Risk of recurrence of mood disorders during pregnancy and the impact of medication: A systematic review.

BACKGROUND: Mood disorders can be difficult to treat during pregnancy. There is still lack of evidence whether pregnancy influences their natural course and whether continuation of pharmacotherapy, despite potential risks for the unborn child, is beneficial in preventing recurrence of mood episodes during pregnancy. METHODS: Systematic review conducted according to the PRISMA guidelines, searching Pubmed, PsycINFO, Embase and Cochrane databases up till January 9th, 2018. Recurrence rates and various measures of risk were calculated. RESULTS: Out of 1387 articles from an initial search 22 studies met the inclusion criteria. Included studies reported a wide variation in the recurrence rate of bipolar disorder and major depressive disorder during pregnancy (BD: mean = 19%, range = 4%-73%; MDD: mean = 8%, range = 1%-75%). Observational data showed a relative risk reduction of maintenance therapy during pregnancy of 66% in women with BD and 54% for women with MDD, a significant difference (95% CI 9.4-14.6; p < 0.001). LIMITATIONS: heterogeneous samples, study designs, and reported outcomes in included studies. CONCLUSIONS: Despite the importance of the topic there is a paucity of evidence on recurrence rates of mood episodes during pregnancy among women with MDD or BD. Unlike the impact of the postpartum period, it is still uncertain whether the course of mood disorders is influenced by pregnancy. Non-randomized studies show that maintenance pharmacotherapy during pregnancy in women with mood disorders significantly (p < 0.01) reduces the risk of recurrence.

Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies.

INTRODUCTION: Many women with a bipolar disorder are of reproductive age and will need to continue lithium treatment during pregnancy. The teratogenic and perinatal effects of lithium are known, but not the long-term effects of lithium on neurodevelopment of the children. This study investigates growth, neurological, cognitive and behavioral development of children exposed to lithium in utero. METHOD: In an observational retrospective cohort study 15 children who were exposed to lithium in utero were investigated at 3-15 years of age. Neurological development was tested using the Hempel or Touwen examination. Cognitive development was assessed with the Bayley Scales of Infant Development III, Wechsler Preschool and Primary Scale of Intelligence or the Wechsler Intelligence Scale for Children. Parents completed the Child Behavior Checklist to assess behavioral development and a standard questionnaire about general development of the child since birth. RESULTS: One child had signs of a minor neurological dysfunction, but without further clinical implications. The results of the cognitive tests were within normal limits, although most children had lower scores on the performance IQ subtest. Growth, behavior and general development were within the normal range. CONCLUSIONS: Continuing lithium therapy during pregnancy did not cause adverse effects on growth, neurological, cognitive and behavioral development of exposed children.

Self-reported psychopathological symptoms and quality of life in outpatients with bipolar disorder.

PURPOSE: Patients with bipolar disorder in a euthymic mood state can suffer from subsyndromal or residual symptoms of depression or hypomania. This study was undertaken to gain insight into the broader spectrum of psychopathological symptoms and quality of life. DESIGN AND METHODS: Participants (n = 157) completed the Symptoms Checklist-90, the World Health Organization Quality of Life Assessment Instrument-Bref, and a questionnaire addressing demographic and clinical characteristics. FINDINGS: Outpatients with bipolar disorder reported fewer symptoms of psychopathology than psychiatric outpatients in general, but relative to the general population, a significantly lower quality of life was reported. The number of symptoms showed consistently negative correlations with the quality of life. PRACTICE IMPLICATIONS: The results of this study urge nurses to not settle for treatment response in terms of reduced manic or depressive episodes, but instead to strive for full remission of all symptoms.

Nursing processes used in the treatment of patients with bipolar disorder.

Psychiatric nurses are increasingly being involved in the provision of care for outpatients with bipolar disorder. The establishment of a body of knowledge for the nursing of these patients is vital for the development of integrated evidence-based treatment. The literature for the period January 1980 to January 2006 is reviewed. A sensitive literature search included not only the nursing care based on research results but also nursing care based on experiences acquired by practising nurses. The results show that formal research on the nursing of patients with a bipolar disorder is remarkably limited. Three quantitative studies were identified in five articles and six qualitative studies addressing a broad range of topics. The remainder of articles meeting the inclusion criteria contained mostly descriptive reports. An overview is presented of the nursing processes used during the euthymic stage of a bipolar disorder and during an acute episode of (hypo)mania. No specific nursing processes for acute episodes of bipolar depression are described in the literature. The results show hardly any evidence for the described nursing processes.