Outcomes at the Motherhood Center: A Comparison of Virtual and On-Site Versions of a Specialized Perinatal Partial Hospitalization Program.

OBJECTIVES: Remotely administered mental health care is becoming increasingly common for treatment of a range of psychiatric disorders; however, there is a dearth of literature overviewing direct comparisons between remote and in-person interventions for treatment of Perinatal Mood and Anxiety Disorders (PMADs). The sudden advent of the Covid-19 pandemic in New York City forced an abrupt conversion for an intensive day treatment program for new mothers with PMADs, from an on-site to a remote program. METHODS: The current report compares outcomes of 81 women who completed the program in-person to those of 60 women who completed the program remotely. RESULTS: Improvement in depression scores was statistically superior in the remote program, and improvement in mother-infant bonding was statistically equivalent between the on-site and remote programs. DISCUSSION: These findings indicate that specialized partial hospitalization treatment for individuals with moderate to severe psychiatric illness can be effectively provided via telehealth, thus offering improved convenience, accessibility, and safety without compromising care. We conclude that remotely administered group psychotherapy is an effective intervention for women with moderate to severe PMADs.

Returning to tricyclic antidepressants for depression during childbearing: clinical and dosing challenges.

Managing depression and anxiety during pregnancy and the postpartum period is challenging. Both pharmacological treatment and the lack thereof can pose threats to a fetus. SSRIs are the drugs of choice for use during pregnancy, but there is considerable evidence for the safety and efficacy of older antidepressants during pregnancy as well. This study highlights a single case of the use of the tricyclic nortriptyline during pregnancy and postpartum. The subject involved had an unexpectedly high ratio of serum level to drug dose during the postpartum period. We monitored the subject for a significantly greater portion of the postpartum period than has been done in previous studies, and explored medical and lifestyle changes that could account for the level-to-dose ratios we observed. Differences in smoking patterns, coupled with the patient's status as a genetic poor metabolizer, were the most likely explanations.

Psychological implications of high-risk pregnancy.

The psychological adjustments of "normal" pregnancy are complex, and those of high-risk pregnancy are even more pronounced and severe. A pregnancy may be determined to be at high risk because of obstetric factors in previous pregnancies or the present one; more general medical factors, such as preexisting or emergent disease (often, diabetes); and conditions that are, themselves, psychosocial: anxiety disorders (GAD, OCD, panic disorder, PTSD), mood disorders, and schizophrenia, all of which are a background for a disturbed pregnancy and might complicate a pregnancy denominated high risk for some other reason. This paper discusses these concepts and, in addition, includes sections on pregnancy in adolescence, in the developmentally disabled, and in the situation of chemical dependence (substance abuse).

An interviewing course for a psychiatry clerkship.

OBJECTIVE: Taking a psychiatric history is a key educational objective in the psychiatry clerkship. Medical students arrive on psychiatry clerkships unprepared for the unique challenges of psychiatric interviewing. This paper describes an interviewing course for psychiatry clerks that combines practice, observation, and feedback in a small group setting. METHODS: A quasi-experimental cohort design with medical student self-ratings as the dependent variable. RESULTS: Students' self-perceived skill in interviewing and differential diagnosis improved more than students who did not have the interviewing course. Students' self-perceived skills also correlated significantly with the number of times they observed interviews. CONCLUSION: Clerkship directors in psychiatry should provide students with opportunities to practice interviewing skills, observe interviews, and receive feedback.

Teaching the mental status examination to medical students by using a standardized patient in a large group setting.

The authors describe their recent experience in using a standardized patient (SP) to illustrate the mental status examination (MSE) to 170 second-year medical students in a large classroom setting. An SP was trained to portray a patient with schizophrenia who was interviewed during the MSE lecture. A six-question survey was distributed to the students to evaluate how the students felt about the learning experience. Results show that the majority of students felt that using an SP in a large classroom setting helped them to understand the material better and was a useful teaching tool. Follow-up studies are under way to objectively measure students' integration and retention of the lecture material.