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Bergink V, Pop VJM, Nielsen PR, Agerbo E, Munk-Olsen T, Liu X. Comorbidity of autoimmune thyroid disorders and psychiatric disorders during the postpartum period: a Danish nationwide register-based cohort study. Psychol Med 2018; 48:1291-1298. [PMID: 28929982 DOI: 10.1017/s0033291717002732] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The postpartum period is well-known risk period for the first onset of autoimmune thyroid disorders (AITDs) as well as first onset of psychiatric disorders. These two disorders are some of the most prevalent medical conditions postpartum, often misdiagnosed and disabling if left untreated. Our study was designed to explore the possible bidirectional association between AITDs and psychiatric disorders during the postpartum period. METHODS A population-based cohort study through linkage of Danish national registers, which comprised 312 779 women who gave birth to their first child during 1997-2010. We conducted Poisson regression analysis to estimate the incidence rate ratio (IRR) of psychiatric disorders among women with first-onset AITDs, the IRR of AITDs among women with first-onset psychiatric disorders as well as the overlap between these disorders using a comorbidity index. RESULTS Women with first-onset AITDs postpartum were more likely to have first-onset psychiatric disorders than women who did not have postpartum AITDs (IRR = 1.88, 95% confidence interval (CI): 1.25-2.81). Women with first-onset postpartum psychiatric disorders had a higher risk of AITDs than women with no psychiatric disorders (IRR = 2.16, 95% CI: 1.45-3.20). The comorbidity index 2 years after delivery was 2.26 (95% CI: 1.61-2.90), indicating a comorbidity between first-onset AITDs and psychiatric disorders. CONCLUSIONS First-onset AITDs and psychiatric disorders co-occur in the postpartum period, which has relevance to further studies on the etiologies of these disorders and why childbirth in particular triggers the onset.
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Affiliation(s)
- V Bergink
- Department of Psychiatry,Erasmus Medical Centre,Rotterdam,The Netherlands
| | - V J M Pop
- Department of Medical and Clinical Psychology,Tilburg University,Tilburg,The Netherlands
| | - P R Nielsen
- The National Center for Register-based Research,Aarhus University,Aarhus,Denmark
| | - E Agerbo
- The National Center for Register-based Research,Aarhus University,Aarhus,Denmark
| | - T Munk-Olsen
- The National Center for Register-based Research,Aarhus University,Aarhus,Denmark
| | - X Liu
- The National Center for Register-based Research,Aarhus University,Aarhus,Denmark
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Counotte J, Drexhage HA, Wijkhuijs JM, Pot-Kolder R, Bergink V, Hoek HW, Veling W. Th17/T regulator cell balance and NK cell numbers in relation to psychosis liability and social stress reactivity. Brain Behav Immun 2018; 69:408-417. [PMID: 29289662 DOI: 10.1016/j.bbi.2017.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/21/2017] [Accepted: 12/27/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Psychotic disorders are characterized by a deranged immune system, including altered number and function of Natural Killer (NK) and T cells. Psychotic disorders arise from an interaction between genetic vulnerability and exposure to environmental risk factors. Exposure to social adversity during early life is particularly relevant to psychosis risk and is thought to increase reactivity to subsequent minor daily social stressors. Virtual reality allows controlled experimental exposure to virtual social stressors. AIM To investigate the interplay between social adversity during early life, cell numbers of NK cells and T helper subsets and social stress reactivity in relation to psychosis liability. METHODS Circulating numbers of Th1, Th2, Th17, T regulator and NK cells were determined using flow cytometry in 80 participants with low psychosis liability (46 healthy controls and 34 siblings) and 53 participants with high psychosis liability (14 ultra-high risk (UHR) patients and 39 recent-onset psychosis patients), with and without the experience of childhood trauma. We examined if cell numbers predicted subjective stress when participants were exposed to social stressors (crowdedness, hostility and being part of an ethnic minority) in a virtual reality environment. RESULTS There were no significant group differences in Th1, Th2, Th17, T regulator and NK cell numbers between groups with a high or low liability for psychosis. However, in the high psychosis liability group, childhood trauma was associated with increased Th17 cell numbers (p = 0.028). Moreover, in the high psychosis liability group increased T regulator and decreased NK cell numbers predicted stress experience during exposure to virtual social stressors (p = 0.015 and p = 0.009 for T regulator and NK cells, respectively). CONCLUSION A deranged Th17/T regulator balance and a reduced NK cell number are associated intermediate biological factors in the relation childhood trauma, psychosis liability and social stress reactivity.
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Affiliation(s)
- J Counotte
- Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH The Hague, The Netherlands.
| | - H A Drexhage
- Erasmus Medical Center Rotterdam, Department of Immunology, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - J M Wijkhuijs
- Health E-Solutions, Westplein 11, 3016 BM Rotterdam, The Netherlands
| | - R Pot-Kolder
- Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH The Hague, The Netherlands; VU University, Department of Clinical Psychology, de Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - V Bergink
- Erasmus Medical Center Rotterdam, Department of Psychiatry, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - H W Hoek
- Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH The Hague, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Psychiatry, PO Box 30.001, 9700 RB Groningen, The Netherlands; Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, NY 10032, New York, NY, USA
| | - W Veling
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Di Florio A, Putnam K, Altemus M, Apter G, Bergink V, Bilszta J, Brock R, Buist A, Deligiannidis KM, Devouche E, Epperson CN, Guille C, Kim D, Lichtenstein P, Magnusson PKE, Martinez P, Munk-Olsen T, Newport J, Payne J, Penninx BW, O’Hara M, Robertson-Blackmore E, Roza SJ, Sharkey KM, Stuart S, Tiemeier H, Viktorin A, Schmidt PJ, Sullivan PF, Stowe ZN, Wisner KL, Jones I, Rubinow DR, Meltzer-Brody S. The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale. Psychol Med 2017; 47:787-799. [PMID: 27866476 PMCID: PMC5369767 DOI: 10.1017/s0033291716002087] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset. METHOD Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA. RESULTS Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01). CONCLUSIONS Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
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Affiliation(s)
- A. Di Florio
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University School of Medicine, Cardiff, UK
| | - K. Putnam
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Altemus
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - G. Apter
- Erasme Hospital, Paris Diderot University, Paris, France
| | - V. Bergink
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
- Department of Economics and Business, National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - J. Bilszta
- Women’s Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - R. Brock
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - A. Buist
- Women’s Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - K. M. Deligiannidis
- Departments of Psychiatry and Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Glen Oaks, NY, USA
| | - E. Devouche
- Erasme Hospital, Paris Descartes University, Paris, France
| | - C. N. Epperson
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - C. Guille
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - D. Kim
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - P. Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. K. E. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. Martinez
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Health and Human Services, Bethesda, MD, USA
| | - T. Munk-Olsen
- Department of Economics and Business, National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - J. Newport
- Department of Psychiatry, University of Miami, Miami, FL, USA
| | - J. Payne
- Department of Psychiatry, The Johns Hopkins University, Baltimore, MD, USA
| | - B. W. Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - M. O’Hara
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | | | - S. J. Roza
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - K. M. Sharkey
- Department of Psychiatry, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - S. Stuart
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - H. Tiemeier
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - A. Viktorin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. J. Schmidt
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Health and Human Services, Bethesda, MD, USA
| | - P. F. Sullivan
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Z. N. Stowe
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K. L. Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - I. Jones
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University School of Medicine, Cardiff, UK
| | - D. R. Rubinow
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S. Meltzer-Brody
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Munk-Olsen T, Maegbaek ML, Johannsen BM, Liu X, Howard LM, di Florio A, Bergink V, Meltzer-Brody S. Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence. Transl Psychiatry 2016; 6:e919. [PMID: 27754485 PMCID: PMC5315550 DOI: 10.1038/tp.2016.190] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/15/2016] [Accepted: 08/17/2016] [Indexed: 11/20/2022] Open
Abstract
Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed to do in the present study. We designed a descriptive prospective study and included information from Danish population registers to study first-time ever and recurrent psychiatric episodes during the perinatal period, including treatment at psychiatric facilities and general practitioners (GPs). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods across moderate and severe perinatal psychiatric episodes.
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Affiliation(s)
- T Munk-Olsen
- Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark,CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark,National Center for Register-Based Research Aarhus University, Fuglesangs Allé 4, Aarhus 8210, Denmark. E-mail:
| | - M L Maegbaek
- Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - B M Johannsen
- Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - X Liu
- Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - L M Howard
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - A di Florio
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - V Bergink
- Department of Economics and Business Economics, National Center for Register-based Research, Aarhus University, Aarhus, Denmark,Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S Meltzer-Brody
- UNC Center for Women's Mood Disorder, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bergink V, Laursen TM, Johannsen BMW, Kushner SA, Meltzer-Brody S, Munk-Olsen T. Letter to the Editor: Postpartum psychosis and pre-eclamptic toxaemia: a reply. Psychol Med 2016; 46:2453. [PMID: 27293149 DOI: 10.1017/s0033291716001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- V Bergink
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University,Aarhus,Denmark
| | - T M Laursen
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University,Aarhus,Denmark
| | - B M W Johannsen
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University,Aarhus,Denmark
| | - S A Kushner
- Department of Psychiatry,Erasmus Medical Center,Rotterdam,The Netherlands
| | - S Meltzer-Brody
- Department of Psychiatry,The University of North Carolina at Chapel Hill,Chapel Hill,NC,USA
| | - T Munk-Olsen
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University,Aarhus,Denmark
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Bergink V, Laursen TM, Johannsen BMW, Kushner SA, Meltzer-Brody S, Munk-Olsen T. Pre-eclampsia and first-onset postpartum psychiatric episodes: a Danish population-based cohort study. Psychol Med 2015; 45:3481-3489. [PMID: 26243040 PMCID: PMC4806793 DOI: 10.1017/s0033291715001385] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent evidence suggests that postpartum psychiatric episodes may share similar etiological mechanisms with immune-related disorders. Pre-eclampsia is one of the most prevalent immune-related disorders of pregnancy. Multiple clinical features are shared between pre-eclampsia and postpartum psychiatric disorders, most prominently a strong link to first pregnancies. Therefore, we aimed to study if pre-eclampsia is a risk factor for first-onset postpartum psychiatric episodes. METHOD We conducted a cohort study using the Danish population registry, with a total of 400 717 primiparous women with a singleton delivery between 1995 and 2011. First-lifetime childbirth was the main exposure variable and the outcome of interest was first-onset postpartum psychiatric episodes. The main outcome measures were monthly incidence rate ratios (IRRs), with the period 11-12 months after birth as the reference category. Adjustments were made for age, calendar period, reproductive history, and perinatal maternal health including somatic and obstetric co-morbidity. RESULTS Primiparous women were at particularly high risk of first-onset psychiatric episodes during the first month postpartum [IRR 2.93, 95% confidence interval (CI) 2.53-3.40] and pre-eclampsia added to that risk (IRR 4.21, 95% CI 2.89-6.13). Having both pre-eclampsia and a somatic co-morbidity resulted in the highest risk of psychiatric episodes during the 3-month period after childbirth (IRR 4.81, 95% CI 2.72-8.50). CONCLUSIONS We confirmed an association between pre-eclampsia and postpartum psychiatric episodes. The possible explanations for this association, which are not mutually exclusive, include the psychological impact of a serious medical condition such as pre-eclampsia and the neurobiological impact of pre-eclampsia-related vascular pathology and inflammation.
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Affiliation(s)
- V. Bergink
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
- Department of Psychiatry, Erasmus Medical Center, ’s Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
| | - T. M. Laursen
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
- CIRRAU, Centre for Integrated Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
| | - B. M. W. Johannsen
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
| | - S. A. Kushner
- Department of Psychiatry, Erasmus Medical Center, ’s Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
| | - S. Meltzer-Brody
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Campus Box #7160, Chapel Hill, NC 27599, USA
| | - T. Munk-Olsen
- National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
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Wesseloo R, Burgerhout KM, Koorengevel KM, Bergink V. [Postpartum psychosis in clinical practice: diagnostic considerations, treatment and prevention]. Tijdschr Psychiatr 2015; 57:25-33. [PMID: 25601625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Postpartum psychosis is a severe psychiatric disease which occurs in the early postpartum period after 1 - 2 per 1000 deliveries. Patients with a history of postpartum psychosis and/or bipolar disorder are at extreme high risk of relapse postpartum. AIM To discuss diagnostic considerations, treatment and the prevention of postpartum psychosis, and to give clinical recommendations. METHOD Literature search with PubMed and relevant textbooks. RESULTS Inpatient psychiatric admission enables the clinician to ensure the safety of mother and baby, perform physical and neurological examination, and laboratory analysis to exclude known organic causes for acute psychosis. Antipsychotic and lithium and ECT are effective treatment options. Women with postpartum psychosis compared to those with bipolar disorder had a substantial difference in their clinical outcomes and prophylaxis requirements. CONCLUSION Inpatient screening for somatic (co)morbidity is essential in patients with postpartum psychosis. With adequate treatment, almost all patients achieve complete remission and the prognosis is optimistic. Initiation of prophylaxis immediately postpartum in women with a history of postpartum psychosis with lithium was highly effective for preventing postpartum relapse.
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Carvalho LA, Bergink V, Sumaski L, Wijkhuijs J, Hoogendijk WJ, Birkenhager TK, Drexhage HA. Inflammatory activation is associated with a reduced glucocorticoid receptor alpha/beta expression ratio in monocytes of inpatients with melancholic major depressive disorder. Transl Psychiatry 2014; 4:e344. [PMID: 24424390 PMCID: PMC3905228 DOI: 10.1038/tp.2013.118] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [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: 04/25/2013] [Revised: 09/09/2013] [Accepted: 10/29/2013] [Indexed: 01/01/2023] Open
Abstract
In this study, we used new technology to investigate whether a coherent pattern of enhanced expression of inflammatory and other immune activation genes in circulating monocytes is found in patients with major depression. Since a high inflammatory state of monocytes might be related to glucocorticoid resistance, we also included the genes for the two isoforms of the glucocorticoid receptor. For this study, we aimed at finding a similar coherent pattern of inflammatory and immune activation genes in monocytes of patients with MDD and recruited 47 medication-free melancholic MDD inpatients and 42 healthy controls. A quantitative-polymerase chain reaction (Q-PCR) monocyte gene expression analysis was performed using a panel of inflammatory-related genes previously identified as abnormally regulated in mood disorder patients. Selected serum cytokines/chemokines were assessed using a cytometric bead array. Depressive symptoms were analysed using Hamilton depression scores (HAMD). Thirty-four of the 47 monocyte inflammatory-related genes were significantly upregulated and 2 were significantly downregulated as compared to controls, the latter including the gene for the active GRα in particular in those with a high HAMD score. The reduced GRα expression correlated strongly to the upregulation of the inflammatory genes in monocytes. Serum levels of IL6, IL8, CCL2 and VEGF were significantly increased in patients compared to controls. Our data show the deregulation of two interrelated homoeostatic systems, that is, the immune system and the glucocorticoid system, co-occurring in major depression.
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Affiliation(s)
- L A Carvalho
- Department of Epidemiology and Public Health, University College London, London, UK,UCL Research Department of Epidemiology and Public Health, 1–19 Torrington Place, Rm356a, London, WC1E 7HB, UK. E-mail:
| | - V Bergink
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - L Sumaski
- Klinik und Poliklinik fur Psychiatrie und Psychotherapie, Universitatsklinikum Munster, Munster, Germany
| | - J Wijkhuijs
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - W J Hoogendijk
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - T K Birkenhager
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - H A Drexhage
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
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Sumaski L, Birkenhäger TK, Carvalho LA, Bergink V, Drexhage HA, Arolt V. Depression symptoms in relation to inflammatory monocyte gene expression in patients with major depressive disorder. Pharmacopsychiatry 2013. [DOI: 10.1055/s-0033-1353351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Noorlander Y, Bergink V, van den Berg MP. Perceived and observed mother-child interaction at time of hospitalization and release in postpartum depression and psychosis. Arch Womens Ment Health 2008; 11:49-56. [PMID: 18270653 DOI: 10.1007/s00737-008-0217-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [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: 03/14/2007] [Accepted: 10/21/2007] [Indexed: 01/03/2023]
Abstract
INTRODUCTION A pilot study was conducted which compared perceived mother-infant bonding in women admitted with postpartum depression or psychosis, with observations of mother-infant interaction by the nursing staff at both the time of hospitalization and that of release. METHOD 25 mother-infant pairs admitted to a psychiatric unit were included in this study. The Postpartum Bonding Questionnaire was used to assess the perceived mother-infant bond and the observation of mother-infant interaction was assessed with the Bethlem Mother-Infant Interaction Scale. RESULTS At the time of both hospitalization and release postpartum depressed women experienced the bond with their child significantly more negative than women with postpartum psychosis. In contrast to women with postpartum psychosis, the experience of postpartum depressed women was significantly correlated with the observations of the nursing staff at time of release. CONCLUSION Treatment that focuses on a mother's experience of the bond with her child could be especially beneficial for mothers with postpartum depression.
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Affiliation(s)
- Y Noorlander
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
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