RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,



SYNOPSIS

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

“COGNITIVE FUNCTIONS AND PSYCHOPATHOLOGY IN WOMEN DURING POSTPARTUM”

Name of the candidate : Dr. CHANDINI

Guide : Dr. P. JOHN MATHAI

Course and Subject : M.D. (PSYCHIATRY)

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Department of Psychiatry

Father Muller Medical College

Kankanady, Mangalore – 575002.

AUGUST-2010

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

ANNEXURE- II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1. |NAME OF THE CANDIDATE |DR. CHANDINI |

| |AND ADDRESS |M.D. PSYCHIATRY, |

| | |DEPARTMENT OF PSYCHIATRY, |

| | |FR.MULLERS MEDICAL COLLEGE, |

| | |KANKANADY, |

| | |MANGALORE – 575002 |

|2. |NAME OF THE INSTITUTION |FATHER MULLER MEDICAL COLLEGE |

| | |KANKANADY |

| | |MANGALORE- 575002 |

|3. |COURSE OF STUDY AND SUBJECT |M.D. PSYCHIATRY |

|4. |DATE OF ADMISSION TO COURSE |30th April 2010 |

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|5. |TITLE OF THE TOPIC |

| |“ COGNITIVE FUNCTIONS AND PSYCHOPATHOLOGY IN WOMEN DURING POSTPARTUM” |

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|6. |BRIEF RESUME OF THE INTENDED WORK |

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| |6.1 NEED FOR THE STUDY: |

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| |Women during postpartum period may experience cognitive dysfunctions in terms of difficulty in thinking abilities, fogginess |

| |in memory, recent memory loss, forgetfulness, difficulty in concentration and distractibility. It has been reported that |

| |postpartum women may find difficulty in performing certain cognitive tasks. They may have reduced ability for intentional |

| |learning and semantic retrieval memory. Alterations in the levels of hormones such as estrogen, progesterone, and |

| |glucocorticoids can have influence on cognitive functions of women during pregnancy and postpartum. |

| |Psychopathology in women during postpartum have been reported ever since Hippocrates who described postnatal depression. |

| |Substantial proportions of women develop psychiatric disorders after childbirth. Women are more vulnerable to develop |

| |psychopathology during postpartum period. |

| |Research in this area is limited. The present investigator could find only a few published papers from India on cognitive |

| |functioning and psychopathology in women during postpartum. |

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|6. |6.2 REVIEW OF LITERATURE: |

| |For some women the weeks after childbirth represent a time of increased vulnerability for psychopathology. The burden of |

| |postpartum psychiatric disorders is significant because it affects the mother, the family and the development of the infant.1 |

| |Classical psychopathology during postpartum period includes postpartum blues (adjustment disorder) postpartum depression (major|

| |depression) and post partum psychosis. More recently postpartum panic disorder and postpartum obsessive compulsive disorder |

| |have been recognized.2, 3 |

| |It has been reported that up to 85% of postpartum mothers experience postpartum blues and postpartum psychosis occurs in 1 -2 |

| |of every 1000 births.4 Although the prevalence of major depression during the 6 months after childbirth is only 10% similar to |

| |that of the general population, its rate has been reported as three times higher during the first 5 postpartum weeks.5 Cox et |

| |al reported that a large proportion of women have severe postnatal depression or milder depression which last at least for 4 |

| |weeks. They found that postpartum psychopathology is related to obstetric and clinical variables.6 |

| |Disturbances in sleep, higher levels of dysphoric mood and cognitive dysfunctions are reported in postpartum patients. Sleep |

| |loss may influence the cognitive functions, performances of memory and psychomotor tasks .7 Memory encoding and retrieval as |

| |assessed with a work learning task are significantly lower during postpartum. General speed of information processing is also |

| |observed to be slower during early motherhood.8 |

| | |

| |OBJECTIVES: |

| |To evaluate the frequency and nature of cognitive functions in women during postpartum. |

| |To evaluate the frequency and nature of psychopathology in women during post partum. |

| |To find out the relationship between cognitive dysfunctions and sociodemographic and clinical variables in women during |

| |postpartum. |

| |To find out the relationship between psychopathology and sociodemographic and clinical variables in women during postpartum. |

| |MATERIALS & METHODS |

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| |7.1 PLACE AND PERIOD : |

| |This clinical study will be carried out in the Department of Obstetrics and Gynaecology and Psychiatry, Father Muller's Medical|

| |College, Mangalore. This clinical investigation will commence from October 2010 and data collection will be completed by August|

| |2012 |

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| |7.2 METHODS OF COLLECTION OF DATA |

| |SAMPLE: |

| |Women who attend the Obstetrics and Gynecology Outpatient Department for first follow up after childbirth will constitute the |

|7. |population for the investigation. One hundred such women selected at random will form the sample for the study. |

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| |INCLUSION CRITERIA : |

| |Women who come for first follow up between 3rd and 6th week after child birth attending Outpatient Department of any of the |

| |three Obstetrics and Gynecology units. |

| |Women between the ages of 20 – 40 years. |

| |Women who are educated above primary school level. |

| |Women who agree for the investigation with written informed consent. |

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| |EXCLUSION CRITERIA : |

| |Women with preexistent neuropsychiatric, neurological or major medical disorders. |

| |Women with history of diabetes mellitus and hypertension during pregnancy. |

| |Women with substance use disorder. |

| |Women with significant sensory, visual or hearing impairments or intellectual deficiency. |

| |Women who are on long term medication such as steroids, antiepileptic drugs or other drugs that are known to cause cognitive |

| |dysfunctions or psychopathology. |

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| |CONTROL: |

| |50 women related to the subjects selected at random, between the age 20 and 40 years will constitute the control group |

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| |INCLUSION CRITERIA: |

| |Non pregnant women who are relatives of subjects who attend the Obstetrics and Gynecology Outpatient Department for first |

| |follow up. |

| |Women between the ages 20 – 40 years. |

| |Women who are educated above primary school level. |

| |Women who have agreed for the investigation with written informed consent. |

| | |

| |EXCLUSION CRITERIA: |

| |Women with preexistent neuropsychiatric, neurological or major medical disorders. |

| |Women with substance use disorder. |

| |Women with significant sensory, visual or hearing impairments or intellectual deficiency. |

| |Women who are on long term medication such as steroids, antiepileptic drugs or other drugs that are known to cause cognitive |

| |dysfunctions or psychopathology. |

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| |INSTRUMENTS FOR ASSESSMENT: |

| |Standardized Mini Mental Status Examination. (SMMSE) |

| |Brief Cognitive Rating Scales. (BCRS) |

| |Trail Making Test - B. (TMT – B ) |

| |Digit Symbol Substitution Test. (DSST) |

| |ICD-10 AM Symptom checklist for Mental Disorders (ICD-10 AM SCL- WHO) |

| |Comprehensive Psychopathology Rating Scale (CPRS- Asberg M.et al 1978) |

| |Marital Quality Scale (MQS- Shah A 1991) |

| |Short Form 36 Health survey (SF 36) |

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| |TYPE OF STUDY : CASE CONTROL STUDY |

| |PROCEDURE: |

| |Written informed consent will be obtained from all the subjects and all the women in the control group. All the subjects |

| |(n=100) and all the women in the control group (n= 50) will undergo a thorough physical and mental status examination. The |

| |clinical assessment and the evaluation of cognitive functions and psychopathology will be done during the 3rd to 6th week after|

| |childbirth depending on the time of first follow up after child birth in the case of subjects. The sociodemographic and |

| |clinical information will be collected from all women and recorded using a specially designed proforma for the clinical study. |

| |Socioeconomic status of the women will be assessed using Socio Economic Status Schedule (SESS- Sodhi and Sharma 1986). Quality |

| |of marital life will be assessed using Marital Quality Scale (MQS- Shah A 1991). Quality of life will be assessed using Short |

| |Form 36 Health Survey (SF 36). Each subject and women in the control group will be screened using ICD10-AM Symptom Check List |

| |for Mental Disorders Screener and ‘cases ’will be identified. All the cases will be administered appropriate modules of ICD |

| |10-AM Symptom Check List. Diagnosis of psychiatric disorders will be made on the basis of Diagnostic Criteria for Research |

| |(DCR-10). The psychopathology will be rated using Comprehensive Psychopathology Rating Scale in all the women. All the women in|

| |the experimental and the control group will be evaluated for the cognitive functioning using Standardized Mini Mental Status |

| |Examination, Brief Cognitive Rating Scales, Trail Making Test- B, and Digit Symbol Substitution Test. |

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| |STATISTICAL ANALYSIS : |

| |The data will be analyzed using chi-square test, t test (independent and paired) and Karl Pearson co-relation co-efficient. |

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| |7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? |

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| |No |

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| |7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3? |

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| |Yes (submitted) |

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| |LIST OF REFERENCES |

| |1. Kendell RE, Chalmers JC, Plats C. Epidemiology of puerperal psychosis. British Journal of Psychiatry. 1987.150.662-673. |

| |2. Shear.MK, Mammen.O. Anxiety disorder in pregnant and postpartum women. Psychopharmacology Bulletin.1995.31.603-703. |

| |3. Brokington I. Obstetric and gynaecological conditions associated with psychiatric disorder. In New Oxford Text Book of |

| |Psychiatry. Edition 2nd Volume – 2.Edited by Gelder MG, Andreason NC, Lopez- Ibor JJ, Geddes JR. Oxford University Press. |

| |Oxford. 2009.1114-1127 |

| |4. O’Hara. MW. Postpartum depression, Causes and Consequences. Edited by O’Hara MW. Springer –Verlag. New York.1995.168-194. |

| |5. Cox JL, Murray D, Chapman G. A controlled study of the onset, duration and prevalence of postnatal depression. British |

| |Journal of Psychiatry.1993.163.27-31. |

| |6. Cox JL, Connor.Y, Kendell.RE. Prospective study of psychiatric disorders of childbirth. British Journal of |

| |Psychiatry.1982.140.111-117 |

| |7. Swain, Annette M.MA, O’Hara, Michael W., Starr, Kathleen R., Gorman, Laura L. A prospective study of sleep, mood, |

| |and cognitive function in postpartum and non postpartum women. Obstetrics and gynaecology 1997; 90(3): 381-386. |

| |8. De Groot R.H.M., Vuurman E.F.P.M., Hornstra G., and Jolles J. Differences in cognitive performance during pregnancy and |

| |early motherhood. Psychological Medicine 2006; 36(7):1023-1032. |

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| |SIGNATURE OF THE CANDIDATE | |

|10 |REMARKS OF THE GUIDE |This is a clinical study to evaluate the psychopathology and cognitive functions in |

| | |postpartum women. |

|11. |NAME AND DESIGNATION OF | |

| |11.1 GUIDE | |

| | |Dr. P. JOHN. MATHAI |

| | |PROFESSOR |

| | |DEPARTMENT OF PSYCHIATRY |

| | |FATHER MULLER MEDICAL COLLEGE |

| |11.2 SIGNATURE |MANGALORE-575002 |

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| |11.3 CO-GUIDE | |

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| |11.4 SIGNATURE | |

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| |11.5 HEAD OF THE DEPARTMENT |DR. K.KRISHNAMURTHY |

| | |PROFESSOR & HOD |

| | |DEPARTMENT OF PSYCHIATRY |

| | |FATHER MULLER MEDICAL COLLEGE |

| | |MANGALORE-575002 |

| |11.6 SIGNATURE | |

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|12. | | |

| |12.1 REMARKS OF THE CHAIRMAN AND | |

| |PRINCIPAL | |

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| |12.2 SIGNATURE | |

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