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性疾病，新的数据表明，对于BD女性，围产期尤其不稳定。前瞻性研究显示，高达70%的孕妇患有情绪障碍，产后躁狂症的风险高达50%。BD对孕妇和新妈妈的负面后遗症包括严重的社会心理障碍，大量的自杀风险，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、小于胎龄儿和小头畸形。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进行预防性情绪稳定，但BD孕妇和产后妇女的停药率高达70%。因此，迫切需要找到方法，以增加适当的治疗参与围产期妇女与BD。作为开发试图增加治疗参与的干预措施的第一步，重要的是要了解限制有效治疗利用的因素。拟议的研究将是第一个检查这些问题，整合定量和定性的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，将在怀孕期间和产后3个月再次完成评估，评估药物利用，BD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，以获得更深入的信息，妇女的治疗决定围产期BD护理。还将评估女性的药物提供者（n=最多80）。本研究的三个主要目的是：（1）检验妇女的疾病相关认知在继续用药决策中的独特差异，以及临床特征和治疗态度;（2）利用定性测量进一步探索决策过程，并建立一个模型，反映影响继续用药决策的因素的相对贡献;（3）综合定量和定性研究阶段的结果，为妇女和提供者制定关于最佳决策支持战略的具体建议。在探索性水平上（4），本研究旨在检查产前药物治疗持续和后续治疗决策与产后3个月母体症状、功能和分娩结局之间的关联。最终，该项目将导致 更全面地了解为什么围产期妇女BD经常停止药物治疗，以及未来干预措施的具体建议，如产前决策支持策略，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.