Hospitalizations and emergency department visits for psychiatric illness during and after pregnancy among women with schizophrenia.

BACKGROUND: Almost 50% of women with schizophrenia become pregnant. Little is known about their psychiatric service use patterns during or shortly after pregnancy. METHODS: Using health administrative data, we identified 1,433 women in Ontario, Canada, with schizophrenia (ICD-9, ICD-10, or DSM-IV-TR) who had a live birth delivery from January 2003 through March 2011 and described their use of acute psychiatric care services including hospitalizations, emergency department visits not requiring hospitalization, and self-harm-related emergency department visits during pregnancy and in the first year postpartum. Incidence rates of psychiatric hospitalization during pregnancy, and also within 1 year postpartum, were each compared to the incidence rate of psychiatric hospitalization in the 1-year period before conception. Results are presented as incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Similar comparisons were made for psychiatric emergency department visits not requiring hospitalization, as well as for self-harm-related emergency department visits. RESULTS: About 12% of the women had at least 1 psychiatric hospitalization during pregnancy, and 19% in the first year postpartum. About 10% had at least 1 psychiatric emergency department visit without hospitalization during pregnancy, and 16% had at least 1 emergency department visit postpartum. Self-harm-related emergency department visits were rarer, affecting only about 1% of the women in each time period. Relative to that in the 1-year period before conception (50 per 100 person-years), the incidence rate of psychiatric hospitalizations was lower during pregnancy (25 per 100 person-years), which is equivalent to an IRR of 0.50 (95% CI, 0.43-0.60). While the IRR of psychiatric hospitalizations was lower over the entire 1-year period postpartum (0.66; 95% CI, 0.57-0.76), it was transiently higher in the first 9 days postpartum (3.59; 95% CI, 2.74-4.69) and then waned by days 10 to 29 postpartum (0.87; 95% CI, 0.56-1.24). Emergency department visits for psychiatric and self-harm reasons were consistently lower during pregnancy and postpartum compared to the year before conception. CONCLUSIONS: Psychiatric hospitalizations and emergency department visits are not uncommon for women with schizophrenia during pregnancy and the postpartum period. However, except for a brief period after delivery, women with schizophrenia are at relatively lower risk of requiring acute psychiatric inpatient and emergency care during and 1 year after pregnancy compared to the 1-year period prior to conception. This is key prognostic information for women with schizophrenia, their families, and providers who counsel them regarding pregnancy, motherhood, and management of schizophrenia. Identifying women at risk of requiring acute psychiatric services in the perinatal period warrants further investigation.

Disruption of the blood-brain barrier exacerbates spreading depression in the locust CNS.

In response to cellular stress in the nervous system of the locust (Locusta migratoria) neural function is interrupted in association with ionic disturbances propagating throughout nervous tissue (Spreading depression; SD). The insect blood-brain barrier (BBB) plays a critical role in the regulation of ion levels within the CNS. We investigated how a disruption in barrier function by transient exposure to 3M urea affects locusts' vulnerability to disturbances in ion levels. Repetitive SD was induced by bath application of ouabain and the extracellular potassium concentration ([K(+)]o) within the metathoracic ganglion (MTG) was monitored. Urea treatment increased the susceptibility to ouabain and caused a progressive impairment in the ability to maintain baseline [K(+)]o levels during episodes of repetitive SD. Additionally, using a within animal protocol we demonstrate that waves of SD, induced by high K(+), propagate throughout the MTG faster following disruption of the BBB. Lastly, we show that targeting the BBB of intact animals reduces their ability to sustain neural function during anoxic conditions. Our findings indicate that locust's ability to withstand stress is diminished following a reduction in barrier function likely due to an impairment of the ability of neural tissue to maintain ionic gradients.

Identifying a high risk cardiovascular phenotype by carotid MRI-depicted intraplaque hemorrhage.

Intraplaque hemorrhage (IPH), a component of late-stage complicated plaque, identified within carotid endarterectomy surgical specimens has been recently demonstrated to predict cardiovascular (CV) events. MRI is able to depict carotid IPH. We investigated the ability of carotid MR-depicted IPH (MR-IPH) to identify high-risk CV patients. From January 2008 to April 2011, 216 patients (mean age, 67.5 years; range 31-100) referred for neurovascular MRI at an academic tertiary care centre, underwent 3T carotid MRI with adjunct 3D high-spatial-resolution coronal imaging to detect MR-IPH. Five experienced neuroradiologists made a binary decision on the presence or absence of MR-IPH. Patients' charts were reviewed blindly for demographic and CV outcomes data. Of the patients with and without MR-IPH, 62.5 % (15/24) and 19.8 % (38/192) had a composite CV event (defined as a past myocardial infarction, coronary intervention (i.e., angioplasty, stenting or bypass graft) and/or peripheral vascular disease), respectively. The odds ratio (OR) of a composite CV event in the MR-IPH group was 6.75 (Bivariable analysis, 95 % CI 2.75-16.6, p < 0.0001) and 3.25 (Multivariable regression analysis, 1.14-9.37, p = 0.028). MR-IPH had the highest OR of a prior CV event compared to other variables including age, sex, hypertension and stenosis. The OR of individual CV events was also significant: MI (3.35, 95 % CI 2.11-14.2, p < 0.01), coronary stenting (26.4, 95 % CI 8.80-79.4, p < 0.01), coronary angioplasty (21, 95 % CI 4.84-91.1, p < 0.01), and PVD (3.35, 95 % CI 1.09-10.3, p < 0.05). MR-IPH is independently associated with prior CV events in patients who are evaluated for neurovascular disease. Carotid MR-IPH, employed easily in routine clinical practice, is emerging as an indicator of systemic vascular disease and may potentially be a useful surrogate marker of CV risk including in those already undergoing neurovascular imaging.