Treatment Decisions for Perinatal Bipolar Disorder

描述(由申请人提供)：双相情感障碍(BD)是一种高度反复发作的致残疾病，新出现的数据表明，对于患有BD的妇女来说，围产期尤其不稳定。前瞻性研究显示，患有这种疾病的孕妇中，情绪发作的发病率高达70%，产后躁狂的风险高达50%。BD对孕妇和新妈妈的负面后遗症包括严重的心理社会损害、极大的自杀风险以及产后精神病的发生率比普通公众高100倍。此外，患有BD的孕妇的婴儿更有可能经历不良结局，如早产、小于胎龄和小头畸形。尽管有这些风险，以及专家建议在整个围产期将预防性情绪稳定在最低有效剂量，但患有BD的孕妇和产后妇女的停药率高达70%。因此，迫切需要找到方法来增加患有BD的围产期妇女的适当治疗参与度。作为开发试图增加治疗参与度的干预措施的第一步，重要的是了解限制有效治疗利用的因素。这项拟议的研究将第一次检查这些问题，结合定量和定性方法来阐明围产期妇女选择继续或停止BD药物治疗的过程。80名患有BD的孕妇，其中一半最近停止了BD药物治疗，她们将在怀孕期间和产后三个月完成评估，评估药物利用、BD症状、治疗态度和与疾病相关的认知。总体样本的一部分(n=24)将参加定性访谈，以获得关于妇女在围产期疾病护理方面的治疗决定的更深入的信息。女性药物提供者(n=80人)也将接受评估。这项研究的三个主要目的是：(1)检验这样一种假设，即除了临床特征和治疗态度之外，女性与疾病相关的认知是继续服药决定的独特差异的原因；(2)利用定性措施进一步探索决策过程，并开发一个反映影响继续服药决定的因素的相对贡献的模型；(3)整合定量和定性两个阶段的研究结果，为女性和提供者制定最优决策支持策略的具体建议。在探索性水平上(4)，本研究旨在研究产前继续药物治疗和随后的治疗决定与产后三个月的母体症状、功能和出生结局之间的关系。最终，这个项目将导致一个 更全面地了解患有BD的围产期妇女为什么经常停止药物治疗，以及对未来干预措施的具体建议，如产前决策支持战略，以解决这一严重问题。

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.