Treatment Decisions for Perinatal Bipolar Disorder

描述（由申请人提供）：双相情感障碍（BD）是一种高度复发的致残疾病，新出现的数据表明，对于患有双相情感障碍的女性来说，围产期尤其不稳定。前瞻性研究显示，高达70%的孕妇患有这种疾病，产后躁狂症的风险高达50%。孕妇和新妈妈的双相障碍的负面后遗症包括严重的社会心理障碍，大量的自杀风险，产后精神病的发生率比一般公众高100倍。此外，患有双相障碍的孕妇的婴儿更容易出现不良后果，如早产、小于胎龄和小头畸形。尽管存在这些风险，以及专家建议在整个围产期以最低有效剂量预防性情绪稳定，孕妇和产后双相障碍妇女的药物停药率高达70%。因此，迫切需要找到增加围产期双相障碍妇女适当治疗参与的方法。了解限制有效治疗的因素是很重要的。该研究将是第一个研究这些问题的研究，结合定量和定性方法来阐明围产期妇女选择继续或停止双相障碍药物治疗的过程。80名患有双相障碍的孕妇，其中一半最近停止了双相障碍药物治疗，将在怀孕期间和产后三个月完成评估，评估药物利用、双相障碍症状、治疗态度和疾病相关认知。总体样本的一个子集（n=24）将参加定性访谈，以获得有关妇女围产期双相障碍护理治疗决策的更深入信息。还将评估妇女药物提供者（n=多达80）。本研究的三个主要目的是：(1)检验在临床特征和治疗态度之外，女性疾病相关认知在继续用药决策中的独特差异的假设；(2)利用定性方法进一步探讨决策过程，建立反映影响继续用药决策因素相对贡献的模型；(3)综合研究的定量和定性两个阶段的结果，就妇女和提供者的最佳决策支持战略提出具体建议。在探索性层面(4)，本研究旨在探讨产前药物治疗继续和后续治疗决定与产后三个月产妇症状、功能和分娩结局之间的关系。最终，这个项目将导致一个

DESCRIPTION (provided by applicant): Bipolar disorder (BD) is a highly recurrent, disabling illness, and emerging data indicate that, for women with BD, the perinatal period is particularly destabilizing. Prospective studies have revealed mood episode morbidity in up to 70% of pregnant women with the disorder, and risk of postpartum mania in as high as 50% of cases. Negative sequelae of BD for expectant and new mothers include severe psychosocial impairment, substantial suicide risk, and rates of postpartum psychosis 100 times greater than in the general public. Moreover, infants of pregnant women with BD are significantly more likely to experience adverse outcomes such as preterm birth, small for gestational age, and microcephaly. Despite these risks, as well as expert recommendations for prophylactic mood stabilization at a minimum effective dose throughout the perinatal period, rates of medication discontinuation are as high as 70% among pregnant and postpartum women with BD. Thus, a critical need exists to find ways to increase appropriate treatment engagement among perinatal women with BD. As a first step toward developing interventions that attempt to increase treatment engagement, it is important to understand factors that limit effective treatment utilization. The proposed study would be the first to examine these questions, integrating quantitative and qualitative methods to elucidate the processes by which perinatal women choose to continue or discontinue BD pharmacotherapy. Eighty pregnant women with BD, half of whom recently discontinued their BD pharmacotherapy, will complete assessments during pregnancy and again at three months postpartum that assess medication utilization, BD symptoms, treatment attitudes, and illness-related cognitions. A subset of the overall sample (n=24) will take part in a qualitative interview to obtain more in-depth information regarding women's treatment decisions regarding perinatal BD care. Women's medication providers (n=up to 80) will also be assessed. The three primary aims of this study are: (1) To test the hypothesis that women's illness-related cognitions account for unique variance in medication continuation decisions, over and above clinical characteristics and treatment attitudes; (2) To utilize qualitative measures to further explore the decision-making process and develop a model reflecting the relative contribution of factors influencing medication continuation decisions; (3) To integrate findings from both quantitative and qualitative phases of the research to develop specific recommendations regarding optimal decision support strategies for women and providers. On an exploratory level (4), this study aims to examine associations between prenatal pharmacotherapy continuation and subsequent treatment decisions and maternal symptom, functioning, and birth outcomes at three months postpartum. Ultimately, this project will lead to a more comprehensive understanding of why perinatal women with BD often discontinue pharmacotherapy, as well as specific recommendations for future interventions, such as prenatal decision support strategies, to address this serious problem.