Creating a Multisite Perinatal Psychiatry Databank: Purpose and Development.

Mental health issues during the perinatal period are common; up to 29% of pregnant and 15% of postpartum women meet psychiatric diagnostic criteria. Despite its ubiquity, little is known about the longitudinal trajectories of perinatal psychiatric illness. This paper describes a collaboration among six perinatal mental health services in Quebec, Canada, to create an electronic databank that captures longitudinal patient data over the course of the perinatal period. The collaborating sites met to identify research interests and to select a standardized set of variables to be collected during clinical appointments. Procedures were implemented for creating a databank that serves both research and clinical purposes. The resulting databank allows pregnant and postpartum patients to complete self-report questionnaires on medical and psychosocial variables during their intake appointment in conjunction with their clinicians who fill in relevant medical information. All participants are followed until 6 months postpartum. The databank represents an opportunity to examine illness trajectories and to study rare mental disorders and the relationship between biological and psychosocial variables.

Child attachment and sensory regulation in psychiatric clinic-referred preschoolers.

BACKGROUND: Individuals with sensory regulation disorders present with many difficulties in terms of managing emotions, behavior, and motor control. Children with such difficulties are often referred to psychiatric clinics for assessment of their behavioral and emotional problems. Few studies have investigated the role of environmental factors on sensory dysfunctions, and none have specifically studied its association with child attachment in a clinical sample. OBJECTIVE: In this cross-sectional study, we examined the association between sensory regulation and child attachment among preschoolers referred to a psychiatric clinic. METHOD: A sample of 60 preschoolers and their mothers were recruited through a child psychiatric clinic. Child attachment was assessed with the gold standard separation-reunion procedure for preschoolers. Parents completed the sensory profile, which assesses the presence of child hypersensitivity (sensitivity and avoidant scale) and hyposensitivity (sensory seeking and registration scale). RESULTS: Data showed that 57% of the children were presented with clinical symptoms of sensory regulation. In addition, 53% of the children were classified insecure behaviorally disorganized or insecure disorganized controlling. In particular, results revealed that children classified as insecure disorganized controlling were significantly more likely to show hypersensitivity avoidance and sensory-seeking behaviors. CONCLUSION: This study underscores the importance of the parent-child relationship for children with sensory regulation difficulties.

Affect Expression and Self-Regulation Capacities of Infants Exposed in utero to Psychotropics.

This study explored the affect expression and self-regulation capacities of 8-month-old infants exposed in utero to psychotropic medications. This was a continuation of our previous study conducted on the same cohort when the infants were 3 months old. Psychotropics implicated included selective serotonin reuptake inhibitors (SSRIs), and a benzodiazepine derivative anxiolytic (clonazepam). The three comparison groups were: control (n = 23; infants not exposed to psychotropics in utero), SSRI-alone (n = 22; infants exposed to SSRIs only and having mothers who had a primary diagnosis of depressive disorder without having comorbid anxiety disorder), and SSRI+ group (n = 15; infants gestationally exposed to SSRIs and clonazepam and having mothers that had both clinical depression and anxiety disorder). Using the Parent-Child Early Relational Assessment Scale, infants were assessed in a dyadic context during free play and a structured task. There were significant differences in psychotropic exposed and non-exposed dyads regarding infant negative affect management. There were significant associations between the SSRI+ group of mothers and infant negative affect. This group of mothers also showed significant associations with infants' averting and avoiding behaviors in both play situations. The SSRI-alone group was similar to the control group and showed variable associations with infant's positive, negative, and sober moods unlike the SSRI+ group. There were no differences in infants' capacity for self-regulation in psychotropic exposed and non-exposed groups. Increased awareness of these vulnerable subgroups (SSRI-alone and SSRI+) is needed, in order to safeguard these dyads through better support systems and improved management.

Clinical Case Rounds in Child and Adolescent Psychiatry: De Novo Self-Mutilation and Depressive Symptoms in a 17-year-old Adolescent Girl Receiving Depot-Medroxyprogesterone Acetate.

INTRODUCTION: Contraception-induced mood changes have been identified since the 1960s. To our knowledge, there has been no reported case about self-mutilation associated to any form of contraception. We report the case of a 17-year-old adolescent girl who presented with de novo self-mutilation and depressive symptoms three and a half weeks after the administration of 150 mg of Depot-Medroxyprogesterone Acetate (DMPA). METHOD: Clinical case report and literature review. Possible confounding factors are reviewed. RESULTS: The patient had no personal psychiatric history and no significant family psychiatric history. A DSM-IV diagnosis of "mood disorder due to DMPA with depressive features" was formulated. There was no evidence of abnormal personality functioning. The mental status exam and collateral information validated the severity of her condition. DISCUSSION: DMPA is a birth control method especially useful for adolescent girls and possible secondary mood symptoms should not limit its access. However, since depressive symptoms substantially interfere with daily functioning and may have unfortunate consequences like self-mutilation and suicidal ideation, it is important to remain vigilant regarding the onset of mood symptoms following contraceptive use in adolescent girls. This vigilance should be more specific regarding adolescent girls with a history of mood disorders, anxiety disorders, self-mutilation or family diathesis of these conditions.

Ziprasidone for psychotic disorders: a meta-analysis and systematic review of the relationship between pharmacokinetics, pharmacodynamics, and clinical profile.

BACKGROUND: Among atypical antipsychotics, ziprasidone exhibits a unique clinical profile. However, prescription rates for this medication remain among the lowest of all atypical antipsychotics. OBJECTIVE: The present meta-analysis examined premature study discontinuation (PSD) and dose-response associated with ziprasidone. Furthermore, a systematic review of the clinical pharmacokinetic and pharmacodynamic properties and tolerability of ziprasidone was conducted to explain the meta-analytic findings. METHODS: A systematic search was performed in the electronic databases PubMed and EMBASE using the key words ziprasidone, randomized, positron emission tomography, pharmacokinetic, and tolerability. This search looked for open-label or blinded studies of oral ziprasidone use in patients with psychoses (schizophrenia-spectrum disorders and/or bipolar mania) published between January 1, 1992, and February 1, 2011. Comparisons with antipsychotics for which there were <3 studies in total were excluded. PSD (all causes) was used as a measure of overall effectiveness. RESULTS: Thirty-one studies were included in the final analysis. The rates of PSD were significantly higher with ziprasidone compared with olanzapine (inefficacy and all causes, P < 0.001) and risperidone (all causes, P = 0.004). In contrast, the rates of PSD due to inefficacy and adverse events were significantly lower with ziprasidone compared with quetiapine (P = 0.03) and haloperidol (P = 0.03), respectively. On dose-response analysis, the rate of all-cause PSD was significantly lower with combined 120-160 mg/d compared with placebo (P = 0.001). Low levels of hyperprolactinemia and weight gain/metabolic adverse events, and moderate extrapyramidal symptoms and corrected QT-interval prolongation were reported with ziprasidone use. Ziprasidone exposure was increased when the medication was administered with food, irrespective of fat content. Ziprasidone 120-160 mg/d was correlated with 60% to 80% occupancy in studies of D(2) binding with the administration of multiple doses. However, the same occupancy was achieved with single-dose administration at much lower doses (20-60 mg/d). CONCLUSIONS: The findings from this meta-analysis and review suggest that ziprasidone 120-160 mg/d is a less effective treatment for psychotic disorders compared with olanzapine and risperidone, but that the low levels of hyperprolactinemia and weight gain/metabolic adverse events associated with ziprasidone may make it a useful option in patients in whom antipsychotics are poorly tolerated for these reasons.

Staff perceptions and organizational factors as predictors of seclusion and restraint on psychiatric wards.

OBJECTIVE: Several factors have been shown to be involved in decisions to use seclusion and restraint in psychiatric inpatient settings. This study examined whether staff perceptions of factors related to the care team and violence on the ward predicted use of seclusion and restraint in psychiatric wards. METHODS: A total of 309 staff members (nurses, rehabilitation instructors, and nurse's aides) providing care to patients with serious mental disorders were recruited from eight university psychiatric hospitals and general-hospital psychiatric units in the province of Quebec. Factors assessed included sociodemographic characteristics, psychological distress, staff perceptions of aggression and of interaction between members of the psychiatric team (team climate), and organizational factors. RESULTS: Bivariate analyses showed that certain aspects of the team climate, staff perceptions of aggression, and organizational factors were associated with greater use of seclusion and restraint. The final multivariate model indicated that the following factors independently predicted greater use: type of hospital ward (emergency department and intensive care unit), staff perception of a higher level of expression of anger and aggression among team members, perception of the frequency of incidents of physical aggression against the self among patients, and perception of insufficient safety measures in the workplace. CONCLUSIONS: These findings represent the first stage of a research program aimed at reducing use of seclusion and restraint in psychiatric settings. They underscore the importance of evaluating a variety of factors, including perceptions of safety and violence, when examining reasons for use of these controversial interventions.