Perinatal Psychiatric Disorders Research Articles

New treatments: Opportunities and challenges

Across the spectrum of perinatal mental illness, there exist a variety of effective treatments. However, the available treatments are not always matched to the presentation, resources, constraints, or values of each patient. Furthermore, provider, local, and systemic factors complicate access to current treatment options. New and emerging approaches offer the potential of more effective treatment for specific perinatal psychiatric disorders. From neuroactive steroid medications to accelerated psychotherapy interventions, recent innovations have demonstrated enhanced efficacy on a faster timeline. Optimally, these developments will also lower barriers to care but this is not necessarily true. We review novel and upcoming interventions across perinatal mental illness and place them in the context of existing treatments and common challenges.

Home Treatment and Perinatal Psychiatry: An Alternative to Acute Psychiatric Wards

IntroductionWomen experiencing severe perinatal mental health problems require specialized services and care. Perinatal mental disorders are common and can contribute to maternal mortality, affecting neonatal, infant, and child outcomes. Home treatment can prevent hospital admissions and promote strategies within the patient’s support network.ObjectivesOur aim is to describe a clinical case in perinatal psychiatry managed by a Psychiatric Home Treatment Unit.MethodsWe present a case of perinatal psychotic depression in a 26-year-old pregnant woman.ResultsWe describe the case of a patient with no prior history of mental health issues. She was 25 weeks pregnant when she first sought psychiatric help in July 2023 and was diagnosed with depressive disorder with psychotic symptoms. She reported symptoms such as low mood, psychomotor inhibition, delusional guilt thoughts, and auditory hallucinations beginning three weeks before her initial visit. Due to her clinical presentation, the patient was admitted to the hospital, where pharmacological treatment was initiated with Olanzapine 5 mg, Sertraline 50 mg, and Lorazepam 1.5 mg. She remained in the hospital for four days, during which she showed gradual improvement but did not achieve full recovery.Considering the improvement observed, home treatment was proposed and accepted by the patient and her relatives. During home treatment, she continued to exhibit persistent depressive and psychotic symptoms, including low mood, inhibition, and delusional thoughts of ruin and catastrophe. Therefore, her treatment was adjusted, with Olanzapine increased to 10 mg, Sertraline raised to 100 mg, and Lorazepam reduced to 0.75 mg. Over time, significant improvement in her clinical symptoms was noted. Throughout the follow-up period, she reported no significant side effects from the pharmacological treatment. After a month of follow-up in our department, she was discharged with outpatient care provided by a specialized community perinatal psychiatric unit.ConclusionsWe illustrate the possibility of home treatment for perinatal psychiatric disorders. The potential benefits of remaining close to one’s support network and developing coping strategies can be advantageous during the course of illness. Further studies should be conducted to explore these potential benefits.Disclosure of InterestNone Declared

Shifting the paradigm in how we assess and treat perinatal psychopathology.

Both syndromic and subsyndromal episodes of psychiatric disorders are common during and after pregnancy and are associated with adverse consequences for the mother and her baby. Despite remarkable opportunities for the detection of at-risk women, the prevention and treatment of peripartum recurrences of psychiatric disorders remain a challenge for physicians, and allied professionals This brief report discusses the importance of subsyndromal symptoms and offers suggestions to improve the assessment, diagnosis, and treatment of perinatal psychiatric disorders.

Weaning and depression: a closer look.

The association of weaning with depression has long been recognized. However, interest in the study of post-weaning depression has waned over the last few decades partly due to changes in the nosology of perinatal psychiatric disorders. In this paper, we review the relevant literature and conclude that post-weaning depression is a rare but severe complication of breastfeeding cessation. Given that post-weaning depression is an understudied and often undiagnosed clinical condition, research is needed to address this important unmet need.

APA releases education resources on maternal mental health

Annually, one in five childbearing persons in the United States experiences a mental health or substance use disorder before, during or after pregnancy, the American Psychiatric Association (APA) stated in an Aug. 1 news release. To ensure that psychiatrists and mental health clinicians are best positioned to respond to this need, the APA, with support from the CDC [Centers for Disease Control and Prevention] Foundation, has released a series of educational materials for addressing perinatal mental health in its Psychiatric Toolkit. The toolkit includes eight fact sheets for clinicians and patients, a white paper, and a four‐part webinar series covering this understudied and underserved area of mental health. These materials can be accessed at APA's Perinatal Mental Health website (https://www.psychiatry.org/psychiatrists/practice/professional‐interests/women‐s‐mental‐health/maternal‐mental‐health‐toolkit). The white paper calls for revisions to academic and continuing education curricula to improve competency and confidence within the behavioral care workforce for treating this population. It examines the care of vulnerable populations, raising such issues as cultural competency and lack of access. This “Mental Health Needs Assessment in the Management of Perinatal Psychiatric Disorders” is supported by the CDC and the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $447,209 funded by the CDC/HHS.

Maternal suicide, a little-known reality that can be prevented

While maternal suicide is an important cause of perinatal mortality, the assessment of this risk can be more difficult in the context of perinatality. Pregnancy acceptance problems and perinatal psychiatric disorders are major risk factors for maternal suicide. The -clinical evaluation focuses on the mental health of the mother on the one hand, but also on the quality of her interactions with the baby and the signs of psychological suffering of the latter during postpartum period. Coordinated and multidisciplinary management is recommended to prevent these fatal outcomes and the indication for hospitalization should always be discussed.

Postpartum Psychosis: Risk factors and Management

Following childbirth, with a psychosis and associated mood disturbance, Postpartum Psychosis (PPP) is studied to be a severe mental health condition. PPP affects 1 to 2 per 1000 women among the psychiatric emergency. To curb this severe disorder, acute clinical intervention is warranted. Maternal mental health problems with a focus on depression as the condition with the biggest public health impact should be the way forward. This review is set to look into the risk factors, prevention and management of PPP. Both the acute onset and recurrence of psychiatric illness are common during the perinatal period as women are more vulnerable during this period. Timely detection and effective management of perinatal psychiatric disorders are critical for managing PPP. Part of the management strategies for women who experience PPP is to seek guidance on further pregnancies and risk of illness. Since PPP is a disturbing complication of childbirth that carries high risks for both mother and child, if one is at high risk of developing puerperal psychosis, there is the need for a specialist care during pregnancy and be seen by a psychiatrist.

The Relevance of Insomnia in the Diagnosis of Perinatal Depression: Validation of the Italian Version of the Insomnia Symptom Questionnaire.

Background. Sleep disorders are common in perinatal women and may underlie or trigger anxiety and depression. We aimed to translate and validate and evaluate the psychometric properties of the Italian version of the Insomnia Symptom Questionnaire (ISQ), in a sample of women during late pregnancy and 6-months postpartum according to the DSM-5 criteria. Methods. The ISQ was administered to 292 women prenatally along with other measures of sleep quality, depression, and anxiety, to examine its construct and convergent validity. Women were readministered the ISQ six months postdelivery to assess test–retest reliability. Women were divided into DSM-5 No-Insomnia (N = 253) and Insomnia (N = 39) groups. Results. The insomnia group had received more psychopharmacotherapy, had more psychiatric family history, increased rates of medically assisted reproduction, of past perinatal psychiatric disorders, and scored higher on almost all TEMPS-A dimensions, on the EPDS, HCL-32, PSQI, and on ISQ prenatally and postnatally. ISQ scores correlated with all scales, indicating adequate convergent and discriminant validity; furthermore, it showed antenatal–postnatal test–retest reliability, 97.5% diagnostic accuracy, 79.5% sensitivity, 94.9% specificity, 70.5% positive predictive power, and 92.8% negative predictive power. Conclusions. The ISQ is useful, valid, and reliable for assessing perinatal insomnia in Italian women. The Italian version showed equivalent properties to the original version.

Postpartum Psychosis: Risk factors and Management

Following childbirth, with a psychosis and associated mood disturbance, Postpartum Psychosis (PPP) is studied to be a severe mental health condition. PPP affects 1 to 2 per 1000 women among the psychiatric emergency. To curb this severe disorder, acute clinical intervention is warranted. Maternal mental health problems with a focus on depression as the condition with the biggest public health impact should be the way forward. This review is set to look into the risk factors, prevention and management of PPP. Both the acute onset and recurrence of psychiatric illness are common during the perinatal period as women are more vulnerable during this period. Timely detection and effective management of perinatal psychiatric disorders are critical for managing PPP. Part of the management strategies for women who experience PPP is to seek guidance on further pregnancies and risk of illness. Since PPP is a disturbing complication of childbirth that carries high risks for both mother and child, if one is at high risk of developing puerperal psychosis, there is the need for a specialist care during pregnancy and be seen by a psychiatrist.

Perinatal Psychiatry in Context to Women ‘S Health

Introduction: Women’s Mental Health Traditionally focuses on women’s reproductive health,like Puberty,Pregnancy, Menopause now it is expanding to include disorders and conditions more prevalent in femalesthan in males, or different in clinical features and risk factors. Perinatal Psychiatry refers to mental healthissues in antenatal and postpartum period like Antenatal depression, Postnatal blues, Postpartum depression,Postpartum psychosis.Methods: The global burden of psychiatric disorders in women is increasing, especially in the perinatalperiod. We have focused on discussing the impact of culture on the perinatal psychiatric disorders andmanagement principles of different perinatal psychiatric disorders. Health?care delivery in the perinatalgroup of population has been improving over the years, but still there is lot to improve.Conclusion: A scientific and evidence?based approach is a definite need toward attaining this goal.

Psychiatric Morbidity, Cultural Factors, and Health-Seeking Behaviour in Perinatal Women: A Cross-Sectional Study from a Tertiary Care Centre of North India.

Background:Poor mental health of the mother affects her physical health and the neonate's health and development. Studies from Southern India place different estimates of perinatal mental ill-health. Cultural variables affect health-seeking behaviour and are thus important to study in perinatal women with psychiatric morbidity.Methods:A total of 281 perinatal women were screened on Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS) and Mini International Neuropsychiatric Interview version 6.0 (MINI), assisted with a clinical interview to identify psychiatric illnesses. The cultural formulation interview (CFI) of DSM-5 was applied on perinatal women having psychiatric illnesses and their caregivers.Results:A psychiatric diagnosis was present in 10.3% of perinatal women. Depression and anxiety disorders were seen in 7.12% and 1.41%, respectively. Marital discord (P < 0.0001), psychosocial stressors (P < 0.0001), and past history of psychiatric disorder (P < 0.001) were significantly higher in perinatal women with a current psychiatric diagnosis. On CFI work-related stress, the gender of the infant, low education and conflict across generations were identified as the negative aspects of the culture associated with psychiatric illness during and after pregnancy. Religion and social support were the major coping strategies, while stigma and financial problems were the major barriers to help-seeking.Conclusion:The high prevalence of psychiatric disorders and the strikingly low help-seeking are noteworthy. These findings can help in planning treatment and prevention programs for timely detection and intervention for perinatal psychiatric disorders.

Transformation of attitude through brief psychoeducation program for the husbands of women with postpartum psychiatric disorders.

According to existing literature on Perinatal Psychiatric Services, husbands have not often been involved in the treatment of their spouses with Perinatal Psychiatric disorders, especially in India, despite the advantages as an adjunctive form of therapy. The current study aimed at evaluating the effectiveness of brief psychoeducation on the attitude of husbands of women with postpartum psychiatric disorder through a biopsychosocial based informative and supportive model of intervention. A 3 session based Brief Psychoeducation Program (BPP) was developed for the targeted population and its effectiveness was evaluated through quasi-experimental research design. Using Community Attitude towards Mentally Ill Scale (CAMI) assessment of the outcome variable was done at 3 levels i.e., Pre (baseline), Post (immediately after the intervention) and Follow-up post (1 month after the intervention). A total of 21 participants were recruited meeting the study criteria. Friedmans test and descriptive statistics were used to analyze the data. Results indicated the transformation in the attitude of the participants in all the 4 domains of the scale from pre-intervention to post-intervention phase. The study has a strong implication for mental health professionals in this area at both clinical (medical and psychiatry settings) and nonclinical settings.

State of the art and future perspectives on the use of non-invasive neuromodulation in peripartum psychiatric disorders

State of the art and future perspectives on the use of non-invasive neuromodulation in peripartum psychiatric disorders

APA Releases New Statement on Perinatal Disorders

APA Releases New Statement on Perinatal Disorders

Trajectory of perinatal mental health in India

The global burden of psychiatric disorders in women is on the rise, especially in the perinatal period. Despite this, the recognition of the need and delivery of health care in women of reproductive age group is scarce and still met by unscientific treatment modalities. Such a scenario is luring in India as well. We have focused on discussing the impact of culture on the treatment practices, different challenges faced, nosological status, and management principles of different perinatal psychiatric disorders. We mainly employed the Google Scholar search engine to look into articles of all sorts (review articles, case reports, expert opinions, newspaper extracts, and Indian government websites) and reviewed them. We also acknowledged the information extracted from these articles which were highly valuable and enlightening. The perspective of the health-care delivery in the perinatal group of population has been changing over the years, but still there is lot to change. A holistic, scientific, evidence-based approach is a definite need toward attaining this goal.

Baroda development screening test for infants in a perinatal psychiatry setting: A preliminary report from India

BACKGROUND: There is a need for early and reliable screening methods to identify the developmental delays in infants born to mothers with perinatal psychiatric disorders. Developmental assessment scales for Indian infants (DASII) is the only standardized tool from India for use in infants but is time-consuming and expensive, which may not be useful in busy outpatient settings or when the mother has a psychiatric illness. AIM: To examine the correlation between the Baroda development screening test (BDST), developmental screening test (DST), and DASII full scale (i.e., both motor and mental scales). METHODS: The study included thirty consecutive infants in the age range of 1–6 months from inpatient and outpatient perinatal psychiatric services. The infants were screened with DST and BDST and later assessed with DASII full scale. RESULTS: Both BDST and DST showed significant correlation with mental subscale and motor subscale of DASII, but only BDST predicted the DASII scores on mental scale (standard error [SE] = 0.14; t = 0.73; P CONCLUSIONS AND IMPLICATIONS: Both DST and BDST show good correlation with DASII, but only BDST predicts the DASII scores. The findings need to be replicated with larger sample size and different settings to establish BDST as an effective screening tool in identifying developmental delays in infants born to mothers with perinatal psychiatric disorders.

Impact of Provider Gender on Patient Engagement With Prenatal Mental Health Care [31K

INTRODUCTION: Perinatal psychiatric disorders affect up to 20% of pregnant women, and are especially prevalent among women of lower socioeconomic status and women who have experienced intimate partner violence (IPV). Here we evaluate the association between provider gender and engagement with mental health care during pregnancy in a group of women seeking care at a safety net hospital. METHODS: This analysis includes retrospectively abstracted clinical data from patients referred to the Obstetrics Mental Health Clinic (OBMH) at a large urban county hospital between July 1, 2014 and September 1, 2016. The OBMH Clinic receives referrals from prenatal care providers and social workers for pregnant women with comorbid psychiatric symptoms. Included in the study were pregnant women, ages 18 and older, who had attended an OBMH intake interview. OBMH adherence was defined as attending at least one follow-up appointment during pregnancy after initial intake. RESULTS: One hundred thirty-seven patients met study criteria and were included in this analysis. There was no significant difference in OBMH adherence for women seeing a male versus a female psychiatric provider for their intake interview (χ2=2.39, df=1, P=.122). Among women with a diagnosis of posttraumatic stress disorder secondary to IPV, there was no significant association between OBMH adherence and provider gender (χ2=.084, df=1, P=.77). CONCLUSION: Provider gender is not a statistically significant predictor of adherence to OB mental health care. Findings suggest that women could benefit from longitudinal prenatal mental healthcare regardless of the gender of their mental health care provider.

Will the DSM-5 and ICD-11 “Make-over” really make a difference to women's mental health?

The recent modifications to the classificatory systems were expected to enhance the recognition of various psychiatric conditions specific to women. Several researchers and clinicians had made specific recommendations regarding four main conditions; that is, female sexual dysfunction (FSD), perinatal psychiatric disorders (PPDs), and premenstrual dysphoric disorder and eating disorders; to improve the clinical utility of these diagnoses. While FSD has undergone considerable change with its own special place outside of mental health, not all suggestions regarding PPDs were considered. A major advance in both Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) and International Classification of Diseases (ICD11) has been the inclusion of the antenatal period in PPDs, which had hitherto been left out. However, two recommendations related to PPDs-increase in the time frame of the postpartum definition and inclusion of mother–infant interaction disorders were not considered, which we believe are valuable opportunities lost. Substantial changes have been included in the clinical manifestations and course of eating disorders, based on evidence and cross-cultural differences. One condition included in ICD-11 which may help women get better treatment is complex posttraumatic stress disorder. It appears that while there are some changes that are positive, more could have been achieved for women's mental health.

Modern Management of Perinatal Psychiatric Disorders (Second edition) Henshaw Carol Cox John Barton Joanne Modern Management of Perinatal Psychiatric Disorders (Second edition) 330pp £35 RCPsych Publications 9781909726772 190972677X [Formula: see text

This book presents a comprehensive synthesis of the evidence on perinatal mental health disorders. Written by perinatal and child psychiatrists, the book provides information for midwives, nurses and other professionals on the care of women with perinatal mental health disorders.

Modern Management of Perinatal Psychiatric Disorders

British Journal of MidwiferyVol. 25, No. 8 Book reviewModern Management of Perinatal Psychiatric DisordersLesley Briscoe, Sylvia Murphy TigheLesley BriscoeSearch for more papers by this author, Sylvia Murphy TigheSearch for more papers by this authorLesley Briscoe; Sylvia Murphy TighePublished Online:2 Aug 2017https://doi.org/10.12968/bjom.2017.25.8.533AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 2 August 2017Volume 25Issue 8ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 2 August 2017 Published in print 2 August 2017 Information© MA Healthcare LimitedPDF download