Neuroendocrine effects on mood.
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Affect↗
Biomedical subjects
Margaret G Spinelli
Publications and source records attributed to Margaret G Spinelli.
Depression and hormone therapy.
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Depressive Disorder↗
Maternal infanticide associated with mental illness: prevention and the promise of saved lives.
OBJECTIVE: Although maternal infanticide is a rare event, a high proportion of cases occurs in the context of postpartum mental illness. The author reviews historical, legislative, and contemporary psychiatric perspectives on infanticide and discusses ways in which the psychiatric community can improve prevention of infanticide and promote appropriate treatment of mentally ill women who commit infanticide. METHOD: The case of Texas v. Andrea Yates, involving a mother with mental illness who drowned her five children, is used to illustrate society's complicated reactions to infanticide in the context of postpartum mental illness. RESULTS: In the United States, the complexity of the response to infanticide is demonstrated by the judicial system's reaction to such cases. Whereas England's Infanticide Law provides probation and mandates psychiatric treatment for mothers with mental illness who commit infanticide, "killer mothers" may face the death penalty in the United States. Contemporary neuroscientific findings support the position that a woman with postpartum psychosis who commits infanticide needs treatment rather than punishment and that appropriate treatment will deter her from killing again. Psychiatrists have a vital role in recognizing the signs and symptoms of peripartum psychiatric disorders, particularly postpartum psychosis, and in early identification of and intervention with at-risk mothers. CONCLUSIONS: The absence of formal DSM-IV diagnostic criteria for postpartum psychiatric disorders promotes disparate treatment under the law. The psychiatric community should develop guidelines for the treatment of postpartum disorders, foster sharing of knowledge between psychiatry and the law, and do more to enlighten society about the effects of mental illness on thought and behavior so that decisions about the treatment and punishment of mentally ill persons will not be left exclusively in the hands of the judicial system.
Age Factors↗
Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women.
OBJECTIVE: Antenatal depression is a significant risk factor for postpartum depression, with a 10%-12% prevalence in all pregnancies. Rates of depression are higher for pregnant women with chronic stressors, financial and housing problems, and inadequate social support. Despite the prevalence and associated family and infant morbidity, there are no controlled clinical treatment trials regarding this topic, to the authors' knowledge. APA has identified treatment of depression during pregnancy as a priority for clinical guidelines. METHOD: A 16-week bilingual controlled clinical trial compared a group receiving interpersonal psychotherapy for antepartum depression to a parenting education control program. Fifty outpatient antepartum women who met DSM-IV criteria for major depressive disorder were randomly assigned to interpersonal psychotherapy or a didactic parenting education program. Thirty-eight women remained in the study and were included in the data analysis. Depressed mood was measured with the Edinburgh Postnatal Depression Scale, the Beck Depression Inventory, and the Hamilton Depression Rating Scale. The Clinical Global Impression (CGI) and the Hamilton depression scale measured recovery. RESULTS: The interpersonal psychotherapy treatment group showed significant improvement compared to the parenting education control program on all three measures of mood at termination. Recovery criteria were met in 60% of the women treated with interpersonal psychotherapy, according to a CGI score of < or = 2. In addition, there was a significant correlation between maternal mood and mother-infant interaction. CONCLUSIONS: Interpersonal psychotherapy is an effective method of antidepressant treatment during pregnancy and should be a first-line treatment in the hierarchy of treatment for antepartum depression.
Adult↗