The Posttraumatic Stress Disorder (PTSD) Checklist (PCL) is a 17-item self-report measure of the 17 DSM-IV symptoms of PTSD. The PCL has a variety of purposes, including screening individuals for PTSD, diagnosing PTSD, monitoring symptom change during and after treatment. There are three versions of the PCL: PCL-C (civilian), PCL-M (military) and PCL-S (specific). PCL-M asks about symptoms in response to “stressful military experiences” and used for active service members and veterans. The PCL-M can be completed by participants of a research study in approximately 5–10 minutes. Interpretation of the PCL-M should be completed by a clinician. There is no valid PCL-M Latvian language version.

The goal of the study is to assess the evaluative and discriminative properties of the Latvian language version of the PCL-M in PTSD risk group patients (PTSD-RGP).

Totally 30 participants (males, Europeans, of average age 26.2, PTSD-RGP - Latvian Contingent of International Operations) were examined. Standart validation protocol was applied for PCL-M Latvian language version's reliability and validity testing: reliability consequence, construct validity, test-retest, Cronbach alpha criterion.

Cronbach alpha criterion was more than 0,70 (means reliable response sets), the reliability-consequence scale is from 0.6 to 0.9 (means precise definition). Test-retest by Spearman showed r ≥ 0.75 (means reliable stability).

It was concluded that the PLC-M Latvian language version has sufficiently acceptable evaluative and discriminatory properties and is therefore a valid instrument for PTSD measurements in clinical and research studies in Latvian military active service members and veterans.

European countries face immigration problems with refugees. Many refugees suffer from Post Traumatic Stress Disorder (PTSD). Numerous studies have shown that PTSD is associated with cognitive problems that interfere with language acquisition.

In this study we have explored demographic and psychological variables that influence language acquisition. Expected is that low levels of language acquisition are associated with severeness of PTSD.

From clinical experience, we have noticed that Dutch fluency is an important factor in social adjustment and mental health. Furthermore it is expected that PTSD symptoms delay language acquisition.

Participants are 150 refuges with PTSD. The severeness of PTSD was assessed with a structured interview and self-rating questionnaires; HTQ, HSCL-25 and PILL scale. The ability to speak Dutch language was measured by the choice of refugees to have an interpreter or not. Demographic data for age, sex, education and years since resettlement are included. We searched for linear relations between PTSD and other variables.

Results confirm our clinical observation of a relation between higher numbers of traumatic experiences related to complex PTSD and the choice to have a interpreter. There are correlations between complex PTSD, number of traumatic events, years since resettlement, age and language acquisition although multiple regressive analysis indicates this result is not significant because of the small variation in this group of refugees with severe PTSD.

This study stresses the necessity to include additional objective instruments to measure language acquisition of refugees.

Emotional and moody behaviour is often normalized in childbearing women. However, increased mood variability is associated with psychiatric problems (anxiety, depression, personality disorder), which are potentially deleterious to the health of the developing fetus and mother.

To increase understanding about mood variability in childbearing women.

Depression was measured using the Edinburgh Postpartum Depression Scale (EPDS). Mood variability was calculated from twice-daily diary ratings of “depressed”, “fear”, and “irritable” mood for one week each in early pregnancy, late pregnancy, and postpartum.

We recruited 47 women. Depression, as measured by the EPDS, and fear mood variability decreased from early pregnancy to postpartum. Depressed and irritable mood variability also declined during pregnancy, but increased in post-partum. Increases in mood variability (depressed, irritable) from late pregnancy to postpartum predicted higher postpartum EPDS. Mood diaries were available from 30 non-parturient women for comparison. Pregnant and postpartum women had higher irritable but not depressed or fear mood variability.

Mood, particularly anxiety, is variable over the course of pregnancy into early postpartum. This may be related to diminishing concerns about the pregnancy and baby's health after birth, sleep disruptions, or hormonal changes. Depressed mood variability is correlated with, but is distinct from depression as measured by the EPDS. We present results counter to the notion that all mood is amplified in childbearing women.

The pregnancy and the motherhood of adolescents are complex phenomena that happen on the trajectory of life of the young persons under physical, psychological and social aspects.

To deepen knowledge of the emotional experiences of socially disadvantaged adolescent primiparous with premature babies.

Qualitative-clinical. Criteria of inclusion: age group, to be primiparous with premature baby and acceptance in participating of the inquiry. The intentional sample was made up of five adolescents aged between 16 and 19. The study was carried between junho/2008 to outubro/2009. Semi-directed interviews based on the trigger question “Tell me about your pregnancy and your baby's birth”. The data were submitted for thematic analysis and from this the following categories emerged: 1. Late discovery of pregnancy: “Mine was a lightning pregnancy”; 2. The symbolization of the child: “It was a present for me…” discussed within a theoretical framework of reference, with special emphasis on the psychodynamic approach.

On the psychological level, the adolescents presented feelings of omnipotence, unfamiliarity, shock, surprise, anger, fear, anguish and happiness at the birth of their child. They appeared to use immature, narcissistic and neurotic defense mechanisms such as denial, dissociation, acting out and idealization as well as revealing the desire to be good mothers and to engage in maternity.

These finds can subsidize the team of health responsible for the service in the UTIN, developing attitudes more effective of support and giving emotional presence aiming to reduce the fear and anguishes resulting from the situation.

Mental illness and pregnancy have always represented a great challenge to psychiatrists. There are certain risks when dealing with severe, long-term and chronic mental illness requiring continuous medication such as schizophrenia, which is always treated by antipsychotics.

A 40-year-old pregnant woman, primipara has been suffering from schizophrenia for 24 and has been married for the last 15 years. Although the pregnancy was unplanned, the patient decided to give birth and was fully supported by her husband. From the very beginning of the illness the patient has been treated by an antipsychotic- flufenazine decanoate, every four weeks. During her life-long illness the patient was hospitalised three times and since the last hospitalization (17 years ago), the patient has continued the treatment on an outpatient basis.The pregnancy itself represented a risk for further psychic decompensation, while the risk of antipsychotic effect on the fetus was also present. A specific life situation of the patient required the introduction of different treatment types in order to assure an intensive monitoring and observation of the patient’s mental state. Besides depot medication, high-risk pregnancy required the introduction of additional supportive therapy (once a week).

Due to a high-risk pregnancy a regular collaborative approach and care of the psychiatrist, gynaecologist and GP were the prerequisites for successful treatment. During pregnancy the remission of schizophrenia was maintained, while during delivery and the postpartum period no relapse occurred. The patient had a full-term pregnancy and a natural childbirth. After delivery ablactation was suggested.

Very few studies have conducted a multivariate analysis incorporating both the major predictors of depression in women, in accordance with comprehensive developmental models of depression, and specific stressors associated with the biological and psychosocial state of the mother-to-be.

We used a cross-sectional cohort design to analyze the associations between prenatal depression and potential risk factors. 693 French-speaking women with singleton pregnancies at 20–28 weeks’ gestation were consecutively recruited. Fifty women with missing values were subsequently excluded from the analysis. Depressive symptoms were assessed on the Edinburgh Postnatal Depression Scale. Risk factors were either extracted from the computerized obstetric records or assessed by means of self-administered questionnaires. The associations between prenatal depression and the potential risk factors were assessed using log-binomial regression models to obtain a direct estimate of relative risk.

The following factors were found to be significant in the multivariate analysis: level of education, past psychiatric history, stress related to the health and viability of the fetus and stress related to severe marital conflicts or to serious difficulties at work. An association was also found with the previous delivery of a child with a major or minor birth defect. Univariate analyses revealed a strong association with childhood adversity (parental rejection and family secrets).

Our study identifies several risk factors that could easily be assessed in clinical practice. It draws attention to the impact of previously delivering a child with a birth defect and to the association with childhood adversity.

Maternal anxiety during pregnancy can have many effects on the outcome of the pregnancy such as gestational length, birthweight, prenatal attachment, prepartum and intrapartum complications.

Three categories of pictures were presented to 149 pregnant women:

1. 1. baby pictures as cues of prenatal attachment;

2. 2. couples in erotic and family situations as cues of relationship to the partner;

3. 3. other pictures related to pregnancy (such as the physical changes of the body, experiencing social support) as cues of potential fears and coping with stressful situations.

The aim of our study is to describe the relation between pregnant women's ratings to affective stimuli and their level of anxiety.

Affective ratings have been assessed on three dimensions: valence (ranging from pleasant to unpleasant), arousal (ranging from calm to excited), and dominance/control (ranging from being overwhelmed by emotions to controling an affective state). Anxiety has been measured with HADS.

Women with high level of anxiety have rated the pregnancy related pictures less pleasant, less arousing but more overwhelming (lower level of control over an emotional state). Women with low level of anxiety have rated the pictures more pleasant, less arousing and less overwhelming (higher level of perceived control an emotional state).

High level of anxiety has correlated with special pattern of emotional reactions to pregnancy related pictures from the IAPS.

Although perfectionism has generally been associated with depressive illness in general, there are no studies on its role in major depression in the postnatal period. The aim of the present study was to explore the relationship between perfectionism and major postpartum depression.

In this case-control study, we compared the differences in perfectionism dimensions between 122 women with major postpartum depression (SCID-I; DSM-IV) and 115 healthy postpartum women. The Frost Multidimensional Perfectionism Scale (FMPS) was used to assess perfectionism. Other variables were also considered: Socio-demographic and obstetric data, psychiatric history, other personality traits, social support, life events and genotype combinations according to serotonin transporter expression (5-HTTLPR and Stin2 VNTR polymorphisms).

Multivariate models confirmed perfectionism as an independent factor associated with major postpartum depression. The FMPS dimension concern over mistakes was associated with a 4-fold increase in risk for major postpartum depression (OR = 4.14; 95%CI: 1.24–13.81). Neuroticism, personal psychiatric history and 5-HTT low-expressing genotypes at one of the loci were also identified as independent factors.

Perfectionism, and particularly the concern over mistakes perfectionism dimension, is associated with major postpartum depression. These results highlight the importance of assessing personality traits together with other risk factors to identify women at risk of depression after childbirth.

Psychiatric illness and suicide in particular have been a leading overall cause of maternal mortality in the United Kingdom. Although the most recent Confidential Enquiry into Maternal and Child Health indicated that this is no longer leading causes, mental health problems before and after childbirth have a significant impact on the health of women, family relationships and children's subsequent development.

To identify the current practice for management and prevention of perinatal mental illness within a community mental health setting.

To identify the extent to which policy recommendations from NICE “Antenatal and postnatal mental health” been implemented

The audit included all women who are pregnant, breastfeeding or who are planning to become pregnant and referred to the CMHT between November 2008 to April 2010

20 Cases identified by asking all team members to recall relevant clients.

65% of those referred were in the antenatal period and 25% were in the post natal period. 40% of those referred had a pre existing mental illness and 60% were new onset during antenatal & postnatal period.

The main diagnosis was depression and anxiety disorders.

55% of those referred to the CMHT were on Psychotropic medications. However following the assessment and follow up by CMHT, only 25% of those referred needed to be on the psychotropics.

Good compliance was achieved in the documentation of past psychiatric history and family history, provision of appropriate psychosocial interventions and specific considerations for the use of antidepressant medication during pregnancy and the postnatal period.

Having a critically ill baby in the NICU is very difficult to cope with, and mothers may feel a whole host of emotions as they cope with the loss of the last part of pregnancy, the dream of a healthy birth, the loss of the first weeks or months of their baby's life. This distress may resemble posttraumatic stress disorder (PTSD).

To examine mothers’ responses to having a baby (preterm or full term) in neonatal intensive -care unit and to determine if they fulfill the criteria for PTSD or depression.

Forty nine mothers of pre term babies and ten mothers of full term babies who had been hospitalized in NICU of Schneider Children's Hospital, Israel, were interviewed at the follow up clinic between 4–17 months after birth. The evaluation was carried out by one senior psychiatrist and was based on diagnostic criteria for PTSD and depression according to DSM-4. Severity of PTSD was measured by PSS-sr and the severity of depression by HAMD-Distress factors in NICU setting were evaluated by Parental Stressor Scale (M&F&C Scale).

1. 1. 50% of mothers of preterm babies and 40% of mothers of full term babies fulfill the criteria for PTSD (N.S.).

2. 2. 25% (15/59) of the whole sample had moderate to severe PTSD.

3. 3. A strong correlation between PTSD and severity of stress during hospitalization in NICU was found.

The development of later ptsd and depression can be predicted by maternal responses to hospitalization of her baby in nicu.

Childbirth and the postpartal period present a form of specific maturational crisis and an extremely vulnerable period for every woman, especially for those who have potential for some psychological disturbances.

We explored sociodemographic and clinical manifestations of women in the postpartal period who were hospitalized at the Institute of Psychiatry, Clinical Center of Serbia.

This retrospective study included 60 patients with psychiatric disorders developed within six months after childbirth. Inclusion criteria were: negative psychiatric hystory, negative history of puerperal episode, and postpartal disorder as a first manifestation of psychiatric disturbances. Patients were diagnosed according to RDC criteria (research diagnostic criteria).

Patients with psychotic features were predominant, average age 23.6; married; mothers of male offspring and with positive family history of psychiatric disorders in 30%. Subacute development of clinical manifestations was noticed, 3.5 weeks after childbirth on average. No psychopathology was observed before third postpartal day. Obstetric manifestations did not influence psychopathology.

Childbirth is a significant risk factor for the expression of mental dysfunction in the puerperal period. The most vulnerable group is women with clinical expression of dysfunction, specific sociodemographic characteristics, and positive family history of psychiatric disorders.

This study investigated the diurnal output of saliva cortisol and saliva amylase in women with symptoms of depression postnatally.

Twenty one depressed and 30 non depressed women at 7.5 weeks postpartum, and 21 non perinatal controls, collected saliva at waking, 30 minutes, and three and twelve hours post waking.

Women who were not depressed postnatally showed a pattern of cortisol secretion over the day similar to non perinatal controls. There was a significant difference in diurnal pattern between postnatally depressed and postnatally non depressed women, due to a difference in the first two time points (waking and +30 mins): compared to the other two groups who each had a significant increase in cortisol levels from waking to +30 minutes, the depressed women had significantly higher cortisol levels at waking and no increase at +30 minutes. Analyses of amylase are underway and will be presented.

The lack of a morning rise in the depressed women is similar to that reported for Post-traumatic Stress Disorder and chronic fatigue syndrome and may reflect a response, in vulnerable women, to the marked cortisol withdrawal that occurs after delivery. Alternatively it could be a trait marker for women at risk of developing postnatal depression.

The experience of labor varies markedly from women to Women. While medications can help women cope with the pain of labor, they usually come with side effects that women did not expect or want. There are many non medical ways to cope with the pain which has not side effect.

The purpose of this study was to evaluate the effect of emotional and physical support during labor for primiparouse women.

In this clinical trial study, convenience sample of 80 primiparous women who fulfilled the inclusion criteria was recruited from one hospital in Sanandaj (Center of Kurdistan provenice), Iran. They were randomly divided in Two groups (Case and Control). Data were collected from May to October 2008 using a demographic form and Visual Analoge Scale(VAS).

The study revealed that emotional and physical support during labor cause women has better tolerance of pain. Furthermore, comparison pain intensity among two groups in dillatation 8 and 10 cm was statically significant (p < 0/03& p = 0/000).

Emotional and physical support during labor can be considered as a non pharmacological therapeutic method to reduce labor pain and decrease side effect of drugs. In addition, education and using of this method increases women satisfying from labor and natural delivery and to make better experience of motherhood.

Reproductive events (cycle length, ovulation) behave regularly in some and chaotic in others. A mathematical model based on empirical data is developed to predict these parameters and hypothalamic oscillations with enough exactness.

Thirty eight cases were evaluated by autoregressive moving average and laboratory study of a series of hormones.

Cycle to cycle correction with noise is the best model fit to both very regular and very irregular patients. Addition of two hormones (estradiol and GnRH twice) at any time during the cycle can predict the time of the next menstruation with an exactness of 10h and fertility based on the simplified formula: T1 = T0 + k ∫ [Ω(Est-d0GnRH0/GnRH1dt)]

1. 1. The hormonal armamentarium of the female reproductive systems ensures single ovulation and single pregnancy.

2. 2. Unlike bone marrow ovaries do not posses a stochastic mechanism and rely solely on suppression of nearby follicles by the dominant follicle.

3. 3. Hypothalamus senses the risk of MP and adjusts pulsation of GnRH in the consecutive cycle by prolonging the low and postponing the high frequency pulsation. Like electric circuits, external stimuli have a changing strength of 1/4 to 1/15 meaning that they can advance or retard ovulation in this range (percentage of the innate cycle of that person).

4. 4. The strongest predictor and determining parameter affecting menstruation cycle is sensing the MP risk by the hypothalamus exemplifying itself as frequency of GnRH pulsation (d0GnRH0/GnRH1dt).

5. 5. Menstruation cycle and fertility can be predicted by mathematical formulas of parametric oscillation.

Metabolic syndrome is an important cause of morbidity among patients with severe mental illnesses. A case of a patient with postpartum psychosis where treatment with olanzapine was followed by vision impairment, metabolic syndrome, and liver dysfunction is presented.

A 35-year old woman was admitted to our clinic 6 days after delivery. She was convinced that she influenced her baby through the posture of her body, and presented with some other acute psychotic symptoms. She was treated with olanzapine and a good remission of symptoms was achieved. After 2 years the treatment was discontinued and she relapsed. She was treated with olanzapine and she remitted once again. A year later she noticed visual problems. Upon ophthalmologist’s suggestion her blood was tested and the tests revealed elevated blood glucose, liver enzymes, and hyperlipidemia. Olanzapine was immediately discontinued and arypiprazole was introduced, along with oral antidiabetic and hypolipidemic therapy. After a week blood glucose dropped significantly. In the next two months all pathologic lab values were normalized. Hypolipidemic and oral antidiabetic therapy was consequently discontinued. The patient is still taking arypiprazole and she is in good remission.

Increased awareness of risks associated with metabolic syndrome, and optimal monitoring and management are required to minimize cardiovascular and other risk factors associated with the syndrome. Antipsychotic tretment should be chosen very carefully in order to avoid the development or aggravation of metabolic syndrome. In the presented case, metabolic syndrome appeared after years of treatment with olanzapine.

Growing interest has been shown in the use of peers as lay health workers in maternal healthcare. This review aimed to examine published evidence on the effectiveness of lay support models for the management of postnatal depression (PND).

MEDLINE, EMBASE, PsycINFO and the Cochrane Library were searched for randomised controlled trials (RCTs) of interventions conducted by lay health workers in postnatal women, published between 1980 and August 2010. The search revealed seven studies, totaling 16,095 participants, which reported outcomes in PND and mothers’ mental health/self-esteem.

The value of lay support models depends on the intervention type and the population targeted. Telephone based peer support, for women identified as high-risk for PND, showed a statistically significant reduction in Edinburgh Postnatal Depression Scale (EPDS) scores at 12 weeks. Universal provision of peer mentoring has been shown to significantly improve self-esteem at one year postpartum, but no studies have shown statistical significance on PND or mental health outcomes (measured by EPDS/SF-36). In poor populations, women's groups led by peer facilitators have been shown to reduce moderate depression by 57%, compared to controls. However, another study, which evaluated community group support showed a low uptake (19%) resulting in no statistical significance. Similarly there was no significant improvement in PND with self-help manuals, despite one study reporting favorable feedback.

There is some evidence from RCTs that high-risk groups and specific demographics can benefit from targeted peer support. However, no particular model can be strongly recommended, and further research is required.

Fertility is an important factor in life which can be disturb due to several factors.

The aim of this study was to determine the relationship between infertility and sexual dysfunction.

In an analytic - descriptive study 384 fertile and 384 infertile referring women to obstetrics and gynecological clinics were studied. All these women were evaluated considering the sexual functions. Finally the results were analyzed statistically.

The age average of these women was 27.84 4.67 and 27.38 5.45 in infertile and fertile groups respectively.

The sexual desire (Pv < 0.001), the sexual arousal (Pv < 0.001). The ability of reach to orgasm (Pv < 0.001) and satisfaction from intercourse was better in fertile women.

It was concluded that the sexual function was significantly better in fertile women.

Nausea and vomiting in the first trimester is a common complaint of about 70% of pregnant women and it has a major effect on their quality of life. Its etiology is unknown but there are some risk factors for it.

The purpose of this study was to obtain the relationship between body mass index (BMI) and nausea and vomiting during pregnancy.

This case-control study was performed on 300 pregnant women who had referred to outpatient clinics. 150 of these women were suffering from nausea and vomiting while the other 150 didn’t have this problem. We determined BMI in two groups. Then the results were analyzed statistically.

The age average was 24.9 and 26.2 in case and control groups respectively. The BMI average was 26.01 kg/m2 and 26.02 kg/m2 in case and control groups respectively. No significant relationship was observed between two groups regarding the presence of nausea but in case group, women with vomiting had lower BMI (p = 0.026).

It was concluded that BMI is not a risk factor for nausea and vomiting during pregnancy.