Amaury Cantilino

Transtornos psiquiátricos na gestação e no puerpério: classificação, diagnóstico e tratamento

Several questions regarding mental health during the period of pregnancy and puerperium are still open. Even this seems contradictory, many patient present sadness or anxiety instead

Postpartum obsessive-compulsive disorder: prevalence and clinical characteristics

OBJECTIVE The principal aims of this study were to examine the prevalence rate, clinical characteristics, and related factors of postpartum obsessive-compulsive disorder (OCD). METHOD The subjects were a nonclinical sample of 400 postpartum women. They were interviewed from the 2nd up to the 26th week after birth. The Mini International Neuropsychiatric Interview was used for diagnosis of OCD, the Yale-Brown Obsessive-Compulsive Symptom Checklist was used to determine the types of obsessions and compulsions, and the Structured Clinical Interview for DSM-IV Axis I Disorders was used to diagnose comorbid depressive episode. RESULTS Thirty-six (9%) of the sample met the diagnostic criteria for OCD according to the Mini International Neuropsychiatric Interview, and 9 (2.3%) reported postpartum onset OCD. Obsessive-compulsive disorder was more frequent in mothers with personal history of previous psychiatric disorder, somatic disease, or obstetric complication in pregnancy/birth, and who were multiparous. The most common obsessions were aggressive, contamination and miscellaneous, and compulsion for washing/cleaning and checking, and 38.9% have a comorbid depressive episode. CONCLUSION Women have increased risk of OCD or obsessive-compulsive symptoms in the postpartum period. For this reason, all women, particularly women with previous psychiatric history, somatic disease, or with complications in pregnancy or at the birth should be carefully screened for OCD in the postpartum period.

Translation, Validation and Cultural Aspects of Postpartum Depression Screening Scale in Brazilian Portuguese:

The aim of this study was to determine the validity and reliability of a Portuguese version of the Postpartum Depression Screening Scale (PDSS). A total of 120 new mothers completed the translated version of PDSS and later were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders, our gold standard for clinical status. The best cut-off score for the Portuguese version was 102, with a sensibility of 94%, a specificity of 95%, a positive predictive value of 75% and a negative predictive value of 99%. Reliability, measured by the alpha coefficient of internal consistency, was .95. The PDSS is considered ready for use in the screening of Brazilian new mothers for postpartum depression.

Transtornos psiquiátricos no pós-parto

OBJECTIVE: The postpartum period is marked by biological, psychological and social changes. Women are considered most susceptible to psychiatric disorders during the postpartum period. Puerperal blues, postpartum depression and postpartum psychosis have been classically associated to the postpartum. Anxiety disorders have also recently been associated to this period. METHOD: The present article reports a review of the literature on postpartum psychiatric disorders based on articles found on the PubMed and SciELO databases, published between 2000 and 2009. Relevant books, theses and other articles cited in the articles found were also included in this review. RESULTS: Puerperal dysphoria occurs in 50% to 85% of women following childbirth and is typically mild and transient in nature and requires no treatment. Postpartum depression has a prevalence rate of around 13% and can have negative repercussions on mother-infant interaction and other life events and must therefore be treated. Postpartum psychosis is rare, occurring in approximately 0.2% of puerperium cases. This condition is severe with psychotic and affective symptoms as well as risk of suicide and infanticide. Postpartum psychosis patients generally require hospital treatment. Anxiety disorders may be exacerbated or precipitated during the postpartum, particularly generalized anxiety disorder, post-traumatic stress disorder and compulsive-obsessive disorder. DISCUSSION: Although not recognized as distinct diagnostic entities under current classification systems, mental disorders during the puerperium present clinical features which warrant the attention of clinicians and researchers.OBJETIVO: O pos-parto e um periodo de alteracoes biologicas, psicologicas e sociais. Essa e considerada a epoca mais vulneravel para a ocorrencia de transtornos psiquiatricos. A disforia puerperal, a depressao pos-parto e a psicose pos-parto tem sido classicamente relacionadas ao pos-parto. Atualmente, tem sido observado que os transtornos ansiosos tambem estao associados a esse periodo. METODO: Neste artigo e feita uma revisao da bibliografia acerca de transtornos psiquiatricos no pos-parto a partir de artigos encontrados no PubMed e no SciELO entre os anos de 2000 e 2009. Livros, teses e outros artigos considerados relevantes citados no material consultado tambem foram incluidos. RESULTADOS: A disforia puerperal ocorre em 50% a 85% das mulheres, o quadro e leve e transitorio e nao requer tratamento. A depressao pos-parto tem prevalencia em torno de 13%, pode causar repercussoes negativas na interacao mae-bebe e em outros aspectos da vida da mulher e deve ser tratada. A psicose pos-parto e rara, aparecendo em cerca de 0,2% das puerperas. Tem quadro grave que envolve sintomas psicoticos e afetivos, havendo risco de suicidio e infanticidio e geralmente requerendo internacao hospitalar. Os transtornos ansiosos podem ser exacerbados ou precipitados no pos-parto, especialmente o transtorno de ansiedade generalizada, o transtorno de estresse pos-traumatico e o transtorno obsessivo-compulsivo. CONCLUSAO: Apesar de nao serem reconhecidos como entidades diagnosticas pelos sistemas classificatorios atuais, os transtornos mentais no puerperio apresentam peculiaridades clinicas que merecem atencao por parte de clinicos e pesquisadores.

Use of psychotropic medications during pregnancy: perception of teratogenic risk among physicians in two Latin American countries

OBJECTIVE Pregnant women and their health care professionals commonly believe that use of medications during pregnancy may be harmful to the unborn fetus. The objective of this study was to evaluate the risk perception of psychotropic drug use in pregnancy among physicians in different medical specialties. METHOD This was a convenience survey conducted at outpatient clinics in the cities of Recife, Brazil, and La Plata, Bahía Blanca, and Buenos Aires, Argentina. Physicians who agreed to participate were asked to rate their perception of teratogenic risk among different classes of drugs, which included antidepressants, antipsychotics, anticonvulsants, and benzodiazepines. RESULTS Two hundred and thirty-eight physicians completed the survey (response rate, 98%). These included psychiatrists, obstetricians, neurologists, cardiologists, gastroenterologists, and general practitioners. Among different specialties, a minority of psychiatrists perceived psychotropic drugs to be highly teratogenic (antidepressants, 12.5%; antipsychotics, 15%; benzodiazepines, 25%) as compared with other specialties (p < 0.003 for each drug class). There was no difference in perceived risk of antiepileptic drugs among specialties, including psychiatrists. CONCLUSION The risk associated with use of psychotropic drugs in pregnancy was overestimated by physicians of all medical specialties, except psychiatry. All physicians should be aware of the safety/risk of psychotropic agents in pregnancy, as they may be required to give advice and/or prescribe these drugs to pregnant women.

Dissociative experience during childbirth

Objective: A dissociative experience refers to phenomena such as depersonalization, derealization, amnesia, out of body experience, altered time perception and body image. The aim of this study was to assess dissociative experience during childbirth and the possible related variables. Method: A total of 328 women, up to 72 hours postpartum, completed the peritraumatic dissociative experience questionnaire (PDEQ), the socio-demographic and obstetrical questionnaire, the pain numeric rating scale, the Trauma History Questionnaire and an SCID-I for traumatic events. Results: A total of 11.3% of the sample experienced significant dissociation. In particular, symptoms like a sensation of time changes during the event/things seemed to be happening in slow motion, not being aware of things that happened, and disorientation. A traumatic childbirth, previous trauma, obstetrical complications, forceps, prematurity, complications with the baby, dissatisfaction with the maternity care, unemployment, high score pain during labor and years of schooling were the factors considered. Conclusion: Dissociative experiences can occur during childbirth.

Instrumentos de avaliação do vínculo entre mãe e bebê

Objective: To identify and describe research tools used to evaluate bonding between mother and child up to one year of age, as well as to provide information on reliability and validity measures related to these tools. Data source: Research studies available on PUBMED, LILACS, ScienceDirect, PsycINFO and CINAHL databases with the following descriptors: mother-child relations and mother infant relationship, as well as the expressions validity, reliability and scale. Data synthesis: 23 research studies were selected and fully analyzed. Thirteen evaluation research tools were identified concerning mother and child attachment: seven scales, three questionnaires, two inventories and one observation method. From all tools analyzed, the Prenatal Attachment Inventory presented the higher validity and reliability measures to assess mother and fetus relation during pregnancy. Concerning the puerperal period, better consistency coefficients were found for Maternal Attachment Inventory and Postpartum Bonding Questionnaire. Besides, the last one revealed a higher sensibility to identify amenable and severe disorders in the affective relations between mother and child. Conclusions: The majority of research tools are reliable to study the phenomenon presented, although there are some limitations regarding the construct and criterion related to validity. In addition to this, only two of them are translated into Portuguese and adapted to women and children populations in Brazil, being a decisive gap to scientific production in this area.Abstract Objective To identify and describe research tools used to evaluate bonding between mother and child up to one year of age, as well as to provide information on reliability and validity measures related to these tools. Data source Research studies available on PUBMED, LILACS, ScienceDirect, PsycINFO and CINAHL databases with the following descriptors: mother-child relations and mother infant relationship, as well as the expressions validity, reliability and scale. Data synthesis 23 research studies were selected and fully analyzed. Thirteen evaluation research tools were identified concerning mother and child attachment: seven scales, three questionnaires, two inventories and one observation method. From all tools analyzed, the Prenatal Attachment Inventory presented the higher validity and reliability measures to assess mother and fetus relation during pregnancy. Concerning the puerperal period, better consistency coefficients were found for Maternal Attachment Inventory and Postpartum Bonding Questionnaire. Besides, the last one revealed a higher sensibility to identify amenable and severe disorders in the affective relations between mother and child. Conclusions The majority of research tools are reliable to study the phenomenon presented, although there are some limitations regarding the construct and criterion related to validity. In addition to this, only two of them are translated into Portuguese and adapted to women and children populations in Brazil, being a decisive gap to scientific production in this area.

Sintomas obsessivo-compulsivos na depressão pós-parto: relatos de casos

Postpartum depression is the most common affective disorder in the puerperium. There are some particular symptoms in its clinical presentation, and one might be the higher frequency of obsessions and compulsions. We report six cases identified from the analysis of medical charts of puerperal women receiving care at the Womens Mental Health Program, Hospital das Clinicas, Universidade Federal de Pernambuco, Brazil. All the women were diagnosed with postpartum depression using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and had associated obsessive-compulsive symptoms. We report time of onset, topics, course and treatment response of these symptoms. Obsessive-compulsive symptoms preceded depressive symptoms in two women, and were succeeded in two other women. There was exacerbation of preexisting obsessions and compulsions in two puerperal women. The most frequent topic was aggressive thoughts toward the baby. Improvement in depressive symptoms tended to reduce obsessive-compulsive symptoms.

A systematic review of the neural correlates of positive emotions.

Objective: To conduct a systematic literature review of human studies reporting neural correlates of positive emotions. Methods: The PubMed and Web of Science databases were searched in January 2016 for scientific papers written in English. No restrictions were placed on year of publication. Results: Twenty-two articles were identified and 12 met the established criteria. Five had been published during the last 4 years. Formation and regulation of positive emotions, including happiness, are associated with significant reductions in activity in the right prefrontal cortex and bilaterally in the temporoparietal cortex, as well as with increased activity in the left prefrontal regions. They are also associated with increased activity in the cingulate gyrus, inferior and middle temporal gyri, amygdalae, and ventral striatum. Conclusion: It is too early to claim that there is an established understanding of the neuroscience of positive emotions and happiness. However, despite overlap in the brain regions involved in the formation and regulation of positive and negative emotions, we can conclude that positive emotions such as happiness activate specific brain regions.

Happiness and health in psychiatry: what are their implications?

Background Happiness is a lasting state and is associated with the absence of negative emotions, the presence of positive emotions, life satisfaction, social engagement and objectives in life. Researchers have demonstrated the benefits of happiness in many aspects of life, but few studies have been conducted within psychiatry.Objectives To develop a critical literature review of studies on happiness and health in order to bring some further and useful information to psychiatry updating the article “Happiness: a review” published in 2007 in Revista de Psiquiatria Clinica.Methods Computational searching was undertaken of digital data basis (PubMed and SciELO) using the keywords “happiness” and “health”. One hundred twenty-seven papers published between 2004 and 2014 were found, but only 76 had the keywords in the title or abstract and with this were selected.Results Personality traits, such as self-direction; being married; being involved in physical and leisure activities; higher educational backgrounds and intelligence quotient; religiosity, volunteering and altruism; good physical and mental health; were positively related to happiness.Discussion Analysis of the concept of happiness and its associated emotions may be more complex than describing the symptoms of psychiatric disorders. Despite this, the study of happiness brings several positive implications for psychiatry.