Symptom profile of postpartum and non-postpartum manic episodes in bipolar I disorder: a within-subjects study.

The relationship of postpartum mania to episodes of mania occurring outside the perinatal period among women with bipolar disorder remains controversial. Previous studies have used between-subjects designs to compare the clinical presentations of these episodes meaning the differences, in part, may reflect between-group differences. To overcome this we have undertaken within-subject comparisons of the symptom profile of postpartum and non-postpartum manic episodes in 50 women with DSM-IV bipolar I disorder. For each woman detailed symptom information on a postpartum episode of mania and a comparison non-postpartum manic episode was collected. The occurrence of manic, psychotic and depressive symptoms in these episodes were compared. Postpartum manic episodes had a significantly higher incidence of perplexity and excessive self-reproach. Classic manic symptoms, specifically pressured speech and increased sociability, were significantly less frequent in postpartum manic episodes. Overall there were significantly fewer manic symptoms and significantly more depressive symptoms in the postpartum episodes than in the non-postpartum episodes. The mixed presentation of postpartum manic episodes suggests childbirth may act as a pathoplastic trigger in women with bipolar disorder. The differences in symptom profiles suggests further research is warranted into whether differences in treatment response exist among women experiencing postpartum and non-postpartum manic episodes.

Smoke-free homes: outcomes of a local service development.

This paper aims to determine the impact of a smoke-free homes initiative in Doncaster. An evaluation was conducted via a self-reported semi-structured questionnaire and telephone survey in 2006. Numbers and types of smoke-free homes promises, self-reported smoking restrictions in the home and factors associated with smoke-free homes were measured. A total of 825 smoke-free home promises were received, of which 567 (69%) were 'gold', 221 (27%) 'silver' and 37 (4%) 'bronze'. Of these promises, 523 (63%) were from smokers. Non-smokers (95%) and smokers who had just stopped (91%) were more likely to opt in for a gold promise when compared to smokers (52%, p<0.001). Over half of smokers who opted for the gold promise reported not allowing smoking in the house (57%, p<0.001). Of 82 responses at follow up, 41 (50%) reported smoking outside the house or in the street. Engaging families in the implementation of smoke-free homes is an effective measure to reduce household second-hand smoke exposure. Further research is required to assess the long-term feasibility, sustainability and cost per quitter.