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Psychiatry Residency Training Program
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Syllabi and Readings
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The following are articles / books pertaining to various topics related to perinatal psychiatry. Where more than one article is listed for a particular topic, they are listed in decreasing order of relevance / yield.


Epidemiology of depression during pregnancy:

Melville, J. L., Gavin, A., Guo, Y., Fan, M. Y., & Katon, W. J. (2010). Depressive disorders during pregnancy: prevalence and risk factors in a large urban sample. Obstetrics and gynecology, 116(5), 1064. Large prospective study that estimates the prevalence of depression, panic disorder and suicidal ideation during pregnancy. Identifies clinically relevant risk factors for depression during pregnancy.


Depression and antidepressants:

Chaudron, L. H. (2013). Complex Challenges in Treating Depression During Pregnancy. American Journal of Psychiatry, 170(1), 12-20.
A broad overview, with case discussion included, comparing risk - benefit of treated and untreated depression. Useful source to inform discussions with patients, especially when comparing outcomes related to antidepressants and to depression.

Byatt N, Deligiannidis KM, Freeman MP. (2012). Antidepressant Use In Pregnancy: A Critical Review Focused On Risks And Controversies. Acta Psychiatrica Scandinavia, 1-21.
This is a recent review article focusing on select neonatal outcomes after antidepressant use during pregnancy. The introduction actually also offers a comprehensive review of the effects of depression on pregnancy and fetal outcomes. It is useful as it concludes with clinical recommendations on this controversial topic.

Yonkers KA, Wisner KL, Stewart DE et al (2009). The Management Of Depression During Pregnancy: A Report From The American Psychiatric Association And The American College Of Obstetricians And Gynecologists. Gen Hosp Psychiatry, 31: 403-413.
Expert consensus guidelines on use of antidepressants during pregnancy and impact of antidepressants on birth outcome. Has some information on behavioral treatments of mood disorders and ECT during pregnancy. Useful flowcharts for clinicians evaluating women with depression: a) Women who present for preconceptual counseling b) depressed pregnant women not on antidepressants c) depressed pregnant women on antidepressants.

Grote, N. K., Bridge, J. A., Gavin, A. R., Melville, J. L., Iyengar, S., & Katon, W. J. (2010). A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of general psychiatry, 67(10), 1012.
Methodologically sound meta analysis of longitudinal studies examining the effect of depression during pregnancy on neonatal outcomes.

Ross, L. E., Grigoriadis, S., Mamisashvili, L., VonderPorten, E. H., Roerecke, M., Rehm, J., ... & Cheung, A. (2013). Selected Pregnancy and Delivery Outcomes After Exposure to Antidepressant Medication A Systematic Review and Meta-analysis Outcomes After Antidepressant Use in Pregnancy. JAMA Psychiatry, 1-8.
A systematic review and meta-analysis addressing the issue of association of antidepressant use with adverse birth outcomes such as spontaneous abortion, low birth weight and low apgar scores. Takes in to account confounding by indication as it includes samples of depressed mothers not exposed to antidepressants.

Yonkers KA, Norwirtz ER, Smith MV et al (2012). Depression and Serotonin Reuptake Inhibitor Treatment as Risk Factors for Preterm Birth. Epidemiology, 23: 677-685.
A prospective cohort study addressing the need to separate the effects of illness from the effects of treatment on neonatal outcomes in evaluating the risk of treating depression during pregnancy.

Hviid, A., Melbye, M., & Pasternak, B. (2013). Use of selective serotonin reuptake inhibitors during pregnancy and risk of autism. New England Journal of Medicine, 369(25), 2406-2415.
A large cohort study that brings us one step closer to resolving the fetal SSRI exposure – autism controversy.

Deligiannidis, K. M., & Freeman, M. P. (2014). Complementary and alternative medicine therapies for perinatal depression. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 85-95.
A recent review of the use of CAM - omega-3 fatty acids, folate, S-adenosyl-methionine, St John’s Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression


Nonpharmacologic interventions for depression:

Dimidjian S, Goodman S (2009). Nonpharmacologic intervention and prevention strategies for depression during pregnancy and the postpartum. Clinical Obstetrics and Gynecology, 52: 498-515.
Review of only randomized controlled trials - hence methodologically sound. Includes review of trials of traditional (Interpersonal therapy, Cognitive behavioral therapy and supportive therapy) and novel (light therapy, nutritional therapy, acupuncture, massage, omega 3 fatty acids) non pharmacologic interventions. In addition, discusses prevention strategies (interventions during pregnancy to prevent the development of postpartum depression).

Stuart, S (2012) Interpersonal Psychotherapy for Postpartum Depression. Clinical Psychol and Psychother, 19:134-140.
An overview of interpersonal psychotherapy for postpartum depression describing the structure of interpersonal psychotherapy and its adaptations for postpartum depressed women. Modifications for the assessment phase and variations in the tactics of interpersonal psychotherapy for postpartum depression are described.

Brandon AR, Freeman MP (2011). When She Says "No" to Medications: Psychotherapy for Antepartum Depression. Curr Psychiatry Rep, 13:459-466.
Summary of Interpersonal Psychotherapy (IPT), Cognitive Behavioral Therapy (CBT) and Partner Assisted Therapy (PAT) for antepartum depression. Includes a list of strong patient indicators for making IPT a first line treatment, and information on specific CBT models for use during pregnancy.

Sockol LE, Epperson CN, Barber JP (2011). A Meta-Analysis Of Treatments For Perinatal Depression. Clinical psychology review, 31: 839-849.
Meta-analysis of 27 studies of pharmacologic and psychological interventions for treatment of perinatal depression. Includes depression during pregnancy and in the first 12 months postpartum. Reports effect sizes of various treatments.


Anxiety disorders during pregnancy and postpartum:

Ross, L. E., McLean, L. M., & Psych, C. (2006). Anxiety disorders during pregnancy and the postpartum period: a systematic review. depression, 6, 9.
A systematic review of the prevalence of anxiety disorders in the perinatal period, with a summary of treatments included.


Bipolar disorder and its treatment during pregnancy and postpartum:

Yonkers, K. W. (2004). Management Of Bipolar Disorder During Pregnancy And The Postpartum Period. Am J Psychiatry, 4:608-620.
Reviews the use and risks of lithium, valproate, carbamazepine, lamotrigine, antipsychotics (first and second generation), benzodiazepines and ECT in pregnancy. Has informative sections on treatment planning for the patient with bipolar disorder during pregnancy and lactation.

Gentile, S (2006). Prophylactic Treatment Of Bipolar Disorder In Pregnancy And Breastfeeding: Focus On Emerging Mood Stabilizers. Bipolar disorders, 8: 207-220.
Updated review of treatment of bipolar disorder during pregnancy and lactation, with more current information on lamotrigine and additional information on oxcarbazepine and atypical antipsychotics, addressing use of each drug during pregnancy and lactation separately.

Diav-Citrin OShechtman STahover EFinkel-Pekarsky VArnon JKennedy DErebara AEinarson AOrnoy A. Pregnancy Outcome Following In Utero Exposure to Lithium: A Prospective, Comparative, Observational Study. The American journal of psychiatry ,2014.
One of the larger prospective studies informing the decision to use / continue lithium during pregnancy.


Psychosis and treatment:

Galbally, M., Snellen, M., & Power, J. (2014). Antipsychotic drugs in pregnancy: a review of their maternal and fetal effects. Therapeutic Advances in Drug Safety, 5(2), 100-109.
A recent review of that includes available information on most first generation and second generation antipsychotics for use during pregnancy among women with schizophrenia and other severe and persistent psychotic disorders.

Doucet, S., Jones, I., Letourneau, N., Dennis, C. L., & Blackmore, E. R. (2011). Interventions for the prevention and treatment of postpartum psychosis: a systematic review. Archives of women's mental health, 14(2), 89-98.
Information specific to postpartum psychosis.

Miller, L. (2010). Psychotherapy for Pregnant Women with Schizophrenia. Current Women's Health Reviews, 6:39-43.
Description of flexible psychotherapy (including techniques of psychoeducation, motivational interviewing, cognitive behavioral therapy, social cognition training and social skills training) as an adjunct to pharmacotherapy and psychosocial rehabilitation for pregnant women with Schizophrenia. Guidelines for evaluation, forming a therapeutic alliance and handling issues specific to pregnancy such as physical changes of pregnancy, prenatal care, pregnancy related anxieties and prior custody loss. Has useful illustrative case examples.


Psychotropic drugs and lactation:

Fortinguerra F, Clavenna A, Bonati M (2009). Psychotropic Drug Use During Breastfeeding: A Review of the Evidence. Pediatrics, 124, e547-e556.
Literature review of use of various classes of psychotropic medications during breastfeeding. Classifies psychotropics as compatible, to be used with caution or contraindicated with breastfeeding.

di Scalea, T. L., & Wisner, K. L. (2009). Antidepressant medication use during breastfeeding. Clinical obstetrics and gynecology, 52(3), 483.
More in-depth information on use of specific antidepressants during breastfeeding, not available in the Fontiguerra et al paper.


Substance use:

Bhuvaneswar C, Chang G. (2009). Substance Use in Pregnancy. In B. S. Brady KT, Women and Addiction: a Comprehensive Handbook (pp. 432 - 452).
New York, NY: Guilford Press. A chapter that reviews epidemiology and consequences of substance use in the perinatal period, covering alcohol, nicotine, marijuana, opioids and cocaine. Includes clinical approaches to treating substance abuse during pregnancy.

Davis KJ, Y. K. (2012, January). Making Lemonade out of Lemons: A Case Report and Literature Review of External Pressure as an Intervention With Pregnant and Parenting Substance-Using Women. J Clin Psychiatry, 73(1), 51-56.
An interesting discussion of explicit pressure (warnings, requirements, mandates, incarceration, loss of child custody), and implicit pressure (threat of child welfare intervention) and their effectiveness in increasing rates of treatment retention and completion for pregnant / postpartum substance abusing women.


Maternal psychological distress and infant temperament:

Waxler E, Thelen K, Muzik M (2011). Maternal Perinatal Depression-Impact on Infant and Child Development. European Psychiatric Review, 7(1), 41-47.
A representative overview of this extensive topic with information on the impact of antenatal depression on the fetus and the neonate and the effect of postpartum depression on parenting, attachment and infant temperament.


Pregnancy Loss:

Kersting, A. (2012). Complicated grief after perinatal loss. Dialogues Clin Neurosci, 14(2), 187-194.
A brief review describing the factors unique to grief after prenatal loss, and risk factors for complicated grief reaction after pregnancy loss and termination. While recognizing the methodological problems that exist in the literature on this topic, does make recommendations on grief interventions after prenatal loss.

Frost M, C. J. (1996). The psychological sequelae of miscarriage: a critical review of the literature. Australian and New Zealand Journal of Psychiatry, 30, 54-62.
A review of the less discussed topic of miscarriage and its consequences. Begins with a brief description of the psychology of pregnancy and goes on to describe separately the psychological and psychiatric effects of miscarriage.



Brandon, A. (2011). Ethical Barriers to Perinatal Mental Health Research and Evidence-Based Treatment: An Empirical Study. AJOB Primary Research, 2, 2-12.
Background on the current environment for research on evidence based treatment of psychiatric illness during pregnancy and lactation. Offers perspective on the reasons for the frustrating lack of evidence based treatment guidelines for psychiatric disorders in the perinatal period.

Light, A., Obedin-Maliver, J., Sevelius, J., & Kerns, J. (n.d.). Transgender Men Who Experienced Pregnancy After Female-to-Male Gender Transitioning. Obstetrics & Gynecology, 1120-1127.

O'Grady JP, R. M. (1989). Pseudocyesis: a modern perspective on an old disorder. Obstetrical and gynecological survey, 44(7), 500-511.
An outline of the neurophysiology and psychology of pseudo pregnancy. Summarizes some interesting history of the disorder, then goes on to describe the clinical features, diagnosis and treatment.

Wiegartz P, G. K. (2009). The Pregnancy and Postpartum Anxiety Workbook. Oakland: New Harbinger Publications.
An excellent patient resource, but also a good overview for practitioners who would like to work on CBT with their patients, as it details modifications to techniques such as deep breathing, specific to pregnancy and the postpartum period.

Eds Sam Tyano, M. K. (2010). Parenthood and mental health. West Sussex: Wiley Blackwell. Parenthood and mental health a bridge between infant and adult psychiatry.
Book with an interesting life span approach, hence less emphasis on treatments. Extends beyond the perinatal period into several topics on parenting. Also has an informative chapter on assessing parental competency - the legal aspects.


OTHER RESOURCES: - A comprehensive compilation of the evidence base for the risks to fetus of specific drugs during pregnancy and lactation. Starts with a short paragraph summarizing the risks, then goes on to list experimental animal studies, clinical trial reports, longer term effects of in utero exposure and safety in lactation. This can be accessed through micromedix for each individual drug.



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