279 research outputs found
Thyroid peroxidase antibodies during early gestation and the subsequent risk of first onset postpartum depression:A prospective cohort study
BackgroundDuring the postpartum period, women are at risk for the new onset of both auto-immune thyroid disorders and depression. The presence of thyroid peroxidase antibodies (TPO-ab) during early gestation is predictive for postpartum auto-immune thyroid dysfunction. The aim of this study was to investigate the association between TPO-ab status during early gestation and first-onset postpartum depression.MethodsProspective cohort study (n = 1075) with follow-up during pregnancy up to one year postpartum. Thyroid function and TPO-ab status were measured during early gestation. Depressive symptomatology was assessed during each trimester and at four time points postpartum with the Edinburgh Depression Scale (EDS). Women with antenatal depression were not eligible for inclusion. Self-reported postpartum depression was defined with an EDS cut-off of β₯ 13.ResultsThe cumulative incidence of self-reported first-onset depression in the first postpartum year was 6.3%. A positive TPO-ab status was associated with an increased risk for self-reported first-onset depression at four months postpartum (adjusted OR 3.8; 95% CI 1.3β11.6), but not at other postpartum time points. Prevalence rates of self-reported postpartum depression declined after four months postpartum in the TPO-ab positive group, but remained constant in the TPO-ab negative group.LimitationsDepression was defined with a self-rating questionnaire (EDS).ConclusionsWomen with an increased TPO-ab titer during early gestation are at increased risk for self-reported first-onset depression. The longitudinal pattern of self-reported postpartum depression in the TPO-ab positive group was similar to the typical course of postpartum TPO-ab titers changes. This suggests overlap in the etiology of first-onset postpartum depression and auto-immune thyroid dysfunction. Thyroid function should be evaluated in women with first-onset postpartum depression.<br/
First-onset postpartum psychosis
Mrs. B, a 28-year-old woman with no prior psychiatric history, delivered a healthy daughter
after a first, normal pregnancy. During the first two days postpartum, she was breastfeeding
her daughter with notably reduced sleep. By the third day postpartum, she became
convinced that her husband wanted to kill their newborn. After her mother suggested
that she discontinue breastfeeding, she became extremely violent, kicking her mother in
the abdomen. Over the next 4 days, the family continued to struggle as Mrs. B became
progressively more impulsive, irritable, and disorganized.
One week postpartum, she wa
Mother-to-infant bonding in women with a bipolar spectrum disorder
Purpose Offspring of mothers with a bipolar disorder are at high-risk for impaired developmental outcomes and psychopathology (e. g., mood, anxiety, sleep disorders) later in life. This increased risk of psychopathology is not only because of genetic vulnerability, but environmental factors may play an important role as well. The often long and debilitating mood episodes of mothers with bipolar disorder might hamper their qualities as a caregiver and may impact the child. We examined early mother-to-infant bonding 1 year postpartum in mothers with bipolar spectrum disorder as compared to mothers of the general population. The association between mother-to-infant bonding and the type of bipolar spectrum diagnosis (bipolar I, bipolar II, bipolar Not Otherwise Specified) as well as relapse within 12 months postpartum was also assessed. Methods In total, 75 pregnant women with a bipolar spectrum disorder participated in the current study. The participants were included in a longitudinal cohort study of women with bipolar spectrum disorder and were prospectively followed from pregnancy until 1 year postpartum. Mother-to-infant bonding was assessed using the Pre- and Postnatal Bonding Scale. A longitudinal population-based cohort of 1,419 pregnant women served as the control group. Multiple linear regression analyses were used to assess the association between bipolar spectrum disorder and mother-to-infant bonding scores, controlling for several confounders. Results Women with bipolar spectrum disorder perceived the bonding with their child as less positive compared to the control group. The type of bipolar spectrum disorder was not associated with poorer bonding scores. Relapse during the 1st year after delivery also did not affect bonding scores in women with bipolar spectrum disorder. Conclusions Our findings could imply that women with bipolar spectrum disorder are more vulnerable to impairments in bonding due to the nature of their psychopathology, regardless of the occurrence of postpartum relapse. Careful follow-up including monitoring of mother-to-infant bonding of pregnant women with a history of bipolar spectrum disorder should be a standard to this vulnerable group of women. In addition, regardless of severity and mood episode relapse, an intervention to improve bonding could be beneficial for all mothers with bipolar spectrum disorder and their newborns
Π‘ΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅ ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΡΠΈΡΡΠ΅ΠΌΡ ΠΌΠ΅Π΄ΠΈΠΊΠΎ-ΠΏΡΠΈΡ ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π² ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ΅ Π΄Π΅ΡΡΠΊΠΎΠΉ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΠΈ
ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π² ΠΎΠ±Π»Π°ΡΡΠΈ Π΄Π΅ΡΡΠΊΠΎΠΉ ΠΏΡΠΈΡ
ΠΎΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΠΈ, ΠΊΠΎΡΠΎΡΠΎΠ΅ Π²ΠΊΠ»ΡΡΠ°Π»ΠΎ ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΠΏΡΠΈΡ
ΠΎΡΠΌΠΎΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ, Π»ΠΈΡΠ½ΠΎΡΡΠ½ΡΡ
ΠΈ ΠΏΠΎΠ²Π΅Π΄Π΅Π½ΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ ΠΎΠ½ΠΊΠΎΠ±ΠΎΠ»ΡΠ½ΡΡ
Π΄Π΅ΡΠ΅ΠΉ ΠΈ ΠΈΡ
ΡΠΎΠ΄ΠΈΡΠ΅Π»Π΅ΠΉ, ΡΠ²ΡΠ·Π°Π½Π½ΡΡ
Ρ ΡΠ΅Π°Π³ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π½Π° ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅, ΡΠ΅ΠΌΠ΅ΠΉΠ½ΠΎΠ΅ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅. ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Ρ ΡΠ°ΠΊΡΠΎΡΡ ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄ΠΈΡΡΡΠ΅ΡΡΠ° ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
ΡΠ°Π±ΠΎΡΠ½ΠΈΠΊΠΎΠ² ΠΈ Π²ΠΎΠ»ΠΎΠ½ΡΠ΅ΡΠΎΠ². ΠΠ° ΠΎΡΠ½ΠΎΠ²Π΅ ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π° ΡΠ΅Π»ΠΎΡΡΠ½Π°Ρ ΡΠΈΡΡΠ΅ΠΌΠ° ΠΌΠ΅Π΄ΠΈΠΊΠΎβΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ ΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π° ΠΎΡΠ΅Π½ΠΊΠ° Π΅Π΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ.ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½Π΅ Π΄ΠΎΡΠ»ΡΠ΄ΠΆΠ΅Π½Π½Ρ Π² Π³Π°Π»ΡΠ·Ρ Π΄ΠΈΡΡΡΠΎΡ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΡΡ, ΡΠΎ ΠΌΡΡΡΠΈΠ»ΠΎ Π²ΠΈΠ²ΡΠ΅Π½Π½Ρ ΠΏΡΠΈΡ
ΠΎΠ΅ΠΌΠΎΡΡΠΉΠ½ΠΎΠ³ΠΎ ΡΡΠ°Π½Ρ, ΠΎΡΠΎΠ±ΠΈΡΡΡΡΠ½ΠΈΡ
Ρ ΠΏΠΎΠ²Π΅Π΄ΡΠ½ΠΊΠΎΠ²ΠΈΡ
ΠΎΡΠΎΠ±Π»ΠΈΠ²ΠΎΡΡΠ΅ΠΉ ΠΎΠ½ΠΊΠΎΡ
Π²ΠΎΡΠΈΡ
Π΄ΡΡΠ΅ΠΉ ΡΠ° ΡΡ
Π½ΡΡ
Π±Π°ΡΡΠΊΡΠ², ΠΏΠΎΠ²'ΡΠ·Π°Π½ΠΈΡ
ΡΠ· ΡΠ΅Π°Π³ΡΠ²Π°Π½Π½ΡΠΌ Π½Π° ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΡΡΠ½Π΅ Π·Π°Ρ
Π²ΠΎΡΡΠ²Π°Π½Π½Ρ, ΡΡΠΌΠ΅ΠΉΠ½Π΅ ΡΡΠ½ΠΊΡΡΠΎΠ½ΡΠ²Π°Π½Π½Ρ. ΠΠΈΠ·Π½Π°ΡΠ΅Π½ΠΎ ΡΠΈΠ½Π½ΠΈΠΊΠΈ ΠΏΡΠΎΡΠ΅ΡΡΠΉΠ½ΠΎΠ³ΠΎ Π΄ΠΈΡΡΡΠ΅ΡΡ ΠΌΠ΅Π΄ΠΈΡΠ½ΠΈΡ
ΠΏΡΠ°ΡΡΠ²Π½ΠΈΠΊΡΠ² ΡΠ° Π²ΠΎΠ»ΠΎΠ½ΡΠ΅ΡΡΠ². ΠΠ° ΠΎΡΠ½ΠΎΠ²Ρ ΠΎΡΡΠΈΠΌΠ°Π½ΠΈΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡΠ² ΡΠΎΠ·ΡΠΎΠ±Π»Π΅Π½ΠΎ ΡΡΠ»ΡΡΠ½Ρ ΡΠΈΡΡΠ΅ΠΌΡ ΠΌΠ΅Π΄ΠΈΠΊΠΎβΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΡΡΠ½ΠΎΡ Π΄ΠΎΠΏΠΎΠΌΠΎΠ³ΠΈ Ρ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΎΡΡΠ½ΠΊΡ ΡΡ Π΅ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ.A complex investigation in the area of pediatric psychooncology including investigation of the psychoemotional state, personality and behavior peculiarities of cancer children and their parents, associated with reaction to cancer and family function, was performed. The factors of professional distress of medical staff and volunteers were determined. The obtained findings were used to work out a comprehensive system of medical psychological aid and to assess its efficacy
Guidelines on treatment of perinatal depression with antidepressants: An international review
Objective: Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice. Methods: An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients. Results: Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines. Conclusion: During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged
Prescription patterns of benzodiazepine and benzodiazepine-related drugs in the peripartum period: A population-based study
Using prescription drugs during pregnancy is challenging and approached with caution. In this study, we present population-based information on prescription patterns of benzodiazepines and benzodiazepine-related drugs in the peripartum period. A population-based study of 1,154,817 pregnancies between 1997 and 2015 in Denmark, of which 205,406 (17.8%) pregnancies in women with a psychiatric history. Prescription drugs starting with Anatomical Therapeutic Chemical codes N05BA, N05CD, and N05CF from 12 months before pregnancy to 12 months following pregnancy were identified. We used generalised estimating equations to estimate the adjusted 5 year risk difference in the proportion of women redeeming benzodiazepines from 1 year to 5 years after. Logistic regression was used to analyze the association between characteristics and discontinuation of benzodiazepines during pregnancy. The prevalence of benzodiazepine prescriptions was 1.9% before pregnancy, 0.6% during pregnancy, and 1.3% after pregnancy. In women with a psychiatric history, the prevalence was 5β6 times higher. A significant decrease in prescriptions to women with a psychiatric history was observed, which was less profound among women with no psychiatric history. Approximately 90% of women discontinue benzodiazepines during pregnancy, with a higher percentage of women discontinuing from 1997 to 2015. The observed decrease is likely explained by changing treatment guidelines
Response to SARS-Covid-19-related visitor restrictions on labor and delivery wards in New York City
The COVID-19 outbreak increases maternal stress during pregnancy, but not the risk for postpartum depression
The COVID-19 pandemic affects society and may especially have an impact on mental health of vulnerable groups, such as perinatal women. This prospective cohort study of 669 participating women in the Netherlands compared perinatal symptoms of depression and stress during and before the pandemic. After a pilot in 2018, recruitment started on 7 January 2019. Up until 1 March 2020 (before the pandemic), 401 women completed questionnaires during pregnancy, of whom 250 also completed postpartum assessment. During the pandemic, 268 women filled out at least one questionnaire during pregnancy and 59 postpartum (1 March-14 May 2020). Pregnancy-specific stress increased significantly in women during the pandemic. We found no increase in depressive symptoms during pregnancy nor an increase in incidence of high levels of postpartum depressive symptoms during the pandemic. Clinicians should be aware of the potential for increased stress in pregnant women during the pandemic
Mother-to-Infant Bonding in Women with Postpartum Psychosis and Severe Postpartum Depression: A Clinical Cohort Study
Mother-to-infant bonding is important for long-term child development. The aim of this
study was to investigate bonding in women admitted to a Mother and Baby Unit with postpartum
depression (PD, n = 64) and postpartum psychosis (PP, n = 91). Participants completed the Postpartum
Bonding Questionnaire (PBQ), the Edinburgh Postnatal Depression Scale (EPDS) and the Young
Mania Rating Scale (YMRS) weekly during admission. At admission, 57.1% of women with PD
had impaired bonding, compared to only 17.6% of women with PP (p-value < 0.001). At discharge,
only 18.2% of women with PD and 5.9% of women with PP still experienced impaired bonding
(p-value = 0.02). There was a strong association between decrease of depressive and manic symptoms
and improved bonding over an eight-week admission period. In a small group of women (5.7%)
impaired bonding persisted despite being in remission of their psychiatric disorder. The results
from our study show that impaired bonding is a more present and evidently severe problem in
postpartum depression but not so much in postpartum psychosis. Treatment of depressive symptoms
will improve bonding in almost all women, but clinicians should assess if impaired bonding is still
present after remission because for a small group special care and treatment focused on bonding
might be required
Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence
Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed to do in the present study. We designed a descriptive prospective study and included information from Danish population registers to study first-time ever and recurrent psychiatric episodes during the perinatal period, including treatment at psychiatric facilities and general practitioners (GPs). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods across moderate and severe perinatal psychiatric episodes
- β¦