http://ajp.psychiatryonline.org American Journal of Psychiatry RSS feed -- recent Treatment in Psychiatry articles 1535-7228 American Journal of Psychiatry 0002-953X http://ajp.psychiatryonline.org/icons/banner/rss.gif http://ajp.psychiatryonline.org http://ajp.psychiatryonline.org/cgi/content/short/166/11/1217?rss=1 Research on postpartum mood disorders has focused primarily on major depressive disorder, bipolar I disorder, and puerperal psychosis and has largely ignored or neglected bipolar II disorder. Hypomanic symptoms are common after delivery but frequently unrecognized. DSM-IV does not consider early postpartum hypomania as a significant diagnostic feature. Although postpartum hypomania may not cause marked impairment in social or occupational functioning, it is often associated with subsequent, often disabling depression. Preliminary evidence suggests that bipolar II depression arising in the postpartum period is often misdiagnosed as unipolar major depressive disorder. The consequences of the misdiagnosis can be particularly serious because of delayed initiation of appropriate treatment and the inappropriate prescription of antidepressants. Moreover, no pharmacological or psychotherapeutic studies of bipolar postpartum depression are available to guide clinical decision making. Also lacking are screening instruments designed specifically for use before or after delivery in women with suspected bipolar depression. It is recommended that the treatment of postpartum bipolar depression follow the same guidelines as the treatment of nonpuerperal bipolar II depression, using medications that are compatible with lactation.

]]> Mon, 02 Nov 2009 10:01:53 PST info:doi/10.1176/appi.ajp.2009.08121902 American Psychiatric Association 11 166 1221 2009-11-01 1217 Treatment in Psychiatry http://ajp.psychiatryonline.org/cgi/content/short/166/9/974?rss=1 Although empirical evidence has recently validated clinical depression in children as young as age 3, few data are available to guide treatment of early childhood depression. Considering this gap in the literature, a novel dyadic psychotherapeutic model, Parent Child Interaction Therapy–Emotion Development, based on a well-known and effective manualized treatment for disruptive preschoolers, is currently being tested for use in depression. To balance safety and efficacy, dyadic developmental approaches are currently recommended as the first line of treatment for preschool depression. In the absence of data on the safety and efficacy of antidepressants in preschool depression, these agents are not recommended as a first- or second-line treatment at this time. This article provides an illustrative case example of preschool depression, outlines key considerations in differential diagnosis, and describes this novel form of treatment. It also clarifies parameters for the rare situations in which antidepressants may be tried when psychotherapeutic options fail and depression is severe and impairing.

]]> Tue, 01 Sep 2009 10:01:41 PDT info:doi/10.1176/appi.ajp.2009.08111709 American Psychiatric Association 9 166 979 2009-09-01 974 Treatment in Psychiatry