Use of antipsychotics during pregnancy and their impact on congenital malformations and early neonatal adaptation.

OBJECTIVE: Review of recent literature dealing with the effect of antipsychotic use during pregnancy on early postpartum adaptation of exposed infants and the development of congenital malformations. RESULTS: The use of antipsychotics during pregnancy does not appear to lead to significantly higher risk of congenital malformations but may pose a greater risk for the early adaptation of the newborn (especially the risk of preterm birth and intensive care unit admission). The study to date face methodological limitations - lack of information on exact doses of antipsychotics, lack of control groups of women with psychiatric problems but not taking antipsychotics and failure to control for confounding factors. CONCLUSION: The available data suggest the relative safety of antipsychotics during pregnancy, provided that potential risks are known, and the woman and her baby are carefully monitored.

Accuracy of the Edinburgh Postnatal Depression Scale in screening for major depressive disorder and other psychiatric disorders in women towards the end of their puerperium.

OBJECTIVE: To assess the accuracy of the Edinburgh Postnatal Depression Scale (EPDS) in screening for severe depression and other mental disorders in women at the end of puerperium. MATERIALS AND METHODS: We administered the Czech version of the EPDS to assess depressive symptoms and the Mini International Neuropsychiatric Interview to determine psychiatric dia-gnoses in 243 women at the end of their puerperium. Then, we determined the frequencies of severe depressive disorder and other psychiatric disorders in our cohort. Furthermore, we assessed the sensitivity, specificity, positive predictive value, negative predictive value, and other dia-gnostic variables for the presence of severe depression and other psychiatric disorders for different threshold scores on EPDS. We evaluated the detection potential of EPDS for detecting monitored mental disorders by using the receiver operating characteristic curve analysis and determining the area under the curve. RESULTS: Severe depressive disorder was present in 2.5% (95% CI: 1.1-5.3%) of women. Any monitored mental disorder was present in 13.6% (95% CI: 9.8-18.5%). The best sensitivity/specificity ratio for detecting major depressive disorder was found for the EPDS threshold score 11; sensitivity was 83% (95% CI: 35-99%) and specificity was 79% (95% CI: 74-84%). The EPDS 11 then achieved a sensitivity of 76% (95% CI: 58-89%) and specificity of 82% (95% CI: 76-87%) for the detection of any mental disorder of interest. CONCLUSION: Our results showed that the Czech version of EPDS has good internal consistency, and the EPDS score 11 achieves the best combination of sensitivity and specificity values for detecting major depressive disorder. Screening with EPDS in women at the end of puerperium can detect psychiatric disorders other than severe major depression.

Effectiveness of the mom supports mom peer support intervention in treating antenatal mental health difficulties in women.

PROBLEM: Up to 75 % of at-risk perinatal women do not receive treatment in Czechia. BACKGROUND: Pregnant women with mental health difficulties are more likely to undergo less controversial nonpharmaceutical treatment during pregnancy, but structural and psychological barriers interfere with their capacity to seek professional help. AIM: We tested the effectiveness of the telephone-based peer support intervention Mom Supports Mom (MSM) in Czech pregnant women at risk of mental disorder. METHODS: The Edinburgh Postnatal Depression Scale (EPDS) was used to assess risk in women (EPDS ≥ 10). Women at risk were randomized into two groups; the intervention group received the MSM, while the control group received the care as usual, which did not contain any psychological support intervention. One month after completing the EPDS, the women's mental statuses were again measured and compared, this time with data before and after the intervention, using the Perinatal Anxiety Screening Scale (PASS) to measure anxiety, the EPDS to measure depression, the Prenatal Psychosocial Profile (PPP) to measure stress, and the Prenatal Attachment Inventory - Revised (PAI-R) to measure attachment. The trial was registered under the name Pregnancy without psychosocial stress (ClinicalTrials.gov ID NCT04853693). FINDINGS: A total of 167 women were included in the study and randomized into two groups. Depressive symptoms did not decrease (Cohen´s d; 95 % CI = 0.48; 0.17-0.79; p = .002), but levels of anxiety (Cohen´s d; 95 % CI = 0.44; 0.13-0.75; p = .005) and psychosocial stress (Cohen´s d; 95 % CI = 0.55; 0.20-0.82; p = .002) were reduced in women in the intervention group compared with women in the control. In addition, prenatal attachment increased among intervened women (Cohen´s d; 95 % CI = 0.48; 0.17-0.79; p = .002). DISCUSSION: The telephone-based peer support intervention MSM is effective in reducing stress and anxiety and increasing prenatal attachment but does not reduce depression among high-risk women.

State of perinatal mental health care in the WHO region of Europe: a scoping review.

Background: Although perinatal mental disorders are the most common health complication among women in the perinatal period, there is a huge gap in the implementation of related research findings in the health care system. We mapped the state of perinatal mental health (PMH) care in the WHO Europe region with aim to identify leading countries, which can serve as models for countries with less developed perinatal mental health care. Methods: Guidelines, policies, and documents related to screening and treatment services for PMH were searched as grey literature. Results were analysed to assess the status of PMH care in the WHO European countries and to identify gaps (absence of relevant service or documents). The state of perinatal mental health care was scored on a 0-5 scale. Results: The grey literature search resulted in a total of 361 websites. Seven countries (Belgium, Finland, Ireland, Netherlands, Sweden, UK, Malta) received full points for the presence of relevant PMH services or documents, while five countries received zero points. Most WHO European countries (48/53) have general mental health policies, but only 25 countries have policies specifically on perinatal mental health. Ten countries offer PMH screening, and 11 countries offer PMH service (of any type). Any PMH guidelines were provided in 23/53 countries. Conclusions: Perinatal mental health care is in its infancy in most WHO European countries. Leading countries (Belgium, Finland, Ireland, Netherlands, Sweden, UK, Malta) in PMH care can serve as conceptual models for those less developed and geopolitically close.

Structural, functional, and metabolic signatures of postpartum depression: A systematic review.

Objective: Postpartum depression (PPD) is a serious condition with debilitating consequences for the mother, offspring, and the whole family. The scope of negative outcomes of PPD highlights the need to specify effective diagnostics and treatment which might differ from major depressive disorder (MDD). In order to improve our clinical care, we need to better understand the underlying neuropathological mechanisms of PPD. Therefore, we conducted a systematic review of published neuroimaging studies assessing functional, structural, and metabolic correlates of PPD. Methods: Relevant papers were identified using a search code for English-written studies in the PubMed, Scopus, and Web of Science databases published by March 2022. Included were studies with structural magnetic resonance imaging, functional magnetic resonance imaging, both resting-state and task-related, magnetic resonance spectroscopy, or positron emission tomography. The findings were analyzed to assess signatures in PPD-diagnosed women compared to healthy controls. The review protocol was registered in PROSPERO (CRD42022313794). Results: The total of 3,368 references were initially identified. After the removal of duplicates and non-applicable papers, the search yielded 74 full-text studies assessed for eligibility. Of them, 26 met the inclusion criteria and their findings were analyzed and synthesized. The results showed consistent functional, structural, and metabolic changes in the default mode network and the salient network in women with PPD. During emotion-related tasks, PPD was associated with changes in the corticolimbic system activity, especially the amygdala. Discussion: This review offers a comprehensive summary of neuroimaging signatures in PPD-diagnosed women. It indicates the brain regions and networks which show functional, structural, and metabolic changes. Our findings offer better understanding of the nature of PPD, which clearly copies some features of MDD, while differs in others.