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Clinical Obstetrics and Gynecology Sep 2018The perinatal period is a vulnerable time for the acute onset and recurrence of psychiatric illness. Primary care providers are opportunely positioned to intervene for... (Review)
Review
The perinatal period is a vulnerable time for the acute onset and recurrence of psychiatric illness. Primary care providers are opportunely positioned to intervene for women who present with mood decompensation, excessive anxiety, or psychosis during the perinatal period. Owing to increased screening efforts in obstetrical clinics and amount of contact during the perinatal period, obstetricians may be able to identify patients who need treatment before their symptoms become severe. In this article, we address imminent and emergent psychiatric symptoms in the perinatal period including management and risk reduction to help obstetrician/gynecologists treat and/or refer patients as clinically appropriate.
Topics: Aggression; Depression, Postpartum; Emergencies; Female; Humans; Obsessive-Compulsive Disorder; Pregnancy; Pregnancy Complications; Psychomotor Agitation; Psychotic Disorders; Puerperal Disorders; Risk Factors; Suicidal Ideation
PubMed: 29794819
DOI: 10.1097/GRF.0000000000000377 -
Obstetrics and Gynecology Clinics of... Sep 2018Postpartum psychosis is a psychiatric emergency that affects 1 to 2 per 1000 women. Key clinical features include mood fluctuation, abnormal thoughts or behaviors, and... (Review)
Review
Postpartum psychosis is a psychiatric emergency that affects 1 to 2 per 1000 women. Key clinical features include mood fluctuation, abnormal thoughts or behaviors, and confusion. Women with a history of bipolar disorder are at heightened risk, as are first-time mothers; current research on the causes focuses on biological triggers, such as immune dysregulation. Women with postpartum psychosis require inpatient hospitalization and should be treated with lithium, antipsychotics, and benzodiazepines.
Topics: Bipolar Disorder; Checklist; Early Diagnosis; Emergency Services, Psychiatric; Female; Humans; Medical History Taking; Mothers; Obstetrics; Postpartum Period; Psychotic Disorders; Puerperal Disorders; Risk Factors
PubMed: 30092921
DOI: 10.1016/j.ogc.2018.04.005 -
Journal of Obstetrics and Gynaecology... Jun 2003To review the literature on the origin, anatomical rationale, techniques, and evidence-based effectiveness of peripartum pelvic floor exercises (PFEs) in the prevention... (Review)
Review
OBJECTIVE
To review the literature on the origin, anatomical rationale, techniques, and evidence-based effectiveness of peripartum pelvic floor exercises (PFEs) in the prevention of pelvic floor problems including urinary and anal incontinence, and prolapse.
DATA SOURCES
Literature was reviewed for background information. MEDLINE, EMBASE, CINAHL, and proceedings of scientific meetings were searched for evidence-based data. A comprehensive literature search was performed to find all studies that involved the use of antepartum and/or postpartum PFEs. For the MEDLINE (1966 to 2002) and CINAHL (1980 to 2002) searches, the following key words were used: urinary incontinence (prevention and control, rehabilitation, therapy), fecal incontinence, exercise or exercise therapy, Kegel, muscle contraction, muscle tonus, muscle development, pelvic floor, pregnancy, puerperium, puerperal disorders. For the EMBASE (1980 to 2002) search, the following key words were used: micturition disorder (prevention, rehab, disease management, therapy), fecal incontinence, labour complication, pregnancy disorder, puerperal disorder, antepartum care, pregnancy, kinesiotherapy, exercise, pelvic floor, bladder. A manual search was performed of available abstracts presented at the annual scientific meetings of the International Continence Society (1997, 1999 to 2002), American Urogynecologic Association (1997 to 1998, 2000 to 2002), and International Urogynecological Association (1997, 1999 to 2002). Twelve studies evaluating the role of antepartum PFE were found, of which 3 randomized controlled trials (RCTs) comparing PFEs for the prevention of urinary incontinence to controls were included. Twelve studies evaluating postpartum PFEs for prevention of urinary incontinence were reviewed, of which 4 RCTs were included. Five studies evaluating postpartum PFEs for the prevention of anal incontinence were reviewed, of which 4 RCTs were included. Participants in the studies were primiparous women. DATA TABULATION AND INTEGRATION: Data were extracted using a standardized collection form. Quality of the data was evaluated using the Jadad scale. Where possible, a meta-analysis was conducted using a random effect model. Heterogeneity between trials was assessed and sensitivity analyses were performed.
RESULTS
Antepartum PFEs, when used with biofeedback and taught by trained health care personnel, using a conservative model, does not result in significant short-term (3 months) decrease in postpartum urinary incontinence, or pelvic floor strength. Postpartum PFEs, when performed with a vaginal device providing resistance or feedback, appear to decrease postpartum urinary incontinence and to increase strength. Reminder and motivational systems to perform "Kegel" exercises are ineffective in preventing postpartum urinary incontinence. Postpartum PFEs do not consistently reduce the incidence of anal incontinence.
CONCLUSION
Postpartum PFEs appear to be effective in decreasing postpartum urinary incontinence. Data regarding the effect of PFEs on prevention of anal incontinence are lacking, and also on its prevention of prolapse.
Topics: Evidence-Based Medicine; Exercise Therapy; Female; Humans; Muscle Contraction; Pelvic Floor; Postpartum Period; Pregnancy; Puerperal Disorders; Treatment Outcome; Urinary Incontinence, Stress
PubMed: 12806450
DOI: 10.1016/s1701-2163(16)30310-3 -
The British Journal of Psychiatry : the... May 2017Maternal anxiety negatively influences child outcomes. Reliable estimates have not been established because of varying published prevalence rates.To establish summary... (Meta-Analysis)
Meta-Analysis Review
Maternal anxiety negatively influences child outcomes. Reliable estimates have not been established because of varying published prevalence rates.To establish summary estimates for the prevalence of maternal anxiety in the antenatal and postnatal periods.We searched multiple databases including MEDLINE, Embase, and PsycINFO to identify studies published up to January 2016 with data on the prevalence of antenatal or postnatal anxiety. Data were extracted from published reports and any missing information was requested from investigators. Estimates were pooled using random-effects meta-analyses.We reviewed 23 468 abstracts, retrieved 783 articles and included 102 studies incorporating 221 974 women from 34 countries. The prevalence for self-reported anxiety symptoms was 18.2% (95% CI 13.6-22.8) in the first trimester, 19.1% (95% CI 15.9-22.4) in the second trimester and 24.6% (95% CI 21.2-28.0) in the third trimester. The overall prevalence for a clinical diagnosis of any anxiety disorder was 15.2% (95% CI 9.0-21.4) and 4.1% (95% CI 1.9-6.2) for a generalised anxiety disorder. Postnatally, the prevalence for anxiety symptoms overall at 1-24 weeks was 15.0% (95% CI 13.7-16.4). The prevalence for any anxiety disorder over the same period was 9.9% (95% CI 6.1-13.8), and 5.7% (95% CI 2.3-9.2) for a generalised anxiety disorder. Rates were higher in low- to middle-income countries.Results suggest perinatal anxiety is highly prevalent and merits clinical attention. Research is warranted to develop evidence-based interventions.
Topics: Anxiety Disorders; Female; Global Health; Humans; Pregnancy; Pregnancy Complications; Pregnancy Trimesters; Prevalence; Puerperal Disorders
PubMed: 28302701
DOI: 10.1192/bjp.bp.116.187179 -
The Journal of Clinical Psychiatry Jul 2019To estimate the prevalence of anxiety disorders in pregnant and postpartum women and identify predictors accounting for variability across estimates. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate the prevalence of anxiety disorders in pregnant and postpartum women and identify predictors accounting for variability across estimates.
DATA SOURCES
An electronic search of PsycINFO and PubMed was conducted from inception until July 2016, without date or language restrictions, and supplemented by articles referenced in the obtained sources. A Boolean search phrase utilized a combination of keywords related to pregnancy, postpartum, prevalence, and specific anxiety disorders.
STUDY SELECTION
Articles reporting the prevalence of 1 or more of 8 common anxiety disorders in pregnant or postpartum women were included. A total of 2,613 records were retrieved, with 26 studies ultimately included.
DATA EXTRACTION
Anxiety disorder prevalence and potential predictor variables (eg, parity) were extracted from each study. A Bayesian multivariate modeling approach estimated the prevalence and between-study heterogeneity of each disorder and the prevalence of having 1 or more anxiety disorder.
RESULTS
Individual disorder prevalence estimates ranged from 1.1% for posttraumatic stress disorder to 4.8% for specific phobia, with the prevalence of having at least 1 or more anxiety disorder estimated to be 20.7% (95% highest density interval [16.7% to 25.4%]). Substantial between-study heterogeneity was observed, suggesting that "true" prevalence varies broadly across samples. There was evidence of a small (3.1%) tendency for pregnant women to be more susceptible to anxiety disorders than postpartum women.
CONCLUSIONS
Peripartum anxiety disorders are more prevalent than previously thought, with 1 in 5 women in a typical sample meeting diagnostic criteria for at least 1 disorder. These findings highlight the need for anxiety screening, education, and referral in obstetrics and gynecology settings.
Topics: Anxiety Disorders; Bayes Theorem; Female; Humans; Pregnancy; Pregnancy Complications; Prevalence; Puerperal Disorders
PubMed: 31347796
DOI: 10.4088/JCP.18r12527 -
The American Journal of Psychiatry Jun 2001Puerperal psychosis, an episode of mania or psychosis precipitated by childbirth, follows approximately one in 1,000 deliveries. The evidence of clinical, outcome, and...
OBJECTIVE
Puerperal psychosis, an episode of mania or psychosis precipitated by childbirth, follows approximately one in 1,000 deliveries. The evidence of clinical, outcome, and genetic studies supports the hypothesis that the majority of puerperal psychotic episodes are manifestations of an affective disorder diathesis with a puerperal trigger. Family studies of puerperal psychosis consistently demonstrate familial aggregation of psychiatric (particularly affective) disorder and suggest a major overlap in the familial factors predisposing to puerperal psychosis and bipolar disorder. The single large study that used direct interview of relatives suggested that familial factors play a role in vulnerability to puerperal triggering itself. The authors' goal was to test this hypothesis further.
METHOD
They conducted a study of the occurrence of episodes of puerperal psychosis in families multiply affected with bipolar disorder participating in an ongoing molecular genetic study of bipolar disorder in sibling pairs.
RESULTS
Episodes of puerperal psychosis followed 81 (26%) of 313 deliveries to 152 parous women with bipolar disorder, 58 (38%) of whom had at least one puerperal psychotic episode. Puerperal episodes clustered in families. Episodes of puerperal psychosis occurred in 74% (N=20) of the 27 parous women with bipolar disorder who had a family history of puerperal psychosis in a first-degree relative but in only 30% (N=38) of the 125 women with bipolar disorder with no such family history.
CONCLUSIONS
These results conclusively demonstrate that familial (probably genetic) factors are implicated in susceptibility to triggering of puerperal episodes in women with bipolar disorder. These findings have implications for future research and will be of use clinically in the management of women with bipolar disorder who are considering pregnancy.
Topics: Adult; Age of Onset; Bipolar Disorder; Cluster Analysis; Depression, Postpartum; Disease Susceptibility; Family; Family Planning Services; Female; Genetic Predisposition to Disease; Genetic Testing; Humans; Psychotic Disorders; Puerperal Disorders
PubMed: 11384899
DOI: 10.1176/appi.ajp.158.6.913 -
The Lancet. Psychiatry Dec 2021
Topics: Female; Humans; Psychotic Disorders; Puerperal Disorders
PubMed: 34801113
DOI: 10.1016/S2215-0366(21)00440-5 -
Ugeskrift For Laeger Jun 2021Post-partum psychosis (PPP) is a severe psychiatric emergency. The condition is rare and has generally not been an area of overwhelming research, and concordantly, early... (Review)
Review
Post-partum psychosis (PPP) is a severe psychiatric emergency. The condition is rare and has generally not been an area of overwhelming research, and concordantly, early identification and treatment is a challenge. Research in the field suggests, that PPP often is a bipolar spectrum illness, and resent research has identified the most common symptoms. This review is an updated description of the phenotypical characteristics of the illness and treatment recommendations based on the newest research.
Topics: Bipolar Disorder; Female; Humans; Postpartum Period; Psychotic Disorders; Puerperal Disorders; Risk Assessment
PubMed: 34120688
DOI: No ID Found -
Archives of Women's Mental Health Apr 2013We describe case histories of three women with post-abortion mania, including two women who underwent a change in diagnosis from bipolar II to bipolar I disorder and...
We describe case histories of three women with post-abortion mania, including two women who underwent a change in diagnosis from bipolar II to bipolar I disorder and another woman who had no prior history of psychiatric disturbance. It is argued that the study of post-abortion mania should provide an opportunity to better understand the aetiology of puerperal mania.
Topics: Abortion, Induced; Abortion, Spontaneous; Adult; Antidepressive Agents; Antimanic Agents; Bipolar Disorder; Female; Humans; Pregnancy; Psychiatric Status Rating Scales; Puerperal Disorders; Treatment Outcome
PubMed: 23381493
DOI: 10.1007/s00737-013-0328-0 -
Bipolar Disorders Feb 2015To compare rates of bipolar episodes following miscarriage and termination with those occurring in the postpartum period.
OBJECTIVES
To compare rates of bipolar episodes following miscarriage and termination with those occurring in the postpartum period.
METHODS
Information in relation to pregnancy and childbirth was gathered retrospectively for 1,283 women with broadly defined bipolar disorder by interview and case-notes review.
RESULTS
Rates of mania or affective psychosis were significantly higher after full-term delivery than after termination (p < 0.001) or miscarriage (p < 0.001). Rates of non-psychotic major depression were similar following full-term deliveries, miscarriages (p = 0.362), and terminations (p = 0.301).
CONCLUSIONS
While women with bipolar disorder and their clinicians should be aware of the possible onset of depression in the weeks following miscarriage or termination, episodes of mania or affective psychosis are less common in comparison with the high rates observed in the postpartum period.
Topics: Abortion, Legal; Abortion, Spontaneous; Adult; Bipolar Disorder; Depression; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Middle Aged; Postpartum Period; Pregnancy; Puerperal Disorders; Recurrence; Retrospective Studies
PubMed: 24912983
DOI: 10.1111/bdi.12217