Perinatal Stress, Mood And Anxiety Disorders: From Bench To Bedside

209 Pages·2005·3.18 MB·English

by  A. Riecher-Rossler

Perinatal Stress,Mood and Anxiety Disorders
Bibliotheca Psychiatrica
No.173
Series Editors
A. Riecher-Rössler Basel
M. Steiner Hamilton
Perinatal Stress, Mood
and Anxiety Disorders
From Bench to Bedside
Volume Editors
A. Riecher-Rössler Basel
M. Steiner Hamilton
11 figures, 1 in color, and 5 tables, 2005
Basel·Freiburg·Paris·London·New York·
Bangalore·Bangkok·Singapore·Tokyo·Sydney
Bibliotheca Psychiatrica
Formerly published as ‘Abhandlung aus der Neurologie, Psychiatrie, Psychologie und
ihren Grenzgebieten’(Founded 1917)
Edited by K. Bonhoeffer, Berlin (1917–1939), J. Klaesi, Bern (1948–1952), J. Klaesi
and E. Grünthal, Bern (1955–1967), E. Grünthal, Bern (1968), E. Grünthal and
Th.Spoerri, Bern (1969–1971), Th. Spoerri, Bern (1973), P. Berner and E. Gabriel,
Wien (1975–1986), B. Saletu, Wien (1986–2003)
Prof.Dr.med.A.Riecher-Rössler M.Steiner,MD,PhD
Psychiatrische Poliklinik Department of Psychiatry
Universitätsspital Basel McMaster University
Petersgraben 4 Women’s Health Concerns Clinic
CH–4031 Basel (Switzerland) St. Joseph’s Healthcare
Hamilton, Ont. (Canada)
Library of Congress Cataloging-in-Publication Data
Perinatal stress, mood, and anxiety disorders : from bench to bedside /
volume editors, A. Riecher-Rössler, M. Steiner.
p. ; cm. – (Bibliotheca psychiatrica ; no. 173)
Includes bibliographical references and indexes.
ISBN 3-8055-7865-2 (hard cover : alk. paper)
1. Postpartum psychiatric disorders. 2. Childbirth–Psychological
aspects. 3. Motherhood–Psychological aspects. 4. Postnatal
care–Psychological aspects. 5. Mothers–Mental health. 6. Stress
(Psychology) 7. Anxiety in women. 8. Postpartum depression. 9. Mental
illness in pregnancy. 10. Pregnant women–Mental health.
[DNLM: 1. Postpartum Period–psychology. 2. Anxiety Disorders. 3. Mood
Disorders. 4. Pregnancy Complications–psychology. WQ 500 P4456 2005] I.
Riecher-Rössler, Anita. II. Steiner, Meir. III. Series.
RG850.P475 2005
618.7(cid:1)6–dc22
2005006482
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or by any information storage and retrieval system, without permission in writing from the publisher.
© Copyright 2005 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland)
www.karger.com
Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel
ISSN 0067–8147
ISBN 3–8055–7865–2
Contents
VII Foreword
Riecher-Rössler, A. (Basel); Steiner, M. (Hamilton)
1 A Historical Perspective on the Psychiatry of Motherhood
Brockington, I. (Bredenbury)
6 Diagnostic Classification of Perinatal Mood Disorders
Riecher-Rössler, A.; Rohde, A. (Basel)
28 Maternal Adversity,Vulnerability and Disease
Matthews, S.G. (Toronto); Meaney, M.J. (Montréal)
50 Behavioral Perinatology
Wadhwa, P.D. (Irvine, Calif.)
70 Maternal Depression:An Adverse Early Environment
Beach, A.J.; Henry, A.L.; Stowe, Z.N.; Newport, D.J. (Atlanta, Ga.)
85 Perinatal Infanticide and Suicide
Spinelli, M.G. (New York, N.Y.)
100 Relevance of Gonadal Hormones to Perinatal Mood and
Anxiety Disorders
Ahokas, A.; Kaukoranta, J.; Wahlbeck, K.; Aito, M. (Helsinki)
112 Pharmacotherapy for Psychiatric Disorders in Pregnancy
Ross, L.E.; Gunasekera, S.; Rowland, M.; Steiner, M. (Hamilton)
V
137 Maternal Depression in the Postpartum Period:
Impact of Breast-Feeding on Treatment Planning
Stowe, Z.N.; Ragan, K.; Newport, D.J. (Atlanta, Ga.)
150 The Use of Interpersonal Psychotherapy for Perinatal
Mood and Anxiety Disorders
Stuart, S.; O’Hara, M.W. (Iowa City, Iowa)
167 Group Psychotherapy for Depression in Early Stages
of Motherhood
Hofecker-Fallahpour, M.; Riecher-Rössler, A. (Basel)
182 Alternative Treatment Strategies for Perinatal
Depression and Anxiety
O’Higgins, M.; Glover, V. (London); Corral, M. (Vancouver)
194 Author Index
195 Subject Index
Contents VI
Foreword
Mood and anxiety disorders are very common during the perinatal period
and confront us with specific needs. Thus, help seeking is often delayed due to
shame and stigma, and diagnosis is often missed due to misinterpretation of
symptoms. Services often do not adequately meet the needs of the women
concerned as they do not take into account their specific situation, problems
and fears. Untreated, peripartum disorders can have especially severe long-term
consequences, not only for the mother but also for the whole family and espe-
cially for the child. Recent research has shown how maternal stress, anxiety and
depression can adversely influence a child’s early and later development.
Despite this, perinatal mental health has until recently been very much
neglected, overlooked, underdiagnosed and undertreated.
A recent surge of clinical and research interest, prompted by some very
active pioneers in this field and also by media exposures of several very tragic
outcomes of mothers who committed infanticide and/or suicide during an
episode of postpartum depression, is a most welcome change in this field.
It is now widely accepted that mental disorders in the perinatal period need
special attention and special treatments with modifications of the classical
pharmacological, non-pharmacological and psychotherapeutic approaches.
Universities around the world have started research programmes and imple-
mented subspecialty clinics for perinatal mental health. Residency programmes
in psychiatry and in obstetrics and gynaecology are including the topic in their
curriculum and granting agencies have declared it a priority for research.
We have assembled a group of internationally renown experts in the field to
contribute to this volume. The twelve articles included here offer a comprehensive
VII
up-to-date overview of the most relevant research and treatment considerations in
this neglected field.
A brief, though very interesting introduction to the history of psychiatry of
motherhood is followed by the discussion of the old question if perinatal disor-
ders are specific entities and if they should have a specific place in our classifi-
cation systems.
Further articles focus on the effects of chronic maternal stress on fetal
developmental outcomes and on the relationship between adversity in early
pre- and postnatal life and the risk for later cognitive and behavioural impairments
and chronic illness. Maternal depression during pregnancy and early childhood
is shown to be one of the child’s earliest adverse life events which can con-
tribute to a child’s vulnerability to later psychiatric illness. Both clinical as well
as preclinical evidence is discussed.
In an article of outstanding importance for each clinician, the danger of
perinatal infanticide and suicide is reviewed.
Further articles deal with specific forms and modifications of therapies for
perinatal mental disorders. The relevance of gonadal hormones in the pathogen-
esis of perinatal mental disorders is discussed, an innovative field of research
which could offer new therapeutic possibilities. The most important questions
of pharmacotherapy during pregnancy and breast-feeding are discussed in
depth. New psychotherapeutic approaches are presented such as interpersonal
psychotherapy as well as a new form of group therapy for mothers with depres-
sion and anxiety disorders. Last but not least, ‘alternative’treatment strategies
for pregnant and breast-feeding women are reviewed.
This book is aimed primarily at clinicians, teachers and researchers from
the fields of psychiatry (adult as well as child and adolescent psychiatry),
obstetrics and gynaecology, paediatrics, psychology, psychotherapy, neurobiol-
ogy and psychoneuroendocrinology as well as their students and learners.
The editors wish to thank all contributors as well as our administrative
assistants, Ms. Cindy Tasch, Hamilton, Mrs. Elisabeth von Castelmur and
Ms. Brigitte Howald, Basel, and the staff of S. Karger AG, Basel, for their
professional help with the publication of this volume.
Anita Riecher-Rössler
Meir Steiner
Foreword VIII
Riecher-Rössler A, Steiner M (eds): Perinatal Stress, Mood and Anxiety Disorders.
From Bench to Bedside. Bibl Psychiatr. Basel, Karger, 2005, No 173, pp 1–5
A Historical Perspective on the
Psychiatry of Motherhood
Ian Brockington
Bredenbury, Herefordshire, UK
The early literature on the psychiatric disorders of reproduction was
focused on psychosis. Hippocrates [1] may have encountered postpartum delir-
ium complicating infections, as in the women from Thasos and Cyzicus (3rd
book of epidemics, cases 2 and 14), and possibly the enigmatic 40th aphorism
from the 5th book of aphorisms. The next case was published in Basel about
2,000 years later in 1593 by Plater [2]. In the 17th and 18th centuries, there
were 30–40 other brief reports, before the Göttingen obstetrician Osiander [3]
(1797) wrote the first full description of puerperal mania. A 3rd form of
psychosis – posteclamptic psychosis – was described by Mercatus [4] in 1614.
At the same time, Society became aware of another group of disorders,
apparently a disturbance of the ‘maternal instinct’. Murder of the newborn
became a major public health problem between the 17th and mid 19th centuries
and led to the development of a whole branch of forensic medicine. The fury of
the mother was shown in some cases by extreme violence, such as beheading or
butchering the infant. Almost all cases followed clandestine illegitimate births,
but occasionally neonaticide was reported within marriage, e.g. Biermann [5]
(1839). Simultaneously, parental child abuse came to light, initially in older
children. Brutal assaults betrayed parental rage, but children dying from starva-
tion – first described by Rothamel [6] in 1845 – indicated persistent states of
hatred and rejection. Tardieu’s [7] classic paper (1860) showed that this cruelty
could extend to very young children. Of his 32 cases, 5 concerned breast-fed
infants and 1 was only 15 days old. He wrote:
When we consider the tender age of these poor defenceless beings, subjected daily and
almost hourly to savage atrocities, unimaginable tortures and harsh privation … and when we
face the fact that their tormentors are the very mothers who gave them life, we are confronted
with one of the most appalling problems that can disturb the soul of a moralist, or the con-
science of justice.