One of the more important articles regarding screening for perinatal mood and anxiety disorders (PMADs) was published in a journal you might not regularly read. While most studies use the EPDS to screen for PMADs, we have long been concerned that this approach to screening might not be identifying of may misdiagnose women with more severe psychiatric illness, such as women with bipolar disorder. Using the Mood Disorder Questionnaire, nearly one in five perinatal women screened positive for bipolar disorder. Furthermore, these women were more likely to screen positive for comorbid substance use. Of greatest concern is the finding that only 42.0% women with positive bipolar screens and 61.3% with pre-existing bipolar disorder reported that they were receiving current psychiatric care.
This article pairs well with a review from Sharma and colleagues published in Lancet Psychiatry which discusses pregnancy as a time where we can identify women at high risk for bipolar illness after childbirth and have the opportunity to prevent bipolar illness from emerging during this time of vulnerability.
For more detailed descriptions of many of these topics, you can read the CWMH NEWSLETTER which comes out every Thursday. You can sign up for our newsletter HERE.
Ruta Nonacs, MD PhD
PMS AND PMDD |
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INFERTILITY AND MENTAL HEALTH |
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PSYCHIATRIC ILLNESS DURING PREGNANCY |
| Positive screening rates for bipolar disorder in pregnant and postpartum women and associated risk factors.
Masters GA, Brenckle L, Sankaran P, Person SD, Allison J, Moore Simas TA, Ko JY, Robbins CL, Marsh W, Byatt N. Gen Hosp Psychiatry. 2019 Oct 22;61:53-59. The Mood Disorder Questionnaire (MDQ) was used to screen for bipolar disorder in 574 women; 18.8% screened positive for bipolar disorder. Compared to those with a negative screen, women with positive bipolar screens had 18.5-times the prevalence of positive substance use screens (11.1% vs. 0.6%, p?<?0.001). Less than half of those with positive bipolar screens (42.0%) and 61.3% with pre-existing bipolar reported receiving current psychiatric care. Galbally M, Watson SJ, Boyce P, Lewis AJ. Int J Soc Psychiatry. 2019 May;65(3):225-234. Women with depression were more likely to report a history of childhood trauma. Depressive symptoms were positively associated with parenting stress while partner support was negatively associated with parenting stress. Transcranial magnetic stimulation in the treatment of depression during pregnancy: a review. Hebel T, Schecklmann M, Langguth B. Arch Womens Ment Health. 2019 Nov 7. Repetitive TMS seems to be safe for both the pregnant woman and her unborn offspring. No obstetric complications or adverse postnatal effects on development have been reported. rTMS alleviated depressive symptoms better than sham treatment in one study.
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MEDICATIONS AND PREGNANCY |
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POSTPARTUM PSYCHIATRIC ILLNESS |
| Childbirth and prevention of bipolar disorder: an opportunity for change.
Sharma V, Bergink V, Berk M, Chandra PS, Munk-Olsen T, Viguera AC, Yatham LN. Lancet Psychiatry. 2019 Sep;6(9):786-792. Review. Despite the mounting evidence that childbirth is one of the most potent and specific triggers of manic symptoms, studies are not available on the effectiveness of targeted interventions in the prevention of bipolar disorder in women who have recently given birth. Allopregnanolone-based treatments for postpartum depression: Why/how do they work? Walton N, Maguire J. Neurobiol Stress. 2019 Oct 24; In this review, the authors examine the clinical and preclinical evidence supporting a role for allopregnanolone in the underlying neurobiology of postpartum depression as well as foundational evidence supporting the therapeutic effects of allopregnanolone for treatment of postpartum depression. Smorti M, Ponti L, Pancetti F. Front Public Health. 2019 Oct 24;7:295. Free Article Bauer AE, Liu X, Byrne EM, Sullivan PF, et al. Transl Psychiatry. 2019 Nov 11;9(1):288. Parental psychiatric history was associated with postpartum psychiatric disorders among women with previous psychiatric history (OR, 1.14; 95% CI 1.02-1.28) but not without psychiatric history (OR, 1.08; 95% CI: 0.81-1.43). Genetic risk score (GRS) for major depression was associated with an increased risk of postpartum psychiatric disorders in both women with (OR, 1.44; 95% CI: 1.19-1.74) and without (OR, 1.88; 95% CI: 1.26-2.81) personal psychiatric history. Schizophrenia GRS was only minimally associated with postpartum disorders and bipolar disorder GRS was not. Amirchaghmaghi E, Malekzadeh F, Chehrazi M, Ezabadi Z, Sabeti SH. Int J Fertil Steril. 2020 Jan;13(4):277-281. The occurrence of PPD in mothers who conceived via ART was similar to those who conceived naturally. |
MEDICATIONS AND BREASTFEEDING |
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PERINATAL SUBSTANCE USE DISORDERS |
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MATERNAL MENTAL HEALTH AND CHILD OUTCOMES |
| Effects of postpartum depression on the behaviour of children born to mothers with epilepsy.
Turner K, Zambrelli E, Bassanese G, Vignoli A, Valvassori Bolgè M, Baldi C, Franza A, Canevini MP. Seizure. 2019 Oct 31;73:31-38. 23.8% of patients presented with PPD. The CBCL results indicate the occurrence of at least one behavioural issue in 25.0% (20/80) of children. Letourneau N, Leung B, Ntanda H, Dewey D, Deane AJ, Giesbrecht GF; APrON Team. BMC Pediatr. 2019 Nov 13;19(1):435. While probable perinatal depression in mothers predicted 2 and 3?year-old children’s behavioural problems, co-occurrence of depression in mothers and fathers had an increased association with internalizing behavioural problems. Hoffman MC, Rinehart DJ, Jochens LK, Valdez C, Durfee J, Mazzoni SE. Arch Womens Ment Health. 2019 Nov 13. Compared with women with and without other mental health diagnoses, women with bipolar disorder have the highest care utilization and charges. They also have higher preterm birth and low birthweight infant rates, two clinically relevant predictors of long-term health for the child. A Qualitative Study of Mentally Ill Women Who Commit Filicide in Gauteng, South Africa. Moodley S, Subramaney U, Hoffman D. Front Psychiatry. 2019 Oct 24. Free Article Most filicidal mothers were psychotic at the time of the offense and perceived trauma and remorse for their offenses.
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MENOPAUSE AND MENTAL HEALTH |
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OTHER TOPICS IN WOMEN’S MENTAL HEALTH |
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