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PubMed2001

Assessing psychopathology in pregnancy and postpartum.

This paper evaluates questionnaire measures of anxiety, depression and posttraumatic stress disorder for use with pregnant and postpartum women. For each area of measurement the main issues or problems are delineated, two appropriate measures are described and the validity and reliability of the measures are discussed, as well as the problems and benefits of using the measures with pregnant or postpartum women. Finally, norms are provided for female and obstetric samples, where available. It is hoped that this paper will provide a valuable resource for future research into psychopathology in pregnant and postpartum women.

Anxiety Disorders↗
PubMed1993

Women and mood disorders. Menarche to menopause.

Considering the multiple issues affecting women and their experiences with mood disorders, several clinical observations may be pertinent: Because women are very vulnerable to depression, physicians in all patient care related specialties need to be familiar with the diagnosis of depression and related mood syndromes. Early intervention may be far more critical than previously considered in preventing chronic, tragic outcomes for major depression, bipolar disorder, and even severe premenstrual depression. Both dysphoric mania (because of its poor prognosis) and rapid cycling bipolar disorder (because the majority of cases involve women) distinguish bipolar illness in women. In these situations, anticonvulsants such as carbamazepine or valproic acid may offer treatment advantages over lithium. Premenstrual depression is very strongly linked to traditional psychiatric mood syndromes and is likely to benefit from appropriate antidepressant therapy. The serotonin-specific reuptake inhibitors are especially attractive in this situation because of their low side effect profiles (including low weight gain percentages) and safety in overdoses. Previous experience with psychiatric illness, especially bipolar disorder, is often predictive of postpartum mood episodes. Aggressive early treatment is critical to prevent or successfully manage postpartum episodes. Menopause cannot yet be linked to a specific or unique mood syndrome.

Adolescent↗
PubMed2003

Estrogen administration does not reduce the rate of recurrence of affective psychosis after childbirth.

BACKGROUND: High rates of postpartum relapse occur in women with histories of bipolar or schizoaffective disorder. These relapses may be triggered by the postdelivery fall in circulating estrogen through alteration of central neurotransmitter (especially dopaminergic) systems. This study tested the hypothesis that estrogen administration after childbirth would prevent postpartum relapse and would alter dopamine receptor sensitivity. METHOD: Twenty-nine pregnant women with a Research Diagnostic Criteria diagnosis of hypomania (bipolar II), mania (bipolar I), or schizoaffective disorder participated in an open clinical trial. Three transdermal dose regimens of estrogen (17beta-estradiol) were tested. Starting doses were 200 (N = 13), 400 (N = 3), and 800 (N = 13) micro g/day, beginning within 48 hours after delivery and reduced by one half every 4 days for a total of 12 days. On the fourth day after starting estradiol therapy (before relapse occurred), subjects participated in a neuroendocrine challenge test that measured the sensitivity of the central nervous system (tubero-infundibular) dopaminergic system (plasma prolactin and growth hormone responses to apomorphine). RESULTS: Estradiol at all dose regimens did not reduce the rate of relapse. However, of the 12 women who relapsed, those who had taken the highest dose of estradiol (800 micro g/day) needed less subsequent psychotropic medication (fewer chlorpromazine equivalents) and were discharged sooner than those who had taken either of the 2 lower doses. No differences in neuroendocrine responses to apomorphine were detected between women receiving the high-dose and the lower-dose regimens. CONCLUSION: The results do not support the hypothesis that a fall in circulating concentrations of estrogens precipitates relapse in subjects at risk of postpartum affective psychosis. The use of prophylactic estrogen in such circumstances is therefore highly questionable.

Administration, Cutaneous↗
PubMedDate not supplied

Sex on the ward.

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Female↗
PubMedDate not supplied

Early detection of postnatal depression.

Although postnatal depression is considered a relatively common problem, it is particularly difficult to detect in the early months following childbirth. The author describes how she and her colleagues examined what action could be taken to increase the detection of postnatal depression in the early stages, and benefited from the use of the Edinburgh Postnatal Depression Scale. While she concedes that the project would need to be developed into a wider study before definitive conclusions could be drawn, the article demonstrates how different parts of the primary health care team can work together to improve services to patients.

Community Health Nursing↗
PubMed1999

[Severe postpartum depression and psychosis--when is electroconvulsive therapy the treatment of choice?].

Numerous reports indicate that severe depression responds well to electroconvulsive therapy. Four cases of severe postpartum depression are presented, three of which had psychotic features. All patients were successfully treated with electro-convulsive therapy. This form of therapy might be the treatment of choice for severe postpartum depressions and for all cases of postpartum psychosis where pharmacological therapy does not give a rapid restoration of the patient's function. A limited number of studies are published on this topic. Guidelines for treatment of these disorders are lacking, resulting in variable treatment practice.

Adult↗