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The anxiety disorders are conventionally subdivided into: generalised anxiety disorder (GAD), panic disorder (PD), social phobia (social anxiety disorder (SAD)), posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). The current edition of the Diagnostic and Statistical Manual of Mental Disorders, the (DSM)-IV-TR lists 12 anxiety disorders, with broadly similar categories listed in the International Classification of Impairments, Disabilities and Handicaps, 10th revision (ICD-10). Neurochemistry and brain imaging studies have influenced the development of theoretical models of GAD. Current neuroanatomical models of panic disorder draw on the understanding of the functional neuroanatomy of fear conditioning in animals. SAD is second only to specific phobia as the most common anxiety disorder in population-based community studies; onset is in the mid-teenage years and extends into the middle of the third decade. There are a wide range of medical conditions that can cause and perpetuate symptoms of anxiety.
Anne Buist, Austin Health, Repatriation Campus, Department of Psychiatry, West Heidelberg, Vic., Australia,
Lori E. Ross, Women's Mental Health & Addiction Research Section, Centre for Addiction & Mental Health, Toronto, Ont., Canada,
Meir Steiner, Department of Psychiatry Behavioural Neurosciences and Obstetrics & Gynecology, McMasters University, St Joseph's Healthcare, Hamilton, Ont., Canada
This chapter outlines the ways of identifying women at risk and/or women who already show signs and symptoms of depression/anxiety associated with childbearing; and suggest treatment options and preventive measures. Depression during pregnancy is common, with reports suggesting that approximately 10-20" of pregnant women meet criteria for a major or minor depressive disorder. Postpartum psychosis may have any of the features of acute schizophreniform disorder, but most frequently resembles an episode of bipolar disorder, with an early manic phase and later depressive swing. Prevention is considered to be the first line of treatment for postpartum depression. A majority of women have significant psychological issues associated with their transition to motherhood. Interpersonal psychotherapy (IPT) has also shown promise in the treatment of depression, both during pregnancy and in the postnatal period. A number of studies have looked at hormonal treatment and prevention of perinatal psychiatric disorders.
This study looks at the outcome of infants exposed to dothiepin in breast milk in an attempt to guide clinicians on the risk-benefit ratio of breast-feeding when on antidepressants.
Thirty women, who had had HDRS scores > 15 within the first five years postpartum from the same women's hospital, were assessed with their children 3–5 years postpartum; half had breast-fed while on dothiepin (study group). Thirty-six non-depressed women were also assessed. Rating scales assessed depression, anxiety, self-esteem, personality, social support, marital relationship, child behaviour and temperament. The children were assessed by the McCarthy Scale.
Comparisons of the two depressed groups showed no significant differences on any measures except marital conflict and child behaviour, which were the most disturbed in the study group (P < 0.001). Overall cognitive scores for the children did not differ between the groups. Higher levels of dothiepin and northiaden were associated with higher cognitive scores on subscales (P = 0.02).
We are cautiously optimistic about the lack of any negative associations between cognitive development and exposure to dothiepin via breast milk.
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