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Stevens AWMM, Draisma S, Goossens PJJ, Broekman BFP, Honig A, der Klein EAMKV, Nolen WA, Post RM, Kupka RW. The course of bipolar disorder in pregnant versus non-pregnant women. Int J Bipolar Disord 2021; 9:35. [PMID: 34734318 PMCID: PMC8566649 DOI: 10.1186/s40345-021-00239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background and rationale Although it has been suggested that pregnancy may influence the course of bipolar disorder (BD), studies show contradictory results. Until now, no studies included a finegrained validated method to report mood symptoms on a daily basis, such as the lifechart method (LCM). The aim of the present study is to investigate the course of BD during pregnancy by comparing LCM scores of pregnant and non-pregnant women. Methods Study design: Comparison of LCM scores of two prospective observational BD cohort studies, a cohort of pregnant women (n = 34) and a cohort of non-pregnant women of childbearing age (n = 52). Main study parameters are: (1) proportions of symptomatic and non-symptomatic days; (2) symptom severity, frequency, and duration of episodes; (3) state sequences, longitudinal variation of symptom severity scores. Results No differences in clinical course variables (symptomatic days, average severity scores, frequency, and duration of episodes in BD were found between pregnant and non-pregnant women. With a combination of State Sequence Analysis (SSA) and cluster analysis on the sequences of daily mood scores three comparable clusters were found in both samples: euthymic, moderately ill and severely ill. The distribution differences between pregnant and non-pregnant women were significant, with a majority of the pregnant women (68%) belonging to the moderately ill cluster and a majority of the non-pregnant women (46%) to the euthymic cluster. In pregnant women the average daily variation in mood symptoms as assessed with Shannon’s entropy was less than in non-pregnant women (respectively 0.43 versus 0.56). Conclusions Although the use of daily mood scores revealed no difference in overall course of BD in pregnant versus non-pregnant women, more pregnant than non-pregnant women belonged to the moderately ill cluster, and during pregnancy the variation in mood state was less than in non-pregnant women. Further research is necessary to clarify these findings.
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Affiliation(s)
- Anja W M M Stevens
- Center for Bipolar Disorders, Dimence Mental Health, Deventer, The Netherlands. .,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Stasja Draisma
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZinGeest Specialized Mental Health Care, Research and Innovation Amsterdam, Amsterdam, The Netherlands
| | - Peter J J Goossens
- Center for Bipolar Disorders, Dimence Mental Health, Deventer, The Netherlands.,Department of Public Health, Faculty of Medicine and Health Sciences, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Birit F P Broekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Psychiatry, OLVG Hospital, Amsterdam, The Netherlands
| | - Adriaan Honig
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Psychiatry, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Willem A Nolen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Bipolar Collaborative Network, Bethesda, MD, USA
| | - Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, District of Columbia, George Washington University, Washington, USA
| | - R W Kupka
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZinGeest Specialized Mental Health Care, Research and Innovation Amsterdam, Amsterdam, The Netherlands.,Bipolar Collaborative Network, Bethesda, MD, USA
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Stevens AWMM, Goossens PJJ, Knoppert-van der Klein EAM, Draisma S, Honig A, Kupka RW. Risk of recurrence of mood disorders during pregnancy and the impact of medication: A systematic review. J Affect Disord 2019; 249:96-103. [PMID: 30769297 DOI: 10.1016/j.jad.2019.02.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/30/2019] [Accepted: 02/05/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mood disorders can be difficult to treat during pregnancy. There is still lack of evidence whether pregnancy influences their natural course and whether continuation of pharmacotherapy, despite potential risks for the unborn child, is beneficial in preventing recurrence of mood episodes during pregnancy. METHODS Systematic review conducted according to the PRISMA guidelines, searching Pubmed, PsycINFO, Embase and Cochrane databases up till January 9th, 2018. Recurrence rates and various measures of risk were calculated. RESULTS Out of 1387 articles from an initial search 22 studies met the inclusion criteria. Included studies reported a wide variation in the recurrence rate of bipolar disorder and major depressive disorder during pregnancy (BD: mean = 19%, range = 4%-73%; MDD: mean = 8%, range = 1%-75%). Observational data showed a relative risk reduction of maintenance therapy during pregnancy of 66% in women with BD and 54% for women with MDD, a significant difference (95% CI 9.4-14.6; p < 0.001). LIMITATIONS heterogeneous samples, study designs, and reported outcomes in included studies. CONCLUSIONS Despite the importance of the topic there is a paucity of evidence on recurrence rates of mood episodes during pregnancy among women with MDD or BD. Unlike the impact of the postpartum period, it is still uncertain whether the course of mood disorders is influenced by pregnancy. Non-randomized studies show that maintenance pharmacotherapy during pregnancy in women with mood disorders significantly (p < 0.01) reduces the risk of recurrence.
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Affiliation(s)
- Anja W M M Stevens
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Peter J J Goossens
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, the Netherlands; University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Stasja Draisma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health research Institute, GGZ inGeest Specialized Mental Health Care, Research and Innovation Amsterdam, the Netherlands
| | - Adriaan Honig
- Department of Psychiatry OLVG/msterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ralph W Kupka
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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van der Lugt NM, van de Maat JS, van Kamp IL, Knoppert-van der Klein EAM, Hovens JGFM, Walther FJ. Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies. Early Hum Dev 2012; 88:375-8. [PMID: 22000820 DOI: 10.1016/j.earlhumdev.2011.09.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 09/14/2011] [Accepted: 09/27/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Many women with a bipolar disorder are of reproductive age and will need to continue lithium treatment during pregnancy. The teratogenic and perinatal effects of lithium are known, but not the long-term effects of lithium on neurodevelopment of the children. This study investigates growth, neurological, cognitive and behavioral development of children exposed to lithium in utero. METHOD In an observational retrospective cohort study 15 children who were exposed to lithium in utero were investigated at 3-15 years of age. Neurological development was tested using the Hempel or Touwen examination. Cognitive development was assessed with the Bayley Scales of Infant Development III, Wechsler Preschool and Primary Scale of Intelligence or the Wechsler Intelligence Scale for Children. Parents completed the Child Behavior Checklist to assess behavioral development and a standard questionnaire about general development of the child since birth. RESULTS One child had signs of a minor neurological dysfunction, but without further clinical implications. The results of the cognitive tests were within normal limits, although most children had lower scores on the performance IQ subtest. Growth, behavior and general development were within the normal range. CONCLUSIONS Continuing lithium therapy during pregnancy did not cause adverse effects on growth, neurological, cognitive and behavioral development of exposed children.
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Goossens PJJ, Hartong EGTM, Knoppert-van der Klein EAM, van Achterberg T. Self-reported psychopathological symptoms and quality of life in outpatients with bipolar disorder. Perspect Psychiatr Care 2008; 44:275-84. [PMID: 18826466 DOI: 10.1111/j.1744-6163.2008.00187.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Patients with bipolar disorder in a euthymic mood state can suffer from subsyndromal or residual symptoms of depression or hypomania. This study was undertaken to gain insight into the broader spectrum of psychopathological symptoms and quality of life. DESIGN AND METHODS Participants (n = 157) completed the Symptoms Checklist-90, the World Health Organization Quality of Life Assessment Instrument-Bref, and a questionnaire addressing demographic and clinical characteristics. FINDINGS Outpatients with bipolar disorder reported fewer symptoms of psychopathology than psychiatric outpatients in general, but relative to the general population, a significantly lower quality of life was reported. The number of symptoms showed consistently negative correlations with the quality of life. PRACTICE IMPLICATIONS The results of this study urge nurses to not settle for treatment response in terms of reduced manic or depressive episodes, but instead to strive for full remission of all symptoms.
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Affiliation(s)
- Peter J J Goossens
- Mental Health Care, Deventer, The Netherlands, and Senior Researcher, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Abstract
Psychiatric nurses are increasingly being involved in the provision of care for outpatients with bipolar disorder. The establishment of a body of knowledge for the nursing of these patients is vital for the development of integrated evidence-based treatment. The literature for the period January 1980 to January 2006 is reviewed. A sensitive literature search included not only the nursing care based on research results but also nursing care based on experiences acquired by practising nurses. The results show that formal research on the nursing of patients with a bipolar disorder is remarkably limited. Three quantitative studies were identified in five articles and six qualitative studies addressing a broad range of topics. The remainder of articles meeting the inclusion criteria contained mostly descriptive reports. An overview is presented of the nursing processes used during the euthymic stage of a bipolar disorder and during an acute episode of (hypo)mania. No specific nursing processes for acute episodes of bipolar depression are described in the literature. The results show hardly any evidence for the described nursing processes.
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Affiliation(s)
- Peter J J Goossens
- Adhesie Mental Health Care Midden-Overijssel, Deventer, The Netherlands.
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