Psychopathology In Women Research Articles

Emotional non‐acceptance mediates the relationship between insecure attachment and specific psychopathology in women with eating disorders

IntroductionInsecure attachment is considered a general risk factor for eating disorders (ED). Emotion dysregulation has been proposed as one of the possible mechanisms by which attachment insecurity may affect ED psychopathology.ObjectivesAim of the present study was to investigate whether difficulties in acceptance of emotions or emotional clarity may mediate the connection between insecure attachment and ED psychopathology.MethodsOne hundred and twenty patients participated and completed the Italian version of Eating Disorder Inventory‐2 (EDI-2), Experience in Close Relationship questionnaire (ECR) and Difficulties in Emotion Regulation Scale (DERS). A mediator path model was performed, in which insecure attachment dimensions were set as independent variables, ED specific psychopathology measures as dependent variables, and non‐acceptance of emotion and lack of emotional clarity as mediators.ResultsThe association between both attachment avoidance and anxiety and ED specific symptoms was mediated by emotional non‐acceptance, but not by emotional clarity.ConclusionsThis study showed the importance to address emotion regulation in individuals with ED, focussing on improving emotional acceptance. Exploring early developmental processes which lead to non‐acceptance of emotions could improve this psychological trait in people with ED.Disclosure of InterestNone Declared

Gender differences in the associations between childhood adversity and psychopathology in the general population.

To explore gender differences of the associations between childhood adversity (CA) subtypes and psychiatric symptoms in the general population. Data of 791 participants were retrieved from a general population twin cohort. The Symptom Checklist-90 Revised (SCL-90) and the Childhood Trauma Questionnaire were used to assess overall psychopathology with nine symptom domains scores and total CA with exposure to five CA subtypes, respectively. The associations between CA and psychopathology were analyzed in men and women separately and were subsequently compared. Total CA was associated with total SCL-90 and all symptom domains without significant gender differences. However, the analyses of CA subtypes showed that the association between emotional abuse and total SCL-90 was stronger in women compared to men [χ2(1) = 4.10, P = 0.043]. Sexual abuse was significantly associated with total SCL-90 in women, but emotional neglect and physical neglect were associated with total SCL-90 in men. Exploratory analyses of CA subtypes and SCL-90 subdomains confirmed the pattern of gender-specific associations. In women, emotional abuse was associated with all symptom domains, and sexual abuse was associated with all except phobic anxiety and interpersonal sensitivity. In men, emotional neglect was associated with depression, and physical neglect was associated with phobic anxiety, anxiety, interpersonal sensitivity, obsessive-compulsive, paranoid ideation, and hostility subdomains. CA is a trans-syndromal risk factor regardless of gender. However, differential associations between CA subtypes and symptom manifestation might exist. Abuse might be particularly associated with psychopathology in women, whereas neglect might be associated with psychopathology in men.

Emotional non-acceptance mediates the relationship between insecure attachment and specific psychopathology in women with eating disorders.

Insecure attachment is considered a general risk factor for eating disorders (ED). Emotion dysregulation has been proposed as one of the possible mechanisms by which attachment insecurity may affect ED psychopathology. Aim of the present study was to investigate whether difficulties in acceptance of emotions or emotional clarity may mediate the connection between insecure attachment and ED psychopathology. One hundred and twenty patients participated and completed the Italian version of Eating Disorder Inventory-2, Experience in Close Relationship questionnaire and Difficulties in Emotion Regulation Scale. A mediator path model was performed, in which insecure attachment dimensions were set as independent variables, ED specific psychopathology measures as dependent variables, and non-acceptance of emotion and lack of emotional clarity as mediators. The association between both attachment avoidance and anxiety and ED specific symptoms was mediated by emotional non-acceptance, but not by emotional clarity. This study showed the importance to address emotion regulation in individuals with ED, focussing on improving emotional acceptance. Exploring early developmental processes which lead to non-acceptance of emotions could improve this psychological trait in people with ED.

Psychopathology Present in Women after Miscarriage or Perinatal Loss: A Systematic Review

Miscarriage or perinatal loss constitutes one of the most important emotional stressors a woman can experience and can be associated with bereavement. This mourning is a way of adapting and coping with the circumstances. However, inadequate management of this process can lead to the development of complicated grief and psychopathologies such as anxiety, depression, and post-traumatic stress disorder. The aim of this systematic review was to evaluate the prevalence of psychopathology (anxiety, depression, and post-traumatic stress disorder) in women with a history of miscarriage or perinatal loss in the year prior, and to compare these results with women without this history. A peer review was conducted in PubMed, Cochrane, Scopus, and Web of Science databases. We included (1) articles that included women of any age who had had a miscarriage or perinatal loss in the year prior, and (2) articles with a longitudinal cohort design with a comparison group of women without a history of miscarriage or perinatal loss. After the screening process, three articles met these inclusion criteria and were included in this study. Psychopathology in women after miscarriage or perinatal loss was higher than in the control groups. In addition, it was observed that these psychopathologies gradually decreased over the first year from the loss. In conclusion, abortion and perinatal loss pose a risk factor for the development of psychopathology. Therefore, we emphasize the importance of implementing a mental health plan for these women.

Low oxytocin levels are broadly associated with more pronounced psychopathology in anorexia nervosa with primarily restricting but not binge/purge eating behavior.

Anorexia nervosa (AN) is commonly associated with depression, anxiety, and deficits in socioemotional functioning. Basal levels of oxytocin, a neurohormone with antidepressant, anxiolytic, and prosocial properties, are low in women with AN. However, the relationship between oxytocin and psychopathology of AN/atypical AN has not been examined in individuals with primarily food restriction (AN/AtypAN-R) or those with restriction plus binge/purge behaviors (AN/AtypAN-BP) alone, which is important to further elucidate the neurobiology of different AN presentations. We investigated whether oxytocin levels are related to eating, affective, and socioemotional psychopathology in women with AN/AtypAN-R and separately AN/AtypAN-BP. In a cross-sectional study of 53 women with low-weight AN or atypical AN based on DSM-5 (AN/AtypAN-R: n=21, AN/AtypAN-BP: n=32), we obtained fasting serum oxytocin levels and self-report measures of psychopathology, including the Eating Disorder Examination-Questionnaire (EDE-Q), Beck Depression Inventory-IA (BDI), State-Trait Anxiety Inventory (STAI), and Toronto Alexithymia Scale (TAS-20). In individuals with AN/AtypAN-R, oxytocin levels were negatively associated with eating psychopathology (EDE-Q Global Score: r=-0.49, p=0.024), depressive and anxiety symptoms (BDI Total Score: r=-0.55, p=0.009; STAI Trait Score: r=-0.63, p=0.002), and socioemotional symptoms (TAS-20 Difficulty Identifying Feelings Score: r=-0.49, p=0.023). In contrast, in those with AN/AtypAN-BP oxytocin levels were negatively associated with depressive symptoms only (BDI Total Score: r=-0.52, p=0.049). These findings support the notion that AN/AtypAN-R and AN/AtypAN-BP might have divergent underlying neurobiology. Understanding these differences is crucial to develop targeted treatments for a population with high levels of chronicity, for which no specific pharmacological treatments are currently available. https://clinicaltrials.gov, identifier: NCT01121211.

The use of SCL-k-9 to measure general psychopathology in women and men with skin conditions

To measure general psychopathology in dermatologic outpatients using the Symptom-Checklist-K-9 (SCL-K-9); to investigate whether the SCL-K-9 is able to categorize patients with and without significant non-psychotic disorders; and to perform a single-item analysis of the SCL-K-9, with a focus on gender differences. Cross-sectional study on consecutive dermatological patients. We used two self-administered questionnaires to assess general psychopathology symptoms: General Health Questionnaire-12 (GHQ-12) and SCL-K-9. Sociodemographic information was collected with standardized forms. The performance of the SCL-K-9 in classifying patients according to their current emotional distress severity was assessed using a ROC procedure. Finally, we measured differences in scores obtained among women and men in SCL-K-9 single items. A total of 292 patients were studied (71.2% women). We observed statistically significant differences in SCL-K-9 total mean scores and in most single items among genders. We found that it would be more appropriate to use gender-specific cut-offs when using SCL-K-9 to screen dermatological patients for general psychopathology. The SCL-K-9, with its compact format could provide, in a short time, a wide range of information related to critical areas that challenge the mental health of patients with skin diseases.

Women’s Mental Health and Pregnancy Loss: What Should We Be Aware Of?

IntroductionPregnancy loss (PL) – by induced or spontaneous termination of pregnancy – is common, although its consequences on women’s mental health are often neglected in clinical practice.ObjectivesTo understand the existence of psychiatric morbidity in women, associated with PL, as well as related risk factors.MethodsNon-systematic review of literature through search on PubMed/MEDLINE for publications up to 2021, following the terms ‘pregnancy loss’, ‘psychiatry disorder’, ‘depression’ and ‘anxiety’.ResultsAfter a PL, anxiety is the most frequent symptomatology in 41% of women. Depression occurs in 22-36% of women in the first two weeks after PL, declining over time. Symptoms compatible with Post Traumatic Stress Disorder (PTSD) are found in 25% of women with PL in the first month. Women who meet criteria for PTSD are more likely to present criteria for Depressive Episode. Substance Use Disorder and Prolonged Grief Disorder are also reported, the latter having, as predictors, previous relational difficulties, poor social support and absence of descendants. Risk factors associated with significant psychopathology within PL are, for example, nulliparity, infertility, previous PL, longer gestation time, lower marital satisfaction, previous psychiatric illness, and history of abuse.ConclusionsIn clinical practice, the risk of psychopathology in women with PL should be considered. This population should be actively questioned about the presence of symptoms, as well as their persistence and impact, requiring timely and appropriate pharmacological and psychotherapeutic intervention. Perinatal Mental Health interventions show important gains in the overall health of women and their offspring.DisclosureNo significant relationships.

Associations of self-repression with disordered eating and symptoms of other psychopathologies for men and women

BackgroundDisordered eating has been found to be associated with constructs involving self-repression, such as selflessness (the tendency to relinquish one’s needs for others’), and concern for appropriateness (an alertness to information about social comparison and tendency to vary one’s behavior in different social situations). This study aimed to examine associations between these self-repression variables and symptoms of general psychopathology for women and men in a community sample.MethodsTwo hundred and thirty-six participants (92 men) aged 18–76 (M = 29.11 ± 10.10) volunteered to complete online measures of disordered eating, concern for appropriateness (cross-situational variability and attention to social comparison information), selflessness, and symptoms of depression, anxiety and somatization. Structural equation models were built to assess pathways between the study variables for men and women separately.ResultsA MANOVA 2*7 design showed that women scored significantly higher than men on measures of selflessness, disordered eating and depression. For men, selflessness scores were positively and significantly associated only with depression scores. Cross-situational variability scores were positively associated with depression, somatization and anxiety scores. For women, selflessness scores were positively and significantly associated with depression, disordered eating, somatization and anxiety scores. Cross-situational variability scores were positively and significantly associated with depression, anxiety and somatization scores but not with disordered eating scores. Attention to Social Comparison Information scores were positively and significantly associated only with disordered eating scores.ConclusionsSelf-repression is more closely linked to psychopathology in women than in men. For men, self-suppression seems to be associated with symptoms of internalizing disorders, but not disordered eating. Even for women, it appears that self-repression is not connected exclusively with disordered eating, but with symptoms of psychopathology in general. Future research should explore why self-suppression plays such a central role in women’s psychopathology.

Negative urgency combined with negative emotionality is linked to eating disorder psychopathology in community women with and without binge eating.

Previous research has shown that negative emotionality (NE) and negative urgency (NU) are each risk factors for disordered eating behaviors among undergraduates and treatment-seekers. However, the interaction of these traits in community-based adults with clinical levels of binge eating is unknown and has implications for risk and maintenance models of disordered eating. We examined a moderated-mediation model of cross-sectional associations among levels of NE (independent variable), NU (mediator), and eating disorder psychopathology (i.e., eating, shape, and weight concerns, and restraint; dependent variable) in 68 community-recruited women with current regular binge eating and 75 control women with no eating disorder history (group = moderator). Participants completed semi-structured diagnostic interviews and self-report questionnaires measuring NE, NU, eating disorder psychopathology, and anxiety and depression symptoms. After adjusting for anxiety and depression symptoms and body mass index, women with binge eating experienced greater NU and eating disorder psychopathology than control women with no eating disorder history. Despite similar levels of NE across groups, both groups exhibited an indirect effect of NE on eating disorder psychopathology via NU. Our findings suggest that greater NE, coupled with a propensity to engage in rash action when experiencing negative emotions, are associated with eating disorder psychopathology in women with and without eating disorders characterized by binge eating. These findings may help explain why some individuals engage in disordered eating behaviors when experiencing negative affect.

Muscle Dysmorphic Disorder Inventory (MDDI): Validation of a German version with a focus on gender.

Muscle dysmorphia (MD) is a condition that is characterized by body image disturbance, a drive for muscularity and excessive exercising. It leads to considerable functional impairment. Most previous studies focused on male samples. The study aimed to validate a German version of the Muscle Dysmorphic Disorder Inventory (MDDI) in order to make the instrument available in German speaking countries. We further aimed to explore for gender differences in the MDDI factors (measurement invariance) and to assess the relationship between MD and positive dimensions of body experience as well as exercise dependence. 394 participants (53% females, mean age 24.3 years) took part in an internet-based survey. The three-factor structure of the English version of the MDDI was replicated, independent of gender (multi group CFA; Base model TLI = .961; CFI = .970). Cronbach´s alpha was .81-.84 for the subscales and .75 for the MDDI total score. MD was associated with exercise dependence and negatively correlated with dimensions of positive body experience, which can be considered relevant for satisfying relationships and a positive sense of self: e.g. body contact and sexual fulfillment. Men and women showed differences in two subscales of the MDDI (appearance intolerance, drive for size). Testing for measurement invariance resulted in weak invariance: Equivalent factor structure for men and women, but significantly different loadings and coefficients. No statistically significant difference in the MDDI total score was found. The findings suggest good psychometric properties of the German version of the MDDI. Future studies should address the question of cut-off scores and norms for different samples as well as a possible overlap between MD and eating disorder psychopathology in women.

Weight suppression and weight elevation are associated with eating disorder symptomatology in women age 50 and older: Results of the gender and body image study.

Weight suppression (WS), the difference between highest past non-pregnancy weight and current weight, predicts negative outcomes in eating disorders, but the impact of WS and related weight constructs are understudied in nonclinical, midlife populations. We examined WS (current weight < highest weight) and weight elevation (WE), the opposite of WS (current weight > lowest weight) and their associations with eating psychopathology in women aged 50+. Participants were a community-based sample (N = 1,776, Mage = 59) who completed demographic and eating psychopathology questions via online survey. WS, WE, and WS × WE were tested as predictors of outcome variables; BMI and medical conditions that affect weight were controlled for. Individuals that were higher on WS and WE were most likely to engage in current weight loss attempts, dieting in the past 5 years, and extreme lifetime restriction. Individuals with higher WS were more likely to experience binge eating, greater frequency of weight checking, overvaluation of shape and weight, and lifetime fasting. Individuals with higher WE were more likely to report negative life impacts of eating and dieting. Higher WS and WE each predicted higher levels of skipping meals over the lifetime. This novel study investigated WS in midlife women and introduced a new conceptualization of weight change (WE) that may be more relevant for aging populations given that women tend to gain weight with age. The findings implicate the utility of investigating both WS and WE as factors associated with eating psychopathology in midlife women.

Rumination and Psychopathology: Are Anger and Depressive Rumination Differentially Associated with Internalizing and Externalizing Psychopathology?

Existing literature on rumination has predominately focused on depressive rumination; thus, there is little research directly comparing different forms of rumination as correlates of psychopathological outcomes. The present study investigated anger and depressive rumination as correlates of internalizing and externalizing psychopathology. Cross-sectional confirmatory factor analyses on data from 764 young adults from the Colorado Longitudinal Twin Study indicated that anger and depressive rumination were separable at the latent variable level, and were both associated with lifetime symptoms of internalizing and externalizing psychopathology. However, depressive rumination was more strongly associated with psychopathology than was anger rumination. Further analysis indicated that depressive rumination was independently associated with internalizing psychopathology, whereas associations between anger rumination and psychopathology were predominately due to shared variance with depressive rumination. Anger rumination was independently associated with externalizing psychopathology in women and was inversely associated with internalizing psychopathology in men. This result supports the clinical relevance of ruminative thought processes and the potential differential utility of anger and depressive content for understanding internalizing and externalizing psychopathology.

Empathic skills and theory of mind in female adolescents with conduct disorder.

Objective:Most studies on conduct disorder (CD) have focused on male adolescents, disregarding analysis of this psychopathology in women. The purpose of this study was to identify differences in empathy and theory of mind (ToM) in a group of adolescent women with CD and a control group.Method:Thirty-six adolescent women were selected from an initial sample of 239 adolescents (CD group = 18, control group = 18). Empathy and ToM were evaluated through objective instruments. Mean comparisons and multivariate analysis were performed to ascertain differences between cases and controls and to propose a prediction model based on clinical status.Results:Significant differences in empathic abilities and ToM were found between the groups. The model that differentiated both groups was composed of eye-reading ability, perspective taking, and personal distress.Conclusion:These findings are consistent with previous studies. Capacity to take the other’s perspective and the recognition of emotions in the face are protective factors against CD in women.

182. Childhood Maltreatment, Postnatal Symptoms, and Neonatal Behavior in Postpartum Psychosis

Abstract Background: Individuals at risk of psychosis unrelated to gestation are reported to experience more childhood maltreatment, which has also been associated with more severe positive and affective symptoms (Thompson et al., 2009). Furthermore, maternal experience of childhood maltreatment is associated with increased risk of perinatal psychopathology (Lang et al., 2006; Mezey et al., 2005) and worse offspring outcomes (Roberts et al., 2004; Miranda et al., 2011). Therefore, it is particularly important to examine the relationship between maternal experience of childhood maltreatment and early postnatal psychopathology and offspring outcome in those women who are at high risk of developing postpartum psychosis (PP) after giving birth. Methods: We assessed pregnant women (n = 104) at 25 weeks gestation: 41 were at risk of PP because of a diagnosis of bipolar disorder (n = 35), schizoaffective disorder (n = 4) or a previous PP (n = 2), and 63 were healthy women. Maternal experience of childhood maltreatment was assessed using the Childhood Experience or Care and Abuse Questionnaire (CECA-Q). Maternal affective and psychotic postnatal symptoms were assessed at 6 days postpartum using standardized scales. Infant behavior was also assessed at 6 days postpartum using the Neonatal Behavioral Assessment Scale (NBAS). Results: Compared to healthy women, women at risk of PP experienced significantly more childhood maltreatment (17% vs. 49%, χ2(1) = 11.4, P < .01), particularly sexual abuse (3% vs. 28%, χ2(1) = 13.3, P < .01) and antipathy (7% vs. 24%, χ2(1) = 6, P = .03). Furthermore, women who experienced childhood maltreatment had significantly more postpartum psychotic symptoms than those who did not experience childhood maltreatment (31% vs. 5%, χ2(1) = 4.6, P = .05).Compared to the infants of healthy women, infants of women at risk of PP had worse social interactive (U = 761.5, Z =−2.0, P = 0.05) and autonomic stability (U = 719.0, Z = −2.3, P = .02) scores. However, maternal experience of childhood maltreatment was not associated with infant behavior. Conclusion: The results suggest that women at risk of PP experience more childhood maltreatment than women not at risk and that experience of childhood maltreatment is associated with more psychotic symptoms in the early postpartum. These findings are in line with the literature on psychosis unrelated to gestation and suggest that experience of childhood maltreatment might play a role in the risk for postpartum psychopathology in women at risk of PP. Infants of women at risk of PP had less optimal social interactive and autonomic stability scores on the NBAS, suggesting they were less alert, less able to attend to auditory and visual stimuli and less physiologically stable than infants born to healthy women. The fact that maternal experience of childhood maltreatment was not associated with infant behavior suggests this may not be the mechanism underlying these impairments.

Evaluating social defeat as a model for psychopathology in adult female rodents.

Social conflict is a predominant stressor in humans and is associated with increased risk for developing psychological illnesses including depression and anxiety. Overwhelmingly, more women suffer from these disorders, which may be due to increased stress sensitivity. Like humans, rodents experience a myriad of physiological and behavioral sequelae due to prolonged stress exposure. Although the motivation for social conflict may differ between humans and rodents, female rodents may provide an opportunity to explore the underlying mechanisms by which stress confers risk for psychopathology in women. Because most female rodents do not express spontaneous aggression, the majority of basic research examines the physiological and behavioral outcomes of social conflict in male rodents. However, there are instances where female rodents exhibit territorial (California mice and Syrian hamsters) and maternal aggression (rats, mice, and hamsters) creating a venue to examine sex differences in physiology and behavior in response to stress. While many studies rely upon nonsocial behavioral assays (e.g., elevated plus maze, forced swim test) to assess the impact of stress on emotionality, here we primarily focus on behavioral outcomes in social-based assays in rodents. This is critically important given that disruptions in social relationships can be a cause and consequence of neuropsychiatric diseases. Next, we briefly discuss how sex differences in the recruitment of neural circuitry and/or neurochemistry in response to stress may underlie sex differences in neuroendocrine and behavioral stress responses. Finally, the translational value of females in rodent stress models and considerations regarding behavioral interpretations of these models are discussed. © 2016 Wiley Periodicals, Inc.

Does the interpersonal model apply across eating disorder diagnostic groups? A structural equation modeling approach

BackgroundInterpersonal model has been validated with binge-eating disorder (BED), but it is not yet known if the model applies across a range of eating disorders (ED). PurposeThe goal of this study was to investigate the validity of the interpersonal model in anorexia nervosa (restricting type; ANR and binge-eating/purge type; ANBP), bulimia nervosa (BN), BED, and eating disorder not otherwise specified (EDNOS). ProcedureData from a cross-sectional sample of 1459 treatment-seeking women diagnosed with ANR, ANBP, BN, BED and EDNOS were examined for indirect effects of interpersonal problems on ED psychopathology mediated through negative affect. ResultsFindings from structural equation modeling demonstrated the mediating role of negative affect in four of the five diagnostic groups. There were significant, medium to large (.239, .558), indirect effects in the ANR, BN, BED and EDNOS groups but not in the ANBP group. The results of the first reverse model of interpersonal problems as a mediator between negative affect and ED psychopathology were nonsignificant, suggesting the specificity of these hypothesized paths. However, in the second reverse model ED psychopathology was related to interpersonal problems indirectly through negative affect. ConclusionThis is the first study to find support for the interpersonal model of ED in a clinical sample of women with diverse ED diagnoses, though there may be a reciprocal relationship between ED psychopathology and relationship problems through negative affect. Negative affect partially explains the relationship between interpersonal problems and ED psychopathology in women diagnosed with ANR, BN, BED and EDNOS. Interpersonal psychotherapies for ED may be addressing the underlying interpersonal-affective difficulties, thereby reducing ED psychopathology.

A randomized controlled trial comparing Circle of Security Intervention and treatment as usual as interventions to increase attachment security in infants of mentally ill mothers: Study Protocol

BackgroundPsychopathology in women after childbirth represents a significant risk factor for parenting and infant mental health. Regarding child development, these infants are at increased risk for developing unfavorable attachment strategies to their mothers and for subsequent behavioral, emotional and cognitive impairments throughout childhood. To date, the specific efficacy of an early attachment-based parenting group intervention under standard clinical outpatient conditions, and the moderators and mediators that promote attachment security in infants of mentally ill mothers, have been poorly evaluated.Methods/DesignThis randomized controlled clinical trial tests whether promoting attachment security in infancy with the Circle of Security (COS) Intervention will result in a higher rate of securely attached children compared to treatment as usual (TAU). Furthermore, we will determine whether the distributions of securely attached children are moderated or mediated by variations in maternal sensitivity, mentalizing, attachment representations, and psychopathology obtained at baseline and at follow-up. We plan to recruit 80 mother-infant dyads when infants are aged 4-9 months with 40 dyads being randomized to each treatment arm. Infants and mothers will be reassessed when the children are 16-18 months of age. Methodological aspects of the study are systematic recruitment and randomization, explicit inclusion and exclusion criteria, research assessors and coders blinded to treatment allocation, advanced statistical analysis, manualized treatment protocols and assessments of treatment adherence and integrity.DiscussionThe aim of this clinical trial is to determine whether there are specific effects of an attachment-based intervention that promotes attachment security in infants. Additionally, we anticipate being able to utilize data on maternal and child outcome measures to obtain preliminary indications about potential moderators of the intervention and inform hypotheses about which intervention may be most suitable when offered in a clinical psychiatric outpatient context.Trial registrationCurrent Controlled Trials ISRCTN88988596

The Effect of Sleep Disturbance during Pregnancy and Perinatal Period on Postpartum Psychopathology in Women with Bipolar Disorder

Background: Postpartum psychosis is a severe condition that usually requires hospital admission as result of the highly disturbed behaviour with potential risks for the mother and her newborn child. Women with bipolar disorder have a high risk of relapse related to childbirth, with up to 67% experiencing an episode in the postpartum period, including psychosis. There is much evidence for a relationship between sleep disruption and mood disorders in the perinatal period. Sleep loss has been suggested as a final common pathway in the development of psychosis in vulnerable women, i.e., women with bipolar disorder or a history of psychosis after childbirth. Prospective studies monitoring sleep and mood are scarce. The purpose of this study is to investigate the relationship between sleep disruption during pregnancy and the perinatal period and postpartum psychopathology in women with bipolar disorder. Methods/design: This is a prospective, observational, naturalistic, non-intervention study in pregnant women with an established diagnosis of bipolar disorder. The period of observation will be from week 13 of pregnancy until 12 weeks postpartum. Mood changes will be assessed using the Life Chart methodology throughout the whole study period. Sleep patterns will be assessed by a sleep diary and actigraphy in week 13 and week 26 of pregnancy and from two weeks before the expected delivery until four weeks after. Data will be collected on demographics, diagnosis, medical history, clinical management, clinical, functional, and obstetrical outcomes. In the weeks mentioned before additional data on mood and life-events will be collected. Primary outcomes are the occurrence of psychiatric symptoms during the first four weeks postpartum, and the number and type of any intervention started for impending psychiatric symptoms during the first four weeks postpartum. Discussion: We hypothesize that sleep disturbances during pregnancy and the perinatal period is associated with increased postpartum psychopathology. If so, intervention strategies aimed to improve sleep patterns may decrease the risk for postpartum psychopathology in women with bipolar disorder or a history of postpartum psychosis. Early treatment of sleep disturbance could be a cost-effective method for the prevention of postpartum mood disorders. This research protocol was approved by the Medical Ethics Review Committee of the VU University Medical Center (2012/3).

EPA-0218 - The role of ovarian function in the psychopathology of delusional disorder

Introduction Recent evidence supports an association between oestrogen levels and severity of psychopathology in women with schizophrenia. However, few studies have investigated differences in the psychopathology of premenopausal and postmenopausal female delusional disorder (DD). Objectives To investigate whether men, premenopausal and postmenopausal women differ in age at onset and psychopathology. Methods Psychopathological symptoms were assessed in 64 outpatients with DD (DSM-IV-TR), as part of the Study on the Development and Course of Delusional Disorder in mean-age and the Elderly (DEVCODEL Study), at baseline and after 6 months. Scores in the PANSS scale, PSP for functionality, HRSD-17 items, C-SSRS for suicide and the first three items of the SUMD Scale were outcome variables. ANOVA and Chi-square tests were performed. Psychopathological differences between groups were investigated by applying Analysis of Covariance. Results 68.8% of the sample were postmenopausal women. When compared to premenopausal women and men, postmenopausal women had a lateonset disease (p Conclusions Our results support the notion that postmenopausal DD women have higher severity in psychopathology in comparison with premenopausal women and men.

Body dissatisfaction and socio-cultural factors in women with and without BED: their relation with eating psychopathology.

The goal of the present study was to assess the role of body dissatisfaction and socio-cultural factors on eating psychopathology in women with Binge Eating Disorder (BED) and women without BED. Seventy obese women consecutively evaluated participated: 35 with BED and 35 without BED who attended for the first time in a weight loss program. All participants completed a battery of questionnaires, including: Body Shape Questionnaire, Questionnaire of Influences on the Aesthetic Body Shape Model, Questionnaire on Eating and Weight Patterns, Three Factor Eating Questionnaire, and they were interviewed with the Interview for the Diagnosis of Eating Disorder-IV. The Body Mass Index, Waist-to-Hip Ratio and Body Fat were calculated. The results showed that 21% of obese women who participated in a weight reduction program met BED criteria. The scores of body dissatisfaction, influences of socio-cultural factors and eating psychopathology were higher in women with BED compared with women without BED. In the same way, significantly stronger correlations were found among influences of socio-cultural factors, specifically, influence of advertisement, social relations and eating psychopathology in women with BED than women without BED. It is concluded that the high body dissatisfaction as well as stronger associations among influence of socio-cultural factors and eating psychopathology could play an important role in women with BED.