Postpartum bipolar episodes are not distinct from spontaneous episodes: Implications for DSM-V
ABSTRACT DSM course modifiers should be based on enough evidence on his impact in the clinical prognosis of patients presenting with a certain clinical feature. The presence of postpartum onset of a mood episode in bipolar disorders has not been sufficiently studied. This is the first prospective clinical study comparing female bipolar patients with and without lifetime history of postpartum mood episode.
Systematic prospective follow-up (12 years) of 200 female bipolar I or II patients with or without history of postpartum episodes. Postpartum mood episode was defined according to DSM-IV criteria. Patients with and without postpartum onset of a mood episode were compared regarding clinical and sociodemographic variables.
Lifetime history of postpartum episode was present in 43 patients and absent in 137 patients. Twenty patients were excluded from the study because lack of agreement of the two independent psychiatrist. Both groups showed almost no differences regarding clinical features, functioning or severity.
The present study does not take account of potential factors that may influence the outcome of a postpartum episode, including obstetric complications and social support before delivery. Similarly, dimensional and qualitative aspects of bipolar disorder were not included in our analysis.
The role of postpartum onset as a DSM course modifier should be reconsidered, as it seems to have no impact on prognosis or functioning.
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- "In accordance with many studies ( Affonso et al . , 1990 ; Colom et al . , 2010 ; Meltzer and Kumar , 1985 ; Murray et al . , 1995 ; Wisner et al . , 1993 , 1995 ) which showed that the clin - ical profile of PP depression did not differ from depression oc - curring at any other time in a woman ' s life , we found similar GAF scores among FEPP and FENPP depression with compara - ble suicidal ideation as well as his"
ABSTRACT: The aims of this study were to assess rates of bipolar spectrum disorders in women experiencing their first episode of postpartum depression, and to find out features indicative of bipolarity in these patients. As part of the international BRIDGE study designed to detect hypo/mania in patients with a major depressive episode, 52 (5.85%) were found to experience a first episode of postpartum (FEPP) depression, whereas 833 (94.13%) had a first episode of nonpostpartum (FENPP) depression. Hypo/mania was assessed using varying definitions of bipolarity, and the two groups compared on sociodemographic, family history and clinical characteristics. Compared to FENPP depressive patients, women with FEPP depression had higher rates of bipolar disorders, with more hypo/mania in first degree relatives. Psychotic symptoms, atypical features, mixed depression, younger age at onset, high number of prior episodes, episodes of short duration, switches on antidepressants, seasonality of mood episodes as well as mood episodes with free intervals were found to be more frequent in FEPP depressives. The following are the limitations of this study: centres not randomly selected, recall bias, cross-sectional design, and limited training of participating psychiatrists. This study confirms, in women experiencing a first depressive episode, high rates (15 to 50%) of bipolar disorders during the postpartum period and is the first to systematically assess and demonstrate the higher prevalence of identifying features of bipolarity in FEPP versus FENPP depression. Early recognition of bipolarity in these patients may help prevent the harmful consequences of this illness.Journal of Affective Disorders 10/2011; 136(3):710-5. DOI:10.1016/j.jad.2011.10.003 · 3.71 Impact Factor
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ABSTRACT: A conceptual study of magnetic flux compression inside a cylindrical coil by an expanding inertial fusion plasma sphere across the magnetic field produced by the coil itself have been performed numerically using a two-dimensional magnetohydrodynamic (MHD) simulations. The concept may find application in inertial fusion energy (IFE) system as a direct energy conversion scheme to convert a part of fusion plasma kinetic energy into pulsed electrical energy. Important theoretical and technical issues that has to be addressed are discussed. Preliminary theoretical analysis are given for the analysis of MHD interchange instabilities of expanding plasma across magnetic field. Overall efficiency of the system is determined numerically for a typical set of initial plasma and system parameters. Ultrahigh coil inter-turn voltages are predicted. Therefore, the application of magnetic self-insulation to avoid coil inter-turn break-down is considered. Also, we have analysed the system performance with different load conditions.Fusion Engineering and Design 03/2011; 86(2):174-182. DOI:10.1016/j.fusengdes.2010.11.008 · 1.15 Impact Factor
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ABSTRACT: The risks of major affective episodes during pregnancy and during the postpartum period have rarely been compared in large samples across diagnoses. The authors hypothesized that perinatal episodes would mainly be depressive, would occur more in the postpartum than the prenatal period, and would be more prevalent with bipolar than unipolar depressive disorders. The authors pooled clinical information on 2,252 pregnancies of 1,162 women with clinically treated DSM-IV bipolar I disorder (479 pregnancies/283 women), bipolar II disorder (641/338), or recurrent major depressive disorder (1,132/541) to compare rates of affective episode types by diagnosis during pregnancy and the postpartum period and to identify risk factors. Among women with bipolar disorder, 23% had illness episodes during pregnancy and 52% during the postpartum period. Among women with unipolar depression, 4.6% had illness episodes during pregnancy and 30% during the postpartum period. Based on exposure-adjusted risk per pregnancy, episodes were 3.5 times more prevalent during the postpartum period than during pregnancy, and the risk was consistently higher with bipolar disorder. Depression was the most frequent morbidity during and following pregnancy. In multivariate modeling, factors associated with affective episodes in pregnancy, in descending order, were younger age at onset, previous postpartum episodes, fewer years of illness, bipolar disorder, fewer children, and not being married. Postpartum episodes were associated with younger age at onset, illness during pregnancy, bipolar disorder, fewer children, and more education. Moreover, pregnancy was less likely and perinatal episodes more likely if diagnosis preceded a first pregnancy. First lifetime episodes occurred in the perinatal period in 7.6% of cases. Among women with major affective disorders, illness risk was much greater during the postpartum period than during pregnancy. Illness mainly involved depression and was strongly associated with younger age at illness onset, bipolar disorder, and high lifetime occurrence rates. The relative risk during pregnancy compared with nonpregnant periods remains uncertain.American Journal of Psychiatry 07/2011; 168(11):1179-85. DOI:10.1176/appi.ajp.2011.11010148 · 13.56 Impact Factor