title: Treatment of severe perinatal mood disorders on a specialized perinatal psychiatry inpatient unit.
abstract: Perinatal patients with bipolar and psychotic mood disorder exacerbations are challenging to treat and often receive suboptimal care. We sought to examine the treatment patterns and outcomes on one of the only US-based Perinatal Psychiatry Inpatient Units (PPIU). Perinatal patients admitted to the PPIU completed self-report measures at admission and before discharge. Retrospective chart reviews extracted history, diagnoses (current and past), and medication treatment. Patients who had discharge diagnoses of bipolar disorder, major depression with psychotic features, or postpartum psychosis were included. Forty-seven met the diagnostic inclusion criteria. Over an average length of stay (ALOS) of 9.96 days, there was significant improvement in depressive and anxiety symptoms and daily functioning (Work and Social Adjustment Scale). Psychiatric comorbidity was common. Polypharmacy was utilized in 87 %. The most common medications prescribed at discharge were antipsychotics, alone or in combination with mood stabilizers or antidepressants. ECT was performed in 10 % of cases. The complexity of patients with severe mood disorders or psychosis admitted to the PPIU supports individualized treatment plans that address both primary diagnosis and psychiatric comorbidities. Our results provide important information that can be disseminated to others to improve clinical outcomes for severe perinatal mood disorders.
authors.affiliation: Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA. mary_kimmel@med.unc.edu.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Kimmel
authors.affiliation: Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA.|University of Illinois Urbana-Champaign, Champaign, USA.
authors.forename: S
authors.initials: S
authors.lastname: Lara-Cinisomo
authors.affiliation: Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA.|Cardiff University, Cardiff, UK.
authors.forename: K
authors.initials: K
authors.lastname: Melvin
authors.affiliation: Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA.
authors.forename: A
authors.initials: A
authors.lastname: Di Florio
authors.affiliation: Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA.
authors.forename: A
authors.initials: A
authors.lastname: Brandon
authors.affiliation: Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA.
authors.forename: S
authors.initials: S
authors.lastname: Meltzer-Brody
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008485:Medical Audit; D011247:Pregnancy; D011618:Psychotic Disorders / Q000188:drug therapy; D012189:Retrospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Bipolar disorder; Major depression with psychotic features; Perinatal psychiatry inpatient unit; Postpartum psychosis; Treatment