Postpartum mental illness arises from a culmination of factors at the time of the motherhood transition, and bears impact on maternal wellbeing, as well as the infant. Whilst traditional psychiatric approach focuses primarily on symptomatology, diagnostic assessment, and treatment aimed largely at symptoms relief, the infant’s wellbeing and development is of key concern. And thus follows the need to address the space between mother and infant – the dyadic experience. Understanding the world of the infant, the nature of mother-infant bonding, and possible disorders allows us to care better for mothers with perinatal mental illness. Methods: Literature review of the evidence and possible approaches to addressing the mother-infant relational disorder will be discussed based on case reports. In particular, the Watch Wait and Wonder technique, an infant/child-led psychotherapy will be demonstrated with case studies. Results: The case studies demonstrate important themes of mother-infant bonding difficulties common to mothers with postpartum mental illness. Therapy specifically addressing these issues can enable mothers to process feelings of ambivalence and conflicts that hamper the development of the dyadic relationship. Conclusion: The maternal-infant dyadic relationship is a key focus in postpartum mental illness, and mental healthcare for postpartum depression and other illness should consider interventions as needed.

Humans ; Immunotherapy ; Neoplasms

Objective: This case report highlights antenatal depression as a common condition with potentially grave outcomes if left untreated. However, treatment options can be limited by the need to protect the fetus from medication-induced side effects. Methods: We report a young female obstetric patient who was carrying twins conceived through assisted reproduction, and her pregnancy was complicated by placenta previa major and repeated antepartum hemorrhages, which necessitated multiple admissions and strict bed rest. She became intensely depressed and anxious, developed suicidal ideation and refused examinations that were necessary to her physical health. She was referred to a psychiatrist and was given low-dose medication, supportive counseling, and case management. Results: She responded well to treatment, showing marked improvement in her mood and cooperation with obstetric care. Her twins were delivered at 35 weeks’ gestation in good health. Her progress was maintained into the postpartum period. Conclusions: This case of antenatal depression was successfully treated using a combination of medication, case management and psychological support. It adds to evidence that this illness benefits from early identification and is highly treatable.
Pregnancy, High-Risk ; Antidepressive Agents

Maternal mental illness is a significant public health concern, with established adverse outcomes on both mother and infant, such as impaired mother-infant bonding and infant cognitive and emotional development. In severe cases, maternal mortality and infanticide can tragically occur. This is a report on the suicide of a mother who jumped to her death at three months postpartum. She suffered from puerperal psychosis with bipolar features, with onset at six weeks postpartum. The case highlights the burden of maternal mental illness in our community as well as the need for resources and services to care well for mothers. With a better understanding of its presentation and risk factors, early identification and intervention can reduce morbidity and mortality.
Adult ; Autopsy ; Fatal Outcome ; Female ; Humans ; Maternal Death ; Mental Disorders ; pathology ; psychology ; Mothers ; psychology ; Postpartum Period ; psychology ; Psychiatry ; methods ; Suicide ; psychology

Type I insulin-like growth factor receptor (IGF-1R) has long been recognized for its role in tumorigenesis and growth, but only recently have the tools for targeting the IGF pathway become available. More than 10 IGF/IGF-1R inhibitors have entered clinical trials, and these belong to three main classes: (1) monoclonal antibodies against IGF-1R, (2) monoclonal antibodies against IGF-1R ligands (IGF-1 and IGF-2), and (3) IGF-1R tyrosine kinase inhibitors. These IGF-1R-targeting agents share common effects on IGF-1R signaling but differ in mechanisms of action, spectrum of target inhibition, and pharmacological features. Clinical activity of IGF-1R inhibitors has been demonstrated with sustained responses in a small number of patients with select tumor types, such as Ewing sarcoma and thymoma. However, many large clinical trials involving patients with adult tumors, including non-small cell lung cancer, breast cancer, and pancreatic cancer, failed to show clinical benefit in the overall patient population. Possible reasons for failure include the complexity of the IGF-1R/insulin receptor system and parallel growth and survival pathways, as well as a lack of patient selection markers. While IGF-1R remains a valid target for selected tumor types, identification of predictive markers and rational combinations will be critical to success in future development.
Antibodies, Monoclonal ; immunology ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Drug Combinations ; Humans ; Insulin-Like Growth Factor I ; antagonists & inhibitors ; Insulin-Like Growth Factor II ; antagonists & inhibitors ; Molecular Targeted Therapy ; Neoplasms ; therapy ; Protein Kinase Inhibitors ; therapeutic use ; Receptor, IGF Type 1 ; antagonists & inhibitors ; immunology ; Sarcoma, Ewing ; therapy ; Signal Transduction

Postnatal depression is a major public health problem with clearly established adverse effects in child outcomes. This study examines the 4-year outcomes of a screening and early intervention programme, in relation to improvement in symptoms, functioning and health quality of life. Women were prospectively recruited up to 6 months postdelivery, using the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool. High-scorers (EPDS >13), were offered psychiatric consultation, and those with borderline scores (EPDS 10-12) were provided counselling, and offered follow-up phone counselling by the assigned case manager. Outcome measures were obtained at baseline, and at 6 months or discharge if earlier, for levels of symptoms, functioning, and health quality of life. From 2008 to 2012, 5245 women were screened, with 307 (5.9%) women with EPDS >13 receiving intervention. Of these, 70.0% had depression, 4.6% anxiety and 3.4% psychosis. In the depression subgroup, the net change was improvement of 93.4% EPDS symptom scores, 92.2% Global Assessment of Functioning (GAF) scores, and 88.3% visual analogue scale (EQ VAS) health quality of life scores. Outcome scores across diagnostic categories demonstrated median changes of 10 points on EPDS, 20 points on GAF, and 25 points on EQ VAS, reflecting 73.9%, 36.4% and 41.7% change from baseline scores. Women with psychosis showed the biggest (80.0%) relative change in GAF functioning scores from baseline to discharge but had the lowest median change in EPDS symptom scores. A screening and intervention programme rightly-sited within an obstetric setting can improve clinical outcomes because of early detection and intervention.
Adult ; Anxiety Disorders ; diagnosis ; therapy ; Case Management ; Counselors ; Delivery of Health Care ; Depression, Postpartum ; diagnosis ; therapy ; Early Medical Intervention ; Female ; Health Status ; Humans ; Mass Screening ; Obstetrics ; Outcome Assessment (Health Care) ; Prospective Studies ; Psychiatry ; Psychotic Disorders ; diagnosis ; therapy ; Puerperal Disorders ; diagnosis ; therapy ; Quality of Life ; Referral and Consultation ; Singapore

Objective: This is the first Singaporean study to examine prescribing practices among clinicians treating women with antenatal psychiatric conditions. This study aims to describe the characteristics of pregnant women who were prescribed psychotropic for new-onset antenatal psychiatric conditions. It also examines psychotropic prescription patterns and explores associations between antidepressant/benzodiazepine prescription and clinical characteristics. Methods: Pregnant women who were seen by psychiatrists from the Mental Wellness Service at the Kandang Kerbau (KK) Women’s and Children’s Hospital over a four-year period for new-onset antenatal psychiatric conditions, and who were prescribed psychotropic medication, were eligible for inclusion in the study. Demographic and obstetric information, psychiatric diagnoses and prescription of psychotropic were recorded in a database. Descriptive analyses were performed and associations between antidepressant/benzodiazepine prescription and clinical characteristics were studied. Results: A total of 110 patients were included in the study. The majority of the subjects were diagnosed with antenatal depression. Most of the subjects were prescribed an antidepressant in combination with Promethazine. Low-dose Dothiepin was the antidepressant of choice. Subjects with antenatal depression were more likely to be prescribed antidepressants (odds ratio (OR) 5.30, 95% confidence interval (CI) 2.29-12.27; p<0.01) while subjects with an adjustment disorder were less likely to be prescribed antidepressants (OR 0.11, 95% CI 0.02-0.52; p=0.001). No significant associations were found between antidepressant prescription and diagnoses of antenatal anxiety or mixed depression-anxiety. Nulliparous subjects were less likely to be prescribed an antidepressant or benzodiazepine, compared to subjects with a history of previous births (OR 0.35, 95% CI 0.16-0.79; p=0.01 and OR 0.91, 95% CI 0.84-0.98; p=0.03 respectively). Conclusions: Future studies of psychotropic prescription for pregnant psychiatric patients should examine severity of symptoms at presentation, timing of first presentation in relation to gestational age, patients’ willingness to accept medication and response to psychotherapy. More studies are needed to explore the association between parity and antidepressant prescription.

OBJECTIVE: This study aims to investigate association between early recognizable minor physical abnormality (MPA) during childhood is associated with mental health problems in young adults. METHODS: In 1984, 169 preschool children in central Taiwan underwent a detailed physical examination for subtle abnormalities (MPA). Fourteen years later, the Brief Symptom Rating Scale (BSRS) and Chinese Health Questionnaire (CHQ) were used to measure specific psychiatric symptoms. RESULTS: There is an association between MPA during childhood and adult characterized with interpersonal sensitivity, anxiety, depression and paranoid mental health symptoms. CONCLUSION: The signs of childhood MPA can be easily identified and should be regarded as risk factors when predicting mental disorder. Mental health professionals should consider MPAs as important signs for possible development of emotional problems.
Adult ; Anxiety ; Asian Continental Ancestry Group ; Child, Preschool ; Depression ; Humans ; Mental Disorders ; Mental Health ; Physical Examination ; Pilot Projects* ; Surveys and Questionnaires ; Risk Factors ; Taiwan ; Young Adult

OBJECTIVE: This study aims to investigate association between early recognizable minor physical abnormality (MPA) during childhood is associated with mental health problems in young adults. METHODS: In 1984, 169 preschool children in central Taiwan underwent a detailed physical examination for subtle abnormalities (MPA). Fourteen years later, the Brief Symptom Rating Scale (BSRS) and Chinese Health Questionnaire (CHQ) were used to measure specific psychiatric symptoms. RESULTS: There is an association between MPA during childhood and adult characterized with interpersonal sensitivity, anxiety, depression and paranoid mental health symptoms. CONCLUSION: The signs of childhood MPA can be easily identified and should be regarded as risk factors when predicting mental disorder. Mental health professionals should consider MPAs as important signs for possible development of emotional problems.
Adult ; Anxiety ; Asian Continental Ancestry Group ; Child, Preschool ; Depression ; Humans ; Mental Disorders ; Mental Health ; Physical Examination ; Pilot Projects* ; Surveys and Questionnaires ; Risk Factors ; Taiwan ; Young Adult