Neonatal feeding trajectories in mothers with bipolar disorder taking lithium: pharmacokinetic data

Purpose: Women who take lithium during pregnancy and continue after delivery may choose to breastfeed, formula feed, or mix these options. The aim of the study was to evaluate the neonatal lithium serum concentrations based on these three feeding trajectories. Methods: We followed 24 women with bipolar disorder treated with lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ). Results: There was complete lithium placental passage at delivery, with a mean ratio of lithium concentration in the umbilical cord to maternal serum of 1.12 ± 0.17. The median times to LoQ were 6–8, 7–8, and 53–60 days for formula, mixed, and exclusive breastfeeding respectively. The generalized log-rank testing indicated that the median times to LoQ differ according to feeding trajectory (p = 0.037). According to the multivariate analysis-adjusted lithium serum concentrations at birth, times to LoQ are, on average, longer under exclusive breastfeeding (formula, p = 0.015; mixed, p = 0.012). No lithium accumulation was observed in infants under either exclusive or mixed breastfeeding. During the lactation follow-up, there was no acute growth or developmental delays in any neonate or infant. Indeed, lithium concentrations in the three trajectories declined in all cases. However, the time needed to reach the LoQ was much longer for those breastfeeding exclusively. Conclusions: In breastfeed infant no sustained accumulation of lithium and no adverse effects on development or growth were observed.Peer ReviewedPostprint (published version

Neonatal behavior of babies exposed to maternal depressive and anxiety disorders during perinatal period

Perinatal depression and perinatal anxiety can affect up to 20% of women during pregnancy and postpartum. Babies exposed to these pathologies suffer consequences in their development at a cognitive, motor, emotional and social level. Some of these can be observed since birth. In addition, adverse effects have been described in the behavior of the newborn exposed to psychopharmacotherapy during pregnancy. The aims of the study were to observe the neonatal behavior of babies exposed to perinatal depression or anxiety and to compare it between both diagnostic groups of mothers. The cohort included 86 newborns, from 2 to 67 days of chronological age (29 ± 13.4, 48% females), exposed to maternal depression (n = 27) or anxiety (n = 59). The Neonatal Behavior Assessment Scale, 4th edition, (Brazelton and Nugent, 2011) was administered at a maternal mental health unit to register the neonatal behavior. Chi-square and Student t-test analyses were calculated to compare item scores and percentages of suboptimal responses between both groups; Pearson correlations were calculated to analyze the relation of obstetric and psychiatric variables of mothers and the behavior of newborns. Significant differences between groups were found only regarding the change in skin color, with higher percentages of suboptimal responses in the group exposed to anxiety than to depression (24% versus 4%, Chi2 = 3.89; p < .05). Correlation analyses show that, although the birth weight is positively related to the interactive social orientation (tracing face and voice: r = .28, p = .02), the last was affected negatively by the dose of antidepressants during the third trimester of pregnancy (tracing face and voice: r = -.31, p = 0.03), indicating that higher doses of antidepressant was related with lower interactive social orientation. Our findings emphasize the need to detect depression and anxiety in women during the perinatal period in order to intervene at a multidisciplinary level in both, mother and baby, and the relationConducta neonatal en bebés expuestos a trastornos de depresión y de ansiedad maternos durante el período perinatal. La depresión y la ansiedad perinatales afectan hasta el 20% de las mujeres durante embarazo y postparto. Los bebés expuestos a ellas sufren consecuencias en su desarrollo a nivel cognitivo, motor y socioemocional, y pueden observarse desde el nacimiento. Además, se han descrito efectos adversos en la conducta del neonato expuesto a psicofármacos durante la gestación. Los objetivos de este estudio fueron observar la conducta neonatal de bebés expuestos a depresión y ansiedad perinatal y compararla entre ambos grupos de diagnóstico materno. La cohorte incluyó 86 neonatos, entre 2 y 67 días de edad cronológica (29 ± 13.4, 48% mujeres), expuestos a depresión (n = 27) o ansiedad (n = 59) materna. La Escala de Evaluación de la Conducta Neonatal, 4ª edición, (Brazelton y Nugent, 2011) fue administrada en una unidad de salud mental perinatal para registrar la conducta neonatal. Se realizaron análisis de Chi-cuadrado y t de Student para comparar las puntuaciones en los ítems y los porcentajes de respuestas subóptimas entre ambos grupos; se calcularon índices de correlación de Pearson para analizar la relación entre variables obstétricas y psiquiátricas de las madres y la conducta de los bebés. Únicamente se encontraron diferencias significativas entre los grupos diagnósticos respecto al cambio del color de la piel, con porcentajes mayores de respuesta subóptima en el grupo expuesto a ansiedad que a depresión (24% versus 4%, Chi2 = 3.89; p < .05). Los análisis de correlación muestran que, aunque el mayor peso al nacer se relaciona positivamente con la respuesta social-interactiva (orientación a cara y voz: r = .28, p = .02), ésta se ve afectada negativamente por el uso de antidepresivos durante el tercer trimestre de gestación (orientación a cara y voz: r = -.31, p = .03), indicando que a mayores dosis, peor orientación social-interactiva. Nuestros hallazgos enfatizan la necesidad de detectar la depresión y la ansiedad en las mujeres durante el período perinatal para intervenir a nivel multidisciplinar sobre ambos, madre y bebé, y sobre la relación

The Stafford Interview:A comprehensive interview for mother-infant psychiatry

This article describes an interview exploring the social, psychological and psychiatric events in a single pregnancy and puerperium. It has been in development since 1992 and is now in its 6th edition. It takes approximately 2 h to administer and has 130 compulsory probes and 185 ratings. It is suitable for clinical practice, teaching and research

Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta‐analysis

OBJECTIVES: A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. METHODS: Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. RESULTS: Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. CONCLUSION: Different interviews may not classify major depression equivalently

Guia d’autoajuda per a dones víctimes d’una agressió sexual recent: un camí cap a la recuperació

Violència sexual; Violència de gènere; AutoajudaViolencia sexual; Violencia de género; AutoayudaSexual violence; Gender violence; Self helpAquesta guia d’autoajuda resumeix l’experiència d’un grup de professionals de la psiquiatria, la psicologia i el treball social, organitzades de manera cooperativa per atendre la psicopatologia i els problemes específics de la dona. La intencionalitat de la guia d’autoajuda és transmetre a les dones agredides sexualment el que han de saber per cuidar d’elles mateixes, ser ateses i restaurar el seu benestar psíquic. Els consells que es donen són el resultat d’una àmplia experiència clínica en el tractament de les víctimes, de la recerca sobre aquest tipus de traumatismes i de les reflexions dels i les professionals que formen part de la Unitat de Psicopatologia Perinatal i Investigació del Gènere de l’Institut Clínic de Neurociències (ICN) de l’Hospital Clínic de Barcelona.Esta guía de autoayuda resume la experiencia de un grupo de profesionales de la psiquiatría, la psicología y el trabajo social, organizadas de manera cooperativa para atender la psicopatología y los problemas específicos de la mujer. La intencionalidad de la guía de autoayuda es transmitir a las mujeres agredidas sexualmente lo que deben saber para cuidar de ellas mismas, ser atendidas y restaurar su bienestar psíquico. Los consejos que se dan son el resultado de una amplia experiencia clínica en el tratamiento de las víctimas, de la investigación sobre este tipo de traumatismos y de las reflexiones de los profesionales que forman parte de la Unidad de Psicopatología Perinatal e Investigación del Género del Instituto Clínico de Neurociencias (ICN) del Hospital Clínico de Barcelona.This self-help guide summarizes the experience of a group of professionals Psychiatry, psychology and social work, organized Cooperatively to attend psychopathology and problems specific to women. The intentionality of the self help guide is to convey Sexually assaulted women what they should know to take care of them   same, be attentive and restore your psychic well-being. The advice given are the result of extensive clinical experience in the treatment of the victims, of the investigation on this type of traumatisms and the reflections of the professionals that are part of the Unit of Perinatal Psychopathology and Gender Research of the Clinical Institute of Neurosciences (ICN) at the Hospital Clínic de Barcelona

Guia d’autoajuda per a dones víctimes d’una agressió sexual recent: un camí cap a la recuperació

Violència sexual; Violència de gènere; AutoajudaViolencia sexual; Violencia de género; AutoayudaSexual violence; Gender violence; Self helpAquesta guia d’autoajuda resumeix l’experiència d’un grup de professionals de la psiquiatria, la psicologia i el treball social, organitzades de manera cooperativa per atendre la psicopatologia i els problemes específics de la dona. La intencionalitat de la guia d’autoajuda és transmetre a les dones agredides sexualment el que han de saber per cuidar d’elles mateixes, ser ateses i restaurar el seu benestar psíquic. Els consells que es donen són el resultat d’una àmplia experiència clínica en el tractament de les víctimes, de la recerca sobre aquest tipus de traumatismes i de les reflexions dels i les professionals que formen part de la Unitat de Psicopatologia Perinatal i Investigació del Gènere de l’Institut Clínic de Neurociències (ICN) de l’Hospital Clínic de Barcelona.Esta guía de autoayuda resume la experiencia de un grupo de profesionales de la psiquiatría, la psicología y el trabajo social, organizadas de manera cooperativa para atender la psicopatología y los problemas específicos de la mujer. La intencionalidad de la guía de autoayuda es transmitir a las mujeres agredidas sexualmente lo que deben saber para cuidar de ellas mismas, ser atendidas y restaurar su bienestar psíquico. Los consejos que se dan son el resultado de una amplia experiencia clínica en el tratamiento de las víctimas, de la investigación sobre este tipo de traumatismos y de las reflexiones de los profesionales que forman parte de la Unidad de Psicopatología Perinatal e Investigación del Género del Instituto Clínico de Neurociencias (ICN) del Hospital Clínico de Barcelona.This self-help guide summarizes the experience of a group of professionals Psychiatry, psychology and social work, organized Cooperatively to attend psychopathology and problems specific to women. The intentionality of the self help guide is to convey Sexually assaulted women what they should know to take care of them   same, be attentive and restore your psychic well-being. The advice given are the result of extensive clinical experience in the treatment of the victims, of the investigation on this type of traumatisms and the reflections of the professionals that are part of the Unit of Perinatal Psychopathology and Gender Research of the Clinical Institute of Neurosciences (ICN) at the Hospital Clínic de Barcelona

Examining the factor structure and discriminant validity of the 12-item General Health Questionnaire (GHQ-12) among Spanish postpartum women

In this study, the authors tested alternative factor models of the 12-item General Health Questionnaire (GHQ-12) in a sample of Spanish postpartum women, using confirmatory factor analysis. The authors report the results of modeling three different methods for scoring the GHQ-12 using estimation methods recommended for categorical and binary data. A discriminant function analysis was also performed to test the utility of a multiple factor model. A two-phase cross-sectional study was designed: (a) 1,453 women visiting at 6 weeks postpartum completed the GHQ-12 and the Edinburgh Postnatal Depression Scale questionnaire and (b) based on the Edinburgh Postnatal Depression Scale outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation. Using the Likert-type scoring approach, Hankins's one-factor model with "method effects" obtained the best fit. In addition, Graetz's three-factor model provided little discrimination between diagnostic groups, the factors being highly correlated. These results support the presence of only one latent factor in the GHQ-12