Verinder Sharma - Academia.edu (original) (raw)

Papers by Verinder Sharma

Molecular Psychiatry, 2015

Atypical antipsychotic adjunctive therapy to lithium or valproate is effective in treating acute ... more Atypical antipsychotic adjunctive therapy to lithium or valproate is effective in treating acute mania. Although continuation of atypical antipsychotic adjunctive therapy after mania remission reduces relapse of mood episodes, the optimal duration is unknown. As many atypical antipsychotics cause weight gain and metabolic syndrome, they should not be continued unless the benefits outweigh the risks. This 52-week double-blind placebo-controlled trial recruited patients with bipolar I disorder (n = 159) who recently remitted from a manic episode during treatment with risperidone or olanzapine adjunctive therapy to lithium or valproate. Patients were randomized to one of three conditions: discontinuation of risperidone or olanzapine and substitution with placebo at (i) entry ('0-weeks' group) or (ii) at 24 weeks after entry ('24-weeks' group) or (iii) continuation of risperidone or olanzapine for the full duration of the study ('52-weeks' group). The primary outcome measure was time to relapse of any mood episode. Compared with the 0-weeks group, the time to any mood episode was significantly longer in the 24-weeks group (hazard ratio (HR) 0.53; 95% confidence interval (CI): 0.33, 0.86) and nearly so in the 52-weeks group (HR: 0.63; 95% CI: 0.39, 1.02). The relapse rate was similar in the 52-weeks group compared with the 24-weeks group (HR: 1.18; 95% CI: 0.71, 1.99); however, subgroup analysis showed discordant results between the two antipsychotics (HR: 0.48, 95% CI: 0.17; 1.32 olanzapine patients; HR: 1.85, 95% CI: 1.00, 3.41 risperidone patients). Average weight gain was 3.2 kg in the 52-weeks group compared with a weight loss of 0.2 kg in the 0-weeks and 0.1 kg in the 24-weeks groups. These findings suggest that risperidone or olanzapine adjunctive therapy for 24 weeks is beneficial but continuation of risperidone beyond this period does not reduce the risk of relapse. Whether continuation of olanzapine beyond this period reduces relapse risk remains unclear but the potential benefit needs to be weighed against an increased risk of weight gain.

The Journal of Clinical Psychiatry, 1998

Sir: Tardive dyskinesia (TD) is one of the most troublesome side effects associated with the use ... more Sir: Tardive dyskinesia (TD) is one of the most troublesome side effects associated with the use of antipsychotics. It is estimated that 20% to 30% of patients on long-term administration of neuroleptics will develop these abnormal involuntary movements that involve most commonly the tongue, face, fingers, arms, shoulders, and legs. 1,2 Elderly patients seem to be particularly vulnerable to the development of these side effects 3,4-this is a particular concern because antipsychotics are often used for the treatment of a number of mental disorders in old age. 5,6 Attempts to treat TD symptoms with neuroleptics, cholinergic drugs, benzodiazepines, and calcium channel blockers have not produced encouraging results. 7 The potential benefit of vitamin E in preventing or reducing the severity of TD has been supported by some studies 8,9 and is probably due to its antioxidant properties (free radical mechanisms). Recent reports have also suggested that the novel atypical antipsychotics may be beneficial in managing at least some types of dyskinesias. 10-12 This report describes the case of an elderly chronic schizophrenic woman who developed moderately severe neuroleptic-induced dyskinetic movements that responded to the use of the recently introduced atypical antipsychotic olanzapine. Case report. Ms. A, a 76-year-old single lady with a diagnosis of schizophrenia since age 24, was referred for the treatment of chronic auditory hallucinations and delusions. She also displayed signs of mild increase in muscle tone and dyskinetic movements of the face, jaw, lips, tongue, arms, and feet that had started sometime during the previous 2 years. At the time of assessment, she was receiving propranolol (40 mg/day), haloperidol (5 mg/day), clomipramine (75 mg/day), and chlorpropamide (125 mg/day). After a 5-week period of drug adjustment, Ms. A was kept on haloperidol, 5 mg/day, biperiden, 3 mg/day, and bromazepam, 4.5 mg/day, for 7 months. Toward the end of this 7-month period, she experienced deterioration of her clinical state and of her dyskinetic movements. The dose of haloperidol was then increased to 7.5 mg/day for another 5 months, which was followed by mental state improvement but further deterioration of the extrapyramidal signs to a point that they often interfered with her eating. After 12 months of follow-up, the abnormal movements were rated according to the AIMS guidelines 13-scores ranged from minimal (face, tongue, and lower limbs) to moderate (lips, jaw, and upper limbs). There was mild muscle rigidity at evaluation, but no gait problems. Treatment alternatives were discussed with Ms. A and her main caregiver (brother). It was agreed that Ms. A would gradually discontinue the use of haloperidol and biperiden over 1 week and that olanzapine would be then introduced up to a dose of 10 mg/day over the next week. There was substantial im

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 2018

The Journal of Clinical Psychiatry, 2003

Sir: I read with interest the excellent article by Busch and colleagues 1 describing the clinical... more Sir: I read with interest the excellent article by Busch and colleagues 1 describing the clinical correlates of suicide among hospitalized patients. It is argued that the presence of severe anxiety and agitation symptoms may be an important but treatable acute predictor of suicide. While aggressive pharmacologic treatment of suicide-related target symptoms is advisable, it is important to determine the context and pattern of evolution of such symptoms in the course of psychiatric illness, particularly mood disorders. The results of this study 1 demonstrated evidence of significant psychic anxiety or agitation in nearly 80% of patients during the week prior to suicide, but only 8% (N = 6 of 76) of the cases were diagnosed with agitated depression at admission. It is not clear whether symptoms of psychic anxiety and agitation were present in variable degrees during the entire index hospitalization or a change in psychomotor activity occurred proximally to the time of suicide. Another issue that needs clarification is the source of these symptoms that can occur in relation to symptomatic or syndromal comorbidity with anxiety. The use of antidepressants in patients with a bipolar diathesis can lead to the development of agitation and insomnia against the backdrop of atypical symptoms such as psychomotor retardation and hypersomnia. Finally, mixed episodes that are associated with a high risk of suicide are often accompanied by symptoms including anxiety and agitation. Contrary to the results of studies showing that the diagnosis of bipolar disorder, particularly bipolar II disorder, is associated with an elevated risk of suicide, the number of individuals with bipolar disorder in this study was surprisingly low. 2,3 The rapidly fluctuating clinical course and the presence of symptoms including mood lability and psychosis in some patients raises the possibility of a higher than reported prevalence of bipolarity, particularly mixed episodes. As antidepressants can cause mood instability in some patients, it is important to study the relationship between changes in the clinical state, especially cognition, mood, psychomotor activity and sleep, and the use of these drugs. If case-controlled studies confirm such an association, caution may be needed regarding the use of antidepressants in at least some patients at acute risk for suicide. Dr. Sharma reports no financial or other support of this letter.

Brazilian Journal of Psychiatry, 2022

A recent meta-analysis estimated that 20.7 % of women have one or more anxiety disorders during p... more A recent meta-analysis estimated that 20.7 % of women have one or more anxiety disorders during pregnancy or in the postpartum period. 1 Another meta-analysis reported that an estimated 8.5% of postpartum women have one or more anxiety disorders. 2 In spite of its common occurrence, the detection and diagnosis of peripartum anxiety disorders can be challenging for several reasons. Assessing anxiety requires consideration of several core anxiety and related disorders. Anxiety disorders are usually accompanied by other psychiatric disorders, particularly major depression. Consequently, anxiety in clinical settings may be considered a symptom of major depressive disorder rather than a co-occurring disorder. Finally, a lack of comprehensive screening may lead to underdiagnosis and sub-optimal treatment of anxiety disorders. This editorial discusses the heterogeneity of peripartum anxiety followed by suggestions for its screening, diagnosis and treatment. As shown in Box 1, anxiety can occur in the context of core disorders such as panic disorder, agoraphobia, generalized anxiety disorder, social phobia, or specific phobia. Anxiety can also be a manifestation of related disorders, such as obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, or illness anxiety disorder. Anxiety can accompany major depressive disorder or bipolar disorder in the form of anxious distress. Comorbidity with other anxiety or related disorders is also common. For example, approximately 90% of women with childbirth-related post-traumatic disorder have postpartum depression, and 31% of women with postpartum depression have childbirth-related post-traumatic stress disorder. 3 Another study found that approximately 70% of women who screened positive for obsessive-compulsive disorder also screened positive for postpartum depression. 4 Peripartum anxiety generally occurs in the context of a pre-existing psychiatric disorder. However, first onset of obsessive-compulsive disorder is not uncommon. Pregnancy appears to be a specific trigger for the onset or exacerbation of obsessive-compulsive disorder or panic disorder. Despite its common occurrence during or

Expert Review of Neurotherapeutics, 2021

The Lancet Psychiatry, 2019

Australian & New Zealand Journal of Psychiatry, 2018

Objective: To derive new criteria sets for defining manic and hypomanic episodes (and thus for de... more Objective: To derive new criteria sets for defining manic and hypomanic episodes (and thus for defining the bipolar I and II disorders), an international Task Force was assembled and termed AREDOC reflecting its role of Assessment, Revision and Evaluation of DSM and other Operational Criteria. This paper reports on the first phase of its deliberations and interim criteria recommendations. Method: The first stage of the process consisted of reviewing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and recent International Classification of Diseases criteria, identifying their limitations and generating modified criteria sets for further in-depth consideration. Task Force members responded to recommendations for modifying criteria and from these the most problematic issues were identified. Results: Principal issues focussed on by Task Force members were how best to differentiate mania and hypomania, how to judge ‘impairment’ (both in and of itself and allowing th...

CNS spectrums, 2017

Mood disorders including major depressive disorder and bipolar disorder are common during and aft... more Mood disorders including major depressive disorder and bipolar disorder are common during and after pregnancy. Timely identification and appropriate management of mood episodes is essential to maximize maternal well-being and minimize adverse outcomes. Failure to do so results in maternal suffering and impaired child bonding, and has the potential for devastating outcomes including suicide and infanticide. Women are routinely screened for unipolar depression during or after pregnancy but not for bipolar disorder, in spite of the fact that childbirth is associated with a major risk for onset or exacerbation of bipolar disorder. Delays in detection as well as misdiagnosis of bipolar disorder as major depressive disorder may put women at risk of many adverse consequences, including symptom exacerbation, psychiatric hospitalization, and suicide. A thorough psychiatric assessment is necessary to establish diagnosis, to address safety issues, and to formulate a treatment plan. Treatment o...

The Canadian Journal of Psychiatry, 2002

Objective: This study assessed the quantitative electroenchephalographic (QEEG) absolute power an... more Objective: This study assessed the quantitative electroenchephalographic (QEEG) absolute power and coherence differences between a group of patients with bipolar I mood disorder (BMD I) and a group of patients with schizophrenia. We also examined the correlation between QEEG measures and family history of BMD. Method: Using the National Institutes of Mental Health (NIMH) Global Rating Scale, we rated 18 adult inpatients with a DSM-III-R diagnosis of BMD I for the severity of the current episode. We also collected data on the family history of the illness. This group was then matched for age, sex, and handedness with an equal number of inpatients with a DSM-III-R diagnosis of schizophrenia. QEEG absolute power and coherence was calculated for the alpha bandwidth (8.0 to 12.0 Hz), assessed at 18 pairs of electrodes in both hemispheres during resting, eyes-closed condition in all the patients. Results: The patients with schizophrenia showed significantly higher coherence ( P = 0.047) a...

The Canadian Journal of Psychiatry, 2001

Objective: To discuss the effect of electroconvulsive therapy (ECT) on suicide risk in patients w... more Objective: To discuss the effect of electroconvulsive therapy (ECT) on suicide risk in patients with mood disorders. Method: A review of the available data on the short-term and long-term effects of ECT on suicide mortality among patients with mood disorders. Conclusion: ECT has an acute but not a long-term beneficial effect on suicidality. Due to the significant limitations of studies in this area, however, the data need to be interpreted with caution.

Psychological Medicine, 2017

BackgroundAlthough quality of life (QoL) is receiving increasing attention in bipolar disorder (B... more BackgroundAlthough quality of life (QoL) is receiving increasing attention in bipolar disorder (BD) research and practice, little is known about its naturalistic trajectory. The dual aims of this study were to prospectively investigate: (a) the trajectory of QoL under guideline-driven treatment and (b) the dynamic relationship between mood symptoms and QoL.MethodsIn total, 362 patients with BD receiving guideline-driven treatment were prospectively followed at 3-month intervals for up to 5 years. Mental (Mental Component Score – MCS) and physical (Physical Component Score – PCS) QoL were measured using the self-report SF-36. Clinician-rated symptom data were recorded for mania and depression. Multilevel modelling was used to analyse MCS and PCS over time, QoL trajectories predicted by time-lagged symptoms, and symptom trajectories predicted by time-lagged QoL.ResultsMCS exhibited a positive trajectory, while PCS worsened over time. Investigation of temporal relationships between QoL...

Journal of affective disorders, Aug 19, 2016

Risk and protective factors for postpartum depression have been extensively studied, and in recen... more Risk and protective factors for postpartum depression have been extensively studied, and in recent studies an association between breastfeeding and maternal mood has been reported. The present retrospective, cross-sectional study was conducted to evaluate the association between breastfeeding-related variables and postpartum depression (based on Edinburgh Postnatal Depression Scale threshold criteria) within the context of other known risk factors. Breastfeeding information, demographic information, and scores on the Edinburgh Postnatal Depression Scale were examined from the Canadian Maternity Experience Survey. This survey contains data collected from 6421 Canadian mothers between October 2006 and January 2007, and 2848 women between five and seven months postpartum were included in the current analyses. In contrast to previous research, logistic regression analyses revealed that when considered within the context of other risk factors, breastfeeding attempt and duration were not ...

Journal of Obstetrics and Gynaecology Canada, 2015

Objective: An association between endometriosis and psychiatric disturbances has been identified ... more Objective: An association between endometriosis and psychiatric disturbances has been identified by some researchers. The purpose of this systematic review was to consolidate existing empirical findings to clarify the association between endometriosis and psychiatric conditions .

Women's Health, 2015

Childbirth can trigger or exacerbate a variety of psychiatric disorders but the extant literature... more Childbirth can trigger or exacerbate a variety of psychiatric disorders but the extant literature has focused primarily on mood disorders. Obsessive–compulsive disorder (OCD) after childbirth can occur alone or in combination with other psychiatric disorders such as major depressive disorder. Due to the general lack of awareness of the relationship between childbirth and OCD among clinicians as well as patients, the disorder may be underdiagnosed or misdiagnosed as major depressive disorder. This article describes the prevalence, clinical features, common psychiatric comorbidities, differential diagnosis and potential consequences of underdiagnosis or misdiagnosis. Using case vignettes strategies for its detection and clinical management are suggested. Finally, areas in need of further research are proposed.

Treatment-Resistant Mood Disorders, 2015

Journal of psychiatry & neuroscience : JPN, 2013

Journal of psychiatry & neuroscience : JPN, 2011

The information in this column is not intended as a definitive treatment strategy but as a sugges... more The information in this column is not intended as a definitive treatment strategy but as a suggested approach for clinicians treating patients with similar histories. Individual cases may vary and should be evaluated carefully before treatment is provided. The patient described in this column is a composite with characteristics of several real patients. Psychopharmacology for the Clinician columns are usually based on a case report that illustrates a point of interest in clinical psychopharmacology. They are about 500-650 words long and do not include references. Columns can include a bibliography which will be available only on the journal website.

Journal of psychiatry & neuroscience : JPN, 1999

An open trial was conducted to determine the efficacy of olanzapine in the treatment of bipolar m... more An open trial was conducted to determine the efficacy of olanzapine in the treatment of bipolar mixed state. Nine inpatients at a provincial psychiatric hospital who met the DSM-IV criteria for bipolar I disorder, most recent episode mixed. Olanzapine was added to the existing drug regime in patients who had failed to respond to adequate trials of mood stabilizers used alone or in combination with neuroleptics. Patients were administered the Clinical Global Impression (CGI) Scale, the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) Scale before the initiation of olanzapine. These scales were repeated and patients were rated on the improvement subscale of the CGI at the time of discharge. Pretreatment means (and standard deviations [SD]) for the CGI scale, BPRS and GAF were 5.7 (1.1), 60.7 (13.7) and 17.8 (7.5), respectively. Post-treatment means and SD for the scales were 1.9 (0.6), 6.3 (3.3) and 71.7 (5.6), respectively. Paired t-tests on all me...

Molecular Psychiatry, 2015

Atypical antipsychotic adjunctive therapy to lithium or valproate is effective in treating acute ... more Atypical antipsychotic adjunctive therapy to lithium or valproate is effective in treating acute mania. Although continuation of atypical antipsychotic adjunctive therapy after mania remission reduces relapse of mood episodes, the optimal duration is unknown. As many atypical antipsychotics cause weight gain and metabolic syndrome, they should not be continued unless the benefits outweigh the risks. This 52-week double-blind placebo-controlled trial recruited patients with bipolar I disorder (n = 159) who recently remitted from a manic episode during treatment with risperidone or olanzapine adjunctive therapy to lithium or valproate. Patients were randomized to one of three conditions: discontinuation of risperidone or olanzapine and substitution with placebo at (i) entry ('0-weeks' group) or (ii) at 24 weeks after entry ('24-weeks' group) or (iii) continuation of risperidone or olanzapine for the full duration of the study ('52-weeks' group). The primary outcome measure was time to relapse of any mood episode. Compared with the 0-weeks group, the time to any mood episode was significantly longer in the 24-weeks group (hazard ratio (HR) 0.53; 95% confidence interval (CI): 0.33, 0.86) and nearly so in the 52-weeks group (HR: 0.63; 95% CI: 0.39, 1.02). The relapse rate was similar in the 52-weeks group compared with the 24-weeks group (HR: 1.18; 95% CI: 0.71, 1.99); however, subgroup analysis showed discordant results between the two antipsychotics (HR: 0.48, 95% CI: 0.17; 1.32 olanzapine patients; HR: 1.85, 95% CI: 1.00, 3.41 risperidone patients). Average weight gain was 3.2 kg in the 52-weeks group compared with a weight loss of 0.2 kg in the 0-weeks and 0.1 kg in the 24-weeks groups. These findings suggest that risperidone or olanzapine adjunctive therapy for 24 weeks is beneficial but continuation of risperidone beyond this period does not reduce the risk of relapse. Whether continuation of olanzapine beyond this period reduces relapse risk remains unclear but the potential benefit needs to be weighed against an increased risk of weight gain.

The Journal of Clinical Psychiatry, 1998

Sir: Tardive dyskinesia (TD) is one of the most troublesome side effects associated with the use ... more Sir: Tardive dyskinesia (TD) is one of the most troublesome side effects associated with the use of antipsychotics. It is estimated that 20% to 30% of patients on long-term administration of neuroleptics will develop these abnormal involuntary movements that involve most commonly the tongue, face, fingers, arms, shoulders, and legs. 1,2 Elderly patients seem to be particularly vulnerable to the development of these side effects 3,4-this is a particular concern because antipsychotics are often used for the treatment of a number of mental disorders in old age. 5,6 Attempts to treat TD symptoms with neuroleptics, cholinergic drugs, benzodiazepines, and calcium channel blockers have not produced encouraging results. 7 The potential benefit of vitamin E in preventing or reducing the severity of TD has been supported by some studies 8,9 and is probably due to its antioxidant properties (free radical mechanisms). Recent reports have also suggested that the novel atypical antipsychotics may be beneficial in managing at least some types of dyskinesias. 10-12 This report describes the case of an elderly chronic schizophrenic woman who developed moderately severe neuroleptic-induced dyskinetic movements that responded to the use of the recently introduced atypical antipsychotic olanzapine. Case report. Ms. A, a 76-year-old single lady with a diagnosis of schizophrenia since age 24, was referred for the treatment of chronic auditory hallucinations and delusions. She also displayed signs of mild increase in muscle tone and dyskinetic movements of the face, jaw, lips, tongue, arms, and feet that had started sometime during the previous 2 years. At the time of assessment, she was receiving propranolol (40 mg/day), haloperidol (5 mg/day), clomipramine (75 mg/day), and chlorpropamide (125 mg/day). After a 5-week period of drug adjustment, Ms. A was kept on haloperidol, 5 mg/day, biperiden, 3 mg/day, and bromazepam, 4.5 mg/day, for 7 months. Toward the end of this 7-month period, she experienced deterioration of her clinical state and of her dyskinetic movements. The dose of haloperidol was then increased to 7.5 mg/day for another 5 months, which was followed by mental state improvement but further deterioration of the extrapyramidal signs to a point that they often interfered with her eating. After 12 months of follow-up, the abnormal movements were rated according to the AIMS guidelines 13-scores ranged from minimal (face, tongue, and lower limbs) to moderate (lips, jaw, and upper limbs). There was mild muscle rigidity at evaluation, but no gait problems. Treatment alternatives were discussed with Ms. A and her main caregiver (brother). It was agreed that Ms. A would gradually discontinue the use of haloperidol and biperiden over 1 week and that olanzapine would be then introduced up to a dose of 10 mg/day over the next week. There was substantial im

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 2018

The Journal of Clinical Psychiatry, 2003

Sir: I read with interest the excellent article by Busch and colleagues 1 describing the clinical... more Sir: I read with interest the excellent article by Busch and colleagues 1 describing the clinical correlates of suicide among hospitalized patients. It is argued that the presence of severe anxiety and agitation symptoms may be an important but treatable acute predictor of suicide. While aggressive pharmacologic treatment of suicide-related target symptoms is advisable, it is important to determine the context and pattern of evolution of such symptoms in the course of psychiatric illness, particularly mood disorders. The results of this study 1 demonstrated evidence of significant psychic anxiety or agitation in nearly 80% of patients during the week prior to suicide, but only 8% (N = 6 of 76) of the cases were diagnosed with agitated depression at admission. It is not clear whether symptoms of psychic anxiety and agitation were present in variable degrees during the entire index hospitalization or a change in psychomotor activity occurred proximally to the time of suicide. Another issue that needs clarification is the source of these symptoms that can occur in relation to symptomatic or syndromal comorbidity with anxiety. The use of antidepressants in patients with a bipolar diathesis can lead to the development of agitation and insomnia against the backdrop of atypical symptoms such as psychomotor retardation and hypersomnia. Finally, mixed episodes that are associated with a high risk of suicide are often accompanied by symptoms including anxiety and agitation. Contrary to the results of studies showing that the diagnosis of bipolar disorder, particularly bipolar II disorder, is associated with an elevated risk of suicide, the number of individuals with bipolar disorder in this study was surprisingly low. 2,3 The rapidly fluctuating clinical course and the presence of symptoms including mood lability and psychosis in some patients raises the possibility of a higher than reported prevalence of bipolarity, particularly mixed episodes. As antidepressants can cause mood instability in some patients, it is important to study the relationship between changes in the clinical state, especially cognition, mood, psychomotor activity and sleep, and the use of these drugs. If case-controlled studies confirm such an association, caution may be needed regarding the use of antidepressants in at least some patients at acute risk for suicide. Dr. Sharma reports no financial or other support of this letter.

Brazilian Journal of Psychiatry, 2022

A recent meta-analysis estimated that 20.7 % of women have one or more anxiety disorders during p... more A recent meta-analysis estimated that 20.7 % of women have one or more anxiety disorders during pregnancy or in the postpartum period. 1 Another meta-analysis reported that an estimated 8.5% of postpartum women have one or more anxiety disorders. 2 In spite of its common occurrence, the detection and diagnosis of peripartum anxiety disorders can be challenging for several reasons. Assessing anxiety requires consideration of several core anxiety and related disorders. Anxiety disorders are usually accompanied by other psychiatric disorders, particularly major depression. Consequently, anxiety in clinical settings may be considered a symptom of major depressive disorder rather than a co-occurring disorder. Finally, a lack of comprehensive screening may lead to underdiagnosis and sub-optimal treatment of anxiety disorders. This editorial discusses the heterogeneity of peripartum anxiety followed by suggestions for its screening, diagnosis and treatment. As shown in Box 1, anxiety can occur in the context of core disorders such as panic disorder, agoraphobia, generalized anxiety disorder, social phobia, or specific phobia. Anxiety can also be a manifestation of related disorders, such as obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, or illness anxiety disorder. Anxiety can accompany major depressive disorder or bipolar disorder in the form of anxious distress. Comorbidity with other anxiety or related disorders is also common. For example, approximately 90% of women with childbirth-related post-traumatic disorder have postpartum depression, and 31% of women with postpartum depression have childbirth-related post-traumatic stress disorder. 3 Another study found that approximately 70% of women who screened positive for obsessive-compulsive disorder also screened positive for postpartum depression. 4 Peripartum anxiety generally occurs in the context of a pre-existing psychiatric disorder. However, first onset of obsessive-compulsive disorder is not uncommon. Pregnancy appears to be a specific trigger for the onset or exacerbation of obsessive-compulsive disorder or panic disorder. Despite its common occurrence during or

Expert Review of Neurotherapeutics, 2021

The Lancet Psychiatry, 2019

Australian & New Zealand Journal of Psychiatry, 2018

Objective: To derive new criteria sets for defining manic and hypomanic episodes (and thus for de... more Objective: To derive new criteria sets for defining manic and hypomanic episodes (and thus for defining the bipolar I and II disorders), an international Task Force was assembled and termed AREDOC reflecting its role of Assessment, Revision and Evaluation of DSM and other Operational Criteria. This paper reports on the first phase of its deliberations and interim criteria recommendations. Method: The first stage of the process consisted of reviewing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and recent International Classification of Diseases criteria, identifying their limitations and generating modified criteria sets for further in-depth consideration. Task Force members responded to recommendations for modifying criteria and from these the most problematic issues were identified. Results: Principal issues focussed on by Task Force members were how best to differentiate mania and hypomania, how to judge ‘impairment’ (both in and of itself and allowing th...

CNS spectrums, 2017

Mood disorders including major depressive disorder and bipolar disorder are common during and aft... more Mood disorders including major depressive disorder and bipolar disorder are common during and after pregnancy. Timely identification and appropriate management of mood episodes is essential to maximize maternal well-being and minimize adverse outcomes. Failure to do so results in maternal suffering and impaired child bonding, and has the potential for devastating outcomes including suicide and infanticide. Women are routinely screened for unipolar depression during or after pregnancy but not for bipolar disorder, in spite of the fact that childbirth is associated with a major risk for onset or exacerbation of bipolar disorder. Delays in detection as well as misdiagnosis of bipolar disorder as major depressive disorder may put women at risk of many adverse consequences, including symptom exacerbation, psychiatric hospitalization, and suicide. A thorough psychiatric assessment is necessary to establish diagnosis, to address safety issues, and to formulate a treatment plan. Treatment o...

The Canadian Journal of Psychiatry, 2002

Objective: This study assessed the quantitative electroenchephalographic (QEEG) absolute power an... more Objective: This study assessed the quantitative electroenchephalographic (QEEG) absolute power and coherence differences between a group of patients with bipolar I mood disorder (BMD I) and a group of patients with schizophrenia. We also examined the correlation between QEEG measures and family history of BMD. Method: Using the National Institutes of Mental Health (NIMH) Global Rating Scale, we rated 18 adult inpatients with a DSM-III-R diagnosis of BMD I for the severity of the current episode. We also collected data on the family history of the illness. This group was then matched for age, sex, and handedness with an equal number of inpatients with a DSM-III-R diagnosis of schizophrenia. QEEG absolute power and coherence was calculated for the alpha bandwidth (8.0 to 12.0 Hz), assessed at 18 pairs of electrodes in both hemispheres during resting, eyes-closed condition in all the patients. Results: The patients with schizophrenia showed significantly higher coherence ( P = 0.047) a...

The Canadian Journal of Psychiatry, 2001

Objective: To discuss the effect of electroconvulsive therapy (ECT) on suicide risk in patients w... more Objective: To discuss the effect of electroconvulsive therapy (ECT) on suicide risk in patients with mood disorders. Method: A review of the available data on the short-term and long-term effects of ECT on suicide mortality among patients with mood disorders. Conclusion: ECT has an acute but not a long-term beneficial effect on suicidality. Due to the significant limitations of studies in this area, however, the data need to be interpreted with caution.

Psychological Medicine, 2017

BackgroundAlthough quality of life (QoL) is receiving increasing attention in bipolar disorder (B... more BackgroundAlthough quality of life (QoL) is receiving increasing attention in bipolar disorder (BD) research and practice, little is known about its naturalistic trajectory. The dual aims of this study were to prospectively investigate: (a) the trajectory of QoL under guideline-driven treatment and (b) the dynamic relationship between mood symptoms and QoL.MethodsIn total, 362 patients with BD receiving guideline-driven treatment were prospectively followed at 3-month intervals for up to 5 years. Mental (Mental Component Score – MCS) and physical (Physical Component Score – PCS) QoL were measured using the self-report SF-36. Clinician-rated symptom data were recorded for mania and depression. Multilevel modelling was used to analyse MCS and PCS over time, QoL trajectories predicted by time-lagged symptoms, and symptom trajectories predicted by time-lagged QoL.ResultsMCS exhibited a positive trajectory, while PCS worsened over time. Investigation of temporal relationships between QoL...

Journal of affective disorders, Aug 19, 2016

Risk and protective factors for postpartum depression have been extensively studied, and in recen... more Risk and protective factors for postpartum depression have been extensively studied, and in recent studies an association between breastfeeding and maternal mood has been reported. The present retrospective, cross-sectional study was conducted to evaluate the association between breastfeeding-related variables and postpartum depression (based on Edinburgh Postnatal Depression Scale threshold criteria) within the context of other known risk factors. Breastfeeding information, demographic information, and scores on the Edinburgh Postnatal Depression Scale were examined from the Canadian Maternity Experience Survey. This survey contains data collected from 6421 Canadian mothers between October 2006 and January 2007, and 2848 women between five and seven months postpartum were included in the current analyses. In contrast to previous research, logistic regression analyses revealed that when considered within the context of other risk factors, breastfeeding attempt and duration were not ...

Journal of Obstetrics and Gynaecology Canada, 2015

Objective: An association between endometriosis and psychiatric disturbances has been identified ... more Objective: An association between endometriosis and psychiatric disturbances has been identified by some researchers. The purpose of this systematic review was to consolidate existing empirical findings to clarify the association between endometriosis and psychiatric conditions .

Women's Health, 2015

Childbirth can trigger or exacerbate a variety of psychiatric disorders but the extant literature... more Childbirth can trigger or exacerbate a variety of psychiatric disorders but the extant literature has focused primarily on mood disorders. Obsessive–compulsive disorder (OCD) after childbirth can occur alone or in combination with other psychiatric disorders such as major depressive disorder. Due to the general lack of awareness of the relationship between childbirth and OCD among clinicians as well as patients, the disorder may be underdiagnosed or misdiagnosed as major depressive disorder. This article describes the prevalence, clinical features, common psychiatric comorbidities, differential diagnosis and potential consequences of underdiagnosis or misdiagnosis. Using case vignettes strategies for its detection and clinical management are suggested. Finally, areas in need of further research are proposed.

Treatment-Resistant Mood Disorders, 2015

Journal of psychiatry & neuroscience : JPN, 2013

Journal of psychiatry & neuroscience : JPN, 2011

The information in this column is not intended as a definitive treatment strategy but as a sugges... more The information in this column is not intended as a definitive treatment strategy but as a suggested approach for clinicians treating patients with similar histories. Individual cases may vary and should be evaluated carefully before treatment is provided. The patient described in this column is a composite with characteristics of several real patients. Psychopharmacology for the Clinician columns are usually based on a case report that illustrates a point of interest in clinical psychopharmacology. They are about 500-650 words long and do not include references. Columns can include a bibliography which will be available only on the journal website.

Journal of psychiatry & neuroscience : JPN, 1999

An open trial was conducted to determine the efficacy of olanzapine in the treatment of bipolar m... more An open trial was conducted to determine the efficacy of olanzapine in the treatment of bipolar mixed state. Nine inpatients at a provincial psychiatric hospital who met the DSM-IV criteria for bipolar I disorder, most recent episode mixed. Olanzapine was added to the existing drug regime in patients who had failed to respond to adequate trials of mood stabilizers used alone or in combination with neuroleptics. Patients were administered the Clinical Global Impression (CGI) Scale, the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) Scale before the initiation of olanzapine. These scales were repeated and patients were rated on the improvement subscale of the CGI at the time of discharge. Pretreatment means (and standard deviations [SD]) for the CGI scale, BPRS and GAF were 5.7 (1.1), 60.7 (13.7) and 17.8 (7.5), respectively. Post-treatment means and SD for the scales were 1.9 (0.6), 6.3 (3.3) and 71.7 (5.6), respectively. Paired t-tests on all me...

Psychological Medicine, 2018

Background: Although quality of life (QoL) is receiving increasing attention in bipolar disorder ... more Background: Although quality of life (QoL) is receiving increasing attention in bipolar disorder (BD) research and practice, little is known about its naturalistic trajectory. The dual aims of this study were to prospectively investigate: (a) the trajectory of QoL under guideline-driven treatment and (b) the dynamic relationship between mood symptoms and QoL.
Methods: In total, 362 patients with BD receiving guideline-driven treatment were prospectively followed at 3-month intervals for up to 5 years. Mental (Mental Component Score - MCS) and physical (Physical Component Score - PCS) QoL were measured using the self-report SF-36. Clinician-rated symptom data were recorded for mania and depression. Multilevel modelling was used to analyse MCS and PCS over time, QoL trajectories predicted by time-lagged symptoms, and symptom trajectories predicted by time-lagged QoL.
Results: MCS exhibited a positive trajectory, while PCS worsened over time. Investigation of temporal relationships between QoL and symptoms suggested bidirectional effects: earlier depressive symptoms were negatively associated with mental QoL, and earlier manic symptoms were negatively associated with physical QoL. Importantly, earlier MCS and PCS were both negatively associated with downstream symptoms of mania and depression.
Conclusions: The present investigation illustrates real-world outcomes for QoL under guideline-driven BD treatment: improvements in mental QoL and decrements in physical QoL were observed. The data permitted investigation of dynamic interactions between QoL and symptoms, generating novel evidence for bidirectional effects and encouraging further research into this important interplay. Investigation of relevant time-varying covariates (e.g. medications) was beyond scope. Future research should investigate possible determinants of QoL and the interplay between symptoms and wellbeing/satisfaction-centric measures of QoL.