Bipolar disorder in the postpartum period: the impact of a prenatal mood episode on maternal improvement at postpartum discharge after joint inpatient hospitalization

INTRODUCTION:Existing studies have not investigated the effectiveness of one long-acting injectable antipsychotic (LAI) versus another in preventing hospitalizations among patients with bipolar disorder (BD). This study was conducted to compare all-cause inpatient healthcare utilization and associated costs among BD patients who initiated LAIs.METHODS:This retrospective cohort analysis used the Truven Health Analytics MarketScan® Commercial and Medicaid claims database. Bipolar patients >18 years with at least one claim for one of the following LAIs were identified between 1 January 2013 and 30 June 2014 (identification period): aripiprazole, haloperidol, paliperidone, and risperidone. The first day of initiating an LAI was considered the index date. Logistic regression and generalized linear regression models were conducted to estimate risk of inpatient hospitalization and associated costs during the 1-year follow up.RESULTS:A total of 1,540 BD patients initiated an LAI: 14.5 percent aripiprazole, 16.3 percent risperidone, 21.0 percent haloperidol, and 48.1 percent paliperidone. With the aripiprazole cohort as the reference group, the odds of having any inpatient hospitalizations were significantly higher in haloperidol [Odds Ratio, OR (95 percent Confidence Interval, CI): 1.49 (1.01 - 2.19)] and risperidone [1.78 (1.19 - 2.66)] cohorts. The paliperidone cohort also had a higher risk of having a hospitalization than aripiprazole, but the difference was not statistically significant (p>.05). Among LAI initiators having any inpatient hospitalizations, the adjusted mean all-cause inpatient costs were lowest in the aripiprazole cohort (USD26,002), followed by risperidone (USD27,937), haloperidol (USD30,411), and paliperidone (USD33,240). However, the cost difference was not statistically significant.CONCLUSIONS:Our study findings highlight the value of aripiprazole in reducing all-cause inpatient hospitalizations and associated costs among patients with BD during the 1-year follow-up. It is worthwhile to note that bipolar diagnoses were identified from healthcare claims coded for reimbursement purposes, thus misclassification was possible. Future studies are warranted to understand the impact of LAI use in a longer period of time.

Download Full-text

Olanzapine and quetiapine in the prevention of a new mood episode in women with bipolar disorder during the postpartum period: a retrospective cohort study

Brazilian Journal of Psychiatry ◽

10.1590/1516-4446-2020-1629 ◽

2021 ◽

Author(s):

Faruk Uguz ◽

Aysegul Kirkas

Keyword(s):

Bipolar Disorder ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Postpartum Period ◽

Retrospective Cohort ◽

Mood Episode

Download Full-text

F117EVALUATING THE IMPACT OF NON-RANDOM MATING: PSYCHIATRIC OUTCOMES AMONG THE OFFSPRING OF PAIRS DIAGNOSED WITH SCHIZOPHRENIA AND BIPOLAR DISORDER

European Neuropsychopharmacology ◽

10.1016/j.euroneuro.2018.08.197 ◽

2019 ◽

Vol 29 ◽

pp. S1173-S1174

Author(s):

James Crowley ◽

Ashley Nordsletten ◽

Gustaf Brander ◽

Patrick Sullivan ◽

Naomi Wray ◽

...

Keyword(s):

Bipolar Disorder ◽

Random Mating ◽

Psychiatric Outcomes ◽

The Impact

Download Full-text

Treatment of Bipolar Disorder During the Postpartum Period

CNS Spectrums ◽

10.1017/s1092852900025724 ◽

2006 ◽

Vol 11 (S5) ◽

pp. 13-14

Author(s):

Adele C. Viguera

Keyword(s):

Bipolar Disorder ◽

Postpartum Period ◽

Clinical Information ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

Antipsychotic Treatment ◽

Close Monitoring ◽

Major Congenital Malformations ◽

Major Depressive Episodes ◽

Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

Download Full-text

Emotional availability in women with bipolar disorder and major depression: A longitudinal pregnancy cohort study

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867421998796 ◽

2021 ◽

pp. 000486742199879

Author(s):

Pavitra Aran ◽

Andrew J Lewis ◽

Stuart J Watson ◽

Thinh Nguyen ◽

Megan Galbally

Keyword(s):

Bipolar Disorder ◽

Major Depressive Disorder ◽

Depressive Symptoms ◽

Major Depression ◽

Depressive Disorder ◽

Emotional Availability ◽

Major Depressive ◽

Interaction Quality ◽

Pregnancy Cohort ◽

The Impact

Objective: Poorer mother–infant interaction quality has been identified among women with major depression; however, there is a dearth of research examining the impact of bipolar disorder. This study sought to compare mother–infant emotional availability at 6 months postpartum among women with perinatal major depressive disorder, bipolar disorder and no disorder (control). Methods: Data were obtained for 127 mother–infant dyads from an Australian pregnancy cohort. The Structured Clinical Interview for the DSM-5 was used to diagnose major depressive disorder ( n = 60) and bipolar disorder ( n = 12) in early pregnancy (less than 20 weeks) and review diagnosis at 6 months postpartum. Prenatal and postnatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, along with self-report psychotropic medication use. Mother and infant’s interaction quality was measured using the Emotional Availability Scales when infants reached 6 months of age. Multivariate analyses of covariance examining the effects of major depressive disorder and bipolar disorder on maternal emotional availability (sensitivity, structuring, non-intrusiveness, non-hostility) and child emotional availability (responsiveness, involvement) were conducted. Results: After controlling for maternal age and postpartum depressive symptoms, perinatal disorder (major depressive disorder, bipolar disorder) accounted for 17% of the variance in maternal and child emotional availability combined. Compared to women with major depressive disorder and their infants, women with bipolar disorder and their infants displayed lower ratings across all maternal and child emotional availability qualities, with the greatest mean difference seen in non-intrusiveness scores. Conclusions: Findings suggest that perinatal bipolar disorder may be associated with additional risk, beyond major depressive disorder alone, to a mother and her offspring’s emotional availability at 6 months postpartum, particularly in maternal intrusiveness.

Download Full-text

Improving the Timely Delivery of Antihypertensive Medication for Severe Perinatal Hypertension in Pregnancy and Postpartum

American Journal of Perinatology ◽

10.1055/s-0041-1728835 ◽

2021 ◽

Author(s):

Patrick Schneider ◽

Patricia Ann Lee King ◽

Lauren Keenan-Devlin ◽

Ann E.B. Borders

Keyword(s):

Quality Improvement ◽

Postpartum Period ◽

Care Team ◽

Quality Improvement Initiative ◽

Elevated Blood ◽

Statistical Process ◽

Pregnancy And Postpartum ◽

Blood Pressures ◽

The Impact ◽

Timely Delivery

Objective Sustained blood pressures ≥160/110 during pregnancy and the postpartum period require timely antihypertensive therapy. Hospital-level experiences outlining the efforts to improve timely delivery of care within 60 minutes have not been described. The objective of this analysis was to assess changes in care practices of an inpatient obstetrical health care team following the implementation of a quality improvement initiative for severe perinatal hypertension during pregnancy and the postpartum period. Study Design In January 2016, NorthShore University HealthSystem Evanston Hospital launched a quality improvement initiative focusing on perinatal hypertension, as part of a larger, statewide quality initiative via the Illinois Perinatal Quality Collaborative. We performed a retrospective cohort study of all pregnant and postpartum patients with sustained severely elevated blood pressure (two severely elevated blood pressures ≤15 minutes apart) with baseline data from 2015 and data collected during the project from 2016 through 2017. Changes in clinical practice and outcomes were compared before and after the start of the project. Statistical process control charts were used to demonstrate process-behavior changes over time. Results Comparing the baseline to the last quarter of 2017, there was a significant increase in the administration of medication within 60 minutes for severe perinatal hypertension (p <0.001). Implementation of a protocol for event-specific debriefing for each severe perinatal hypertension episode was associated with increased odds of the care team administering medication within 60 minutes of the diagnosis of severe perinatal hypertension (adjusted odds ratio 3.20, 95% confidence interval 1.73–5.91, p < 0.01). Conclusion Implementation of a quality improvement initiative for perinatal hypertension associated with pregnancy and postpartum improved the delivery of appropriate and timely therapy for severely elevated blood pressures and demonstrated the impact of interdisciplinary communication in the process. Key Points

Download Full-text

Timing of onset of lithium relapse prevention in bipolar disorder: evidence from randomised trials

The British Journal of Psychiatry ◽

10.1192/bjp.2018.177 ◽

2018 ◽

Vol 213 (5) ◽

pp. 664-666 ◽

Cited By ~ 4

Author(s):

Matthew J. Taylor

Keyword(s):

Bipolar Disorder ◽

Relapse Prevention ◽

Early Onset ◽

Hazard Ratio ◽

Randomised Trials ◽

Mood Episode ◽

Early Effects ◽

Timing Of Onset

SummaryLithium is widely prescribed, but the timing of key effects remains uncertain. The timing of onset of its relapse prevention effects is clarified by placebo-controlled randomised trials (3 studies, n = 1120). Lithium reduced relapse into any mood episode over the first 2 weeks of treatment (hazard ratio 0.40, 95% CI 0.16–0.97). Fewer manic relapses were evident within the first 4 weeks, however, early effects on depressive relapse were not demonstrated. There is an early onset of lithium relapse prevention effects in bipolar disorder, particularly against manic relapse. Full effects against depressive relapse may develop over a longer period.Declaration of interestM.J.T. reports personal fees from Sunovion, Otsuka, Lundbeck, outside the submitted work.

Download Full-text

The Impact of Probiotic Supplements on Cognitive Parameters in Euthymic Individuals with Bipolar Disorder: A Pilot Study

Neuropsychobiology ◽

10.1159/000492537 ◽

2018 ◽

Vol 79 (1) ◽

pp. 63-70 ◽

Cited By ~ 7

Author(s):

Eva Z. Reininghaus ◽

Lisa-Christin Wetzlmair ◽

Frederike T. Fellendorf ◽

Martina Platzer ◽

Robert Queissner ◽

...

Keyword(s):

Bipolar Disorder ◽

Pilot Study ◽

The Impact

Download Full-text

Free contraception and behavioural nudges in the postpartum period: evidence from a randomised control trial in Nairobi, Kenya

BMJ Global Health ◽

10.1136/bmjgh-2018-000888 ◽

2018 ◽

Vol 3 (5) ◽

pp. e000888 ◽

Cited By ~ 2

Author(s):

Margaret McConnell ◽

Claire Watt Rothschild ◽

Allison Ettenger ◽

Faith Muigai ◽

Jessica Cohen

Keyword(s):

Postpartum Period ◽

Randomised Control Trial ◽

Control Group ◽

Modern Contraceptive ◽

Contraceptive Methods ◽

Birth Intervals ◽

Financial Barriers ◽

Maternity Hospitals ◽

Sms Reminder ◽

The Impact

BackgroundShort birth intervals are a major risk factor for poor maternal and newborn outcomes. Utilisation of modern contraceptive methods during the postpartum period can reduce risky birth intervals but contraceptive coverage during this critical period remains low.MethodsWe conducted a randomised controlled experiment to test whether vouchers for free contraception, provided with and without behavioural ‘nudges’, could increase modern contraceptive use in the postpartum period. 686 pregnant women attending antenatal care in two private maternity hospitals in Nairobi, Kenya, were enrolled in the study. The primary outcomes were the use of modern contraceptive methods at nearly 3 months and 6 months after expected delivery date (EDD). We tested the impact of a standard voucher that could be redeemed for free modern contraception, a deadline voucher that expired 2 months after delivery and both types of vouchers with and without a short message service (SMS) reminder, relative to a control group that received no voucher and no SMS reminder.ResultsBy nearly 6 months after EDD, we find that the combination of the standard voucher with an SMS reminder increased the probability of reporting utilisation of a modern contraceptive method by 25 percentage points (pp) (95% CI 6 pp to 44 pp) compared with the control group. Estimated impacts in other treatment arms were not statistically significantly different from the control group.ConclusionsReducing financial barriers to postpartum contraception alone may not be enough to encourage take-up. Programmes targeting the postpartum period should consider addressing behavioural barriers to take-up.

Download Full-text