplified without reducing the overall prevalence of psychiatric diagnoses in youth.
Collapse
Affiliation(s)
- Cody G Dodd
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Claire L Kirk
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Paul J Rathouz
- Department of Population Health University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - James Custer
- Department of Population Health University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Amy S Garrett
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Leslie Taylor
- Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Justin F Rousseau
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cynthia Claasen
- Department of Psychiatry and Behavioral Health Services, University of North Texas Health Sciences Center, Fort Worth, Texas, USA
| | - Myesha M Morgan
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - D Jeffrey Newport
- Department of Women's Health, University of Texas at Austin Dell Medical School, Austin, Texas, USA
- Department of Psychiatry & Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Karen D Wagner
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Charles B Nemeroff
- Department of Psychiatry & Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| |
Collapse
|
2
|
Srivastava AV, Brown R, Newport DJ, Rousseau JF, Wagner KD, Guzick A, Devargas C, Claassen C, Ugalde IT, Garrett A, Gushanas K, Liberzon I, Cisler JM, Nemeroff CB. The role of resilience in the development of depression, anxiety, and post-traumatic stress disorder after trauma in children and adolescents. Psychiatry Res 2024; 334:115772. [PMID: 38442477 DOI: 10.1016/j.psychres.2024.115772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/07/2024]
Abstract
This investigation, conducted within the Texas Childhood Trauma Research Network, investigated the prospective relationships between resiliency and emergent internalizing symptoms among trauma-exposed youth. The cohort encompassed 1262 youth, aged 8-20, from twelve health-related institutions across Texas, who completed assessments at baseline and one- and six-month follow-ups for resiliency, symptoms of depression, generalized anxiety, posttraumatic stress disorder (PTSD), and other demographic and clinical characteristics. At baseline, greater resilience was positively associated with older age, male (vs female) sex assigned at birth, and history of mental health treatment. Unadjusted for covariates, higher baseline resilience was associated with greater prospective depression and PTSD symptoms but not anxiety symptoms. Upon adjusting for demographic and clinical factors, higher baseline resilience was no longer associated with depression, PTSD, or anxiety symptoms. Our analyses demonstrate that the predictive value of resilience on psychopathology is relatively small compared to more readily observable clinical and demographic factors. These data suggest a relatively minor prospective role of resilience in protecting against internalizing symptoms among trauma-exposed youth and highlight the importance of controlling for relevant youth characteristics when investigating a protective effect of resilience on internalizing symptoms.
Collapse
Affiliation(s)
- Arjun V Srivastava
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity Blvd, Austin, TX 78701, USA
| | - Ryan Brown
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity Blvd, Austin, TX 78701, USA
| | - D Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity Blvd, Austin, TX 78701, USA; Department of Women's Health, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Justin F Rousseau
- Department of Population Health, University of Texas at Austin Dell Medical School, Austin, TX, USA; Department of Neurology, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Karen D Wagner
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrew Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Cecilia Devargas
- Department of Psychiatry, Texas Tech University Health Sciences Center - El Paso Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Cynthia Claassen
- Department of Psychiatry, JPS Health Network / University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Irma T Ugalde
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amy Garrett
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Kim Gushanas
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Israel Liberzon
- Department of Psychiatry and Behavioral Sciences, Texas A&M University School of Medicine, Bryan, TX, USA
| | - Josh M Cisler
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity Blvd, Austin, TX 78701, USA.
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity Blvd, Austin, TX 78701, USA
| |
Collapse
|
3
|
Aksan N, Guzick AG, Taylor L, Richmond R, Liberzon I, Cross J, Garza C, Rousseau J, Shahidullah JD, Clark SL, Rathouz PJ, Dodd CG, Cisler J, Newport DJ, Wagner KD, Nemeroff CB. Evaluating traumatic event scoring schemas for their predictive value to concurrent diagnostic profiles: Texas Childhood Trauma Research Network. J Affect Disord 2024; 345:94-102. [PMID: 37848091 DOI: 10.1016/j.jad.2023.10.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND To prospectively chart pathways of risk and resiliency following childhood trauma studies need to address three limitations of prior work: 1) recruit beyond social service/ treatment settings; 2) include broad spectrum of trauma types and 3) cast a broad longitudinal measurement framework of both clinical diagnoses and traumatic exposures. The Texas-Childhood Trauma Research Network (TX-CTRN) is a multi-site collaboration that addresses these limitations. In this baseline-only report, we examined domains of trauma and evaluated the concurrent predictive validity of various traumatic event scoring schemas for clinical diagnoses. METHODS Broad-base recruitment of 8-20 year-olds (N = 1289) included trauma centers, emergency departments, pediatric and primary care clinics, and other community settings. Assessments were comprehensive and based on clinical interviews by trained research interviewers. RESULTS Factor analyses supported a five-factor solution of trauma domains including unintentional/acute, intentional/interpersonal, bullying, in-home versus community witnessed interpersonal harms. Trauma burden scoring schemas were examined for their predictive superiority. Domain-specific counts of traumas that met DSM-5 post-traumatic-stress disorder (PTSD) Criterion-A was the best overall schema in distinguishing among youth with no diagnosis, comorbidities, those with depression, suicidality, substance misuse, and PTSD. LIMITATIONS There were no assessments of neglect. CONCLUSIONS Findings largely aligned with earlier studies on the relative importance of intentional interpersonal traumas and showed bullying may be an important source of traumatic stress that independently adds to prediction of several diagnoses and should be considered in clinical practice.
Collapse
Affiliation(s)
- Nazan Aksan
- Dept of Population Health, Dell Medical School, University of Texas at Austin, United States of America.
| | - Andrew G Guzick
- Dept of Psychiatry, Baylor College of Medicine, University of Pennsylvania, United States of America
| | - Leslie Taylor
- Dept of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, Houston, United States of America
| | - Robyn Richmond
- Dept of Surgery, Texas Tech University Lubbock, United States of America
| | - Israel Liberzon
- Dept of Psychiatry, Texas A&M University, United States of America
| | - Jeremyra Cross
- Dept of Psychiatry, University of Texas Health Science Center, San Antonio, United States of America
| | - Cynthia Garza
- Adult Primary Care University of Texas Health Science Center Rio Grande Valley, United States of America
| | - Justin Rousseau
- Dept of Population Health, Dell Medical School, University of Texas at Austin, United States of America; Dept of Neurology, Dell Medical School, University of Texas at Austin, United States of America
| | - Jeffrey D Shahidullah
- Dept of Psychiatry, Dell Medical School, University of Texas at Austin, United States of America
| | - Shaunna L Clark
- Dept of Psychiatry, Texas A&M University, United States of America
| | - Paul J Rathouz
- Dept of Population Health, Dell Medical School, University of Texas at Austin, United States of America
| | - Cody G Dodd
- Dept of Psychiatry & Behavioral Sciences, University of Texas Medical Branch, United States of America
| | - Josh Cisler
- Dept of Psychiatry, Dell Medical School, University of Texas at Austin, United States of America
| | - D Jeffrey Newport
- Dept of Psychiatry, Dell Medical School, University of Texas at Austin, United States of America
| | - Karen D Wagner
- Dept of Psychiatry & Behavioral Sciences, University of Texas Medical Branch, United States of America
| | - Charles B Nemeroff
- Dept of Psychiatry, Dell Medical School, University of Texas at Austin, United States of America
| |
Collapse
|
4
|
Mattera JA, Campagna AX, Goodman SH, Gartstein MA, Hancock GR, Stowe ZN, Newport DJ, Knight BT. Associations between mothers' and fathers' depression and anxiety prior to birth and infant temperament trajectories over the first year of life: Evidence from diagnoses and symptom severity. J Affect Disord 2023; 343:31-41. [PMID: 37741466 PMCID: PMC10672733 DOI: 10.1016/j.jad.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Developmental shifts in infant temperament predict distal outcomes including emerging symptoms of psychopathology in childhood. Thus, it is critical to gain insight into factors that shape these developmental shifts. Although parental depression and anxiety represent strong predictors of infant temperament in cross-sectional research, few studies have examined how these factors influence temperament trajectories across infancy. METHODS We used latent growth curve modeling to examine whether mothers' and fathers' anxiety and depression, measured in two ways - as diagnostic status and symptom severity - serve as unique predictors of developmental shifts in infant temperament from 3 to 12 months. Participants included mothers (N = 234) and a subset of fathers (N = 142). Prior to or during pregnancy, both parents were assessed for lifetime diagnoses of depression and anxiety as well as current severity levels. Mothers rated their infants' temperament at 3, 6, and 12 months of age. RESULTS Mothers' depression and anxiety primarily predicted initial levels of temperament at 3 months. Controlling for mothers' symptoms, fathers' depression and anxiety largely related to temperament trajectories across infancy. Lifetime diagnoses and symptom severities were associated with distinct patterns. LIMITATIONS Infant temperament was assessed using a parent-report measure. Including an observational measure would provide a more comprehensive picture of the infants' functioning. CONCLUSIONS These results indicate that mothers' and fathers' mental health are uniquely associated with infant temperament development when measured using diagnostic status and/or symptom severity. Future studies should examine whether these temperament trajectories mediate intergenerational transmission of risk for depression and anxiety.
Collapse
Affiliation(s)
| | | | | | - Maria A Gartstein
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Zachary N Stowe
- Department of Psychiatry and Behavioral Sciences, University of Wisconsin at Madison, Madison, WI, USA
| | - D Jeffrey Newport
- Departments of Psychiatry & Behavioral Sciences and Women's Health, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Bettina T Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
5
|
Clark SL, Dodd CG, Taylor L, Stewart S, Yang N, Shahidullah JD, Guzick AG, Richmond R, Aksan N, Rathouz PJ, Rousseau JF, Newport DJ, Wagner KD, Nemeroff CB. Characterizing patterns of substance use in trauma exposed youth. J Psychiatr Res 2023; 167:1-9. [PMID: 37778242 DOI: 10.1016/j.jpsychires.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/17/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Previous work investigating the impact of childhood trauma on substance use and co-occurring psychiatric disorders has primarily been conducted in adults or on specific trauma types. This limits understanding of traumas impact in childhood and how different types of traumas play a role. We sought to characterize substance use in a sample of trauma-exposed youth in the context of psychiatric comorbidities. METHOD 1152 youth from the Texas Childhood Trauma Research Network (TX-CTRN) that were exposed to at least one trauma meeting DSM-5 Criterion A were assessed for current substance use and psychiatric diagnoses. Latent class analysis was used to identify patterns of substance use. To characterize these patterns, we examined if demographics, number of trauma types experienced, or childhood psychiatric disorders predicted class membership. RESULTS We identified four primary patterns of substance use: Non-use (66.1%), predominantly alcohol use (19.7%), predominantly cannabis use (4.5%), and polysubstance use (9.7%). Compared to the non-users, polysubstance users tended to be older, Non-Hispanic White, have experienced more types of trauma. They were also more likely to have fulfilled diagnostic criteria for suicidality and ADHD. Comparisons among the substance using classes were more nuanced. CONCLUSION The findings highlight the need for universal assessments of trauma, substance misuse, and mental health symptoms in youth as the presence or absence of their co-occurrence has implications for treatment.
Collapse
Affiliation(s)
| | - Cody G Dodd
- University of Texas Medical Branch, United States
| | - Leslie Taylor
- University of Texas Health Science Center, United States
| | | | | | | | | | - Robyn Richmond
- Texas Tech University Health Sciences Center, United States
| | - Nazan Aksan
- University of Texas at Austin, United States
| | | | | | | | | | | |
Collapse
|
6
|
Pingeton BC, Cochran A, Goodman SH, Laurent H, Sbrilli MD, Knight B, Newport DJ, Stowe ZN. Positive affect improves a transdiagnostic model of perinatal depression symptoms. J Affect Disord 2023; 336:112-119. [PMID: 37230263 PMCID: PMC10448502 DOI: 10.1016/j.jad.2023.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Accurate measurement of perinatal depression is vital. We aimed to 1) test whether a factor that measured positive affect (PA) bettered a transdiagnostic model of depression symptoms and 2) replicate the model in a second sample. METHODS We conducted secondary analyses from two samples (n's = 657 and 142) of women in treatment at perinatal psychiatric clinics. Data were derived from items from seven commonly used measures. We compared fit indices from our original factor model-one general and six specific factors derived from the Research Domain Criteria (Loss, Potential Threat, Frustrative Nonreward, and Sleep-Wakefulness) and depression literatures (Somatic and Coping)-to our novel factor model with a PA factor. The PA factor was created by recategorizing items that measured affective states with a positive valence into a new factor. Sample 1 data were split into six perinatal periods. RESULTS In both samples, the addition of a PA factor improved model fit. At least partial metric invariance was found between perinatal periods, with the exception of trimester 3 - postpartum period 1. LIMITATIONS Our measures did not operationalize PA in the same way as in the positive valence system in RDoC and we were unable to perform longitudinal analyses on our cross-validation sample. CONCLUSIONS Clinicians and researchers are encouraged to consider these findings as a template for understanding symptoms of depression in perinatal patients, which can be used to guide treatment planning and the development of more effective screening, prevention, and intervention tools to prevent deleterious outcomes.
Collapse
Affiliation(s)
- Blaire C Pingeton
- Department of Psychology, Emory University, United States of America.
| | - Amy Cochran
- Department of Mathematics, Department of Population Health Sciences, University of Wisconsin, United States of America
| | - Sherryl H Goodman
- Department of Psychology, Emory University, United States of America
| | - Heidemarie Laurent
- Department of Psychology, University of Illinois at Urbana-Champaign, United States of America
| | - Marissa D Sbrilli
- Department of Psychology, University of Illinois at Urbana-Champaign, United States of America
| | - Bettina Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, United States of America
| | - D Jeffrey Newport
- Departments of Psychiatry and Behavioral Sciences and Women's Health, University of Texas at Austin Dell Medical School, United States of America
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin at Madison, United States of America
| |
Collapse
|
7
|
Shahidullah JD, Custer J, Widales-Benitez O, Aksan N, Hatchell C, Newport DJ, Wagner KD, Storch EA, Claassen C, Garrett A, Ugalde IT, Weber W, Nemeroff CB, Rathouz PJ. Establishing a training plan and estimating inter-rater reliability across the multi-site Texas childhood trauma research network. Psychiatry Res 2023; 323:115168. [PMID: 36931015 DOI: 10.1016/j.psychres.2023.115168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Minimal guidance is available in the literature to develop protocols for training non-clinician raters to administer semi-structured psychiatric interviews in large, multi-site studies. Previous work has not produced standardized methods for maintaining rater quality control or estimating interrater reliability (IRR) in such studies. Our objective is to describe the multi-site Texas Childhood Trauma Research Network (TX-CTRN) rater training protocol and activities used to maintain rater calibration and evaluate protocol effectiveness. METHODS Rater training utilized synchronous and asynchronous didactic learning modules, and certification involved critique of videotaped mock scale administration. Certified raters attended monthly review meetings and completed ongoing scoring exercises for quality assurance purposes. Training protocol effectiveness was evaluated using individual measure and pooled estimated IRRs for three key study measures (TESI-C, CAPS-CA-5, MINI-KID [Major Depressive Episodes - MDE & Posttraumatic Stress Disorder - PTSD modules]). A random selection of video-recorded administrations of these measures was evaluated by three certified raters to estimate agreement statistics, with jackknife (on the videos) used for confidence interval estimation. Kappa, weighted kappa and intraclass correlations were calculated for study measure ratings. RESULTS IRR agreement across all measures was strong (TESI-C median kappa 0.79, lower 95% CB 0.66; CAPS-CA-5 median weighted kappa 0.71 (0.62), MINI-MDE median kappa 0.71 (0.62), MINI-PTSD median kappa 0.91 (0.9). The combined estimated ICC was ≥0.86 (lower CBs ≥0.69). CONCLUSIONS The protocol developed by TX-CTRN may serve as a model for other multi-site studies that require comprehensive non-clinician rater training, quality assurance guidelines, and a system for assessing and estimating IRR.
Collapse
Affiliation(s)
- Jeffrey D Shahidullah
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.
| | - James Custer
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Oscar Widales-Benitez
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Nazan Aksan
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Carly Hatchell
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - D Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA; Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Karen Dineen Wagner
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Amy Garrett
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Irma T Ugalde
- Department of Emergency Medicine, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - Wade Weber
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Paul J Rathouz
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
8
|
Nieser KJ, Stowe ZN, Newport DJ, Coker JL, Cochran AL. Detection of differential depressive symptom patterns in a cohort of perinatal women: an exploratory factor analysis using a robust statistics approach. EClinicalMedicine 2023; 57:101830. [PMID: 36798754 PMCID: PMC9925853 DOI: 10.1016/j.eclinm.2023.101830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/10/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Postpartum depression can take many forms. Different symptom patterns could have divergent implications for how we screen, diagnose, and treat postpartum depression. We sought to utilise a recently developed robust estimation algorithm to automatically identify differential patterns in depressive symptoms and subsequently characterise the individuals who exhibit different patterns. METHODS Depressive symptom data (N = 548) were collected from women with neuropsychiatric illnesses at two U.S. urban sites participating in a longitudinal observational study of stress across the perinatal period. Data were collected from Emory University between 1994 and 2012 and from the University of Arkansas for Medical Sciences between 2012 and 2017. We conducted an exploratory factor analysis of Beck Depression Inventory (BDI) items using a robust expectation-maximization algorithm, rather than a conventional expectation-maximization algorithm. This recently developed method enabled automatic detection of differential symptom patterns. We described differences in symptom patterns and conducted unadjusted and adjusted analyses of associations of symptom patterns with demographics and psychiatric histories. FINDINGS 53 (9.7%) participants were identified by the algorithm as having a different pattern of reported symptoms compared to other participants. This group had more severe symptoms across all items-especially items related to thoughts of self-harm and self-judgement-and differed in how their symptoms related to underlying psychological constructs. History of social anxiety disorder (OR: 4.0; 95% CI [1.9, 8.1]) and history of childhood trauma (for each 5-point increase, OR: 1.2; 95% CI [1.1, 1.3]) were significantly associated with this differential pattern after adjustment for other covariates. INTERPRETATION Social anxiety disorder and childhood trauma are associated with differential patterns of severe postpartum depressive symptoms, which might warrant tailored strategies for screening, diagnosis, and treatment to address these comorbid conditions. FUNDING There are no funding sources to declare.
Collapse
Affiliation(s)
- Kenneth J. Nieser
- Department of Population Health Sciences, University of Wisconsin–Madison, United States
| | - Zachary N. Stowe
- Department of Psychiatry, University of Wisconsin–Madison, United States
| | - D. Jeffrey Newport
- Department of Psychiatry & Behavioral Sciences, University of Texas at Austin Dell Medical School, United States
- Department of Women's Health, University of Texas at Austin Dell Medical School, United States
| | - Jessica L. Coker
- Department of Psychiatry, University of Arkansas for Medical Sciences, United States
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, United States
| | - Amy L. Cochran
- Department of Population Health Sciences, University of Wisconsin–Madison, United States
- Department of Mathematics, University of Wisconsin–Madison, United States
- Corresponding author. Department of Population Health Sciences, University of Wisconsin–Madison, 610 Walnut Street, Madison, WI, 53726, United States.
| |
Collapse
|
9
|
Cahill AG, Olshavsky ME, Newport DJ, Benzer J, Chambers KM, Custer J, Rathouz PJ, Nutt S, Jwaied S, Leslie R, Matsui EC. Occupational Risk Factors and Mental Health Among Frontline Health Care Workers in a Large US Metropolitan Area During the COVID-19 Pandemic. Prim Care Companion CNS Disord 2022; 24. [DOI: 10.4088/pcc.21m03166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
10
|
Sharp SJ, Bond MA, Chiang KS, Collier SJ, Farrington J, Lanza di Scalea T, Nemeroff CB, Newport DJ, Spelber DA, Strakowski SM, Almeida J. Validity and severity thresholds for the depression subscale of the affective self rating scale: An equipercentile equating study using classical test theory. J Affect Disord 2022; 296:541-548. [PMID: 34606804 DOI: 10.1016/j.jad.2021.09.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 09/09/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Affective Symptoms Scale (ASRS) is a unique instrument designed to separately measure depressive and manic symptoms in mood disorders. We validated the ASRS against the Patient Health Questionnaire (PHQ-9) and the Quick Inventory of Depressive Symptomatology (QIDS-16). METHODS A retrospective study of 258 patients who completed the PHQ-9, QIDS-16 and ASRS as part of routine clinical care. To establish meaningful clinical thresholds for the depression subscale of the ASRS, it was equated with the QIDS and the PHQ-9. RESULTS The depression subscale of the ASRS had significant positive correlations with the QIDS-16 and the PHQ-9 (respectively, r= 0.8, t[253] = 19.8, p < 0.001, and r= 0.8, t[245] = 28.2, p < 0.001). The equipercentile equating method with the PHQ-9 indicated that the thresholds corresponded to ASRS depression subscale scores of 5.4, 10.6, 16.1, and 23. Equating with the QIDS indicated that thresholds corresponded to ASRS depression subscale scores of 5.1, 11, 18.4, and 27.5. LIMITATIONS Limitations include a small sample size that did not allow more detailed statistical analysis, such as Item Response Theory. The population is a heterogenous population at a university outpatient setting. CONCLUSIONS The ASRS depression subscale significantly correlated with the PHQ-9 and QIDS-16. Our proposed threshold scores for the ASRS are 5, 11, 16 and 23 to indicated mild, moderate, severe and very severe depression respectively.
Collapse
Affiliation(s)
- S J Sharp
- University of Texas Austin - Dell Medical School, Texas, USA.
| | - M A Bond
- University of Texas Austin - Dell Medical School, Texas, USA
| | - K S Chiang
- University of Texas Austin - Dell Medical School, Texas, USA
| | - S J Collier
- University of Texas Austin - Dell Medical School, Texas, USA
| | - J Farrington
- University of Texas Austin - Dell Medical School, Texas, USA
| | | | - C B Nemeroff
- University of Texas Austin - Dell Medical School, Texas, USA
| | - D J Newport
- University of Texas Austin - Dell Medical School, Texas, USA
| | - D A Spelber
- University of Texas Austin - Dell Medical School, Texas, USA
| | - S M Strakowski
- University of Texas Austin - Dell Medical School, Texas, USA
| | - Jrc Almeida
- University of Texas Austin - Dell Medical School, Texas, USA
| |
Collapse
|
11
|
Baez LM, Newport DJ, Stowe ZN, Knight BT, Heller AS. The severity and role of somatic depressive symptoms in psychological networks in a longitudinal sample of peripartum women. J Psychiatr Res 2021; 142:283-289. [PMID: 34403970 PMCID: PMC8429214 DOI: 10.1016/j.jpsychires.2021.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/09/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
The inclusion of somatic symptoms in assessing peripartum depression (PPD), which encompasses depression during pregnancy and the postpartum period, has remained controversial, as there is substantial overlap between somatic depression symptoms and normal features of pregnancy/postpartum. This study examined whether trajectories differed by PPD symptom subscale and whether PPD symptom networks changed as a function of the peripartum phase. 418 women with a history of neuropsychiatric illness participated in a longitudinal observational study, completing symptom questionnaires assessing affective, cognitive, and somatic symptoms throughout pregnancy and the first year postpartum. Assessments were grouped into five peripartum phases: three trimesters of pregnancy and early/late postpartum. Two analyses were performed. First, a series of multilevel spline regression models examined depression subscale trajectories over peripartum phase. Second, symptom networks and related metrics were estimated for each peripartum phase and compared. Somatic symptoms were most severe and had the most variable peripartum trajectory. The role of somatic symptoms within the networks also changed as a function of peripartum phase. Our results suggest that somatic symptoms can be severe and may play a crucial role in the maintenance of PPD. Thus, somatic symptoms should not be disregarded when assessing for PPD in obstetrical, psychiatric, and pediatric clinics, and clinical research.
Collapse
Affiliation(s)
- Lara Michelle Baez
- University of Miami, Department of Psychology, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33124, USA.
| | - D Jeffrey Newport
- The University of Texas at Austin Dell Medical School, Departments of Psychiatry & Behavioral Sciences and Women's Health, 1601 Trinity Street, Austin TX, 78712, USA.
| | - Zachary N Stowe
- University of Wisconsin at Madison, Wisconsin Psychiatric Institute and Clinics, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA.
| | - Bettina T Knight
- University of Arkansas for Medical Sciences, Department of Psychiatry, 4301 West Markham St., Little Rock, AR, 72205-7199, USA.
| | - Aaron Shain Heller
- University of Miami, Department of Psychology, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33124, USA.
| |
Collapse
|
12
|
Goodman SH, Liu R, Lusby CM, Park JS, Bell MA, Newport DJ, Stowe ZN. Consistency of EEG asymmetry patterns in infants of depressed mothers. Dev Psychobiol 2020; 63:768-781. [PMID: 33067826 DOI: 10.1002/dev.22046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 01/15/2023]
Abstract
We evaluated frontal electroencephalogram (EEG) asymmetry across multiple contexts as an index of a general affective response predisposition in 12-month-old infants whose mothers were at elevated risk for perinatal depression due to their mother's history of depression. We further examined mothers' prenatal, postnatal, and concurrent depressive symptom levels in relation to infants' frontal EEG asymmetry consistency. Mothers (n = 132) with a history of depression prior to pregnancy completed depressive symptom scales repeatedly during pregnancy and the first year postpartum. Their 12-month-old infants' frontal EEG asymmetry was recorded across five contexts (baseline/bubbles, peek-a-boo, play, feeding, and distract). Frontal EEG asymmetries showed small to moderate correlations across contexts. Mothers' prenatal depression symptom levels (not postnatal or concurrent) were associated with infants having consistent right, rather than left, frontal EEG asymmetry, even after controlling for infants' observed affect. These findings demonstrate the consistency of EEG asymmetry scores across contexts in 12-month-old infants at risk for the development of psychopathology, providing support for relative right frontal EEG asymmetry as a trait marker of vulnerability to depression. Findings also suggest the importance of mothers' prenatal, rather than postnatal or concurrent depression, in predicting infants' consistent patterns of relative right frontal EEG asymmetry across contexts.
Collapse
Affiliation(s)
| | - Ran Liu
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Cara M Lusby
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Ji Soo Park
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Martha Ann Bell
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | | | - Zachary N Stowe
- Department of Psychology, Emory University, Atlanta, GA, USA
| |
Collapse
|
13
|
Cochran AL, Pingeton BC, Goodman SH, Laurent H, Rathouz PJ, Newport DJ, Stowe ZN. A transdiagnostic approach to conceptualizing depression across the perinatal period in a high-risk sample. J Abnorm Psychol 2020; 129:689-700. [PMID: 32852962 PMCID: PMC7541773 DOI: 10.1037/abn0000612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clinical guidelines recommend assessing depression during pregnancy and postpartum but often overlook potential changes in symptoms across this developmental period. Such changes contribute to difficulties in conceptualizing maternal depression. This study aimed to situate depressive symptoms and related concerns (anxiety, stress, sleep) across the perinatal period within a transdiagnostic framework and to use this framework to better understand how depressive symptoms change across the perinatal period. First, items from seven symptom scales were a priori categorized into six transdiagnostic factors: four based on Research Domain Criteria (loss, potential threat, frustrative nonreward, and sleep-wakefulness) and two based on the depression literature (somatic and coping symptoms). Second, using prospective data from women with a history of an affective disorder (n = 657) in an observational study of neuropsychiatric illness, factor analyses were performed in seven periods (three trimesters of pregnancy and four quarters of first year postpartum). For each period, a bifactor model with six transdiagnostic factors and a general factor fit data better than models that combined or dropped a factor (p < .003). Except around delivery, item loadings and intercepts could be fixed between consecutive periods and still adequately fit data from both periods. Means of sleep-wakefulness and somatic factors increased significantly from second to third trimester (p < .01), with trends reversing early postpartum. In conclusion, depressive symptoms and related concerns exhibit factor structures that are only partly congruent across the perinatal period. This conclusion suggests that greater attention to specific life phases is warranted in the conceptualization of depression during this time in women's lives. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
14
|
McKenna BG, Hendrix CL, Brennan PA, Smith AK, Stowe ZN, Newport DJ, Knight AK. Maternal prenatal depression and epigenetic age deceleration: testing potentially confounding effects of prenatal stress and SSRI use. Epigenetics 2020; 16:327-337. [PMID: 32660321 DOI: 10.1080/15592294.2020.1795604] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Previous studies suggest epigenetic alterations may contribute to the association between maternal prenatal depression and adverse offspring outcomes. Developmental researchers have recently begun to examine these associations in relation to epigenetic age acceleration/deceleration, a biomarker of developmental risk that reflects the deviation between epigenetic age and chronological age. In the perinatal period, preliminary studies indicate that maternal prenatal depression may lead to epigenetic age deceleration in newborns, which may predict adverse developmental outcomes. The present study examined the relationship between maternal prenatal exposures (i.e., depression, stress, and SSRI use) and offspring epigenetic age deceleration in 303 mother-offspring dyads. Women were recruited in the first trimester of pregnancy and followed longitudinally until delivery. Maternal depression, perceived stress, and SSRI use were assessed at each prenatal visit. Newborn epigenetic age was determined via cord blood samples. Results indicated maternal prenatal stress was not associated with newborn epigenetic age deceleration (ΔR2 = 0.002; p = 0.37). Maternal prenatal depression was associated with decelerated epigenetic age (ΔR2 = 0.01, p = 0.04), but this relationship did not hold when accounting for maternal use of SSRIs (ΔR2 = 0.002, p = 0.43). Conversely, maternal SSRI use significantly predicted newborn epigenetic age deceleration over and above the influence of maternal depression (ΔR2 = 0.03, p = 0.001). These findings suggest maternal prenatal SSRI use may significantly contribute to the previously documented association between maternal prenatal depression and epigenetic age deceleration. Further studies are needed to examine how these epigenetic differences at birth may contribute to adverse outcomes in later development.
Collapse
Affiliation(s)
| | | | | | - Alicia K Smith
- Department of Gynecology and Obstetrics, Emory University , Atlanta, GA, USA.,Department of Psychiatry and Behavioral Sciences, Emory University , Atlanta, GA, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin , Madison, WI, USA
| | - D Jeffrey Newport
- Department of Psychiatry, University of Texas at Austin , Austin, TX, USA
| | - Anna K Knight
- Department of Gynecology and Obstetrics, Emory University , Atlanta, GA, USA
| |
Collapse
|
15
|
Vega ML, Newport GC, Bozhdaraj D, Saltz SB, Nemeroff CB, Newport DJ. Implementation of Advanced Methods for Reproductive Pharmacovigilance in Autism: A Meta-Analysis of the Effects of Prenatal Antidepressant Exposure. Am J Psychiatry 2020; 177:506-517. [PMID: 32375539 DOI: 10.1176/appi.ajp.2020.18070766] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Observational studies of prenatal antidepressant safety are hindered by methodological concerns, including susceptibility to surveillance bias. Some studies address potential bias by using alternative strategies to operationalize study comparison groups. In a meta-analysis of the association between prenatal antidepressant exposure and autism risk, the authors examined the utility of comparison group operationalization in reducing surveillance bias. METHODS A systematic search of multiple databases through August 2017 was conducted, selecting controlled observational studies of the association of prenatal antidepressant exposure with autism. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis produced summary effect measures with 95% confidence intervals stratified by comparator group composition, antidepressant class, and trimester of exposure. RESULTS Fourteen studies were included, with 13 reporting results using a population-based comparison group, five using a psychiatric control group, and four using a discordant-sibling control group. Eight of the 14 studies were rated poor because of inadequate control for prenatal depression and maternal ethnicity. Autism risk estimates after prenatal exposure to any antidepressant were decidedly different for population-based designs (hazard ratio=1.42, 95% CI=1.18, 1.70; odds ratio=1.58, 95% CI=1.25, 1.99) compared with psychiatric control (hazard ratio=1.14, 95% CI=0.84, 1.53; odds ratio=1.24, 95% CI=0.93, 1.66) and discordant-sibling (hazard ratio=0.97, 95% CI=0.68, 1.37; odds ratio=0.85, 95% CI=0.54, 1.35) designs. Findings for prenatal exposure to selective serotonin reuptake inhibitors were similar. Meta-regression of population-based studies demonstrated that despite statistical adjustment, ethnicity differences remained a significant source of study heterogeneity. CONCLUSIONS In this meta-analysis, neither psychiatric control nor discordant-sibling designs supported an association between prenatal antidepressant exposure and autism. Discordant-sibling designs effectively addressed surveillance bias in pharmacovigilance reports derived from national registries and other large databases.
Collapse
Affiliation(s)
- Monica L Vega
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| | - Graham C Newport
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| | - Durim Bozhdaraj
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| | - Samantha B Saltz
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| | - D Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| |
Collapse
|
16
|
Davis M, Goodman SH, Lavner JA, Maier M, Stowe ZN, Newport DJ, Knight B. Patterns of Positivity: Positive Affect Trajectories Among Infants of Mothers with a History of Depression. Infancy 2019; 24:911-932. [PMID: 32099536 PMCID: PMC7041642 DOI: 10.1111/infa.12314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 09/22/2019] [Indexed: 02/02/2023]
Abstract
This study examined positive affect (PA) trajectories over the first year of life among infants of mothers with a history of depression (N = 191) as well as predictors (i.e., maternal prenatal and postpartum depression symptoms, maternal parenting behaviors) of those trajectories. Infant PA was observed in play and feeding tasks during lab visits at 3, 6, and 12 months of age; parenting behaviors were observed at 3 months. Mothers completed questionnaires regarding their symptoms of depression throughout the prenatal period and during the first 3 months postpartum. Growth curve analyses indicated that infant PA increased across time, and this finding replicated across both the play and feeding tasks, though increases slowed over time. Neither maternal prenatal nor postpartum depression symptoms predicted infants' PA trajectories, but mothers' PA, positive parenting, and disengaged parenting were associated with infant PA during the play task. Our finding that infant PA increased over the first year postpartum suggests PA trajectories among infants of mothers with a history of depression may be indices of resilience, despite risks associated with their mothers' history of depression. Furthermore, this study highlights parenting behaviors that may be important targets of prevention and early intervention efforts to bolster infant PA.
Collapse
Affiliation(s)
- Molly Davis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Justin A Lavner
- University of Georgia, Department of Psychology, Athens, Georgia
| | - Meeka Maier
- Emory University, Department of Psychology, Atlanta, Georgia
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - D Jeffrey Newport
- University of Texas at Austin, Dell Medical School, Departments of Psychiatry and Women's Health, Austin, TX
| | - Bettina Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
17
|
Laurent H, Goodman SH, Stowe ZN, Halperin M, Khan F, Wright D, Nelson BW, Newport DJ, Ritchie JC, Monk C, Knight B. Course of ante- and postnatal depressive symptoms related to mothers' HPA axis regulation. J Abnorm Psychol 2019; 127:404-416. [PMID: 29745705 DOI: 10.1037/abn0000348] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Given high health costs of depression during pregnancy and the first postnatal year, it is important to understand mechanisms involved in the emergence and perpetuation of symptoms during this time. In a series of 2 studies, we aim to clarify bidirectional relations between mothers' physiological stress regulation-stress-related activation of the hypothalamic-pituitary-adrenal (HPA) axis-and their course of depressive symptoms. In Study 1, 230 pregnant women recruited from a women's mental health program gave 3 saliva samples in the context of psychosocial stress at 24, 30, and 36-weeks gestation. They self-reported depressive symptoms across the three trimesters of pregnancy and first year postpartum. Multilevel models revealed women with elevated salivary cortisol during pregnancy showed a course of escalating ante- and postnatal symptoms, implicating HPA hyperactivation as a precursor to worsening mood problems. In Study 2, 54 mothers from a community sample self-reported depressive symptoms at 3, 6, 12, and 18 months postnatal. At 18 months, they participated in a dyadic stress task with their infant and gave 4 saliva samples for cortisol assay. For mothers with a lifetime depression diagnosis, an escalating course of postnatal symptoms predicted a higher, flatter cortisol response profile. Together, the results of these studies suggest that for high-risk mothers, a trajectory of worsening depression may both follow from and give rise to neuroendocrine stress hyperactivation. These findings suggest greater attention is warranted to course of depressive symptoms across the ante- and postnatal period, rather than symptom levels at any given time, to characterize health risks. (PsycINFO Database Record
Collapse
Affiliation(s)
| | | | | | | | - Faaiza Khan
- Department of Psychology, University of Illinois at Urbana-Champaign
| | | | | | | | - James C Ritchie
- Department of Pathology and Laboratory Medicine, Emory University
| | - Catherine Monk
- Department of Psychiatry and Obstetrics and Gynecology, Columbia University Medical Center
| | - Bettina Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences
| |
Collapse
|
18
|
Falk DE, Ryan ML, Fertig JB, Devine EG, Cruz R, Brown ES, Burns H, Salloum IM, Newport DJ, Mendelson J, Galloway G, Kampman K, Brooks C, Green AI, Brunette MF, Rosenthal RN, Dunn KE, Strain EC, Ray L, Shoptaw S, Ait-Daoud Tiouririne N, Gunderson EW, Ransom J, Scott C, Leggio L, Caras S, Mason BJ, Litten RZ. Gabapentin Enacarbil Extended-Release for Alcohol Use Disorder: A Randomized, Double-Blind, Placebo-Controlled, Multisite Trial Assessing Efficacy and Safety. Alcohol Clin Exp Res 2018; 43:158-169. [PMID: 30403402 DOI: 10.1111/acer.13917] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several single-site alcohol treatment clinical trials have demonstrated efficacy for immediate-release (IR) gabapentin in reducing drinking outcomes among individuals with alcohol dependence. The purpose of this study was to conduct a large, multisite clinical trial of gabapentin enacarbil extended-release (GE-XR) (HORIZANT® ), a gabapentin prodrug formulation, to determine its safety and efficacy in treating alcohol use disorder (AUD). METHODS Men and women (n = 346) who met DSM-5 criteria for at least moderate AUD were recruited across 10 U.S. clinical sites. Participants received double-blind GE-XR (600 mg twice a day) or placebo and a computerized behavioral intervention (Take Control) for 6 months. Efficacy analyses were prespecified for the last 4 weeks of the treatment period. RESULTS The GE-XR and placebo groups did not differ significantly on the primary outcome measure, percentage of subjects with no heavy drinking days (28.3 vs. 21.5, respectively, p = 0.157). Similarly, no clinical benefit was found for other drinking measures (percent subjects abstinent, percent days abstinent, percent heavy drinking days, drinks per week, drinks per drinking day), alcohol craving, alcohol-related consequences, sleep problems, smoking, and depression/anxiety symptoms. Common side-effects were fatigue, dizziness, and somnolence. A population pharmacokinetics analysis revealed that patients had lower gabapentin exposure levels compared with those in other studies using a similar dose but for other indications. CONCLUSIONS Overall, GE-XR at 600 mg twice a day did not reduce alcohol consumption or craving in individuals with AUD. It is possible that, unlike the IR formulation of gabapentin, which showed efficacy in smaller Phase 2 trials at a higher dose, GE-XR is not effective in treating AUD, at least not at doses approved by the U.S. Food and Drug Administration for treating other medical conditions.
Collapse
Affiliation(s)
- Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Megan L Ryan
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Joanne B Fertig
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Eric G Devine
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Ricardo Cruz
- Section of General Internal Medicine, Department of Medicine, School of Medicine and Boston Medical Center, Section of General Internal Medicine, Boston University, Boston, Massachusetts
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heather Burns
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ihsan M Salloum
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - D Jeffrey Newport
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Kyle Kampman
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Brooks
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Richard N Rosenthal
- Division of Addiction Psychiatry, Stony Brook University, Stony Brook, New York.,Mount Sinai St. Luke's Hospital, New York, New York
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lara Ray
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Steven Shoptaw
- Department of Family Medicine and of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Erik W Gunderson
- Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Janet Ransom
- Fast Track Drugs and Biologics, North Potomac, Maryland
| | - Charles Scott
- Fast Track Drugs and Biologics, North Potomac, Maryland
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | | | - Barbara J Mason
- Department of Neuroscience, The Scripps Research Institute, La Jolla, California
| | - Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | | |
Collapse
|
19
|
Cammack AL, Hogue CJ, Drews-Botsch CD, Kramer MR, Pearce BD, Knight B, Stowe ZN, Newport DJ. An exploratory study of whether pregnancy outcomes influence maternal self-reported history of child maltreatment. Child Abuse Negl 2018; 85:145-155. [PMID: 29478731 PMCID: PMC6529201 DOI: 10.1016/j.chiabu.2018.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/19/2018] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Abstract
Childhood maltreatment is common and has been increasingly studied in relation to perinatal outcomes. While retrospective self-report is convenient to use in studies assessing the impact of maltreatment on perinatal outcomes, it may be vulnerable to bias. We assessed bias in reporting of maltreatment with respect to women's experiences of adverse perinatal outcomes in a cohort of 230 women enrolled in studies of maternal mental illness. Each woman provided a self-reported history of childhood maltreatment via the Childhood Trauma Questionnaire at two time points: 1) the preconception or prenatal period and 2) the postpartum period. While most women's reports of maltreatment agreed, there was less agreement for physical neglect among women experiencing adverse perinatal outcomes. Further, among women who discrepantly reported maltreatment, those experiencing adverse pregnancy outcomes tended to report physical neglect after delivery but not before, and associations between physical neglect measured after delivery and adverse pregnancy outcomes were larger than associations that assessed physical neglect before delivery. There were larger associations between post-delivery measured maltreatment and perinatal outcomes among women who had not previously been pregnant and in those with higher postpartum depressive symptoms. Although additional larger studies in the general population are necessary to replicate these findings, they suggest retrospective reporting of childhood maltreatment, namely physical neglect, may be prone to systematic differential recall bias with respect to perinatal outcomes. Measures of childhood maltreatment reported before delivery may be needed to validly estimate associations between maternal exposure to childhood physical neglect and perinatal outcomes.
Collapse
Affiliation(s)
- Alison L Cammack
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Carol J Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Carolyn D Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Brad D Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Bettina Knight
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
| | - D Jeffrey Newport
- Departments of Psychiatry & Behavioral Sciences and Obstetrics & Gynecology, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14 Street, Suite 1446, Miami, FL 33136, USA
| |
Collapse
|
20
|
George JS, Malik S, Symes S, Caralis P, Newport DJ, Godur A, Mills G, Karmin I, Menon B, Potter JE. Trafficking Healthcare Resources and Intra-disciplinary Victim Services and Education (THRIVE) Clinic: A Multidisciplinary One-stop Shop Model of Healthcare for Survivors of Human Trafficking. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23322705.2018.1530528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joshua S. George
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sana Malik
- School of Social Welfare, Stony Brook University, Stony Brook, New York, USA
| | - Stephen Symes
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | | | - Anastasia Godur
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Grechen Mills
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ira Karmin
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Blaine Menon
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - JoNell E. Potter
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| |
Collapse
|
21
|
Londono Tobon A, Newport DJ, Nemeroff CB. The Role of Oxytocin in Early Life Adversity and Later Psychopathology: a Review of Preclinical and Clinical Studies. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s40501-018-0158-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
22
|
Voinescu PE, Park S, Chen LQ, Stowe ZN, Newport DJ, Ritchie JC, Pennell PB. Antiepileptic drug clearances during pregnancy and clinical implications for women with epilepsy. Neurology 2018; 91:e1228-e1236. [PMID: 30185446 PMCID: PMC6161546 DOI: 10.1212/wnl.0000000000006240] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/15/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the magnitude and time course of pregnancy-related clearance changes for different antiepileptic drugs (AEDs): levetiracetam, oxcarbazepine, topiramate, phenytoin, and valproate. A secondary aim was to determine if a decreased AED serum concentration was associated with increased seizure frequency. METHODS Women with epilepsy were enrolled preconception or early in pregnancy and prospectively followed throughout pregnancy and the first postpartum year with daily diaries of AED doses, adherence, and seizures. Study visits with AED concentration measurements occurred every 1-3 months. AED clearances in each trimester were compared to nonpregnant baseline using a mixed linear regression model, with adjustments for age, race, and hours postdose. In women on monotherapy, 2-sample t test was used to compare the ratio to target concentrations (RTC) between women with seizure worsening each trimester and those without. RESULTS AED clearances were calculated for levetiracetam (n = 18 pregnancies), oxcarbazepine (n = 4), topiramate (n = 10), valproate (n = 5), and phenytoin (n = 7). Mean maximal clearances were reached for (1) levetiracetam in first trimester (1.71-fold baseline clearance) (p = 0.0001), (2) oxcarbazepine in second trimester (1.63-fold) (p = 0.0001), and (3) topiramate in second trimester (1.39-fold) (p = 0.025). In 15 women on AED monotherapy, increased seizure frequency in the first, second, and all trimesters was associated with a lower RTC (p < 0.05). CONCLUSION AED clearance significantly changes by the first trimester for levetiracetam and by the second trimester for oxcarbazepine and topiramate. Lower RTC was associated with seizure worsening. Early therapeutic drug monitoring and dose adjustment may be helpful to avoid increased seizure frequency.
Collapse
Affiliation(s)
- P Emanuela Voinescu
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - Suna Park
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - Li Q Chen
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - Zachary N Stowe
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - D Jeffrey Newport
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - James C Ritchie
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - Page B Pennell
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA.
| |
Collapse
|
23
|
Swales DA, Winiarski DA, Smith AK, Stowe ZN, Newport DJ, Brennan PA. Maternal depression and cortisol in pregnancy predict offspring emotional reactivity in the preschool period. Dev Psychobiol 2018; 60:557-566. [PMID: 29802624 DOI: 10.1002/dev.21631] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 02/14/2018] [Accepted: 02/23/2018] [Indexed: 11/11/2022]
Abstract
Prenatal exposures to higher levels of maternal cortisol and depression have been linked to a variety of adverse physiological, neurological, and behavioral outcomes, such as dysregulated cortisol production, structural and functional differences in limbic areas of the brain, and greater negative emotionality. This study investigated prospective associations between maternal prepartum depression/cortisol levels and offspring emotional reactivity in 163 mother-child pairs. Women were assessed repeatedly during pregnancy, and later participated in a laboratory visit with their preschool-aged children. Mothers self-reported on depressive symptomatology during pregnancy and provided saliva samples for cortisol assay. Offspring emotional reactivity was assessed through multiple measures, including caregiver reports, cortisol response following a stressor, and laboratory observations of behavior. The findings suggest potential prenatal timing effects, with depression and maternal cortisol measured in the first and second trimesters being more strongly associated with child emotional reactivity. Sex was found to moderate associations between maternal prepartum depression/cortisol and child emotional reactivity, with the general pattern reflecting positive associations in girls, and negative associations in boys.
Collapse
Affiliation(s)
| | | | - Alicia K Smith
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia.,Department of Gynecology & Obstetrics, Emory University, Atlanta, Georgia
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - D Jeffrey Newport
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Department of Obstetrics & Gynecology, University of Miami Miller School of Medicine, Miami, Florida
| | | |
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW Bipolar disorder (BD) medical comorbidity presents significant clinical and public health concerns with serious impact on health. The aim of this article is to present an updated narrative review of original research articles (case control, longitudinal cohort, and cross-sectional studies) and meta-analyses published in English language journals from January 2013 to May 2017 focusing on general medical comorbidity in BD, including the added risks of iatrogenic factors relevant to the treatment of BD. RECENT FINDINGS We found numerous patterns of association between BD and various medical disorders involving multiple organ systems. One pattern indicated reciprocal increase in the rate of each comorbid condition, such as an increased rate of BD in asthma or migraine, and likewise an increase in the rate of asthma or migraine in patients with BD. A second pattern was a predominantly unidirectional increase in the rate of BD in patients with certain medical disorders, such as multiple sclerosis or cerebellar diseases. A third pattern was a predominantly unidirectional increased rate of medical disorders in patients with BD. One study suggested the potential involvement of genetic mechanisms for the association between BD and migraine. Most of the studies had cross-sectional or retrospective designs, and many relied on analysis of large administrative databases inviting multiple potential biases. Our review highlights the association between BD and a variety of medical disorders. Further research is needed to elucidate the potential underlying etiopathological mechanisms that contribute to observed comorbidities. The results of this review also emphasize the need for comprehensive screening for medical disorders in BD and for adoption of an integrated model of care to address these complex comorbidities.
Collapse
Affiliation(s)
- Aktriti Sinha
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Anam Shariq
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Khaled Said
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Abhinav Sharma
- Homewood Health Center, Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - D Jeffrey Newport
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Ihsan M Salloum
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
| |
Collapse
|
25
|
Suri R, Stowe ZN, Cohen LS, Newport DJ, Burt VK, Aquino-Elias AR, Knight BT, Mintz J, Altshuler LL. Prospective Longitudinal Study of Predictors of Postpartum-Onset Depression in Women With a History of Major Depressive Disorder. J Clin Psychiatry 2017; 78:1110-1116. [PMID: 28297589 DOI: 10.4088/jcp.15m10427] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 06/14/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Risk factors for postpartum depression in euthymic pregnant women with histories of major depressive disorder (MDD) were evaluated. METHODS From April 2003 to March 2009, 343 pregnant women with a history of Structured Clinical Interview for DSM-IV (SCID)-diagnosed major depressive disorder were prospectively assessed from the third trimester into the postpartum period using the SCID mood module and 17-item Hamilton Depression Rating Scale (HDRS). Data from 300 subjects who completed at least 2 mood module assessments (1 within 60 days before and the other within 60 days after delivery) were analyzed for predictive associations between variables assessed in the third trimester and the development of a postpartum depression. RESULTS The majority of women were euthymic in pregnancy by SCID criteria. Women with third trimester SCID-diagnosed depression (n = 45) versus euthymia (n = 255) had a significantly higher risk for having depression after delivery (24% vs 11%, P = .013). For pregnant euthymic women, third trimester total HDRS scores significantly predicted postpartum depression (P < .0001); specifically, scores on 3 HDRS items alone-work activities, early insomnia, and suicidality-significantly predicted postpartum depression. Antidepressant use in the third trimester in euthymic women did not confer protection against the onset of postpartum depression. CONCLUSIONS Among women with a history of MDD who are euthymic in the third trimester, 3 HDRS items-work activities, early insomnia, and suicidality-may be useful as screening items for clinicians working with pregnant women with histories of MDD to identify a group at risk for developing postpartum depression. Additionally, in euthymic women with a history of MDD, antidepressant use in the third trimester may not reduce the risk of developing postpartum depression.
Collapse
Affiliation(s)
- Rita Suri
- 760 Westwood Plaza, Ste 28-251, Los Angeles, CA 90095-7057. .,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, California, USA.,Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Zachary N Stowe
- Departments of Psychiatry, Pediatrics, and Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lee S Cohen
- Perinatal and Reproductive Psychiatry Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - D Jeffrey Newport
- Departments of Psychiatry & Behavioral Sciences and Obstetrics & Gynecology, University of Miami Miller School of Medicine, Florida, USA
| | - Vivien K Burt
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, California, USA.,Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Ana R Aquino-Elias
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, California, USA.,Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Bettina T Knight
- Departments of Psychiatry, Pediatrics, and Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, California, USA.,Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| |
Collapse
|
26
|
Coker JL, Tripathi SP, Knight BT, Pennell PB, Magann EF, Newport DJ, Stowe ZN. Rating scale item assessment of self-harm in postpartum women: a cross-sectional analysis. Arch Womens Ment Health 2017; 20:687-694. [PMID: 28664216 PMCID: PMC10906960 DOI: 10.1007/s00737-017-0749-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
We examined the utility of screening instruments to identify risk factors for suicidal ideation (SI) in a population of women with neuropsychiatric illnesses at high risk for postpartum depression. Pregnant women with neuropsychiatric illness enrolled prior to 20 weeks of gestation. Follow-up visits at 4-8-week intervals through 13 weeks postpartum included assessment of depressive symptoms with both clinician and self-rated scales. A total of 842 women were included in the study. Up to 22.3% of postpartum women admitted SI on rating scales, despite the majority (79%) receiving active pharmacological treatment for psychiatric illness. Postpartum women admitting self-harm/SI were more likely to meet criteria for current major depressive episode (MDE), less than college education, an unplanned pregnancy, a history of past suicide attempt, and a higher score on the Childhood Trauma Questionnaire. In women with a history of neuropsychiatric illness, over 20% admitted SI during the postpartum period despite ongoing psychiatric treatment. Patient-rated depression scales are more sensitive screening tools than a clinician-rated depression scale for +SI in the postpartum period.
Collapse
Affiliation(s)
- Jessica L Coker
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA.
| | - Shanti P Tripathi
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA
| | - Bettina T Knight
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA
| | - Page B Pennell
- Division of Epilepsy, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA
- Department of Maternal-Fetal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA
| | - D Jeffrey Newport
- Women's Reproductive Mental Health, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1446, Miami, FL, 33136, USA
| | - Zachary N Stowe
- Women's Mental Health Program, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, No. 843, Little Rock, AR, 72205-7199, USA
| |
Collapse
|
27
|
Bank AM, Stowe ZN, Newport DJ, Ritchie JC, Pennell PB. Placental passage of antiepileptic drugs at delivery and neonatal outcomes. Epilepsia 2017; 58:e82-e86. [PMID: 28387929 DOI: 10.1111/epi.13733] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2017] [Indexed: 11/29/2022]
Abstract
Children of women treated with antiepileptic drugs (AEDs) are at increased risk of adverse outcomes detectable in the neonatal period, which may be associated with the amount of AEDs in the fetal circulation. Placental passage of AEDs can be measured by calculating the ratio of umbilical cord to maternal AED concentrations collected at delivery. The aims of this study were to determine the umbilical cord concentrations and umbilical-to-maternal ratios for AEDs, and whether higher cord concentrations are associated with increased risk of neonatal complications. AED cord and maternal blood concentrations from 70 mother-newborn dyads and neonatal complications were recorded. Logistic regressions were performed to determine the association between AED concentrations and complications. Mean umbilical-to-maternal ratios for total concentrations ranged from 0.79 for carbamazepine to 1.20 for valproic acid, and mean umbilical-to-maternal ratios for free concentrations ranged from 0.86 for valproic acid to 1.42 for carbamazepine, indicating complete placental passage. Neither umbilical cord concentrations nor umbilical-to-maternal ratios were associated with adverse neonatal outcomes. Additional investigations are warranted to delineate the relationship between quantified fetal AED exposure and neonatal complications.
Collapse
Affiliation(s)
- Anna M Bank
- Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.,Massachusetts General Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Zachary N Stowe
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.,Arkansas Children's Hospital Research Institute, Little Rock, Arkansas, U.S.A
| | - D Jeffrey Newport
- University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - James C Ritchie
- Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Page B Pennell
- Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| |
Collapse
|
28
|
Newport DJ, Hostetter AL, Juul SH, Porterfield SM, Knight BT, Stowe ZN. Prenatal Psychostimulant and Antidepressant Exposure and Risk of Hypertensive Disorders of Pregnancy. J Clin Psychiatry 2016; 77:1538-1545. [PMID: 28076672 DOI: 10.4088/jcp.15m10506] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 02/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the association, if any, of prenatal mental illness and psychotropic exposure with the risk of hypertensive disorders of pregnancy (HDP). METHODS A case-cohort analysis was conducted of 686 pregnant women participating in prospective, longitudinal observational studies in a tertiary referral center between January 1998 and May 2012. Risk estimates were produced using multivariate logistic regression modeling. Medication- and diagnosis-specific data were utilized to conduct post hoc confirmatory analyses of the risk estimates. RESULTS After adjustment for confounders, HDP were significantly associated with psychostimulant (odds ratio [OR] = 6.11; 95% CI, 1.79-20.9) and serotonin-norepinephrine reuptake inhibitor (SNRI) (OR = 2.57; 95%, 1.34-4.93) exposure following the 20th week of gestation and lifetime histories of cocaine dependence (OR = 2.99; 95% CI, 1.12-7.98) and panic disorder (OR = 1.78; 95% CI, 1.06-2.98) using DSM-IV diagnostic criteria. HDP risk was not associated with prenatal selective serotonin reuptake inhibitor exposure or other psychiatric disorders. Post hoc analyses demonstrated an increased risk for HDP with higher maternal daily doses of amphetamine psychostimulants and the SNRI venlafaxine. CONCLUSIONS These data indicate that psychostimulant and SNRI exposure following the 20th week of gestation conveys considerable risk for the emergence of HDP. Overall, the findings suggest that heightened vascular reactivity to noradrenergic, rather than serotonergic, stimulation may be pivotal to HDP risk among women with psychiatric illness.
Collapse
Affiliation(s)
- D Jeffrey Newport
- Women's Reproductive Mental Health, University of Miami Miller School of Medicine, 1120 NW 14th St, Ste 1446, Miami, FL 33136. .,Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | - Sunny M Porterfield
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Bettina T Knight
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Zachary N Stowe
- Department of Pediatrics and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
29
|
Knight AK, Craig JM, Theda C, Bækvad-Hansen M, Bybjerg-Grauholm J, Hansen CS, Hollegaard MV, Hougaard DM, Mortensen PB, Weinsheimer SM, Werge TM, Brennan PA, Cubells JF, Newport DJ, Stowe ZN, Cheong JLY, Dalach P, Doyle LW, Loke YJ, Baccarelli AA, Just AC, Wright RO, Téllez-Rojo MM, Svensson K, Trevisi L, Kennedy EM, Binder EB, Iurato S, Czamara D, Räikkönen K, Lahti JMT, Pesonen AK, Kajantie E, Villa PM, Laivuori H, Hämäläinen E, Park HJ, Bailey LB, Parets SE, Kilaru V, Menon R, Horvath S, Bush NR, LeWinn KZ, Tylavsky FA, Conneely KN, Smith AK. An epigenetic clock for gestational age at birth based on blood methylation data. Genome Biol 2016; 17:206. [PMID: 27717399 PMCID: PMC5054584 DOI: 10.1186/s13059-016-1068-z] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/20/2016] [Indexed: 12/18/2022] Open
Abstract
Background Gestational age is often used as a proxy for developmental maturity by clinicians and researchers alike. DNA methylation has previously been shown to be associated with age and has been used to accurately estimate chronological age in children and adults. In the current study, we examine whether DNA methylation in cord blood can be used to estimate gestational age at birth. Results We find that gestational age can be accurately estimated from DNA methylation of neonatal cord blood and blood spot samples. We calculate a DNA methylation gestational age using 148 CpG sites selected through elastic net regression in six training datasets. We evaluate predictive accuracy in nine testing datasets and find that the accuracy of the DNA methylation gestational age is consistent with that of gestational age estimates based on established methods, such as ultrasound. We also find that an increased DNA methylation gestational age relative to clinical gestational age is associated with birthweight independent of gestational age, sex, and ancestry. Conclusions DNA methylation can be used to accurately estimate gestational age at or near birth and may provide additional information relevant to developmental stage. Further studies of this predictor are warranted to determine its utility in clinical settings and for research purposes. When clinical estimates are available this measure may increase accuracy in the testing of hypotheses related to developmental age and other early life circumstances. Electronic supplementary material The online version of this article (doi:10.1186/s13059-016-1068-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna K Knight
- Genetics and Molecular Biology Program, Emory University, Atlanta, GA, USA
| | - Jeffrey M Craig
- Murdoch Childrens Research Institute and Department of Paediatrics, University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Christiane Theda
- The Royal Women's Hospital, Murdoch Childrens Research Institute and University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Marie Bækvad-Hansen
- Section of Neonatal Genetics, Danish Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - Jonas Bybjerg-Grauholm
- Section of Neonatal Genetics, Danish Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - Christine S Hansen
- Section of Neonatal Genetics, Danish Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - Mads V Hollegaard
- Section of Neonatal Genetics, Danish Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark.,The Danish Neonatal Screening Biobank, Department for Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - David M Hougaard
- Section of Neonatal Genetics, Danish Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark.,The Danish Neonatal Screening Biobank, Department for Congenital Disorders, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - Preben B Mortensen
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, 8210, Aarhus V, Denmark
| | - Shantel M Weinsheimer
- Institute of Biological Psychiatry, Sct. Hans Mental Health Center, Copenhagen Mental Health Services, iPSYCH - The Lundbeck Foundation's Initiative for Integrative Psychiatric Research, Boserupvej, DK-4000, Roskilde, Denmark
| | - Thomas M Werge
- Institute of Biological Psychiatry, Sct. Hans Mental Health Center, Copenhagen Mental Health Services, iPSYCH - The Lundbeck Foundation's Initiative for Integrative Psychiatric Research, Boserupvej, DK-4000, Roskilde, Denmark
| | | | - Joseph F Cubells
- Genetics and Molecular Biology Program, Emory University, Atlanta, GA, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - D Jeffrey Newport
- Departments of Psychiatry & Behavioral Sciences and Obstetrics & Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zachary N Stowe
- Departments of Psychiatry & Behavioral Sciences, Pediatrics, and Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeanie L Y Cheong
- Murdoch Childrens Research Institute and Department of Paediatrics, University of Melbourne, Parkville, Victoria, 3052, Australia.,The Royal Women's Hospital, Murdoch Childrens Research Institute and University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Philippa Dalach
- Murdoch Childrens Research Institute and Department of Paediatrics, University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute and Department of Paediatrics, University of Melbourne, Parkville, Victoria, 3052, Australia.,The Royal Women's Hospital, Murdoch Childrens Research Institute and University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Yuk J Loke
- Murdoch Childrens Research Institute and Department of Paediatrics, University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Andrea A Baccarelli
- Laboratory of Environmental Precision Biosciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Allan C Just
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O Wright
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mara M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Katherine Svensson
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Letizia Trevisi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Elisabeth B Binder
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.,Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Stella Iurato
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Darina Czamara
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Katri Räikkönen
- Institute of Behavioral Sciences, University of Helsinki, 00014, Helsinki, Finland
| | - Jari M T Lahti
- Institute of Behavioral Sciences, University of Helsinki, 00014, Helsinki, Finland.,Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Centre, Helsinki, Finland
| | - Anu-Katriina Pesonen
- Institute of Behavioral Sciences, University of Helsinki, 00014, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Children's Hospital, Helsinki University Hospital, 00271, Helsinki, Finland.,University of Helsinki, 00029, Helsinki, Finland.,Department of Obstetrics and Gynecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pia M Villa
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, 00014, Helsinki, Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics, and Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, 00014, Helsinki, Finland.,Institute for Molecular Medicine Finland, University of Helsinki, 00014, Helsinki, Finland
| | - Esa Hämäläinen
- HUSLAB and Department of Clinical Chemistry, Helsinki University Central Hospital, 00014, Helsinki, Finland
| | - Hea Jin Park
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, US
| | - Lynn B Bailey
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, US
| | - Sasha E Parets
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Varun Kilaru
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, US
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, US
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine University of California Los Angeles, Los Angeles, CA, 90095, US.,Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, US
| | - Nicole R Bush
- Department of Psychiatry, University of California, San Francisco, CA, US.,Department of Pediatrics, University of California, San Francisco, CA, US
| | - Kaja Z LeWinn
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Frances A Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, US
| | - Karen N Conneely
- Genetics and Molecular Biology Program, Emory University, Atlanta, GA, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Alicia K Smith
- Genetics and Molecular Biology Program, Emory University, Atlanta, GA, USA. .,Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA. .,Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, US.
| |
Collapse
|
30
|
Nourollahpour Shiadeh M, Rostami A, Pearce BD, Gholipourmalekabadi M, Newport DJ, Danesh M, Mehravar S, Seyyedtabaei SJ. The correlation between Toxoplasma gondii infection and prenatal depression in pregnant women. Eur J Clin Microbiol Infect Dis 2016; 35:1829-1835. [PMID: 27502929 DOI: 10.1007/s10096-016-2734-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
Previous studies have demonstrated that latent toxoplasmosis is associated with neuropsychiatric disorders. We evaluated the correlation between Toxoplasma gondii infection and prenatal depression. In this case-control study, we enrolled 116 depressed pregnant women and 244 healthy controls. The Edinburgh Postpartum Depression Scale (EPDS) was used to evaluate the depression symptom severity in study participants. All participants were screened for the anti-Toxoplasma IgG by enzyme-linked immunosorbent assay. Seroprevalence of T. gondii did not significantly differ between the depressed pregnant women and healthy controls (OR = 1.4; 95 % CI = 0.9-2.19; P = 0.142). T. gondii IgG titer was significantly higher in depressed women (18.6 ± 10.9 IUs) than those in the control group (13.6 ± 8.1 IUs) (z = -5.36, P < 0.001). The T. gondii-positive depressed women showed a positive correlation of T. gondii IgG titer with the EPDS scores (r = 0.52; P < 0.01). The mean EPDS score was also significantly higher in the T. gondii-positive depressed women (20.7 ± 2.7) compared with the controls (18.36 ± 2.7) (P < 0.001). The results obtained from the current study revealed that T. gondii infection might affect susceptibility to depression and severity of depressive symptoms in pregnant women, particularly in those patients who have high antibody titers. Further study is required to fully elucidate the characteristics and mechanisms of this association.
Collapse
Affiliation(s)
- M Nourollahpour Shiadeh
- Department of Midwifery and Reproductive Health, Nursing and Midwifery School, Mazandaran University of Medical Sciences, Sari, Iran
| | - A Rostami
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - B D Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M Gholipourmalekabadi
- Department of Tissue Engineering and Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Science, Tehran, Iran.,Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - D J Newport
- Departments of Psychiatry & Behavioral Sciences and Obstetrics & Gynecology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - M Danesh
- Department of Midwifery and Reproductive Health, Nursing and Midwifery School, Mazandaran University of Medical Sciences, Sari, Iran
| | - S Mehravar
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - S J Seyyedtabaei
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
31
|
Newport DJ, Schatzberg AF, Nemeroff CB. WHITHER KETAMINE AS AN ANTIDEPRESSANT: PANACEA OR TOXIN? Depress Anxiety 2016; 33:685-8. [PMID: 27459676 DOI: 10.1002/da.22535] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- D Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Center on Aging, University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
32
|
Newport DJ, Nemeroff CB. Response to Zhang and Ho: Addressing Ketamine's Use in Depression. Am J Psychiatry 2016; 173:431-2. [PMID: 27035536 DOI: 10.1176/appi.ajp.2016.15111401r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D Jeffrey Newport
- From the Departments of Obstetrics and Gynecology and of Psychiatry and Behavioral Sciences, and the Center on Aging, University of Miami Miller School of Medicine, Miami
| | - Charles B Nemeroff
- From the Departments of Obstetrics and Gynecology and of Psychiatry and Behavioral Sciences, and the Center on Aging, University of Miami Miller School of Medicine, Miami
| |
Collapse
|
33
|
Johnson KC, Smith AK, Stowe ZN, Newport DJ, Brennan PA. Preschool outcomes following prenatal serotonin reuptake inhibitor exposure: differences in language and behavior, but not cognitive function. J Clin Psychiatry 2016; 77:e176-82. [PMID: 26930533 PMCID: PMC5512164 DOI: 10.4088/jcp.14m09348] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To test the hypothesis that prenatal exposure to serotonin reuptake inhibitors (SRIs) is associated with language and behavioral outcomes in preschool-aged children, while accounting for confounds such as concomitant exposures and maternal mental illness. METHOD An observational, prospective, longitudinal study of mental illness in pregnancy was conducted at a university-based women's mental health clinic (April 2010-November 2012). A sample of 178 mother-child dyads participated in a laboratory visit at preschool age (2.5-5.5 years). The majority of women (87%) received psychotropic medication during pregnancy. Psychiatric status (based on DSM-IV), other medication use, and substance use were serially assessed and tested as confounds. Primary outcome measures included standardized measures of expressive language and cognitive function and mother and alternate caregiver ratings of child behavior problems, including the Pervasive Developmental Disorders (PDD) subscale of the Child Behavior Checklist. RESULTS Linear regression analyses revealed that, after controlling for relevant covariates, expressive language scores from the Test of Early Language Development, 3rd edition, were negatively associated with prenatal SRI exposure (β = -0.15, t = -2.41), while the PDD behavioral problems subscales completed by alternate caregivers and mothers were positively associated with prenatal SRI exposure (β = 0.17, t = 2.01; β = 0.16, t = 2.00, respectively). Cognitive function, measured using the Differential Ability Scales, 2nd edition, was not associated with any medication exposures. CONCLUSIONS The current data suggest a small but significant association between prenatal SRI exposure and preschool outcomes, including expressive language and behavior problems. These data corroborate data from recent, population-based studies, although overall, published findings are mixed. Replication and identification of moderating risk factors are needed to understand potential clinical implications.
Collapse
Affiliation(s)
- Katrina C. Johnson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Alicia K. Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Zachary N. Stowe
- Departments of Psychiatry, Pediatrics, and Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - D. Jeffrey Newport
- Departments of Psychiatry & Behavioral Health and Obstetrics & Gynecology, University of Miami, Miami, FL
| | | |
Collapse
|
34
|
Juul SH, Hendrix C, Robinson B, Stowe ZN, Newport DJ, Brennan PA, Johnson KC. Maternal early-life trauma and affective parenting style: the mediating role of HPA-axis function. Arch Womens Ment Health 2016; 19:17-23. [PMID: 25956587 DOI: 10.1007/s00737-015-0528-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
A history of childhood trauma is associated with increased risk for psychopathology and interpersonal difficulties in adulthood and, for those who have children, impairments in parenting and increased risk of negative outcomes in offspring. Physiological and behavioral mechanisms are poorly understood. In the current study, maternal history of childhood trauma was hypothesized to predict differences in maternal affect and HPA axis functioning. Mother-infant dyads (N = 255) were assessed at 6 months postpartum. Mothers were videotaped during a 3-min naturalistic interaction, and their behavior was coded for positive, neutral, and negative affect. Maternal salivary cortisol was measured six times across the study visit, which also included an infant stressor paradigm. Results showed that childhood trauma history predicted increased neutral affect and decreased mean cortisol in the mothers and that cortisol mediated the association between trauma history and maternal affect. Maternal depression was not associated with affective measures or cortisol. Results suggest that early childhood trauma may disrupt the development of the HPA axis, which in turn impairs affective expression during mother-infant interactions in postpartum women. Interventions aimed at treating psychiatric illness in postpartum women may benefit from specific components to assess and treat trauma-related symptoms and prevent secondary effects on parenting.
Collapse
Affiliation(s)
- Sarah H Juul
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA. .,Women's Mental Health Program, Emory University, 12 Executive Park Dr. NE, Suite 323, Atlanta, GA, 30329, USA.
| | | | | | - Zachary N Stowe
- Departments of Psychiatry, Pediatrics, and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - D Jeffrey Newport
- Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Katrina C Johnson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
35
|
House SJ, Tripathi SP, Knight BT, Morris N, Newport DJ, Stowe ZN. Obsessive-compulsive disorder in pregnancy and the postpartum period: course of illness and obstetrical outcome. Arch Womens Ment Health 2016; 19:3-10. [PMID: 26173597 PMCID: PMC4715787 DOI: 10.1007/s00737-015-0542-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
Abstract
The study aimed to examine the course of obsessive-compulsive disorder (OCD) across pregnancy and its impact on obstetric and neonatal outcomes. Women enrolled prior to 20-week gestation in a prospective, observational study. The Structured Clinical Interview for DSM-IV was completed to obtain lifetime Axis I diagnoses. A total of 56 women with OCD were followed at 1 to 3-month intervals through 52 weeks postpartum. Each visit, the Yale-Brown Obsessive Compulsive Scale (YBOCS), clinical assessment, and medication/exposure tracking were performed. Obstetric and neonatal data were abstracted from the medical record. In subjects with OCD, associations between perinatal obsessive-compulsive symptoms (OCSs) and outcomes were examined. Additionally, outcomes were compared to 156 matched psychiatric patients without OCD. Maternal age inversely correlated with the YBOCS scores across the study period (β = -0.5161, p = .0378). Cesarean section was associated with increased OCSs in the postpartum period compared to vaginal delivery (β = 5.3632, p = 0.043). No associations were found between severity of perinatal obsessions or compulsions and any specific obstetric or neonatal complications. Subjects without OCD had higher frequency of fetal loss compared to mothers with OCD (χ (2) = 4.03, p = 0.043). These novel prospective data fail to identify an association of OCSs with adverse outcomes. In contrast, there is an association of delivery method and younger maternal age with increased postnatal symptoms of OCD. Psychiatric subjects without OCD may have a higher risk of miscarriage and intrauterine fetal demise compared to subjects with OCD.
Collapse
Affiliation(s)
- Samuel J House
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA.
| | - Shanti P Tripathi
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA
| | - Bettina T Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA
| | - Natalie Morris
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA
| | - D Jeffrey Newport
- Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA
| |
Collapse
|
36
|
Newport DJ, Carpenter LL, McDonald WM, Potash JB, Tohen M, Nemeroff CB. Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression. Am J Psychiatry 2015; 172:950-66. [PMID: 26423481 DOI: 10.1176/appi.ajp.2015.15040465] [Citation(s) in RCA: 399] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The authors conducted a systematic review and meta-analysis of ketamine and other N-methyl-d-aspartate (NMDA) receptor antagonists in the treatment of major depression. METHOD Searches of MEDLINE, PsycINFO, and other databases were conducted for placebo-controlled, double-blind, randomized clinical trials of NMDA antagonists in the treatment of depression. Primary outcomes were rates of treatment response and transient remission of symptoms. Secondary outcomes included change in depression symptom severity and the frequency and severity of dissociative and psychotomimetic effects. Results for each NMDA antagonist were combined in meta-analyses, reporting odds ratios for dichotomous outcomes and standardized mean differences for continuous outcomes. RESULTS Ketamine (seven trials encompassing 147 ketamine-treated participants) produced a rapid, yet transient, antidepressant effect, with odds ratios for response and transient remission of symptoms at 24 hours equaling 9.87 (4.37-22.29) and 14.47 (2.67-78.49), respectively, accompanied by brief psychotomimetic and dissociative effects. Ketamine augmentation of ECT (five trials encompassing 89 ketamine-treated participants) significantly reduced depressive symptoms following an initial treatment (Hedges' g=0.933) but not at the conclusion of the ECT course. Other NMDA antagonists failed to consistently demonstrate efficacy; however, two partial agonists at the NMDA coagonist site, d-cycloserine and rapastinel, significantly reduced depressive symptoms without psychotomimetic or dissociative effects. CONCLUSIONS The antidepressant efficacy of ketamine, and perhaps D-cycloserine and rapastinel, holds promise for future glutamate-modulating strategies; however, the ineffectiveness of other NMDA antagonists suggests that any forthcoming advances will depend on improving our understanding of ketamine's mechanism of action. The fleeting nature of ketamine's therapeutic benefit, coupled with its potential for abuse and neurotoxicity, suggest that its use in the clinical setting warrants caution.
Collapse
Affiliation(s)
- D Jeffrey Newport
- From the University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami; the University of Miami Miller School of Medicine, Department of Obstetrics and Gynecology, Miami; the University of Miami Miller School of Medicine, Center on Aging, Miami; the Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, R.I.; Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta; the University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa; and the University of New Mexico Health Science Center, Department of Psychiatry and Behavioral Sciences, Albuquerque, N.M
| | - Linda L Carpenter
- From the University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami; the University of Miami Miller School of Medicine, Department of Obstetrics and Gynecology, Miami; the University of Miami Miller School of Medicine, Center on Aging, Miami; the Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, R.I.; Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta; the University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa; and the University of New Mexico Health Science Center, Department of Psychiatry and Behavioral Sciences, Albuquerque, N.M
| | - William M McDonald
- From the University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami; the University of Miami Miller School of Medicine, Department of Obstetrics and Gynecology, Miami; the University of Miami Miller School of Medicine, Center on Aging, Miami; the Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, R.I.; Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta; the University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa; and the University of New Mexico Health Science Center, Department of Psychiatry and Behavioral Sciences, Albuquerque, N.M
| | - James B Potash
- From the University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami; the University of Miami Miller School of Medicine, Department of Obstetrics and Gynecology, Miami; the University of Miami Miller School of Medicine, Center on Aging, Miami; the Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, R.I.; Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta; the University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa; and the University of New Mexico Health Science Center, Department of Psychiatry and Behavioral Sciences, Albuquerque, N.M
| | - Mauricio Tohen
- From the University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami; the University of Miami Miller School of Medicine, Department of Obstetrics and Gynecology, Miami; the University of Miami Miller School of Medicine, Center on Aging, Miami; the Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, R.I.; Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta; the University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa; and the University of New Mexico Health Science Center, Department of Psychiatry and Behavioral Sciences, Albuquerque, N.M
| | - Charles B Nemeroff
- From the University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami; the University of Miami Miller School of Medicine, Department of Obstetrics and Gynecology, Miami; the University of Miami Miller School of Medicine, Center on Aging, Miami; the Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, R.I.; Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta; the University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa; and the University of New Mexico Health Science Center, Department of Psychiatry and Behavioral Sciences, Albuquerque, N.M
| | | |
Collapse
|
37
|
Cammack A, Hogue C, Drews-Botsch C, Kramer M, Pearce B, Newport DJ. Maternal Exposure to Child Abuse, Preterm Birth, and Very Preterm Birth in Nulliparas. Ann Epidemiol 2015. [DOI: 10.1016/j.annepidem.2015.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Simeonova DI, Attalla AM, Nguyen T, Stagnaro E, Knight BT, Craighead WE, Stowe ZN, Newport DJ. Temperament and behavior in toddlers of mothers with bipolar disorder: a preliminary investigation of a population at high familial risk for psychopathology. J Child Adolesc Psychopharmacol 2014; 24:543-50. [PMID: 25514541 PMCID: PMC4268554 DOI: 10.1089/cap.2013.0136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There are no published studies examining concurrent associations between temperament and behavior during toddlerhood in offspring of parents with bipolar disorder (OBD), a population at high familial risk for psychopathology. Better understanding of early determinants contributing to well-being or mental illness in this high-risk population has the potential to aid in the identification of problem domains to be targeted clinically, and facilitate the development of early intervention and prevention initiatives for an appropriate subgroup of children at the youngest possible age. METHODS A total of 30 offspring of mothers with BD (mean age=25.4±4.9 months) participated in this study at Emory University. The mothers completed the Early Childhood Behavior Questionnaire (ECBQ) and the Child Behavior Checklist (CBCL). RESULTS The results of the correlational analyses indicated that the broad temperament dimension Negative Affectivity and the individual ECBQ scales Sadness and Shyness were positively associated with the broad CBCL dimension Internalizing Problems, whereas Sociability was negatively associated with Internalizing Problems. In addition, the temperament scales Soothability and Frustration were negatively and positively associated with Internalizing Problems, respectively. All ECBQ scales included in the broad temperament dimension Effortful Control, except for Cuddliness, were significantly negatively associated with the broad CBCL dimension Externalizing Problems. A significant sex difference was found for the ECBQ scale Positive Anticipation and the CBCL scale Sleep Problems, with a higher mean rank score for girls than for boys. CONCLUSIONS This is the first systematic investigation of temperament and behavior and concurrent associations between these two domains in toddlers of mothers with BD. The present findings provide a platform for future investigations of the contribution of temperament and early behavior to potential well-being or mental illness in OBD.
Collapse
Affiliation(s)
- Diana I. Simeonova
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | - Theresa Nguyen
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Emily Stagnaro
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bettina T. Knight
- Departments of Psychiatry, Pediatrics, and Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - W. Edward Craighead
- Departments of Psychology and Psychiatry & Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Zachary N. Stowe
- Departments of Psychiatry, Pediatrics, and Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - D. Jeffrey Newport
- Departments of Psychiatry and Obstetrics & Gynecology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| |
Collapse
|
39
|
Goodman SH, Lusby CM, Thompson K, Newport DJ, Stowe ZN. MATERNAL DEPRESSION IN ASSOCIATION WITH FATHERS’ INVOLVEMENT WITH THEIR INFANTS: SPILLOVER OR COMPENSATION/BUFFERING? Infant Ment Health J 2014; 35:495-508. [DOI: 10.1002/imhj.21469] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
40
|
Mehta D, Newport DJ, Frishman G, Kraus L, Rex-Haffner M, Ritchie JC, Lori A, Knight BT, Stagnaro E, Ruepp A, Stowe ZN, Binder EB. Early predictive biomarkers for postpartum depression point to a role for estrogen receptor signaling. Psychol Med 2014; 44:2309-2322. [PMID: 24495551 DOI: 10.1017/s0033291713003231] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Postpartum depression (PPD) affects approximately 13% of women and has a negative impact on mother and infant, hence reliable biological tests for early detection of PPD are essential. We aimed to identify robust predictive biomarkers for PPD using peripheral blood gene expression profiles in a hypothesis-free genome-wide study in a high-risk, longitudinal cohort. METHOD We performed a genome-wide association study in a longitudinal discovery cohort comprising 62 women with psychopathology. Gene expression and hormones were measured in the first and third pregnancy trimesters and early postpartum (201 samples). The replication cohort comprised 24 women with third pregnancy trimester gene expression measures. Gene expression was measured on Illumina-Human HT12 v4 microarrays. Plasma estradiol and estriol were measured. Statistical analysis was performed in R. RESULTS We identified 116 transcripts differentially expressed between the PPD and euthymic women during the third trimester that allowed prediction of PPD with an accuracy of 88% in both discovery and replication cohorts. Within these transcripts, significant enrichment of transcripts implicated that estrogen signaling was observed and such enrichment was also evident when analysing published gene expression data predicting PPD from a non-risk cohort. While plasma estrogen levels were not different across groups, women with PPD displayed an increased sensitivity to estrogen signaling, confirming the previously proposed hypothesis of increased sex-steroid sensitivity as a susceptibility factor for PPD. CONCLUSIONS These results suggest that PPD can be robustly predicted in currently euthymic women as early as the third trimester and these findings have implications for predictive testing of high-risk women and prevention and treatment for PPD.
Collapse
Affiliation(s)
- D Mehta
- Max Planck Institute of Psychiatry, Munich,Germany
| | - D J Newport
- Emory University School of Medicine,Department of Psychiatry and Behavioral Sciences, Atlanta, GA,USA
| | - G Frishman
- Institute for Bioinformatics and Systems Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg,Germany
| | - L Kraus
- Max Planck Institute of Psychiatry, Munich,Germany
| | | | - J C Ritchie
- Department of Pathology and Laboratory Medicine,Emory University,Atlanta, GA,USA
| | - A Lori
- Department of Human Genetics,Emory University,Atlanta, GA,USA
| | - B T Knight
- Psychiatry Research Institute,University of Arkansas for Medical Sciences,Little Rock, AR,USA
| | - E Stagnaro
- Emory University School of Medicine,Department of Psychiatry and Behavioral Sciences, Atlanta, GA,USA
| | - A Ruepp
- Institute for Bioinformatics and Systems Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg,Germany
| | - Z N Stowe
- Psychiatry Research Institute,University of Arkansas for Medical Sciences,Little Rock, AR,USA
| | - E B Binder
- Max Planck Institute of Psychiatry, Munich,Germany
| |
Collapse
|
41
|
Johnson KC, Brennan PA, Stowe ZN, Leibenluft E, Newport DJ. Physiological regulation in infants of women with a mood disorder: examining associations with maternal symptoms and stress. J Child Psychol Psychiatry 2014; 55:191-8. [PMID: 23981139 PMCID: PMC3947112 DOI: 10.1111/jcpp.12130] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND The offspring of mothers with mood disorders may evidence increased behavioral problems as early as preschool; however, no study to date has examined psychophysiological characteristics during infancy, particularly among offspring of mothers diagnosed with bipolar disorder. Elucidating psychobiological mechanisms of risk early in development is critical to inform prevention and early intervention efforts. METHOD This study compared physiological and behavioral responsivity in 6-month-old infants (N = 329) of mothers with lifetime histories of bipolar disorder (BD, n = 44), major depressive disorder (MDD, n = 244), or no history of Axis I disorders (CTL, n = 41). Infant respiratory sinus arrhythmia (RSA) was measured in a laboratory stressor paradigm. Measures of infant affect and behavior during mother-infant interaction, current maternal depressive symptoms, and exposure to stressful life events were examined with respect to diagnostic group and RSA. RESULTS Groups did not differ in baseline RSA or infant affect measures. However, during the stressor task, infants of mothers with BD evidenced increases in RSA, while infants of MDD and CTL mothers evidenced decreases in RSA. Though levels of postnatal stress and current levels of maternal depressive symptoms differed among groups, neither of these factors predicted infant psychophysiological responses. CONCLUSIONS At 6 months of age, infants of mothers with BD show differences in psychophysiological regulation. These differences cannot be accounted for by perinatal outcome, current maternal depressive symptoms, or exposure to stressful life events, and thus may reflect endophenotypic markers of psychopathological risk.
Collapse
Affiliation(s)
- Katrina C. Johnson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | | | - Zachary N. Stowe
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, United States
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institutes of Mental Health, Maryland, United States
| | - D. Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| |
Collapse
|
42
|
Polepally AR, Pennell PB, Brundage RC, Stowe ZN, Newport DJ, Viguera AC, Ritchie JC, Birnbaum AK. MODEL-BASED LAMOTRIGINE CLEARANCE CHANGES DURING PREGNANCY: CLINICAL IMPLICATION. Ann Clin Transl Neurol 2014; 1:99-106. [PMID: 24883336 PMCID: PMC4038031 DOI: 10.1002/acn3.29] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective The objective of the study was to characterize changes in the oral clearance (CL/F) of lamotrigine (LTG) over the course of pregnancy and the postpartum period through a model-based approach incorporating clinical characteristics that may influence CL/F, in support of developing clinical management guidelines. Methods Women receiving LTG therapy who were pregnant or planning pregnancy were enrolled. Maternal blood samples were collected at each visit. A pharmacokinetic analysis was performed using a population-based, nonlinear, mixed-effects model. Results A total of 600 LTG concentrations from 60 women (64 pregnancies) were included. The baseline LTG CL/F was 2.16 L/h with a between-subject variability of 40.6%. The influence of pregnancy on CL/F was described by gestational week. Two subpopulations of women emerged based on the rate of increase in LTG CL/F during pregnancy. The gestational age-associated increase in CL/F displayed a 10-fold higher rate in 77% of the women (0.118 L/h per week) compared to 23% (0.0115 L/h per week). The between-subject variability in these slopes was 43.0%. The increased CL/F at delivery declined to baseline values with a half-life of 0.55 weeks. Interpretation The majority of women had a substantial increase in CL/F from 2.16 to 6.88 L/h by the end of pregnancy, whereas 23% of women had a minimal increase. An increase in CL/F may correspond to decreases in LTG blood concentrations necessitating the need for more frequent dosage adjustments and closer monitoring in some pregnant women with epilepsy. Postpartum doses should be tapered to preconception dose ranges within 3 weeks of delivery.
Collapse
Affiliation(s)
- Akshanth R Polepally
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Page B Pennell
- Department of Neurology and Division of Women's Health at Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard C Brundage
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Zachary N Stowe
- Department of Psychiatry, Pediatrics, and Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - D Jeffrey Newport
- Departments of Psychiatry and Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio ; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | - James C Ritchie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia ; Department of Pathology, Emory University School of Medicine
| | - Angela K Birnbaum
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
43
|
Heim C, Newport DJ, Heit S, Graham YP, Wilcox M, Bonsall R, Miller AH, Nemeroff CB. Stress Affects Expression of Inflammatory Genes in Immune Cells. JAMA 2014. [PMID: 10918705 DOI: 10.1001/jama.2013.285447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- C Heim
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1639 Pierce Dr, WMRB, Suite 4000, Atlanta, GA 30322, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Lusby CM, Goodman SH, Bell MA, Newport DJ. Electroencephalogram patterns in infants of depressed mothers. Dev Psychobiol 2013; 56:459-73. [PMID: 23852456 DOI: 10.1002/dev.21112] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 02/26/2013] [Indexed: 12/19/2022]
Abstract
Electroencephalogram (EEG) patterns may reflect a vulnerability to depression. In an effort to understand their earliest origin, we examined their stability and consistency and their associations with perinatal depressive symptoms. Depressive symptoms were measured prospectively throughout the perinatal period in 83 women with histories of depression and/or anxiety. Infant's EEG was recorded during baseline, feeding, and play at 3 and 6 months of age. Prenatal and postpartum depressive symptoms interacted significantly to predict 3- and 6-month-olds' EEG asymmetry scores. Asymmetry scores were consistent across contexts, except from baseline to feeding and play at 6 months, and stable across ages, except during feeding. Changes in depressive symptoms across ages were not associated with changes in infant EEG. Findings highlight the importance of considering both prenatal and postpartum depressive symptoms in the prediction of infant EEG, as well as the need to consider context to understand stability of infant EEG patterns.
Collapse
Affiliation(s)
- Cara M Lusby
- Department of Psychology, Emory University, Atlanta, GA, 30322
| | | | | | | |
Collapse
|
45
|
Monk C, Newport DJ, Korotkin JH, Long Q, Knight B, Stowe ZN. Uterine blood flow in a psychiatric population: impact of maternal depression, anxiety, and psychotropic medication. Biol Psychiatry 2012; 72:483-90. [PMID: 22695184 PMCID: PMC3424380 DOI: 10.1016/j.biopsych.2012.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 04/07/2012] [Accepted: 05/05/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Accumulating evidence suggests that fetal exposure to maternal psychiatric symptoms is associated with future risk for psychopathology. One potential pathway is distress-linked constriction in uterine or umbilical blood flow (UBF). With approximately 6.6% of pregnant women taking an antidepressant, an ecologically valid investigation of this hypothesis must consider the potential concomitant influence of pharmacotherapy on UBF. METHODS Pregnant women (n = 101) with lifetime histories of mental illness were evaluated every 4 to 6 weeks during gestation for mood symptoms and medication use; women underwent an ultrasound examination for UBF at approximately 25 weeks gestation. RESULTS No associations were observed between UBF and three assessments of maternal prenatal depression and anxiety (acute: coincident with the UBF scan; proximal: within 2 weeks of the scan; chronic: serial symptom ratings). Chronic and acute use of bupropion was associated with reduced UBF, even after controlling for pregnancy complications. Chronic use of atypical antipsychotics also was associated with decreased UBF. There were no associations between serotonergic antidepressant use and UBF. CONCLUSIONS Contrary to a popular hypothesis, depression and anxiety-associated reductions in UBF may not be a pathway by which risk is conferred during prenatal development. However, while requiring replication, our findings suggest that prenatal bupropion exposure may be associated with reductions in UBF.
Collapse
Affiliation(s)
- Catherine Monk
- Department of Psychiatry, Behavioral Medicine, Columbia University, New York, New York, USA.
| | - D. Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, Women’s Mental Health Program, Emory University
| | | | - Qi Long
- Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University
| | - Bettina Knight
- Department of Psychiatry and Behavioral Sciences, Women’s Mental Health Program, Emory University
| | - Zachary N. Stowe
- Department of Psychiatry and Behavioral Sciences, Women’s Mental Health Program, Emory University
| |
Collapse
|
46
|
Abstract
CONTEXT Despite the expanding clinical utility of antipsychotics beyond psychotic disorders to include depressive, bipolar, and anxiety disorders, reproductive safety data regarding the neurodevelopmental sequelae of fetal antipsychotic exposure are scarce. OBJECTIVE To examine whether intrauterine antipsychotic exposure is associated with deficits in neuromotor performance and habituation in 6-month-old infants. DESIGN, SETTING, AND PARTICIPANTS A prospective controlled study was conducted from December 1999 through June 2008 at the Infant Development Laboratory of the Emory Psychological Center examining maternal-infant dyads (N=309) at 6 months postpartum with pregnancy exposure to antipsychotics (n=22), antidepressants (n=202), or no psychotropic agents (n=85). Examiners masked to maternal-infant exposure status administered a standardized neuromotor examination (Infant Neurological International Battery [INFANIB]) that tests posture, tone, reflexes, and motor skills and a visual habituation paradigm using a neutral female face. MAIN OUTCOME MEASURES The INFANIB composite score; number of trials required to achieve a 50% decrease in infant fixation during a visual habituation task; and mean time looking at the stimulus across 10 trials. RESULTS Infants prenatally exposed to antipsychotics (mean=64.71) showed significantly lower INFANIB scores than those with antidepressant (mean=68.57) or no psychotropic (mean=71.19) exposure, after controlling for significant covariates (F(2,281)=4.51; P=.01; partial η(2)=0.033). The INFANIB scores were also significantly associated with maternal psychiatric history, including depression, psychosis, and overall severity/chronicity (P's.05) and maternal depression during pregnancy was associated with less efficient habituation (r(245)=0.16; P.02). There were no significant differences regarding habituation between medication exposure groups. CONCLUSIONS Among 6-month-old infants, a history of intrauterine antipsychotic exposure, compared with antidepressant or no psychotropic exposure, was associated with significantly lower scores on a standard test of neuromotor performance, highlighting the need for further scrutiny of the reproductive safety and neurodevelopmental sequelae of fetal antipsychotic exposure. Disentangling medication effects from maternal illness effects, which also contributed, remains a critical challenge.
Collapse
Affiliation(s)
- Katrina C Johnson
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA.
| | | | | | | | | |
Collapse
|
47
|
Dunlop BW, Binder EB, Cubells JF, Goodman MM, Kelley ME, Kinkead B, Kutner M, Nemeroff CB, Newport DJ, Owens MJ, Pace TWW, Ritchie JC, Rivera VA, Westen D, Craighead WE, Mayberg HS. Predictors of remission in depression to individual and combined treatments (PReDICT): study protocol for a randomized controlled trial. Trials 2012; 13:106. [PMID: 22776534 PMCID: PMC3539869 DOI: 10.1186/1745-6215-13-106] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 05/22/2012] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Limited controlled data exist to guide treatment choices for clinicians caring for patients with major depressive disorder (MDD). Although many putative predictors of treatment response have been reported, most were identified through retrospective analyses of existing datasets and very few have been replicated in a manner that can impact clinical practice. One major confound in previous studies examining predictors of treatment response is the patient's treatment history, which may affect both the predictor of interest and treatment outcomes. Moreover, prior treatment history provides an important source of selection bias, thereby limiting generalizability. Consequently, we initiated a randomized clinical trial designed to identify factors that moderate response to three treatments for MDD among patients never treated previously for the condition. METHODS/DESIGN Treatment-naïve adults aged 18 to 65 years with moderate-to-severe, non-psychotic MDD are randomized equally to one of three 12-week treatment arms: (1) cognitive behavior therapy (CBT, 16 sessions); (2) duloxetine (30-60 mg/d); or (3) escitalopram (10-20 mg/d). Prior to randomization, patients undergo multiple assessments, including resting state functional magnetic resonance imaging (fMRI), immune markers, DNA and gene expression products, and dexamethasone-corticotropin-releasing hormone (Dex/CRH) testing. Prior to or shortly after randomization, patients also complete a comprehensive personality assessment. Repeat assessment of the biological measures (fMRI, immune markers, and gene expression products) occurs at an early time-point in treatment, and upon completion of 12-week treatment, when a second Dex/CRH test is also conducted. Patients remitting by the end of this acute treatment phase are then eligible to enter a 21-month follow-up phase, with quarterly visits to monitor for recurrence. Non-remitters are offered augmentation treatment for a second 12-week course of treatment, during which they receive a combination of CBT and antidepressant medication. Predictors of the primary outcome, remission, will be identified for overall and treatment-specific effects, and a statistical model incorporating multiple predictors will be developed to predict outcomes. DISCUSSION The PReDICT study's evaluation of biological, psychological, and clinical factors that may differentially impact treatment outcomes represents a sizeable step toward developing personalized treatments for MDD. Identified predictors should help guide the selection of initial treatments, and identify those patients most vulnerable to recurrence, who thus warrant maintenance or combination treatments to achieve and maintain wellness.
Collapse
Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Elisabeth B Binder
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Joseph F Cubells
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Mark M Goodman
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mary E Kelley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Becky Kinkead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - D Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Michael J Owens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Thaddeus W W Pace
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - James C Ritchie
- Department of Clinical Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Vivianne Aponte Rivera
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - Drew Westen
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA
| |
Collapse
|
48
|
Smith AK, Conneely KN, Newport DJ, Kilaru V, Schroeder JW, Pennell PB, Knight BT, Cubells JC, Stowe ZN, Brennan PA. Prenatal antiepileptic exposure associates with neonatal DNA methylation differences. Epigenetics 2012; 7:458-63. [PMID: 22419127 DOI: 10.4161/epi.19617] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Antiepileptic drugs (AEDs) are used to treat a variety of neuropsychiatric illnesses commonly encountered in women during their reproductive years, including epilepsy and bipolar disorder. Despite their widespread use, the impact of prenatal exposure on fetal development remains obscure. To evaluate whether AEDs taken by pregnant mothers influence DNA methylation patterns in their neonates, DNA was extracted from the umbilical cord blood of 201 neonates whose mothers were treated for neuropsychiatric illness during pregnancy and interrogated across 27,578 CpG sites using the Illumina HumanMethylation27 BeadChip. The association of each methylation value with the cumulative duration of prenatal AED exposure was examined using a linear mixed model. The average methylation level across all CpG sites was calculated for each subject, and this global methylation measure was evaluated similarly. Neonates with a longer duration of AED exposure in pregnancy showed a decrease in average global methylation (p = 0.0045). Further, DNA methylation of CpG sites in 14 genes significantly decreased with the duration of prenatal AED exposure even after adjusting for multiple comparisons (FDR < 0.05). For a small subset (n = 19) of these neonates, a second tissue, placenta, was available in addition to cord blood. Methylation of 3 of these 14 CpG sites was also significantly decreased in placental tissue. These novel data suggest decreased DNA methylation in neonates of mothers who took AEDs during pregnancy. The long-term stability and potential impact of these changes warrant further attention, and caution may be warranted before prescribing AEDs to pregnant women.
Collapse
Affiliation(s)
- Alicia K Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Katz ER, Stowe ZN, Newport DJ, Kelley ME, Pace TW, Cubells JF, Binder EB. Regulation of mRNA expression encoding chaperone and co-chaperone proteins of the glucocorticoid receptor in peripheral blood: association with depressive symptoms during pregnancy. Psychol Med 2012; 42:943-956. [PMID: 21995950 DOI: 10.1017/s0033291711002121] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Major depressive disorder during pregnancy associates with potentially detrimental consequences for mother and child. The current study examined peripheral blood gene expression as a potential biomarker for prenatal depressive symptoms. METHOD Maternal RNA from whole blood, plasma and the Beck Depression Inventory were collected longitudinally from preconception through the third trimester of pregnancy in 106 women with a lifetime history of mood or anxiety disorders. The expression of 16 genes in whole blood involved in glucorticoid receptor (GR) signaling was assessed using real-time polymerase chain reaction. In parallel, plasma concentrations of progesterone, estradiol and cortisol were measured. Finally, we assessed ex vivo GR sensitivity in peripheral blood cells from a subset of 29 women. RESULTS mRNA expression of a number of GR-complex regulating genes was up-regulated over pregnancy. Women with depressive symptoms showed significantly smaller increases in mRNA expression of four of these genes - FKBP5, BAG1, NCOA1 and PPID. Ex vivo stimulation assays showed that GR sensitivity diminished with progression of pregnancy and increasing maternal depressive symptoms. Plasma concentrations of gonadal steroids and cortisol did not differ over pregnancy between women with and without clinically relevant depressive symptoms. CONCLUSIONS The presence of prenatal depressive symptoms appears to be associated with altered regulation of GR sensitivity. Peripheral expression of GR co-chaperone genes may serve as a biomarker for risk of developing depressive symptoms during pregnancy. The presence of such biomarkers, if confirmed, could be utilized in treatment planning for women with a psychiatric history.
Collapse
Affiliation(s)
- E R Katz
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | | | | | | | | | | | | |
Collapse
|
50
|
Schroeder JW, Conneely KN, Cubells JC, Kilaru V, Newport DJ, Knight BT, Stowe ZN, Brennan PA, Krushkal J, Tylavsky FA, Taylor RN, Adkins RM, Smith AK. Neonatal DNA methylation patterns associate with gestational age. Epigenetics 2012; 6:1498-504. [PMID: 22139580 DOI: 10.4161/epi.6.12.18296] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Risk for adverse neonatal outcome increases with declining gestational age (GA), and changes in DNA methylation may contribute to the relationship between GA and adverse health outcomes in offspring. To test this hypothesis, we evaluated the association between GA and more than 27,000 CpG sites in neonatal DNA extracted from umbilical cord blood from two prospectively-characterized cohorts: (1) a discovery cohort consisting of 259 neonates from women with a history of neuropsychiatric disorders and (2) a replication cohort consisting of 194 neonates of uncomplicated mothers. GA was determined by obstetrician report and maternal last menstrual period. The associations between proportion of DNA methylated and GA were evaluated by fitting a separate linear mixed effects model for each CpG site, adjusting for relevant covariates including neonatal sex, race, parity, birth weight percentile and chip effects. CpG sites in 39 genes were associated with GA (false discovery rate < 0.05) in the discovery cohort. The same CpG sites in 25 of these genes replicated in the replication cohort, with each association replicating in the same direction. Notably, these CpG sites were located in genes previously implicated in labor and delivery (e.g., AVP, OXT, CRHBP and ESR1) or that may influence the risk for adverse health outcomes later in life (e.g., DUOX2, TMEM176A and CASP8). All associations were independent of method of delivery or induction of labor. These results suggest neonatal DNA methylation varies with GA even in term deliveries. The potential contribution of these changes to clinically significant postnatal outcomes warrants further investigation.
Collapse
Affiliation(s)
- James W Schroeder
- Genetics and Molecular Biology Program, Emory University, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|