Roch Cantwell

The classification of perinatal mood disorders—suggestions for DSMV and ICD11

The link between childbirth and affective disorders has been recognised for many hundreds of years. It is also clear that episodes of mood disorder occurring at this time are of great clinical and public health importance with suicide a leading cause of maternal death in the developed world (CEMACH 2007). The nosology of perinatal episodes, however, is controversial and has lead to confusion in both clinical practice and research. In this paper we will briefly and selectively consider a number of studies that have been published since DSM IV and ICD10 and make suggestions for how perinatal mood disorders could be dealt with in DSM-V and ICD11.

To meta-analyse or not to meta-analyse: abortion, birth and mental health

Two recent meta-analyses claim that abortion leads to a deterioration in mental health. Previous reviews concluded that the mental health outcomes following an unwanted pregnancy are much the same whether the woman gives birth or terminates the pregnancy, although there is an increased mental health risk with an unwanted pregnancy. Meta-analysis is particularly susceptible to bias in this area. The physical health outcomes for women with an unwanted pregnancy have improved greatly by making abortion legal. To further improve the mental health outcomes associated with an unwanted pregnancy we should focus practice and research on the individual needs of women with an unwanted pregnancy, rather than how the pregnancy is resolved.

British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017:

Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.

Invited commentaries on... Abortion and mental health disorders

The finding that induced abortion is a risk factor for subsequent psychiatric disorder in some women raises important clinical and training issues for psychiatrists. It also highlights the necessity for developing evidence-based interventions for these women. P.C. / Evidence suggesting a modest increase in mental health problems after abortion does not support the prominence of psychiatric issues in the abortion debate, which is primarily moral and ethical not psychiatric or scientific. M.O. et al.

Policy and practice in the management of postnatal depression in Scotland.

To investigate current policy and practice in postnatal depression in Scotland and to consider how effectively guidelines were addressed. A questionnaire survey of all National Health Service Boards in Scotland between September 2003 and February 2004 to determine what written policies for postnatal depression were in place as at September 2003. This was followed by a questionnaire survey of a representative sample of general practices in Scotland to determine the routine procedures in use for managing postnatal depression in general practice primary care teams. NHS Boards and general practices in Scotland, UK. Forty-seven per cent of policies and 68% of General Practices had implemented the majority of the Scottish Intercollegiate Guidelines Network 60 evidence based recommendations. Practices were more likely than NHS Boards to have addressed a higher percentage of the recommendations (p < 0.05). Practices were more likely to implement antenatal screening for a history of puerperal psychosis if they were within NHS Boards that recommend this as routine practice. Practices within NHS Boards that had in-patient facilities for mother and baby admissions were more likely to identify these services as a treatment option than in the areas where the NHS Boards indicated the facilities were unavailable. Board guidance did not relate significantly to the likelihood of practices following the other evidence-based recommendations. Minimum standards represented by the SIGN 60 evidence-based recommendations were mostly followed in both policy and practice. If Board policy followed guidelines, the guidelines were more likely to be implemented at primary care level.

Baby blues — 100 words

Does common mean normal? If 50-80% of women experience transient mood lability, weepiness and irritability in the early postpartum, can we call it illness? Baby blues has dropped off the radar a little in recent years, yet in the past ‘this trivial disorder has aroused almost as much curiosity as