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Recent papers from the Department of Psychiatry examine clinical initiatives around integration of behavioral health teams in OB-GYN clinics, fetal inflammatory response and risk for psychiatric disorders, and the association between benzodiazepine use and risk of cognitive impairment among older adults. 

Impact of colocated behavioral health on OB-GYN clinicians' rate of perinatal behavioral health diagnosis and psychotropic prescription

Perinatal behavioral health disorders affect 15–50% of individuals who give birth. Such disorders drive preventable maternal death from drug overdoses and suicide, and increase risk for adverse perinatal outcomes and suboptimal child development. Despite widespread improvements in rates of perinatal behavioral health disorder screening, effective treatment is hindered by factors including patients’ lack of access to behavioral health practitioners, lack of transportation, absent/inadequate health insurance, and fear of intrusion by child welfare and legal systems. 

Physicians including Eydie Moses-Kolko, MD (Associate Professor of Psychiatry); Priya Gopalan, MD (Associate Professor of Psychiatry and Obstetrics, Gynecology and Reproductive Sciences); and Abigail Schlesinger, MD (Associate Professor of Psychiatry and Pediatrics), from Pitt Psychiatry, collaborated with the University of Pittsburgh Clinical and Translational Science Institute (CTSI) and Biostatistics core to analyze electronic medical record behavioral health data from UPMC Magee-Womens Hospital community OB-GYN clinics. They measured the rates of behavioral health diagnoses and prescriptions made by OB-GYN clinicians before and after colocation of a psychiatrist (0.1 FTE) and three behavioral health clinicians (2.0 FTE). 

“Birthing people face many barriers to accessing behavioral health care, but they see OB-GYN clinicians regularly throughout their pregnancy. We wanted to find out whether real-world integration of behavioral health care teams in OB-GYN clinics would increase OB-GYN clinician behaviors to diagnose behavioral health disorders and prescribe psychotropic medications to pregnancy and postpartum individuals,” said Dr. Moses-Kolko.

In General Hospital Psychiatry, the investigators reported that the integration of psychiatrists into OB-GYN clinics was associated with a 45.7% higher likelihood of patients receiving a behavioral health diagnosis from their OB-GYN physician, and was not associated with any change in OB-GYN behavioral health prescriptions. They additionally found that OB-GYN clinicians made fewer behavioral health diagnoses and prescribed fewer psychotropics after behavioral health clinician integration.

“Integrated models of care are vital to the improvement of access and availability of evidence-based treatment,” said Dr. Schlesinger. “This study is particularly important because it provides evidence that the presence of psychiatrists in OB-GYN integrated care models improves the ability to appropriately diagnose women with peripartum mood disorders, thereby increasing quality of care.” 

Impact of colocated behavioral health on OB-GYN clinicians' rate of perinatal behavioral health diagnosis and psychotropic prescription
Moses-Kolko EL, Li R, Gopalan P, Poerschke R, Schlesinger AB.
General Hospital Psychiatry Volume 84, September–October 2023, Pages 18-24.

Fetal inflammatory response and risk for psychiatric disorders

Maternal or fetal inflammation is one of the mechanisms implicated in the long-term alteration of brain development throughout childhood. A recent study in Translational Psychiatry examines the link between fetal inflammatory syndrome (placental inflammation in the peri-partem period) and neuropsychiatric disorders during childhood. 

Investigators including Nadine Melhem, PhD (Associate Professor of Psychiatry and Clinical and Translational Science), from Pitt Psychiatry, and Blake Gibson, MD (UPMC Western Psychiatric Hospital child & adolescent psychiatry fellow), analyzed data from 4,851 children born with placentas meeting criteria for fetal inflammatory syndrome through a diagnosis of funisitis and/or chorionic vasculitis, and from a comparison group of children without funisitis and/or chorionic vasculitis. 

The investigators found an increased risk of neuropsychiatric disorders in children born with fetal inflammatory syndrome  compared to those without fetal inflammatory syndrome. More specifically, the incidence of autism spectrum disorder, attention deficit hyperactivity disorder, conduct disorder, post-traumatic stress disorder, and any psychiatric disorder was elevated in these children, which was significant even after adjusting for maternal history of psychiatric disorders, maternal substance use during pregnancy, and maternal lifetime history of suicide attempts.

“This work is the result of an interdisciplinary team with training in pathology, psychiatry, and machine learning, providing the first evidence of a relationship between fetal inflammatory syndrome and risk for neuropsychiatric disorders,” said Dr. Melhem, the study’s corresponding author. “These results highlight an early developmental period where prevention and intervention efforts could pay off long-term, reducing the burden of childhood psychiatric disorders.” 

Fetal inflammatory response and risk for psychiatric disorders
Gibson B, Goodfriend E, Zhong Y, Melhem NM.
Translational Psychiatry volume 13, Article number: 224 (2023)

Benzodiazepine use and risk of incident MCI and dementia in a community sample

Among older adults, benzodiazepines reduce anxiety symptoms but are also associated with the risk of short-term cognitive impairment and falls. Controversy persists regarding whether benzodiazepines carry risk for long-term adverse cognitive effects such as progressive cognitive impairment. 

Investigators including Esther Teverovsky, MD (Assistant Professor of Psychiatry); Ariel Gildengers, MD (Professor of Psychiatry); and Mary Ganguli, MD, MPH (Professor of Psychiatry, Epidemiology, and Neurology), from Pitt Psychiatry, examined whether benzodiazepine use was associated with the development of mild cognitive impairment or dementia in older adults without cognitive impairment. Study participants were recruited from small towns of relatively low socioeconomic status in southwestern Pennsylvania, and included in the Monongahela-Youghiogheny Health Aging Team (MYHAT) cohort, a population study sponsored by a research grant from the National Institute on Aging.

“Population-based research offers the opportunity to learn from individuals who may not be well-represented in clinic-based research and allows us to ask more nuanced questions than can captured using healthcare databases. Many studies have examined the relationship between benzodiazepine use and the development of dementia, but few have been done in community-based samples, and fewer still have examined both mild cognitive impairment and dementia.” said Dr. Teverovsky, the study’s lead author. 

In the journal International Psychogeriatrics, the scientists reported findings that benzodiazepine use was associated with a 50% elevated risk of development of mild cognitive impairment, but not dementia. 

“In the population at large, not everyone with mild cognitive impairment progresses to dementia; benzodiazepine use may increase risk of the kind of mild cognitive impairment that does not. Minimizing the use of these drugs by older adults might reduce their risk of developing mild cognitive impairment,”  said Dr. Ganguli, the study’s senior author. 

Benzodiazepine use and risk of incident MCI and dementia in a community sample
Teverovsky EG, Gildengers A, Ran X, Jacobsen E, Chang EH, Ganguli M.
International Psychogeriatrics, 1-7. doi:10.1017/S1041610223000455