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The American Journal of Psychiatry Jul 2014Attention deficit hyperactivity disorder (ADHD) has been increasingly recognized and treated in children and adults in recent years. As a result, a growing number of...
Attention deficit hyperactivity disorder (ADHD) has been increasingly recognized and treated in children and adults in recent years. As a result, a growing number of women enter their reproductive years treated with medication for ADHD or are diagnosed and start medication during their reproductive years. A common question in perinatal psychiatry regards the risk-benefit profile of pharmacotherapy for ADHD, particularly with stimulants. At this time, there are no guidelines to inform the treatment of ADHD across pregnancy and the postpartum period. Concerns about in utero exposure to stimulants are based primarily on the impact these medications might have on fetal growth. While stimulants do not appear to be associated with major congenital malformations, more human data regarding potential behavioral teratogenicity are needed in order to understand both the short- and long-term risks. Severity of illness, presence of comorbid disorders, and degree of impairment have an impact on treatment decisions. Crucial considerations include driving safety and ability to function in occupational roles. While most women can successfully avoid the use of stimulant medication during pregnancy, there are cases in which the benefits of stimulant treatment outweigh known and putative risks of in utero medication exposure.
Topics: Adult; Attention Deficit Disorder with Hyperactivity; Bupropion; Central Nervous System Stimulants; Cognition Disorders; Combined Modality Therapy; Drug Substitution; Female; Humans; Infant, Newborn; Neuropsychological Tests; Pregnancy; Pregnancy Complications; Psychotherapy; Puerperal Disorders; Referral and Consultation; Risk Factors
PubMed: 24980168
DOI: 10.1176/appi.ajp.2013.13050680 -
The Practitioner Mar 2015The postnatal period appears to be associated with higher rates of adjustment disorder, generalised anxiety disorder, and depression. Women who have a history of serious... (Review)
Review
The postnatal period appears to be associated with higher rates of adjustment disorder, generalised anxiety disorder, and depression. Women who have a history of serious mental illness are at higher risk of developing a postpartum relapse, even if they have been well during pregnancy. Psychiatric causes of maternal death are more common than some direct causes of death. UK rates increased from 13/100,000 in 2006-2008 to 16/100,000 in 2010-2012, higher than, for example, mortality caused by haemorrhage or anaesthetic complications of childbirth. Postnatal depression is more severe than baby blues, follows a chronic course and may relapse outside the perinatal period. Although 13% of patients already have depression in pregnancy, the majority tend to be diagnosed after delivery; up to 19% from childbirth to three months postpartum. NICE recommends using the Two Question Depression Screen and the Generalized Anxiety Disorder scale from the booking visit through to one year postpartum. A positive response to depression or anxiety questions warrants a full assessment using either PHQ-9 or the Edinburgh Postnatal Depression Scale. Bipolar disorder may present as a first depressive episode in pregnancy or the postnatal period. In the postpartum period women have a high risk of severe relapse. Postpartum psychosis has a sudden and dramatic presentation with delusions, mania, severe depression, or mixed episodes with wide fluctuations of symptoms and severe mood swings.
Topics: Adult; Anxiety Disorders; Female; Humans; Mood Disorders; Pregnancy; Pregnancy Complications; Puerperal Disorders
PubMed: 26062269
DOI: No ID Found -
CMAJ : Canadian Medical Association... Jan 1986Postpartum blues, postpartum neurotic depression and puerperal psychoses have distinct clinical features; they affect women in all social classes and in all cultures,... (Review)
Review
Postpartum blues, postpartum neurotic depression and puerperal psychoses have distinct clinical features; they affect women in all social classes and in all cultures, and despite numerous studies they have not been linked definitively with any biologic or psychosocial variables. The only possible exception is puerperal psychosis, which emerges much more often in women with a personal or family history of a bipolar affective disorder than in women without, a finding that probably explains the reluctance of some researchers to recognize puerperal psychotic episodes as distinct from psychotic episodes at other times. If postpartum blues last longer than 2 weeks and are disabling they are classified as neurotic depression and warrant treatment, often requiring both psychosocial approaches and psychotropic drug therapy. Antidepressants, major tranquillizers, electroconvulsive therapy and lithium have proved effective in the treatment of postpartum psychoses, depending on the symptoms. Both lithium and diazepam have been reported to cause deleterious side effects on breast-fed infants, and as the side effects of other psychotropic drugs given to a nursing mother are imperfectly understood, bottle feeding seems prudent.
Topics: Adult; Antidepressive Agents, Tricyclic; Family; Female; Humans; Infant, Newborn; Lithium; Milk, Human; Pregnancy; Psychotherapy, Brief; Psychotic Disorders; Puerperal Disorders; Recurrence; Time Factors
PubMed: 3510069
DOI: No ID Found -
Therapeutische Umschau. Revue... Jun 2009Pregnancy and the postpartum are times of increased risk for women with bipolar disorder to develop mood episodes, especially depressions that may require... (Review)
Review
Pregnancy and the postpartum are times of increased risk for women with bipolar disorder to develop mood episodes, especially depressions that may require pharmacotherapy. If mood stabilizing agents are discontinued prior or due to pregnancy, the risk for relapse increases dramatically. On the other hand, there is no psychotropic drug that is completely risk-free for the unborn. Some mood stabilizing medications are teratogenic, others can cause severe perinatal complications. Thus, the decision whether to treat the pregnant women with psychotropic drugs is difficult to make. In this paper, the reproductive risks of mood stabilizing agents, antidepressants, neuroleptics and benzodiazepines for the fetus are reviewed. During the postpartum period severe mood disorders can occur. The signs and symptoms of these disorders are reviewed and therapeutic strategies are discussed.
Topics: Abnormalities, Drug-Induced; Anticonvulsants; Antidepressive Agents; Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Breast Feeding; Depression, Postpartum; Diagnosis, Differential; Female; Gestational Age; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Puerperal Disorders; Risk Factors; Secondary Prevention
PubMed: 19496044
DOI: 10.1024/0040-5930.66.6.475 -
Psychiatric Services (Washington, D.C.) Dec 2018Up to 20% of women who screen positive for depression in the perinatal period in primary care and obstetric settings may have bipolar disorder, but little is known about...
Up to 20% of women who screen positive for depression in the perinatal period in primary care and obstetric settings may have bipolar disorder, but little is known about best practices for this population. This column describes clinical programs that support identification and management of depression and bipolar disorder among women in non-mental health settings. The programs use diverse management strategies, including referral to specialty mental health, collaborative care, and consultation and care coordination. Most mental health programs based in primary care and obstetric settings are designed for depression treatment. Assessment and treatment strategies need to be refined to ensure that women with bipolar disorder receive appropriate care.
Topics: Adult; Bipolar Disorder; Delivery of Health Care, Integrated; Female; Humans; Massachusetts; Mental Health Services; Perinatal Care; Pregnancy; Pregnancy Complications; Program Development; Puerperal Disorders; Washington
PubMed: 30122137
DOI: 10.1176/appi.ps.201800133 -
Medical Hypotheses Oct 2003Puerperal psychosis is a rare but serious psychiatric disorder following delivery. Although controversy continues to surround its nosological status, puerperal psychosis...
Puerperal psychosis is a rare but serious psychiatric disorder following delivery. Although controversy continues to surround its nosological status, puerperal psychosis is generally considered a mood episode with psychotic features occurring in the context of bipolar disorder or schizoaffective disorder. Due to the close temporal association with childbirth, the etiological role of gonadal steroids, particularly estrogen, has been considered. Familial factors have also been implicated in the triggering of episodes of puerperal psychosis. Sleep deprivation arising from an array of diverse factors is a common occurrence surrounding parturition. The author suggests that sleep loss plays a pivotal role in the causation of puerperal psychosis. Clinical implications of this hypothesis are discussed. Studies on the aetiology and pathogenesis of puerperal psychosis are urgently needed not only for prevention and better treatment strategies of puerperal psychosis but also for understanding the biological underpinnings of bipolar disorder.
Topics: Female; Humans; Psychotic Disorders; Puerperal Disorders; Sleep Deprivation
PubMed: 13679016
DOI: 10.1016/s0306-9877(03)00200-7 -
BMJ (Clinical Research Ed.) Apr 1991
Topics: Child Development; Child, Preschool; Cognition; Depressive Disorder; Female; Humans; Infant, Newborn; Mother-Child Relations; Pregnancy; Puerperal Disorders
PubMed: 2039891
DOI: 10.1136/bmj.302.6783.978 -
Archives of General Psychiatry Jul 1981Fifty-eight psychoses beginning within two weeks of childbirth are compared with 52 episodes of nonpuerperal psychotic illness occurring in young women. A clinical...
Fifty-eight psychoses beginning within two weeks of childbirth are compared with 52 episodes of nonpuerperal psychotic illness occurring in young women. A clinical approach based on the use of multiple information sources and integrated assessment was used. Statistically significant differences between the two groups of patients were found in 52 of 214 psychopathological variables. Postpartum patients had more manic symptoms and "confusion," while nonpuerperal patients had more schizophrenic symptoms. The Research Diagnostic Criteria (RDC) showed an excess of schizoaffective (manic) puerperal patients and schizoaffective (depressed) or schizophrenic nonpuerperal patients. Only five of 58 puerperal episodes met RDC for schizophrenia. The relative lack of schizophrenic symptoms in the puerperal group was confirmed by self-ratings. The results are interpreted as supporting a link between puerperal psychosis and manic-depressive disease.
Topics: Adult; Bipolar Disorder; Diagnosis, Differential; Female; Humans; Pregnancy; Psychology; Psychotic Disorders; Puerperal Disorders; Schizophrenia
PubMed: 7247645
DOI: 10.1001/archpsyc.1981.01780320109013 -
Thyroid : Official Journal of the... Jul 1999It has long been known that primary thyroid disorder is associated with mood disorder and vice versa so that the features of major depression can occur in individuals... (Review)
Review
It has long been known that primary thyroid disorder is associated with mood disorder and vice versa so that the features of major depression can occur in individuals with hypothyroidism. Also, primary depression is often associated with disturbance of the hypothalamic-pituitary-thyroid axis. Roberton's historic description of the relatively common occurrence of postpartum hyperthyroidism eventually led to the discovery that thyroid antibody-positive women are prone to hypothyroidism, which is often preceded by transient hyperthyroidism after delivery. Various aspects of depression and the association with thyroid antibody status are described and the importance of treatment and management of the condition emphasized, particularly in view of the risk of later permanent hypothyroidism in mothers. The effects of associated mood disorder on attachment to the baby, the family, and later development of the child are also described.
Topics: Autoantibodies; Depressive Disorder; Female; Humans; Hypothalamo-Hypophyseal System; Hypothyroidism; Life Change Events; Puerperal Disorders; Thyroid Diseases; Thyroid Gland
PubMed: 10447017
DOI: 10.1089/thy.1999.9.699 -
The British Journal of Psychiatry : the... Mar 1994Most clinical and genetic evidence suggests that puerperal psychosis is closely related to bipolar affective disorder. During a linkage study of bipolar disorder we...
Most clinical and genetic evidence suggests that puerperal psychosis is closely related to bipolar affective disorder. During a linkage study of bipolar disorder we ascertained a British family in which puerperal psychosis was associated with consanguinity in three sisters. All three subjects had lifetime RDC diagnoses of bipolar I or manic disorder. An inbred brother also had bipolar I disorder. The only female member of the sibship to escape puerperal psychosis was outbred. These findings are consistent with several genetic models for bipolar disorder in this family. The most interesting possibility is a single major susceptibility locus of recessive effect. Under this assumption, the family could be used for homozygosity mapping to help localise the putative recessive locus. If other inbred families can be found in which the same putative recessive locus is operating, the power to localise the gene by homozygosity mapping would be greatly increased.
Topics: Bipolar Disorder; Consanguinity; Female; Genetic Linkage; Homozygote; Humans; Karyotyping; Male; Models, Genetic; Pedigree; Psychiatric Status Rating Scales; Puerperal Disorders; X Chromosome
PubMed: 8199790
DOI: 10.1192/bjp.164.3.359