Antipsychotic drugs for pregnant and breastfeeding women with non-affective psychosis. Editorial

The University of Manchester, Manchester, England, United Kingdom
BMJ (online) (Impact Factor: 17.45). 11/2004; 329(7472):933-4. DOI: 10.1136/bmj.329.7472.933
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    • "In addition women of childbearing age are also often routinely excluded from aetiological and intervention studies (e.g. neuro-imaging studies or drug trials) because of fears that if they are pregnant, or conceive during the study, the foetus will be put at risk [12], though there is evidence that this is changing [13,14]. Secondly, certain groups are less likely to access mental health services and will therefore not be available for studies that recruit through service contacts, e.g. "
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    ABSTRACT: It is well established that the incidence, prevalence and presentation of mental disorders differ by gender, ethnicity and age, and there is evidence that there is also differential representation in mental health research by these characteristics. The aim of this paper is to a) review the current literature on the nature of barriers to participation in mental health research, with particular reference to gender, age and ethnicity; b) review the evidence on the effectiveness of strategies used to overcome these barriers. Studies published up to December 2008 were identified using MEDLINE, PsycINFO and EMBASE using relevant mesh headings and keywords. Forty-nine papers were identified. There was evidence of a wide range of barriers including transportation difficulties, distrust and suspicion of researchers, and the stigma attached to mental illness. Strategies to overcome these barriers included the use of bilingual staff, assistance with travel, avoiding the use of stigmatising language in marketing material and a focus on education about the disorder under investigation. There were very few evaluations of such strategies, but there was evidence that ethnically matching recruiters to potential participants did not improve recruitment rates. Educational strategies were helpful and increased recruitment. Mental health researchers should consider including caregivers in recruitment procedures where possible, provide clear descriptions of study aims and describe the representativeness of their sample when reporting study results. Studies that systematically investigate strategies to overcome barriers to recruitment are needed.
    BMC Psychiatry 12/2010; 10(1):103. DOI:10.1186/1471-244X-10-103 · 2.21 Impact Factor
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    • "In a prospective comparative study of pregnancy outcomes of women using second generation antipsychotic drugs, McKenna et al. (2005) reported that of 110 pregnant women exposed to a second generation antipsychotic the only statistically significant difference in pregnancy outcomes was low birth weight babies in 10% of those exposed to second generation antipsychotics compared with 2% in the comparison group of women not taking antipsychotic medication. Reports of safety for the foetus and baby with the use of both the first generation and second generation antipsychotics vary across the spectrum ranging from no or low risk (Altshuler et al. 1996, MacKay et al. 1998, Hill et al. 2000, Nagy et al. 2001, Koren et al. 2002, Goldstein et al. 2004, Yaris et al. 2004, McKenna et al. 2005); some risk (Sacker et al. 1996, Cohen & Rosenbaum 1998, Pinkofsky 2000) to high risk (Dev & Krupp 1995, Howard et al. 2004). Others say the risks are uncertain (Ernst & Goldberg 2002). "
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    ABSTRACT: Women who are pregnant and who have a history of psychosis are commonly managed with antipsychotic medications. The evidence regarding the use of antipsychotics in pregnancy has been insufficient to provide adequate support for this practice and is a concern for clinicians and women alike. This review presents literature surrounding the use of antipsychotic medications in pregnancy, providing an overview of the historical and contemporary perspectives which influence clinicians prescribing practices. Data were sourced from Medline, CINAHL, PsycINFo, using the terms antipsychotics with pregnancy and psychosis or schizophrenia. This was expanded to include the most common atypical antipsychotics: olanzapine, risperidone, clozapine, quetiapine, ziprasidone and aripiprazole. Literature was found reporting the use of antipsychotic medications in pregnancy since the introduction of antipsychotics in the 1950s, comprising mainly of authors' reviews of the literature, case studies, retrospective reports, drug company registries and more recently a prospective comparative study. This review identifies that the literature provides no clear answer for clinicians as to the risk associated with the use of antipsychotics in pregnancy. To this effect, recently in Australia, the National Register of Antipsychotic Medications in Pregnancy was established to prospectively collect information regarding outcomes for mother and baby, when antipsychotic medications have been used during pregnancy.
    Journal of Psychiatric and Mental Health Nursing 03/2010; 17(2):97-104. DOI:10.1111/j.1365-2850.2009.01481.x · 0.84 Impact Factor
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    • "Foetal exposure to prescribed psychotropic drugs may also be important but ethical constraints have precluded the conduct of randomized evaluations of psychotropic medication in pregnancy (Howard et al. 2004), and there are few large population-based observational studies that have measured these exposures directly. Munk et al. (2005) conducted a large cohort study across four Danish counties (a combined population of 1.4 million people) by linking prescription registry data to the national Medical Birth Register. "
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    ABSTRACT: Few large studies describe links between maternal mental illness and risk of major birth defect in offspring. Evidence is sparser still for how effects vary between maternal diagnoses and no previous study has assessed risk with paternal illnesses. A population-based birth cohort was created by linking Danish national registers. We identified all singleton live births during 1973-1998 (n=1.45 m), all parental psychiatric admissions from 1969 onwards, and all fatal birth defects until 1 January 1999. Linkage and case ascertainment were almost complete. Relative risks were estimated using Poisson regression. Risk of fatal birth defect was elevated in relation to history of any maternal admission and also with affective disorders specifically, although the strongest effect found was with maternal schizophrenia. The rate was more than doubled in this group compared to the general population [relative risk (RR) 2.34, 95% confidence interval (CI) 1.45-3.77], which also represented a significant excess risk compared with all other admitted maternal disorders (p=0.018). Risk of death from causes other than birth defect was no higher with schizophrenia than with other maternal conditions. There was no elevation in risk of fatal birth defect if the father was admitted with schizophrenia or any other psychiatric diagnosis. There are many possible explanations for a higher risk of fatal birth defect with maternal schizophrenia and affective disorder. These include genetic effects directly linked with maternal illness, lifestyle factors (diet, smoking, alcohol and drugs), poor antenatal care, psychotropic medication toxicity, and gene-environment interactions. Further research is needed to elucidate the causal mechanisms.
    Psychological Medicine 04/2008; 38(10):1495-503. DOI:10.1017/S0033291707002280 · 5.94 Impact Factor
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