Diagnosis of peripartum depression disorder: A state-of-the-art approach from the COST Action Riseup-PPD.

BACKGROUND: Peripartum depression (PPD) is a major depression disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. The goal of this study was to summarize the similarities and differences between PPD and MDD by synthesizing the current research on PPD diagnosis concerning different clinical features and give directions for improving diagnosis of PPD in clinical practice. METHODS: To lay the groundwork for this narrative review, several databases were searched using general search phrases on PPD and its components of clinical diagnosis. RESULTS: When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications. CONCLUSION: There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) addition of specific symptoms (i.e., anxiety), (ii) onset specifier extending to the first year following childbirth, (iii) and change the peripartum onset specifier to either "pregnancy onset" or "postpartum onset". Diagnostic criteria for PPD are further discussed.

Neurobiological associations between smoking and internalizing disorders.

People with severe mental disorders have a higher mortality rate due to preventable conditions like cardiovascular diseases and respiratory diseases. Nicotine addiction is a preventable risk factor, with tobacco use being twice as high in people with mental disorders. An integrative model that divides mental disorders into externalising, internalising, and thought disorders could be useful for identifying common causalities and risk factors. This review aims to examine the interface between smoking and internalising disorders, specifically schizophrenia, depressive disorders, and anxiety disorders. The review finds that there is a clear association between smoking behaviour and these disorders. Schizophrenia is associated with polymorphisms that result in an imbalance between glutamate and GABA release and abnormalities of dopaminergic pathways. Nicotine improves dopaminergic signalling and balances glutamatergic and GABAergic pathways, improving symptoms and increasing the risk of nicotine dependence. In depressive disorders, smoking is associated with functional changes in brain regions affected by smoking and self-medication. In anxiety disorders, there is a bidirectional relationship with smoking, involving the amygdala and changes in dopaminergic pathways and cortisol production. Smoking poses a threat to people living with psychiatric disorders and calls for further research to assess the interactions between nicotine dependence and internalising and thought disorders.

Psychopharmacology of smoking cessation medications: focus on patients with mental health disorders.

The adverse effects of smoking cessation in individuals with mental health disorders have been a point of concern, and progress in the development of treatment has been slow. The primary first-line treatments for smoking cessation are Nicotine Replacement Therapy, Bupropion, Varenicline, and behavioural support. Nortriptyline and Clonidine are second-line treatments used when the first-line treatments are not effective or are contraindicated. Smoking cessation medications have been shown to be effective in reducing nicotine cravings and withdrawal symptoms and promoting smoking cessation among patients living with mental disorders. However, these medications may have implications for patients' mental health and need to be monitored closely. The efficacy and side effects of these medications may vary depending on the patient's psychiatric condition, medication regimen, substance use, or medical comorbidities. The purpose of this review is to synthesise the pharmacokinetics, pharmacodynamics, therapeutic effects, adverse effects, and pharmacological interactions of first- and second-line smoking cessation drugs, with an emphasis on patients suffering from mental illnesses. Careful consideration of the risks and benefits of using smoking cessation medications is necessary, and treatment plans must be tailored to individual patients' needs. Monitoring symptoms and medication regimens is essential to ensure optimal treatment outcomes.

[Meeting your baby and becoming a father]. / Rencontrer son bébé et devenir père.

The birth, the moment when the father physically discovers his baby, is essential in the development of fatherhood. Accompanying this encounter during the stay in the postnatal unit leads to a greater commitment to care on the part of the father over the following three months. It therefore seems essential to support him during these first moments, by offering him skin-to-skin contact, for example, or by showing him in practical terms how to provide nursing care for his newborn. Encouraging the development of the father-baby relationship is beneficial for the family alliance that is being built around the cradle.

[Fatherhood in the mother-baby unit: the experience of the Panda unit]. / La paternité en unité mère-bébé : l'expérience de l'unité Panda.

Mother-baby units offer a care environment that is conducive to better care for fathers. However, these units still need to evolve in terms of organization and attitude to care. The systematic use of pre- and postnatal interviews is an interesting approach to consider.

Neonatal Hypotonia Following in Utero Exposure to Antidepressant Drugs.

Associations between fetal exposure to antidepressants and neonatal hypotonia were studied using VigiBase and the French PharmacoVigilance Database. We identified significant associations between neonatal hypotonia and clomipramine, venlafaxine, and imipramine. Reports from the French database implicated prolonged fetal exposure. Neonatal hypotonia may be associated with in utero exposure to antidepressants.

Clinical practice guidelines with recommendations for peripartum depression: A European systematic review.

OBJECTIVE: This study aims to systematically review all Clinical Practice Guidelines (CPGs) with recommendations for peripartum depression in European countries. METHODS: A systematic review according to the PRISMA statement was conducted. CPGs focussing on peripartum depression or with at least one specific recommendation for peripartum depression from European countries were selected. Searching was conducted in electronic databases (MEDLINE and PsycINFO), and by contacting professional societies and international experts until November 24th, 2021. Characteristics of the included CPGs and their recommendations were extracted. A methodological quality assessment was conducted using the AGREE-II tool. RESULTS: A total of 239 records were identified after duplicate removal. Of these, 54 were examined for full-text inspection. The final selection yielded 14 CPGs from 11 European countries in 10 languages. Of them, 11 provided recommendations on pharmacological treatments, 10 on psychological treatment (e.g., cognitive-behavioural therapy), 10 on screening, 8 on diagnosis, 6 on other treatments (e.g., physical exercise), 5 on prevention, and 5 other recommendations (e.g., provide information). Regarding the overall methodological quality, only five (35.7%) guidelines were rated as of adequate quality, reaching a score ≥ 70% in the overall assessment of the AGREE-II instrument. Of the six AGREE-II domains, applicability scored the lowest and clarity of presentation scored the highest. CONCLUSION: The absence of CPGs in most European countries, the discrepancy in recommendations and the low methodological quality of the guidelines may lead to disparities and inequalities in peripartum depression management in Europe. The COST Action Riseup-PPD highlights key considerations for future guideline developers.

[Intrusive touch of borderline parenting and risk of disorganized attachment of children]. / Toucher intrusif de la parentalité borderline et risque d'attachement désorganisé des enfants.

The development of attachment in toddlers is linked to the quality of their early interactions with their mother and father. The impact of interactive dysfunctions, in relation to different parental circumstances, constitutes an important risk for the development of disorganized attachment. Although this aspect is fairly well known, few studies have been done on the children of people with borderline personality disorder.

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study.

BACKGROUND: Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study. METHODS: This is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6 months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V). DISCUSSION: This study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04595123 .

[Rhythms and early interactions]. / Rythmes et interactions précoces.

Early interactions are established in accordance to their own rhythms the tempo of which is set by the parent-infant dyad. The adjustment is made by the adult partner, who must be able to ensure this mutual interactive rhythm. It is in fact these initial interactions which form the foundations of a secure attachment.

[Creation of an observation scale for newborns in the maternity setting]. / Élaboration d'une échelle d'observation des nouveau-nés en maternité.

In clinical practice in the maternity setting, professionals are regularly confronted with situations for which a clinical observation of the newborn's condition is necessary. The Assessment for Newborn Development and Abilities (Panda) scale is a tool for evaluating the sensory-motor skills of newborns and their relationship with others, as well as raising professionals' awareness of their fine observation.

[Supporting the encounter of mothers suffering from borderline conditions with their baby]. / Accompagner la rencontre des mères souffrant d'états limites avec leur bébé.

Mothers suffering from borderline conditions are overwhelmed by emotions. Their interactions are tainted with qualitative discontinuities, unpredictable for infants. These high-risk situations must not be trivialised. They are characterised by the importance of providing rapid support to the baby and by the existence of maternal suffering. The infant's basic needs guide the professionals working with these families.

Update on Mental Health of Infants and Children of Parents Affected With Mental Health Issues.

This paper highlights the most recent publications, in the field of psychiatry, on offspring of patients with psychiatric illnesses such as schizophrenia and bipolar disorder, and then summarizes what we know about the progeny of adults with mood disorders, the most prevalent of parental disorders. Studies examining personality disorders and contextual factors such as stress and trauma are examined with a focus on the crucial question of development and attachment status in children. Findings converge to reveal that offspring of parents (generally mothers) with most major psychiatric disorders present a higher risk for all mental disorders, and a wide range of disorders are also found in children, adolescent, and finally adult offspring of mothers with mood and anxiety disorders. Developmental psychopathology and infant and child psychiatry have focused on early relationship formation through social interaction and attachment patterns as pathways affected by vulnerability or resilience factors. First year of life longitudinal studies following mothers and infants has shown that maternal psychopathology is positively correlated with higher risk of attachment issues. It would seem that pathology appears when adaptation to real-life contexts becomes difficult in association with an accumulation of negative individual characteristics and environmental circumstances. We suggest that in order to move forward psychiatry should embrace a developmental cascade model, which posits a cumulative pathway for the emergence of psychopathology in the developing child. We propose that we have sufficient knowledge today to start implementing multilevel approaches to enhance the health and mental health of the next generation.

Helping mothers with the emotional dysregulation of borderline personality disorder and their infants in primary care settings.

BACKGROUND: Six per cent of patients who present to primary care have borderline personality disorder (BPD). Mothers with full or partial features of BPD, often undiagnosed and perhaps previously functioning adequately enough on the surface, may rapidly be-come emotionally dysregulated by the normal needs of an infant. Family and maternal functioning can rapidly destabilise. Management of patients with BPD in primary care may be challenging. OBJECTIVE: The objectives of this article are to provide primary care practitioners with relevant information on current knowledge of BPD and its management when mothers with BPD are caregivers to an infant. DISCUSSION: Useful guidelines for general practitioners that can help women who are emotionally dysregulated with infants include: keeping the diagnosis in mind openly discussing BPD diagnosis where relevant providing psychoeducational material and ongoing support to the woman and her familyreferring to specialised services for BPD referring to standard maternal-child health services and specialised .infant mental health services ongoing communication with other services and supervision for the practitioner.

[An innovative position during skin-to-skin contact in neonatology]. / Une installation innovante lors du peau à peau en néonatologie.

Skin-to-skin is, by its very nature, the only relational care entirely devoted to the parent-baby relationship, from the infant's time in neonatal intensive care. However, current practice is unsuited to visual and tactile exchange. A simple change to the baby's positioning helps to improve the quality of the immediate interaction between the infant and the mother, benefiting the development of the baby and parenthood.

[Supporting the establishment of the parent-child bond in cases of prematurity]. / Soutenir l'élaboration de la relation parent-enfant en cas de prématurité.

The evolution of the care of premature babies is having an effect on a particular difficulty, that of the development of parenthood and the parent-baby relationship hampered by an early birth. The short- and long-term consequences of any disruption to these two dimensions can be considerable and the hospital must take into account the issue when caring for parents and their premature baby.

[Stories and drawings by children after the 2015 terrorist attacks in Paris]. / Récits et dessins d'enfants après les attentats de 2015 à Paris.

Through the stories and drawings of children in a medical-psychological centre, it is possible to explore their psychological representations of the terrorist attacks which took place in Paris in January 2015. This work highlights the need to rethink the methods of care provided to these children in order to adapt them to their specific needs.

Impact of pregnancy on psychotropic medication prescription: a French cohort study.

OBJECTIVES: To determine if and when prescription of psychotropic medication in women is modified by pregnancy. METHOD: Psychotropic prescription of 87 213 pregnant women affiliated with the French General Health System was examined. Period of analyses lasted 17 months to cover 4 months before and after pregnancy. A comparable cohort of 87 213 non pregnant women constituted the control group. RESULTS: More than half of pregnant women to whom a psychoactive drug was prescribed were novel users during all three trimesters and after delivery. Prevalence of psychotropic medication before pregnancy is comparable to that of non-pregnant women. Rate of psychotropic medication during the peripartum stayed high, even though it decreased by half during the first trimester, showing a "pregnancy impact effect". CONCLUSIONS: Data show a dramatic impact of pregnancy. More information on specific patterns of prescription needs to be gained in order to establish decision-making models for psychotropic prescription during pregnancy.

Promoting emotional and behavioral interventions in ASD treatment: Evidence from EPIGRAM, A naturalistic, prospective and longitudinal study.

BACKGROUND: Prognostic factors from naturalistic treatment studies of children with Autism Spectrum Disorder (ASD) remain largely unknown. We aimed to identify baseline and treatment-related prognostic predictors at 1-year follow-up after Integrative Care Practices (ICPs). METHODS: Eighty-nine preschool children with severe ASD were given ICP combining nine therapeutic workshops based on children's needs. Participants were assessed at baseline and during 12 months follow-up with the Psycho-educational Profile-3-R, Children Autism Rating Scale, Parental Global Impression, and the Autistic Behaviors Scale. We assessed prognostic predictors using multivariable regression models and explored treatment ingredients influencing outcome using Classification and Regression Trees (CART). RESULTS: Multivariable models showed that being a child from first generation immigrant parents predicted increased maladaptive behaviors, whereas play activities had an opposite effect; severity of ASD symptoms and impaired cognitive functions predicted worse autism severity at follow-up; and lower play activities predicted worse parent impression. Regarding treatment effects, more emotion/behavioral interventions predicted better outcomes, and more communication interventions predicted lower autism severity, whereas more education and cognitive interventions had an opposite effect. CART confirmed that more hours of intervention in the emotion/behavioral domain helped classifying cases with better outcomes. More parental support was associated with decreased maladaptive behaviors. Sensorimotor and education interventions also significantly contributed to classifying cases according to outcomes but defined subgroups with opposite prognosis. CONCLUSION: Children who exhibited the best prognosis following ICPs had less autism severity, better cognition, and non-immigrant parents at baseline. Emotion/behavior interventions appeared key across all outcomes and should be promoted.