The long-term psychiatric and medical prognosis of perinatal mental illness.
ABSTRACT The perinatal period provides an important window into a woman's long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions.
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ABSTRACT: Limited neurobiological data have implicated central arginine vasopressin in the pathobiology of obsessive-compulsive disorder (OCD). Based on twin, family genetic, and pharmacological studies, some forms of OCD are etiologically related to Tourette's syndrome. The role of arginine vasopressin and related compounds such as oxytocin in Tourette's syndrome has not been previously explored. To compare cerebrospinal fluid (CSF) levels of arginine vasopressin and oxytocin, we collected CSF at midday in a standardized fashion from a total of 83 individuals (29 patients with OCD, 23 patients with Tourette's syndrome, and 31 normal controls). We also collected family study data on each subject to determine which subjects had a family history positive for Tourette's syndrome, OCD, or related syndromes. In contrast to previous reports, we report similar concentrations of arginine vasopressin for all three groups but increased oxytocin levels in patients with OCD. Remarkably, this increase was observed only in a subset of patients with OCD (n = 22) independently identified as being without a personal or family history of tic disorders (P = .0003). In this subgroup of patients, the CSF oxytocin level was correlated with current severity of OCD (n = 19, r = .47, P < .05). A possible role for oxytocin in the neurobiology of a subtype of OCD is suggested by the elevated CSF levels of oxytocin and by the correlation between CSF oxytocin levels and OCD severity. These findings reinforce the value of family genetic data in identifying biologically homogeneous (and perhaps more etiologically homogeneous) groups of patients with OCD. Together with emerging pharmacological data showing differential responsiveness to treatment of tic-related OCD vs non-tic-related OCD, these data also argue strongly for the incorporation of tic-relatedness as a variable in biological and behavioral studies of patients with OCD.Archives of General Psychiatry 11/1994; 51(10):782-92. · 13.75 Impact Factor
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ABSTRACT: The postpartum period has typically been considered a time of heightened vulnerability for development of affective disorders, and women with bipolar disorder have consistently demonstrated vulnerability to puerperal worsening of mood. This retrospective study examined the extent to which mood-stabilizing agents provide prophylactic benefit to bipolar women during the postpartum period. The clinical course of 27 women meeting the DSM-III-R criteria for bipolar disorder was followed during pregnancy and the postpartum period. Information regarding severity of illness (as measured by number of episodes of mania, depression, or both) was obtained, in addition to data on pharmacotherapy (if any) received before, during, and after pregnancy. The extent to which the prophylactic use of antimanic agents minimized the risk of relapse was explored. Only one of the 14 patients taking prophylactic agents during the acute puerperium relapsed within the first 3 months postpartum, while eight of the 13 who did not receive antimanic drugs showed evidence of recurrent affective instability during those 3 months. A survival analysis indicated that the women receiving prophylactic treatment with mood stabilizers maintained well-being significantly longer than the women who did not receive such treatment. Women with bipolar disorder appear to benefit from puerperal prophylaxis with mood stabilizers. Consistent with results of earlier studies, postpartum prophylaxis was associated with lower rates of relapse into affective disorders. The findings have implications for the early identification and treatment of subgroups of women at particular risk for puerperal illness.American Journal of Psychiatry 12/1995; 152(11):1641-5. · 13.56 Impact Factor
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ABSTRACT: To determine the efficacy of an individualized, family-based intervention with preterm infants and their families. Randomized, repeated measures intervention outcome study. Level III neonatal intensive care nursery. Random sample of 34 preterm infants < or = 1500 g and their families. Individualized, family-based intervention during the hospitalization and transition to home addressed problems identified by parents in four domains including: infant behavior and characteristics, family organization and functioning, caregiving environment, and home discharge and community resources. Standardized questionnaires were administered at baseline and discharge to mothers, and predischarge bottle-feeding interactions were videotaped and coded by two blinded observers. Results were in favor of intervention (Int) versus control (Con) mothers (baseline; discharge) (P < .05) on the Parental Stressor Scale Sights and Sounds subscale (Int 2.4 +/- 1.0; 2.0 +/- 0.8 vs Con 2.4 +/- 0.9; 2.6 +/- 0.8); Child's Appearance and Behavior subscale (Int 2.8 +/- 1.0; 2.5 +/- 1.1 vs Con 2.8 +/- 0.8; 3.1 +/- 0.6); and Total Stressor Score (Int 93.9 +/- 36.6; 72.3 +/- 41.8 vs Con 87.5 +/- 26.7; 87.8 +/- 26.2). On the Beck Depression Inventory, intervention mothers had significant decreases in depressive symptoms (39%; 11%) vs control mothers (31%; 44%). Maternal self-esteem in both groups improved over time. There were no significant group differences in family environment. During feeding interactions, intervention infants grimaced (P < .001) and gagged (P < .05) less than controls. Intervention mothers less frequently interrupted feedings (P < .001); less frequently stimulated infant sucking (P < .01); smiled more (P < .001); vocalized more (P < .01); demonstrated greater sensitivity to infant behavior (P < .001), better quality of physical contact (P < .001), and more positive affect (P < .01). Individualized, family-based intervention appears to reduce maternal stress and depression, and to enhance early mother-infant feeding interactions. Further research is needed to determine whether these short-term beneficial effects persist beyond the newborn period.Pediatrics 02/1994; 93(2):241-6. · 5.30 Impact Factor