Saturday, October 10th10.3°C
Your Mental Health

Postpartum psychosis

As you likely know, pregnancy and the postpartum period are times of increased risk for women to develop mood symptoms. This risk is highest among those with a history of psychiatric illness. 

While we are aware of the risk and do have treatments to help alleviate postpartum depression or psychosis when it occurs, there has always been a certain amount of discussion surrounding what steps should be taken during pregnancy for those who know they are at the highest risk. 

As in any medical treatment, the goal is always to measure the potential benefits of a treatment against its inherent risks. When it comes to medical treatment during pregnancy, we are always very cautious because of the vulnerability of the unborn baby. Very often, treatments are delayed or stopped during pregnancy to avoid exposing the fetus to unnecessary risks. 

When it comes to psychiatric treatment, things can be complicated. There are some medications we know to be harmful to a developing fetus, yet many psychiatric medications are considered safe to take while pregnant. Women generally consider whether a relapse of their psychiatric condition is likely to put the baby at risk. If stopping medication could trigger psychotic symptoms, a deep depression or manic episode, it may be safer for mother and child if treatment is continued. 

One study of women at risk for relapse in bipolar disorder or postpartum psychosis came to some interesting conclusions. 

When it comes to preventing postpartum psychosis or mania, treatment with lithium is known to be effective. However, in light of the need to balance risks with benefits, researchers compared the effectiveness of continuing lithium treatment throughout pregnancy with starting it immediately postpartum. 

For this study, 70 women known to be high risk for postpartum psychosis took part. Those who were not already taking lithium were advised to begin lithium immediately postpartum, while those who were already being treated continued their lithium throughout the pregnancy. 

All women with a history of postpartum psychosis (who did not experience psychotic symptoms at other times in their lives) remained stable throughout their pregnancy regardless of whether they were taking lithium.  Nearly half (44 percent) of women who declined to take lithium postpartum experienced a psychosis relapse.

Of the women with bipolar disorder, almost a quarter relapsed during pregnancy in spite of lithium treatment during pregnancy. 

In light of these results, study authors recommend simply starting treatment postpartum for women with a history of psychosis that is limited to the postpartum period. This will reduce unnecessary fetal exposure to medication. 

Women with bipolar disorder should likely continue their treatment throughout pregnancy and the postpartum period to avoid relapse.

As always, if you are pregnant or considering having a child, it is best to discuss your medical and psychiatric history with your doctor as early as possible to come up with a plan that will be best suited to your individual situation. 

Telomere test

Do you know whether or not you have short telomeres? Strange question, but knowing the answer may provide some insight into the state of your health or your risk of developing certain health problems in the future. 

Telomeres are part of our genetic code – often likened to the plastic tips on the ends of shoelaces. They seem to protect the ends of chromosomes and keep cells from aging too quickly. Each time a cell divides, the telomeres get shorter and once they are too short, the cell can no longer divide. In healthy cells, telomeres also rebuild. 

Many studies have linked unusually short telomeres to health problems such as heart disease, diabetes, cancer and chronic stress. 

Dr. Elizabeth Blackburn is a researcher at the University of California in San Francisco. She won the Nobel Prize in medicine in 2009 for her work on telomeres.

As scientific understanding around telomeres and their links to health issues has increased, there has been some demand for a test to measure them. Dr. Blackburn has developed such a test and also founded a company to market it. 

Some in the research community doubt the usefulness of measuring telomeres because it is not a test for a specific health issue or disease. In spite of these critiques, Dr. Blackburn believes the test could be a useful tool for patients and doctors alike – comparing it to a check engine light in a vehicle. If your test showed you had shorter than normal telomeres, it may warrant doing some other medical investigating, and could be an indicator that some preventive measures are needed.

Healthy cells restore their own telomeres with the enzyme telomerase, and there may be ways to increase its action in the cell. Some preventive measures such as exercise, healthy food choices, losing excess weight and reducing stress could help to prevent telomeres from getting shorter or even restore those that have already declined. 

More studies continue into the connections between telomeres and mental and physical health and may prove more concrete cause and effect relationships. In the meantime, there will be a test on the market soon. For a few hundred dollars, interested people could learn the answer to the strange question of whether they have short or long telomeres.  

Maybe this will not be a specific predictor of disease or length of life, but a telomere test could be part of a larger health picture and may move us further along the way to preventive healthcare rather than simply interventional healthcare.


Anxiety in children

All children experience fears as they grow up – it is simply part of the developmental process and a natural reaction to a great big world not yet understood.

When children begin avoiding the things and situations that scare them, the fears can seriously interfere with participation in everyday activities. For some, normal fears about new situations or experiences can become a more serious and long-lasting problem if they develop into an anxiety disorder.

It has long been thought that avoidance behaviour and anxiety disorders go hand in hand. A 2013 study out of the Mayo Clinic is confirming this when it comes to children.

More than 800 children between the ages of seven and 18 took part in this study, which dealt specifically with tendencies to avoid feared situations. After taking data from both the children themselves and their parents, researchers found that measuring avoidance could also predict the future development of an anxiety disorder.

It turns out that children who avoid feared situations are likely to have anxiety.

In this study (published in the journal Behavior Therapy), children who showed avoidance behaviours at the beginning of the study period were more likely to be anxious a year later.

Researchers are pleased because the tools developed for this study may become useful in identifying children who are at risk for an anxiety disorder and could help parents and professionals to manage fears before they become truly problematic in the life of a child.

Aside from predicting the likelihood of anxiety, this study also showed that cognitive behavior therapy to reduce avoidance behaviour truly helped. Twenty-five anxious children were surveyed after receiving cognitive behaviour therapy to slowly expose them to feared situations. Their avoidance decreased by half.

This study has created some useful tools and also proven a long-held belief about the connection between avoidance and anxiety. It serves as a good reminder for parents dealing with fear in children as well.

While we all want to protect our kids and should do what we can to keep them safe, it is not always in their best interest to shield them from every fear or endlessly accommodate them if they do not want to try a new thing or face a particular situation.

Although we may help them to feel better in the short term, when we accommodate our children in this way we can serve to cement fears. Instead of shielding our children in a helpful way, we may hinder them from learning to manage the fears that are part of life.

If you think your child’s fears have already gone beyond what is normal, speak with your doctor. Proven techniques do exist to help alleviate anxiety even in children and dealing with it at a young age could save years of difficulty.

Maternal thought habits

Since depression is one of the leading causes of disability worldwide, there is an ongoing quest to better understand the disease.

Although understanding and treatment options have improved dramatically over the past few decades, there is still much we simply don’t know. If we could unlock the causes of the disease we would be much better equipped to prevent it.

One theory about the cause of depression deals with a person’s cognitive style. Negative belief systems about self, the world, and future could impact the way we interpret life events and ultimately underlie the development of depression. Studies have shown negative cognitive style is associated with current and future episodes of depression.

Based on this theory, cognitive behaviour therapy does include cognitive style as one of its target areas. Although we may not be able to remove stress and negative experiences from our lives, we could potentially change our interpretation of these events.

But where do we get our cognitive style in the first place? Studies have shown there are likely genetic and environmental influences and there has been speculation about the role of maternal modeling on the way our thinking patterns develop throughout our lives - although studies of this have been inconsistent so far.

One study published in the American Journal of Psychiatry took a closer look at the maternal/offspring connection when it comes to cognitive style. Results showed a positive association between maternal and offspring cognitive styles.

Using data from 4,000 mothers in the UK, researchers investigated maternal cognitive style during their pregnancy as well as the cognitive style of their children at age 18.

Perhaps it’s not surprising to imagine that the way our mothers thought or interpreted events could have impacted the way we do. For genetic and environmental reasons it makes sense. What the correlation suggests is that if we can help mothers to improve their cognitive style, it could be helpful to both mother and child in the long run.

This study is interesting but raises as many questions as it answers. It is by no means conclusive evidence that it is the mother’s behavior, as opposed to her genetics, that gives rise to the negative cognitive style. It also would remain to be demonstrated that altering the mother’s cognitive style would change the child’s cognitive style or prevent depression in either parent of child. I am sure research to answer these questions will follow in the years to come. Unfortunately, this type of research is very expensive and since there are no medications involved there is lack of industry funding for such research.

For mothers, just one more thing to add to the new-parent preparation handbook – improve your thought habits and you could potentially prevent your children from developing depression when they become adults.

Read more States of Mind articles

About the author...

Paul Latimer has over 25 years experience in clinical practice, research, and administration.

After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar.

Since 1983 he has been practicing psychiatry in Kelowna, BC, where he has held many administrative positions and conducted numerous clinical trials.

He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders.

He is an avid photographer, skier and outdoorsman.

Like us on Facebook:

Follow us on Twitter: @OCT_ca

The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet presents its columns "as is" and does not warrant the contents.

Previous Stories

RSS this page.
(Click for RSS instructions.)