Marie Bendix

The occurrence of treatment resistance in women with postpartum depression (PPD) and risk factors for treatment resistance remain less studied. This study aimed to determine the rate of treatment resistance and the associated risk factors among women with PPD in a nationwide setting. Here we conducted a nationwide register-based cohort study of 58,618 patients with a first-ever PPD during 2006–2021 in Sweden. Information on demographics, pregnancy characteristics, pre-existing physical and psychiatric conditions and treatment was retrieved from Swedish national registers. The outcome was treatment-resistant PPD (TRPPD) within 1 year following PPD diagnosis. Associations between potential risk factors and TRPPD were assessed using multivariable Poisson regression. Among the 58,618 patients with PPD, 3,522 (6.0%) met the criteria for TRPPD during 1 year after PPD diagnosis. Lower educational level, lower household income, being non-cohabiting, smoking in early pregnancy, delivery by cesarean section, pre-existing physical conditions and pre-existing psychiatric disorders were significantly associated with a higher risk of TRPPD. In addition, patients with two births (versus primiparity) or with a prior premenstrual disorder had a lower risk of TRPPD. Treatment resistance in patients with PPD is common and is notably associated with specific demographic and clinical profiles. These findings may provide grounds for practical risk assessment at PPD diagnosis and highlight the need for personalized management strategies.

Objectives: Lithium is a first-line treatment option for preventing relapse in bipolar disorder but may be discontinued periconceptionally due to safety concerns. We aimed to examine the prevalence of lithium discontinuation among pregnant women with bipolar disorder in Sweden, using a novel method to identify daily dose, and to describe the characteristics of the discontinuers and continuers. Design: Cohort study. Setting: Swedish population-based registers (2006–2019). Participants: Women with bipolar disorder and an ongoing lithium treatment episode 6 months prior to pregnancy were identified. Natural language processing (NLP) of the prescription free-text information was used to define the daily dose, and to construct treatment episodes. Interventions: Not applicable. Main outcome measures: Lithium discontinuation was defined as the end of a continuous treatment episode between 6 months before the start of pregnancy and delivery. The performance of the NLP method was compared with manual review of the prescription texts. The characteristics of the discontinuers and the continuers were described, including psychiatric comorbidities and other medications used. Findings: In 662 pregnancies, 438 women (70%) discontinued lithium treatment, the majority in prepregnancy or first trimester. The NLP method showed high internal validity compared with manual review of prescription texts; however, the estimated date of discontinuation could not be validated against measures of actual drug use. Discontinuers, compared with continuers, had a higher prevalence of comorbid substance use disorder (7.8% vs 2.7%), personality disorder (11.4% vs 6.0%) and attention-deficit/hyperactivity disorder (13.5% vs 7.6%). After discontinuation, there was no increased use of other mood stabilisers, and 46% had a new dispensation of lithium within 6–12 months. Conclusions: The majority of lithium-treated women with bipolar disorder discontinued treatment around the start of pregnancy; however, lithium discontinuation is also common outside pregnancy, and the reason for discontinuation in our cohort remains unknown. Discontinuers had a higher rate of psychiatric comorbidity, and switches to other mood stabilising treatments did not appear to be common. Given that both the peripartum period and withdrawal of mood stabilising treatment may contribute to increased risk of relapse, the consequences of lithium discontinuation for maternal psychiatric health should be studied further.

Individuals with severe mental disorders (SMDs) such as psychotic disorders, bipolar disorders, and single manic episodes have increased mortality associated with COVID-19 infection. We set up a population-based study to examine whether individuals with SMD also had a higher risk of hospitalization and death from other infectious conditions. Anonymized and summarized data from multiple Swedish patient registers covering the entire Swedish population were supplied by the Swedish National Board of Health and Welfare. The frequencies of hospitalizations and deaths associated with influenza/pneumonia and sepsis in individuals with SMD were compared with the rest of the population during 2018–2019. Possible contributing comorbidities were also examined, of which diabetes, cardiovascular disease, chronic lung disease, and hypertension were chosen. A total of 7,780,727 individuals were included in the study; 97,034 (1.2%) cases with SMD and 7,683,693 (98.8%) controls. Individuals with SMD had increased risk of death associated with influenza/pneumonia (OR = 2.06, 95% CI [1.87–2.27]) and sepsis (OR = 1.61, 95% CI [1.38–1.89]). They also had an increased risk of hospitalization associated with influenza/pneumonia (OR = 2.12, 95% CI [2.03–2.20]) and sepsis (OR = 1.89, 95% CI [1.75–2.03]). Our results identify a need for further evaluation of whether these individuals should be included in prioritized risk groups for vaccination against infectious diseases other than COVID-19.

Background: Individuals with severe mental disorder (SMD) have a higher risk of somatic comorbidity and mortality than the rest of the population. We set up a population-based study to assess whether individuals with SMD had a higher risk of death associated with a COVID-19 infection (COVID-19 associated death) than individuals without SMD. Methods: Exploratory analysis with a cross-sectional design in the framework of a population-based register study covering the entire Swedish population. The Swedish Board for Health and Welfare (Socialstyrelsen) provided anonymised tabulated summary data for further analysis. We compared numbers of COVID-19 associated death in individuals with SMD (cases) and without SMD (controls). We calculated the odds ratio (OR) for the whole sample and by age group and four potential risk factors, namely diabetes, cardiovascular disease, hypertension, chronic lung disease. Results: The sample comprised of 7,923,859 individuals, 103,999 with SMD and 7,819,860 controls. There were 130 (0.1%) COVID-19 associated deaths in the SMD group and 4945 (0.06%) in the control group, corresponding to an OR of 1.98 (CI 1.66-2.35; p < 0.001). The odds were fourfold in the age group between 60 and 79 years. Cardiovascular diseases increased the odds by 50%. Individuals with SMD without any of the risk factors under study had three-folds odds of COVID-19 associated death. Conclusion: Our preliminary results suggest that individuals with SMD are a further group at increased risk of COVID-19 associated death. The factors contributing to this increased mortality risk require clarification.

Sweden has a unique opportunity to identify and follow up women presenting with, or at risk for, perinatal mental health problems and disorders because universal screening programmes are provided by its primary healthcare system. Although they are implemented across almost the entire population, screening programmes are not necessarily leading to effective interventions because the multidisciplinary perinatal mental healthcare teams that provide for the assessment and treatment of moderate to severe disorders are very few in number and must be increased. In particular, efforts to reach immigrant parents must be intensified to achieve equal quality of care for all.

Epilepsy has a diverse spectrum of consequences that can necessitate multi-professional cooperation in order to guarantee a high level of care. Psychiatric comorbidity is common, which influences quality of life, seizure control and mortality. Multi-professional teams, with participation from neurology, psychiatry, psychology, occupational therapy and social work, can together tailor the individual care for patients with complex needs. Close cooperation among team members increases quality and efficiency of care and reassurance for patients and their relatives while decreasing the work load for individual team members.

Mental disorders are common during the perinatal period and expose mother and child to major risks. Almost all women in Sweden attend maternal and child health care centers regularly before and after birth. This constitutes a unique opportunity to detect women with early signs of mental disorder or at risk of recurrence of prior illness. Identified women need fast access to diagnostic and treatment providers with specialized knowledge on perinatal mental disorders. As perinatal mental disorders can have severe consequences for mothers and their children a tight cooperation between caregivers is often needed.