Perinatal psychiatric disorders: an overview.

Perinatal mental illness has a significant implication on maternal health, birth outcomes, and the offspring's development. Prevalence estimates of perinatal psychiatric illnesses range widely, with substantial heterogeneity in different population studies, with a lower prevalence rate in high- rather than low- or middle-income countries. Because of the potential negative impact on maternal and child outcomes and the potential lability of these disorders, the perinatal period is a critical time to identify psychiatric illnesses. Thus, obstetricians and midwives play a crucial role in assessing women's mental health needs and to refer identified women promptly for multidisciplinary specialist assessment. However, there is still limited evidence on best practice assessment and management policies during pregnancy and postpartum. This review focuses on the prevalence of common perinatal mental disorders and antenatal screening policies to identify women at risk. The effect of these conditions and their management on pregnancy, fetal outcomes, and child development are discussed.

Efficacy and safety of perindopril arginine + amlodipine in hypertension.

To study the efficacy and safety of a new combination of perindopril arginine and amlodipine besylate, 837 subjects were enrolled in a three-arm, prospective, 59-center, randomized clinical trial. For 42 days, subjects (average seated blood pressure [BP], 158 ± 12/101 ± 5 mm Hg; age, 52 ± 10 years; 52% male; 34% black; 20% diabetic) received amlodipine/perindopril arginine (10/14 mg/d), perindopril erbumine (16 mg/d), or amlodipine (10 mg/d). Goal BP was <140/90 or <130/80 mm Hg in diabetics, per JNC 7 guidelines. The combination showed the largest change in seated BP (-23.7/-15.7 vs. -13.7/-9.5 vs. -19.3/-13.2 mm Hg, respectively; P < .0001), the highest proportion at goal BP (51% vs. 26% vs. 37%; P < .0001), and a lower incidence of pedal edema and adverse events compared with amlodipine. No deaths or significant differences across groups in early discontinuation, serum potassium, or rates of total or serious adverse events or glomerular filtration, were observed.

The impact of disruptive behavior disorder on substance use treatment outcome in adolescents.

The current study examined the impact of disruptive behavior disorder (DBD) on substance use outcomes in an adolescent sample. Sixty-eight adolescents and their caregivers were randomized to one of two fourteen-week, outpatient treatments: Motivational Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT)+Parent Management Training+Contingency Management (CM; experimental) and MET/CBT+Parent Drug Education (attention control). This study assessed abstinence, substance use, externalizing behavior, and parenting outcomes over five assessment periods for youth with DBD (DBD(+)) and without DBD (DBD(-)). Results showed DBD(+)/experimental adolescents reported fewer days of marijuana use than DBD(+)/control adolescents. Results also showed that parents of DBD(-) adolescents in the experimental condition reported significantly better parenting outcomes compared to DBD(-)/control. Substance abuse treatment for adolescents with DBD which includes a component such as contingency management and parent training has the potential to contribute to substance use outcomes. Such treatment strategies, however, should include additional support for parents.

Predictors of parenting concern in a Mother and Baby Unit over a 10-year period.

AIMS: To review the characteristics of 462 mothers consecutively admitted to a co-joined mother and baby unit and to examine the incidence and predictors of social services input and separate discharge. METHOD: Admissions to the Birmingham Mother and Baby Unit from 1998 to 2007 were reviewed. Demographic and clinical information, social services involvement and parenting outcome data were collected from case notes and computerized records. RESULTS: One hundred and forty six (146) women received some form of social services input (32%); 44 cases of separate discharge were identified (10%). Diagnosis, involuntary admission, single status, younger age, Afro-Caribbean ethnicity and social services referral predicted parenting concern. Only 9% of separations were to women suffering a new postpartum mental illness; most were to women experiencing the continuation of an existing illness. Poor parenting skills, absence of a good partner relationship and alcohol/substance misuse were frequently reported in those discharged without their baby. CONCLUSION: The incidence of separate discharge is lower than in other studies. Potential reasons for this difference are discussed. Further work must be conducted to understand the social inequities and regional differences in social service intervention during perinatal psychiatric admission and determine if parenting outcomes can be improved in women at risk of separation.