Preeclampsia, Perinatal Complications Linked to Developmental, Psychiatric Disorders in Children

Preeclampsia and perinatal complications such as preterm birth and low birth weight may raise the risk of neurodevelopmental and psychiatric disorders in children and adolescents, a study in JAMA Network Open has found.

Linghua Kong, Ph.D., of the Karolinska Institutet in Stockholm and colleagues analyzed data from more than 1 million people born in Finland between January 1, 1996, and December 31, 2014. The researchers followed the children until December 31, 2018, when the oldest in the study were 22 years old. There were no twins, triplets, or other children born in multiple births in the study. The researchers used Finnish health registries to determine how many of the children’s mothers had preeclampsia while pregnant. They also determined how many children were born earlier than 34 weeks’ gestation or had low birth weight, defined together as perinatal complications.

Compared with children who were not exposed to preeclampsia or perinatal complications, children who were exposed only to perinatal complications had 1.77 times the risk of developing any neurodevelopmental or psychiatric disorder, and children who were exposed to both conditions had 2.11 times the risk. Children who were exposed only to preeclampsia did not appear to have increased risk when the researchers adjusted the results to account for shared familial risk factors.

Children who were exposed to both preeclampsia or perinatal complications also had 3.24 times the risk of intellectual disabilities, 3.56 times the risk of developmental disorders, 2.42 times the risk of attention-deficit/hyperactivity disorder and conduct disorders, and 2.45 times the risk of other behavioral and emotional disorders compared with children who were exposed to neither condition.

The researchers noted several limitations to the study, including a lack of data on paternal factors.

“[E]xploration of factors moderating and mediating the association of exposure to both preeclampsia and perinatal complications with neurodevelopmental and psychiatric disorders in offspring is warranted,” Kong and colleagues wrote.

(Image: iStock/AndreyPopov)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

High Rates of Polypharmacy Found Among Adults With Intellectual Disability Seeking Psychiatric Care

By the time adults with intellectual disability sought specialized psychiatric outpatient services in a Canadian clinic, 70% had already been prescribed one psychotropic medication, and 22% had received three or more psychotropic medications, according to a study in Psychiatric Services in Advance. The findings underscore the importance of educating non-specialist providers about prescribing guidelines for this patient population.

“Understanding the demographic, organizational, and clinical characteristics that place individuals at greater risk of polypharmacy may help in the design of future intervention efforts,” wrote lead author Yona Lunsky, Ph.D., a professor in the Department of Psychiatry at the University of Toronto, and colleagues.

The researchers identified predictors of psychotropic polypharmacy using a retrospective chart audit for patients referred to a specialized psychiatric outpatient clinic for people with intellectual disabilities in Canada between 2005 and 2013. Predictors that psychotropic polypharmacy was likely to occur among these patients included (1) living in a supervised residential setting; (2) having a diagnosis of anxiety, mood, or psychotic disorder; (3) having a diagnosis of psychiatric complexity (two or more diagnostic categories); and (4) being a woman. 

In this study and a prior study, polypharmacy rates were not associated with the severity of intellectual disability or autism spectrum disorder.

The study sample consisted of 517 outpatients (199 females; 318 males) aged 15 to 73 in an urban, tertiary-level mental health care facility in Ontario, Canada. Before receiving specialist care, these individuals with intellectual disability received their medications from either family physicians or general psychiatrists. 

Of the 70% of the study patients prescribed at least one psychotropic medication, 146 (40%) had no psychiatric diagnosis on their intake form. One hundred and twelve (22%) referred to the service received three or more psychotropic medications concurrently, 30 of them without having any psychiatric diagnosis. The most commonly prescribed medication class was antipsychotics (n=275, 53%), followed by antidepressants (n=151, 29%). The most common interclass polypharmacy combination was antipsychotics, mood stabilizers, and antidepressants (n=52). 

“Although there are circumstances in which psychotropic polypharmacy may be warranted, guidelines suggest that intraclass polypharmacy be avoided, that medications for behavior management be offered in combination with psychological or other interventions, and that there be regular monitoring of medication use, with the goal of reducing multiple medications when possible,” the authors wrote. “Both psychiatrists and family physicians can play a role in the judicious use of medications for this vulnerable population.”

(Image: iStock/smartstock)

Supreme Court Rules on Use of IQ in Death Penalty Cases

The U.S. Supreme Court yesterday decided that a fixed IQ score alone cannot be used by the states to evaluate intellectual disability and thus determine eligibility for the death penalty. In a 5-to-4 decision, the Court ruled in favor of Freddie Lee Hall, convicted more than three decades ago in Florida for the rape and murder of a 21-year-old woman.

“The majority demonstrated a recognition of the complexities in diagnosing intellectual disability and that such a diagnosis involves much more than reliance on an IQ score,” Richard Frierson, M.D., a professor of clinical psychiatry at the University of South Carolina School of Medicine, told Psychiatric News.

APA contributed to an amicus curiae brief on Hall’s behalf, arguing that an IQ score of 70 could not be used without also considering adaptive functioning and the age of onset of the condition. Those criteria reflect standards adopted in DSM-5, which the Court cited in its opinion. “As the majority opinion indicates, there are areas where professional expertise can inform the legislature and the courts so that the decision makers will have the consensus of the field before them in these very important determinations, commented APA President Paul Summergrad, M.D. “APA is pleased that the Court considered the advances in diagnosis contained in DSM-5 and our arguments in the amicus brief we filed along with the American Psychological Association in outlining the legal approach to be used for the determination of intellectual disability in death penalty cases.”

“The Court’s decision in Hall recognizes that criteria for diagnosis of mental disorders—here specifically intellectual disability—should be determined by professional standards, not by the arbitrary decisions of state legislatures,” said Paul Appelbaum, M.D., the Dollard Professor of Psychiatry, Medicine, and Law and director of the Division of Law, Ethics, and Psychiatry at Columbia University, in an interview. “From a court that is often skeptical of psychiatry, this is a major acknowledgment that courts should turn to psychiatry when issues related to the diagnosis of mental disorders arise.” Appelbaum is chair of the APA Committee on Judicial Action.

For more in Psychiatric News about the case Hall v. Florida, see the article, "High Court Weighs Standards for Intellectual Disability."

(Image: antb/Shutterstock.com)

New Findings on Genetic Mutations Shed Light on Schizophrenia—and More

Much of the genetic risk for schizophrenia is inherited, but not all. Now, a study finds that a small number of de novo mutations—those occurring in the individual but not the parents—disrupt certain genes encoding postsynaptic proteins, which may have a part in triggering the disorder.

Furthermore, the study of 623 patients and their families found significant overlaps between these mutations and pathogenic mechanisms underlying autism and intellectual disability, wrote Michael Owen, M.D., Ph.D., director of the Institute of Psychological Medicine and Clinical Neurosciences at Britain’s Cardiff University, and colleagues. The study was published today in the journal Nature.

“How disruption of these synaptic mechanisms affects brain function to produce psychopathology cannot be answered by genetic studies alone, but our identification of de novo mutations in these gene sets provides the basis to address this,” said Owen and colleagues. Findings of overlaps among the mechanisms associated with schizophrenia, autism, and intellectual disability may add support to approaching research into mental illnesses that “places more emphasis on domains of psychopathology (for example, cognition) and their neurobiological substrates rather than current diagnostic categories,” they suggested.

To read more about research directions in mental illness, see the Psychiatric News article, "Despite Brain Research Advances, Significant Challenges Remain." Also see the American Journal of Psychiatry study,
"Genome-Wide Linkage Analyses of 12 Endophenotypes for Schizophrenia From the Consortium on the Genetics of Schizophrenia."

(Image: suravid/Shutterstock.com)