Translation and validation of the Perinatal Grief Scale in a sample of Greek women with perinatal loss during the 1st and 2nd trimester of pregnancy.

OBJECTIVE: To translate and validate the Perinatal Grief Scale (PGS) (short version) in a sample of Greek women with perinatal loss during the first and second trimester of pregnancy. METHODS: One hundred seventy-six women were approached a few hours after the loss. Along with the PGS, three more questionnaires were completed: the Edinburgh Postnatal Depression Scale (EPDS), the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI), in order to assess the convergent validity of the PGS. RESULTS: Total sample mean age was 34.1 years (SD = 5.2). Mean values and Cronbach's alpha coefficients for PGS subscales exceeded the minimum reliability standard of 0.70. Mean score for "Active grief" was 31.47 (SD = 9.31), for "Difficulty Coping" was 23.13 (SD = 7.54) and for "Despair" was 21.07 (SD = 7.07). By applying Pearson's correlation coefficients, PGS subscales positively correlated with scores on EPDS, STAI and HADS. CONCLUSIONS: The PGS Greek version is a reliable instrument in terms of internal consistency and the Cronbach's alpha coefficients are high. The Greek version of PGS can be a useful instrument for the detection of the psychological impact after a perinatal loss and it has implications for both scientific research and clinical routine.

Schema therapy for patients with chronic depression: a single case series study.

BACKGROUND AND OBJECTIVES: This study tested the effectiveness of schema therapy (ST) for patients with chronic depression. METHODS: Twelve patients with a diagnosis of chronic depression participated. The treatment protocol consisted of 60 sessions, with the first 55 sessions offered weekly and the last five sessions on a biweekly basis. A single case series A-B-C design, with 6 months follow-up was used. Baseline (A) was a wait period of 8 weeks. Baseline was followed by introduction to ST and bonding to therapist (phase B) with individually tailored length of 12-16 sessions, after which further ST was provided (phase C) up to 60 sessions (included the sessions given as introduction). Patients were assessed with Hamilton Rating Scale for Depression three times during baseline, at the end of phase B, then every 12 weeks until the end of treatment and at 6 months follow-up. Secondary outcome measures were the Hamilton Rating Scale for Anxiety and the Young Schema Questionnaire. RESULTS: At the end of treatment 7 patients (approximately 60%) remitted or satisfactorily responded. The mean HRSD dropped from 21.07 during baseline to 9.40 at post-treatment and 10.75 at follow-up. The effects were large and the gains of treatment were maintained at 6-month follow-up. Only one patient dropped out for reasons not related to treatment. LIMITATIONS: The lack of control group, the small sample and the lack of a multiple baseline case series. CONCLUSIONS: This preliminary study supports the use of ST as an effective treatment for chronic depression.

Psychiatric manifestations preceding fetal death in antiphospholipid syndrome.

OBJECTIVES: Antiphosholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of thrombotic events, pregnancy morbidity and antiphospholipid antibodies. The objective of this report is to sensitize mental health professionals to the psychiatric manifestations of APS during pregnancy. To our knowledge, this is the first report on this matter. CASE SUMMARY: A 34-year-old pregnant woman, with no previous medical, obstetrical or psychiatric history, at the 18th week of pregnancy, acutely developed depressed mood, feelings of anxiety and insomnia with a strong premonition that "the fetus would die." Actual fetal loss ensued a few days later. During induced labor, the patient had an agitated delirium. Symptoms of depression, slowed mentation and apprehension persisted for at least 2 months after fetal demise and required pharmacological treatment. APS diagnosis was established based on clinical events and persistent findings of antiphosholipid antibodies as well as multiple high-density foci in the subcortical white matter of the frontal lobes in brain magnetic resonance imaging. CONCLUSIONS: Psychiatric symptomatology, as well as a premonitory sense of upcoming loss of pregnancy, preceded actual fetal loss and APS diagnosis in the presented case, indicating that psychiatric symptoms may present during pregnancy, perhaps as an early sign.

The impact of miscarriage on women's pregnancy-specific anxiety and feelings of prenatal maternal-fetal attachment during the course of a subsequent pregnancy: an exploratory follow-up study.

This study assesses the implications a miscarriage history has on women's pregnancy-specific anxiety and feelings of prenatal maternal-fetal attachment during the 1st and 3rd trimesters of a subsequent pregnancy. Thirty-five pregnant women (N = 10 with a history of miscarriage) volunteered participation completing the Pregnancy Outcome Questionnaire (POQ), the Maternal Antenatal Attachment Scale (MAAS and a demographic/reproductive history questionnaire during the first trimester of pregnancy. Of these, 24 participants completed the measures again during the third trimester of pregnancy. Women with a miscarriage history reported significantly higher pregnancy-specific anxiety at trimester 1 than women with no miscarriage history; even when the effects of parity were controlled. All expectant mothers, irrespective of miscarriage history, scored similarly at trimester 1 on the MAAS scales. By the 3rd trimester, pregnancy-specific anxiety had significantly decreased for women with a miscarriage history whose mean scores on the POQ were now similar to women with no history of miscarriage. Maternal-fetal attachment had significantly risen by the 3rd trimester for all women. These findings suggest that having a miscarriage history may not have a long-lasting adverse effect on woman's psychological adaptation during the course of a subsequent pregnancy.