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Adolescent Psychiatry

Author(s): Osarumen N. Doghor*, Faith O. Nomamiukor, Efetobore N. Okotcha and Edore Onigu-Otite

DOI: 10.2174/2210676609666190531102808

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Addressing Crises in Teenage Pregnancy

Page: [69 - 80] Pages: 12

  • * (Excluding Mailing and Handling)

Abstract

Background: Adolescent pregnancy is a major public health concern with medical, psychiatric, and social implications. Within this population, there is an elevated rate of co-occurring psychiatric conditions including mood disorders, anxiety disorders, suicidality, and substance use. However, little is known about the assessment and treatment of adolescent pregnancy within the context of these co-occurring psychiatric conditions, particularly in an emergency situation.

Objective: This article utilizes a case report to illustrate the challenges faced in consultative psychiatry in the assessment and treatment of a pregnant suicidal youth with a complex psychosocial history. Topics addressed include: 1) The role of childhood trauma and suicidality in adolescent pregnancy 2) A consideration of the risks and benefits of treating adolescents with psychotropics during pregnancy.

Methods: A literature search was performed with the key words of adolescent, pregnancy, child sexual abuse and psychiatric illness. In addition, expert opinions of a reproductive psychiatrist and a psychiatrist who had specialized in addiction and adolescents were enlisted on key aspects of the case formulation and treatment.

Results: Several studies were found that focused on depression, substance abuse and trauma in adolescent pregnancy. There were more studies that looked at psychopharmacological treatment in adult pregnant women and a few that focused on adolescents.

Conclusion: Addressing the crisis of psychiatric illness in adolescent pregnancy requires a thorough approach in understanding the severity of the illness and the contribution of child abuse and suicidality. Psychotherapeutic interventions are most certainly always necessary and beneficial when dealing with this population. Deciding when to start and maintain medication during pregnancy should be individualized, with considerations of the risks of untreated illness and of medication exposure.

Keywords: Adolescent, pregnancy, child sexual abuse, depression, antidepressants, psychotherapeutic interventions.

Abas, M., Ostrovschi, N.V., Prince, M., Gorceag, V.I., Trigub, C., Oram, S. (2013). Risk factors for mental disorders in women survivors of human trafficking: A historical cohort study. BMC Psychiatry, 13(1), 204.
American College of Obstetrics and Gynecology. (2015). Depression and postpartum depression: Resource overview. Retrieved January 12, 2017, from http://www.acog.org/womenshealth/depression-and-postpartum-depression#resources
Aftab, A., Shah, A. (2017). Behavioral emergencies: Special considerations in the pregnant patient. Psychiatr. Clin. North Am., 40(3), 435-448.
Anderson, E.L., Reti, I.M. (2009). ECT in pregnancy: A review of the literature from 1941 to 2007. Psychosom. Med., 71, 235-242.
Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., Coventry, P. (2012). Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews. Issue 10. Art. No., CD006525, pub2.
[http://dx.doi.org/10.1002/14651858.CD006525]
Ban, L., West, J., Gibson, J. E., Fiaschi, L., Sokal, R., Doyle, P., Tata, L. J. (2014). First trimester exposure to anxiolytic and hypnotic drugs and the risks of major congenital anomalies: A United Kingdom populationbased cohort study. PLoS One, Jun 25; 9(6), : e100996.
Bansil, P., Kuklina, E.V., Meikle, S.F., Posner, S.F., Kourtis, A.P., Ellington, S.R., Jamieson, D.J. (2010). Maternal and fetal outcomes among women with depression. J. Womens Health, 19(2), 329-334.
Becker, M., Weinberger, T., Chandy, A., Schmukler, S. (2016). Depression during pregnancy and postpartum. Curr. Psychiatry Rep., 18, 32.
Boukhris, T., Sheehy, O., Mottron, L., Bérard, A. (2016). Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. Journal of the American Medical Association, 170(2), 117-124.
Brown, H.K., Ray, J.G., Wilton, A.S., Lunsky, Y., Gomes, T., Vigod, S.N. (2017). Association between serotonergic antidepressant use during pregnancy and autism spectrum disorder in children. JAMA, 317(15), 1544-1552.
Bruning, A.H., Heller, H.M., Kieviet, N., Bakker, P.C., de Groot, C.J., Dolman, K.M., Honig, A. (2015). Antidepressants during pregnancy and postpartum hemorrhage: A systematic review. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 189, 38-47.
Castro, V.M., Kong, S.W., Clements, C.C., Brady, R., Kaimal, A.J., Doyle, A.E. … Perlis, R. H. (2016). Absence of evidence for increase in risk for autism or attention-deficit hyperactivity disorder following antidepressant exposure during pregnancy: a replication study. Translational Psychiatry, 6(1), e708-e714.
Cavazos-Rehg, P.A., Spitznagel, E.L., Krauss, M.J., Shootman, M., Bucholz, K.K., Cotler, L.B., Bierut, L.J. (2010). Understanding adolescent parenthood from a multisytstemic perspective. Journal of Adolescent Health, 46, 525-531.
Chambers, C.D., Hernandez-Diaz, S., Van Marter, L.J., Werler, M.M., Louik, C., Jones, K.L., Mitchell, A.A. (2006). Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N. Engl. J. Med., 354(6), 579-587.
Chan, L.F., Mohamed Adam, B., Norazlin, K.N., Siti Haidi, M.I., Lee, V.Y., Norazura, W. (2016). Suicidal ideation among single parents, pregnant adolescents: The role of sexual and religious knowledge, attitudes and practices. J. Adolesc., 52, 162-169.
Coelho, R.T., Pinheiro, R.A., Silva, L., Quevedo, L.D., Mattos Souza, M.B. (2014). Parental bonding and suicidality in pregnant teenagers: A population-based study in southern Brazil. Soc. Psychiatry Psychiatr. Epidemiol., 49(8), 1241-1248.
Cox, J.L., Holden, J.M., Sagovsky, R. (1987). Edinburgh Postnatal Depression Rating Scale. Br. J. Psychiatry, 150, 782-786.
Croen, L.A., Grether, J.K., Yoshida, C.K., Odouli, R., Hendrick, V. (2011). Antidepressant use during pregnancy and childhood autism spectrum disorders. Arch. Gen. Psychiatry, 68(11), 1104-1112.
Dolovich, L.R., Addis, A., Vaillancourt, J.M.R., Power, J.D.B., Koren, G., Einarson, T.R. (1998). Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. British Medical Journal, 317(7162), 839-843.
Figueiredo, B., Pacheco, A., Costa, R. (2007). Depression during pregnancy and the postpartum period in adolescent and adult Portuguese mothers. Arch. Women Ment. Health, 10(3), 103-109.
Francis, J., Malbon, K., Braun-Courville, D., Lourdes, L.O., Santelli, J. (2015). Ambivalence about pregnancy and its association with symptoms of depression in adolescent females initiating contraception. J. Adolesc. Health, 56(1), 44-51.
Francisco, V.N., Carlos, V.R., Eliza, V.R., Octelina, C.R., Maria, I.I. (2016). Tobacco and alcohol use in adolescents with unplanned pregnancies: Relation with family structure, tobacco and alcohol use at home and by friends. Afr. Health Sci., 16(1), 27-35.
Fraser, A.M., Brockert, J.E., Ward, R.H. (1995). Association of young maternal age with adverse reproductive outcomes. N. Engl. J. Med., 332(17), 1113-1118.
Freitas, G.V.S., Cais, C.F.S., Stefanello, S., Botega, N.J. (2008). Psychosocial conditions and suicidal behavior in pregnant teenagers. Eur. Child Adolesc. Psychiatry, 17(6), 336-342.
Gadot, Y., Koren, G. (2015). The use of antidepressants in pregnancy: Focus on maternal risks. Obstet. Gynecol. Surv., 37(1), 56-63.
Green, C.M., Manohar, S.V. (1990). Neonaticide and hysterical denial of pregnancy. Br. J. Psychiatry, 156, 121-123.
Gressier, F., Guillard, V., Cazas, O., Falissard, B., Glangeaud-Freudenthal, N., Sutter-Dallay, A. (2017). Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. J. Psychiatr. Res., 84, 284-291.
Grigoriadis, S. VonderPorten, E. H., Mamisashvili, L., Roerecke, M., Rehm, J., Dennis, C. L. . . Ross, L. E. (2013b). Antidepressant exposure during pregnancy and congenital malformations: Is there an association? A systematic review and meta-analysis of the best evidence. J. Clin. Psychiatry, 74(4), e293-e308.
Hall, K.S., Richards, J.L., Harris, K.M. (2017). Social disparities in the relationship between depression and unintended pregnancy during adolescence and young adulthood. J. Adolesc. Health, 60(6), 688-697.
Harrington, R.A., Lee, L., Crum, R.M., Zimmerman, A.W., Hertz Picciotto, I. (2014). Prenatal SSRI use and offspring with autism spectrum disorder or developmental delay. Pediatrics, 133(5), e1241-e1248.
Herman, J.L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. J. Trauma. Stress, 5(3), 377-391.
Hu, R., Li, Y., Zhang, Z., Yan, W. (2015). Antenatal depressive symptoms and the risk of preeclampsia or operative deliveries: a meta-analysis. PLoS One, 10(3)e0119018
Huybrechts, K. (2015). Design of epidemiologic studies to evaluate the impact of SSRI exposure during pregnancy. Unpublished.
Huybrechts, K.F., Bateman, B.T., Palmsten, K., Desai, R.J., Patorno, E., Gopalakrishnan, C. (2015). Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA: Journal of the American Medical Association, 313(21), 2142-2151.
Huybrechts, K.F., Palmsten, K., Avorn, J., Cohen, L.S., Holmes, L.B., Franklin, J.M. (2014). Antidepressant use in pregnancy and the risk of cardiac defects. N. Engl. J. Med., 370(25), 2397-2407.
Hviid, A., Melbye, M., Pasternak, B. (2013). Use of selective serotonin reuptake inhibitors during pregnancy and risk of autism. N. Engl. J. Med., 369(25), 2406-2415.
Jones, I., Chandra, P.S., Dazzan, P., Howard, L.M. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet, 384(9956), 1789-1799.
Klein, J. (2005). Adolescent pregnancy: Current trends and issues. Pediatrics, 116(1), 281-286.
Koleva, H., Stuart, S. (2014). Risk factors for depressive symptoms in adolescent pregnancy in a late-teen subsample. Arch. Women Ment. Health, 17(2), 155-158.
Larsen, E.R., Saric, K. (2017). Pregnancy and bipolar disorder: The risk of recurrence when discontinuing treatment with mood stabilisers: A systematic review. Acta Neuropsychiatr., 29(5), 259-266.
[http://dx.doi.org/10.1017/neu.2016.60]
Mason, W.A., January, S.A., Chmelka, M.B., Parra, G.R., Savolainen, J., Miettunen, J., Moilanen, I. (2016). Cumulative contextual risk at birth in relation to adolescent substance use, conduct problems, and risky sex: General and specific predictive associations in a Finnish birth cohort. Addict. Behav., 58, 161-166.
Mehlum, L. (2016). Dialectical behavioral therapy compared with enhanced usual care for adolescents with repeated suicidal and self harm behavior: Outcome over a one year follow-up. J. Am. Acad. Child Adolesc. Psychiatry, 55(4), 295-300.
Mose-Kolko, E., Bogen, D., Perel, J., Bregar, A., Uhl, K., Levin, B., Wisner, K.L. (2005). Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: Literature review and implications for clinical applications. Journal of the American Medical Association, 293(19), 2372-2383.
Nora, J.J., Nora, A.H., Toews, W.H. (1974). Lithium, Ebstein’s anomaly and other congenital heart defects. Lancet, 1, 594-595.
Oram, S., Khondoker, M., Abas, M., Broadbent, M., Howard, L.M. (2015). Characteristics of trafficked adults and children with severe mental illness: A historical cohort study. Lancet Psychiatry, 2(12), 1084-1091.
Ornoy, A., Weinstein-Fudim, L., Ergaz, Z. (2017). Antidepressants, antipsychotics, and mood stabilizers in pregnancy: What do we know and how should we treat pregnant women with depression? Birth Defects Res., 109(12), 933-956.
Orsolini, L., Valchera, A., Vecchiotti, R., Tomasetti, C., Iasevoli, F., Fornaro, M., Bellantuono, C. (2016). Suicide during the perinatal period: Epidemiology, risk factors, and clinical correlates. Front. Psychiatry, 7, 138.
Painuly, N., Heun, R., Painuly, R., Sharan, P. (2013). Risk of cardiovascular malformations after exposure to paroxetine in pregnancy: Meta-analysis. Psychiatrist, 37(6), 198-203.
Rai, D., Lee, B.K., Dalman, C., Golding, J., Lewis, G., Magnusson, C. (2013). Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: Population based case-control study. BMJ, 346, f2059.
Reefhuis, J., Devine, O., Friedman, J.M., Louik, C., Honein, M.A. (2015). Specific SSRIs and birth defects: Bayesian analysis to interpret new data in the context of previous reports. BMJ, 351, h3190.
Robinson, G.E. (2015). Controversies about the use of antidepressants in pregnancy. J. Nerv. Ment. Dis., 203(3), 159-163.
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. JAMA Psychiatry, 70(4), 436-443.
Sit, D., Luther, J., Buysse, D., Dills, J.L., Eng, H., Okun, M., Wisner, K.L. (2015). Suicidal ideation in depressed postpartum women: Associations with childhood trauma, sleep disturbance and anxiety. J. Psychiatr. Res., 0, 95-104.
Schou, M., Amdisen, A. (1973). Lithium and Pregnancy—III, Lithium Ingestion by Children Breast-Fed by Women on Lithium Treatment. BMJ, 2(5859), 138.
Smith, B., Dubovsky, S.L. (2017). Pharmacotherapy of mood disorders and psychosis in pre- and post-natal women. Expert Opin. Pharmacother., 18(16), 1703-1719.
Schmidt, R.M., Wiemann, C.M., Rickert, V.I., Smith, E.O. (2006). Moderate to severe depressive symptoms among adolescent mothers followed four years postpartum. J. Adolesc. Health, 38, 712-718.
Siegel, R.S., Brandon, A.R. (2014). Adolescents, pregnancy and mental health. J. Pediatr. Adolesc. Gynecol., 27(3), 138-150.
Spielvogel, A.M., Hohener, H.C. (1995). Denial of pregnancy: A review and case reports. Birth Issues in Perinatal Care, 22(4), 220-226.
Spinelli, M.G., Endicott, J. (2003). Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am. J. Psychiatry, 160(3), 555-562.
t'Jong, G. W., Einarson, T., Koren, G., & Einarson, A. (2012). Antidepressant use in pregnancy and persistent pulmonary hypertension of the newborn (PPHN): A systematic review. Reproductive Toxicology, 34, 293-297.
Troutman, B.R., Cutrona, C.E. (1990). Nonpsychotic depression among adolescent mothers. J. Abnorm. Psychol., 99(1), 69-78.
Tsutsumi, A., Izutsu, T., Poudyal, A.K., Kato, S., Marui, E. (2008). Mental health of female survivors of human trafficking in Nepal. Soc. Sci. Med., 66(8), 1841-1847.
United Nations Population Division. (2015). Adolescent fertility rate (births per 1,000 women ages 15-19). Retrieved from http://data.worldbank.org/indicator/SP.ADO.TFRT
U. S. Department of Justice (2017). Prostitution of children. Retrieved from www.justice.gov/criminal/ceos/ subjectareas/prostitution.html
U. S. Food and Drug Administration. (2005). Public health advisory: Paroxetine. Retrieved from https://www. fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm051731.htm
U. S. Food and Drug Administration. (2011, 12/14/2011). FDA drug safety communication: Selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and reports of a rare heart and lung condition in newborn babies. Retrieved from www.fda.gov/Drugs/DrugSafety/ucm283375.htm
Venkatesh, K., Riley, L., Castro, V., Perlis, R.K.A. (2016). Association of antenatal depression symptoms and antidepressant treatment with preterm birth. Obstet. Gynecol., 127(5), 926-933.
Wessel, J., Gauruder-Burmester, A., Gerlinger, C. (2007). Denial of pregnancy- characteristics of women at risk. Acta Obstet. Gynecol. Scand., 86(5), 542-546.
Widom, C.S. (2000). Childhood victimization and the derailment of girls and women to the criminal justice system. In B. E. Richie, K. Tsenin, & C. S. Widom (Eds.) Plenary papers of the 1999 Conference on criminal justice research and evaluation enhancing policy and practice through research. (Vol. 3, pp. 27-36). Washington, DC: U. S. Department of Justice, Office of Justice Programs, National Institute of Justice. Retrieved from https://www.ncjrs.gov/pdffiles1/ nij/180973.pdf
Yonkers, K.A., Wisner, K.L., Stewart, D.E., Oberlander, T.F., Dell, D.L., Stotland, N. . . Lockwood, C. (2009). The management of depression during pregnancy: A report from the American Psychiatric Association and American College of Obstetricians and Gynecologists. Gen. Hosp. Psychiatry, 31(5), 403.
Zimmerman, C., Hossain, M., Yun, K., Gajdadziev, V., Guzun, N., Tchomarova, M. … Watts, C. (2008). The health of trafficked women: A survey of women entering posttrafficking services in Europe. American Journal of Public Health, 98(1), 55-59.