Analysis of Perinatal Women Attending a Mother and Baby Unit Taking Sodium Valproate or Lithium with a Diagnosis of Bipolar Affective Disorder.

In this study we describe the management of postnatal women with a bipolar disorder diagnosis who were prescribed either lithium or sodium valproate. There was a 38.2% (13 out of 34) relapse rate in patients discharged on lithium, compared to 46.7% (14 out of 30) relapse in patients discharged with valproate. Only 20 women (29.9%) continued to breastfeed at discharge. There were 32 (47.8%) who ceased breastfeeding during their MBU admission and 23 (34.3%) of whom ceased due to initiation of lithium therapy.

Pulmonary exacerbations in patients with primary ciliary dyskinesia: an expert consensus definition for use in clinical trials.

Pulmonary exacerbations are a cause of significant morbidity in patients with primary ciliary dyskinesia (PCD) and are frequently used as an outcome measure in clinical research into chronic lung diseases. So far, there has been no consensus on the definition of pulmonary exacerbations in PCD. 30 multidisciplinary experts and patients developed a consensus definition for children and adults with PCD. Following a systematic review, the panel used a modified Delphi process with a combination of face-to-face meetings and e-surveys to develop a definition that can be used in research settings for children and adults with PCD. A pulmonary exacerbation was defined by the presence of three or more of the following seven items: 1) increased cough, 2) change in sputum volume and/or colour, 3) increased shortness of breath perceived by the patient or parent, 4) decision to start or change antibiotic treatment because of perceived pulmonary symptoms, 5) malaise, tiredness, fatigue or lethargy, 6) new or increased haemoptysis, and 7) temperature >38°C. The consensus panel proposed that the definition should be used for future clinical trials. The definition should be validated and the usability assessed during these studies.

The structure of negative emotional states in a postpartum inpatient sample.

BACKGROUND: Depression and anxiety disorders exhibit comorbidity, and the same relationships have been observed in postpartum samples. The tripartite model posits that anxiety and depression overlap due to shared and unique symptom components. The present study tested whether a one-factor model, or a three-factor model consistent with the tripartite model, provided a better fit to anxiety and depression symptoms in a postpartum sample. METHODS: The sample consisted of 663 postpartum psychiatric inpatients who completed self-reported questionnaires assessing symptoms of anxiety and depression. RESULTS: Confirmatory factor analysis revealed that a three-factor model consistent with the tripartite model provided a good fit to anxiety/depression data. This model consisted of three factors: positive affect, negative affect, and autonomic arousal. Positive affect was related to depressive diagnoses and negatively related to anxiety diagnoses; autonomic arousal was related to anxiety diagnoses; and negative affect was uniquely related to mixed anxiety-depressive diagnoses. LIMITATIONS: The sample consisted of postpartum psychiatric inpatients and the generalisability of results to other postpartum samples is not known. CONCLUSIONS: Postpartum anxiety and depression appear to be characterised by three differentiable symptom clusters. Postpartum anxiety, depression, and mixed anxiety-depressive diagnoses are differentially associated with these symptom clusters. These findings suggest that the tripartite model may be useful in guiding assessment, differentiation, and treatment of postpartum emotional disorders.

Does the Edinburgh Postnatal Depression Scale measure the same constructs across time?

The Edinburgh Postnatal Depression Scale is the most widely used measure for screening for depression in perinatal populations. A weakness is that the factor structure of the scale is inconsistent across studies. It is unclear the degree to which this inconsistency results from variability arising from the Edinburgh Postnatal Depression Scale (EPDS). The present study aimed to determine whether the EPDS factor structure remained stable in the same individuals reporting on their levels of distress across two testing occasions. Data were analysed for 636 postpartum inpatient females who were administered the EPDS at admission and discharge from a psychiatric mother and baby unit. Exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs) were conducted separately on the admission and discharge data to determine the optimal factor structure at each time point. The EFAs and CFAs supported a two-factor model at admission and a three-factor model at discharge. Given that the EPDS did not demonstrate an invariant number of factors, no further tests of measurement invariance were conducted. The EPDS does not appear to be invariant from admission to discharge. These findings suggest that individuals may respond differently to items depending on their level of distress. Potential implications for the EPDS in terms of comparability of scores across groups/time and its screening abilities are discussed.

The structure of emotional symptoms in the postpartum period: is it unique?

BACKGROUND: In perinatal mental health there is a lack of consensus as to whether postpartum emotional disorders are unique in their aetiology and clinical presentation. If the clinical presentation is unique, then the factor structure should be different in a postpartum sample. METHODS: Admission and discharge scores on the Depression Anxiety Stress Scales (DASS; Lovibond and Lovibond, 1995b) scores were collected for 527 inpatients admitted to a Psychiatric Mother and Baby Unit. Reliability and validity of the DASS were examined, and confirmatory factor analysis evaluated the fit of a series of models of the DASS. RESULTS: The DASS had sound reliability and validity in the postpartum inpatient sample. The optimal fitting factor solution for the DASS was a revised three-factor model previously supported in studies of other clinical and non-clinical populations. The factor structure was invariant across admission and discharge. LIMITATIONS: The sample consisted of postpartum inpatients and the generalisability of results to other postpartum samples is not known. CONCLUSIONS: Postpartum emotional symptoms have the same factor structure previously observed in non-postpartum populations, consistent with the hypothesis that postpartum emotional disorders are similar to those occurring at other times. The present study provides support for the reliability and validity of the DASS in the postpartum period.

Brief report: faces cause less distraction in autism.

Individuals with autism have difficulties interpreting face cues that contribute to deficits of social communication. When faces need to be processed for meaning they fail to capture and hold the attention of individuals with autism. In the current study we illustrate that faces fail to capture attention in a typical manner even when they are non-functional to task completion. In a visual search task with a present butterfly target an irrelevant face distracter significantly slows performance of typical individuals. However, participants with autism (n = 28; mean 10 years 4 months) of comparable non-verbal ability are not distracted by the faces. Interestingly, there is a significant relationship between level of functioning on the autism spectrum and degree of face capture or distraction.

Attention to faces in Williams syndrome.

Williams syndrome (WS) is associated with distinct social behaviours. One component of the WS social phenotype is atypically prolonged face fixation. This behaviour co-exists with attention difficulties. Attention is multi-faceted and may impact on gaze behaviour in several ways. Four experiments assessed (i) attention capture by faces, (ii) interference from facial stimuli, (iii) face bias, and (iv) attention disengagement. Individuals with WS were compared to typically developing participants of comparable nonverbal ability and chronological age. The first three experiments revealed no atypicality of attention to faces in WS. However, in experiment 4 there was a suggestion that individuals with WS (compared to those developing typically) found it much more time consuming to disengage from faces than objects. The results are discussed in terms of attention abnormalities and possible face disengagement difficulties in WS.

Haplotypes of the beta-2 adrenergic receptor associate with high diastolic blood pressure in the Caerphilly prospective study.

OBJECTIVES: Current evidence demonstrates that both genetic and environmental factors influence blood pressure. The sympathetic nervous system is a key player in blood pressure control and functional genetic variants of the beta-2 adrenergic receptor (B2AR) have been identified and implicated in the pathogenesis of hypertension. The present study aimed to determine the effects of common haplotypes of the B2AR gene upon blood pressure in the Caerphilly Prospective Study. DESIGN: Two thousand five hundred and twelve men (aged 45-59 years) participated in the study. We selected individuals in the upper (n = 347) and lower (n = 279) quintiles of the diastolic blood pressure distribution fixed at two time points [phase 2 (1984-88) or phase 3 (1989-93)] as cases and controls. METHODS: We analysed two functional polymorphisms (Arg16Gly and Gln27Glu) of B2AR and their haplotypes. RESULTS: We found a higher risk of hypertension in individuals homozygous for the Gln27 compared to those individuals homozygous for Glu27 [odds ratio (OR) = 1.94; 95% confidence interval (CI) = 1.34-2.81; P = 0.001]. Three haplotypes (Gly16Gln27, Gly16Glu27 and Arg16Gln27) were present in both quintile groups. Logistic regression analysis showed that haplotypes with a Gln27 allele (Gly16Gln27 and Arg16Gln27) conferred a significantly higher risk for hypertension than the Gly16Glu27 haplotype (OR = 1.55; 95% CI = 1.11-2.17, OR = 1.37; 95% CI = 1.04-1.81; P = 0.009 and P = 0.027, respectively). However, there was no evidence to support a statistically significant difference in odds ratios for the Gly16Gln27 and Arg16Gln27 haplotypes (P = 0.477), suggesting that it is the Gln27 allele alone, rather than any haplotype, which best explains the association. CONCLUSIONS: In a prospectively studied Caucasian male cohort, high diastolic blood pressure was associated with B2AR haplotypes containing the pro-downregulatory Gln27 variant.