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Major depressive disorder (MDD) is a common disorder in pregnancy. Although sertraline is the most frequently prescribed antidepressant for pregnant people in the United States, limited information about its pharmacokinetics in pregnancy is available. Our objectives were to characterize plasma sertraline concentration to dose (C/D) ratios across pregnancy and postpartum and investigate the effect of pharmacogenetic variability on sertraline elimination. We performed a prospective observational cohort study in people with a singleton pregnancy ≤ 18 weeks gestation and a lifetime diagnosis of MDD at the 3 Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)-funded Obstetrical-Fetal Pharmacology Research Center sites. Subjects (N = 47) were receiving maintenance sertraline therapy and chose to continue it during pregnancy. Blood samples were obtained 24-hours postdose every 4 weeks across pregnancy and twice postpartum for measurement of plasma concentrations of sertraline and desmethylsertraline. Overall mean sertraline C/D ratios were decreased at study onset and remained consistently low until after delivery. During the last 4 weeks of pregnancy the mean sertraline C/D ratio (95% confidence interval (CI)), 0.25 (95% CI, 0.19, 0.3) ng/mL/dose (mg/day), was smaller than the mean ratio at ≥ 8 weeks after delivery, 0.32 (95% CI, 0.27, 0.37) ng/mL/dose (mg/day), a 22% difference. Mean sertraline/desmethylsertraline ratios were highest after birth, which confirmed increased sertraline elimination during pregnancy. Sertraline C/D ratios in participants with functional CYP2C19 activity did not change significantly during pregnancy, whereas ratios in participants with poor or intermediate CYP2C19 activity decreased by 51%. Exploratory pharmacogenomic analysis indicated that pregnant people with poor or intermediate CYP2C19 activity are at risk for subtherapeutic sertraline concentrations during pregnancy.

Timeout is an effective behavior-reduction strategy with considerable generality. However, little is known about how timeout is implemented under natural conditions, or how errors in implementation impact effectiveness. During Experiment 1, we observed teachers implementing timeout during play to evaluate how frequently the teachers implemented timeout following target behavior (omission errors) and other behaviors (commission errors) for four children. Teachers rarely implemented timeout; thus, omission errors were frequent, but commission errors rarely occurred. During Experiment 2, we used a reversal design to compare timeout implemented with 0% omission integrity, 100% integrity, and the level of omission integrity observed to occur during Experiment 1 for two of the participants. Timeout implemented with reduced-integrity decreased problem behavior relative to baseline, suggesting that infrequent teacher implementation of timeout may have been sufficient to reduce problem behavior.

Tracking perinatal mood and anxiety disorders is championed by the American Psychiatric Association and the International Marcé Society for Perinatal Mental Health. We conducted this study to examine trajectories of monthly depressive and anxiety symptoms through pregnancy and postpartum.This is a prospective longitudinal observational cohort study of pregnant women interviewed at baseline (≤18th gestational week), every four weeks through delivery and at 6 and 14 weeks postpartum at three urban academic medical centers (Three relatively stable depression trajectories emerged, described as Minimal, Mild, and Subthreshold, in each group across pregnancy. Two of the four anxiety trajectories were stable, including Asymptomatic and Minimal, while the third, termed Breakthrough, was ascending with increasing symptoms and the fourth trajectory, described as Mild, had descending symptoms.Screening for anxiety with depression for pregnant women will yield a comprehensive view of psychiatric symptoms and treatment targets in perinatal women.

The Edinburgh postnatal depression scale (EPDS; Cox, Holden, & Sagovsky, 1987 ) is one of the most extensively researched self-report tools to screen for perinatal depression. Depression with peripartum onset (PPD) is defined as the onset of depression during pregnancy or after delivery. The EPDS is a 10-item self-report that measures the severity of a person’s mood and anxiety symptoms in the past 7 days. This chapter presents an overview of the EPDS format, purpose, and administration. We describe the method of scoring and interpreting results, its psychometric properties, and relevant cultural considerations. We will also describe how the EPDS can be used in clinical and research initiatives. Applications include the detection of PPD symptoms during the perinatal phase, evaluation of treatment efficacy, use in neuroscience research initiatives, and the improvement of patient care coordination.

Resurgence is the reemergence of a previously reinforced behavior following the extinction of an alternative behavior. Although several variables are known to impact resurgence, few studies have examined resurgence when the target response was previously punished. Results of two studies examining resurgence after punishment have been mixed. In the current study, we employed a human-operant procedure to compare resurgence following differential reinforcement of alternative behavior (DRA) with extinction and DRA with extinction and response cost. For the three participants, target responding was eliminated more rapidly and fully following DRA with response cost. Similar levels of resurgence, however, occurred following both procedures. These data provide evidence that arranging response cost during DRA facilitates suppression of target responding without affecting subsequent resurgence. The results further our understanding of the role of negative punishment in resurgence as a process and have implications for the development of clinical intervention packages.

Background Preeclampsia remains a major cause of maternal and neonatal morbidity and mortality. Biologic plausibility, compelling preliminary data, and a pilot clinical trial support the safety and utility of pravastatin for the prevention of preeclampsia. Objective We previously reported the results of a phase I clinical trial using a low dose (10 mg) of pravastatin in high-risk pregnant women. Here, we report a follow-up, randomized trial of 20 mg pravastatin versus placebo among pregnant women with previous preeclampsia who required delivery before 34+6 weeks’ gestation with the objective of evaluating the safety and pharmacokinetic parameters of pravastatin. Study Design This was a pilot, multicenter, blinded, placebo-controlled, randomized trial of women with singleton, nonanomalous pregnancies at high risk for preeclampsia. Women between 12+0 and 16+6 weeks of gestation were assigned to receive a daily pravastatin dose of 20 mg or placebo orally until delivery. In addition, steady-state pravastatin pharmacokinetic studies were conducted in the second and third trimesters of pregnancy and at 4 to 6 months postpartum. Primary outcomes included maternal-fetal safety and pharmacokinetic parameters of pravastatin during pregnancy. Secondary outcomes included maternal and umbilical cord blood chemistries and maternal and neonatal outcomes, including rates of preeclampsia and preterm delivery, gestational age at delivery, and birthweight. Results Of note, 10 women assigned to receive pravastatin and 10 assigned to receive the placebo completed the trial. No significant differences were observed between the 2 groups in the rates of adverse or serious adverse events, congenital anomalies, or maternal and umbilical cord blood chemistries. Headache followed by heartburn and musculoskeletal pain were the most common side effects. We report the pravastatin pharmacokinetic parameters including pravastatin area under the curve (total drug exposure over a dosing interval), apparent oral clearance, half-life, and others during pregnancy and compare it with those values measured during the postpartum period. In the majority of the umbilical cord and maternal samples at the time of delivery, pravastatin concentrations were below the limit of quantification of the assay. The pregnancy and neonatal outcomes were more favorable in the pravastatin group. All newborns passed their brainstem auditory evoked response potential or similar hearing screening tests. The average maximum concentration and area under the curve values were more than 2-fold higher following a daily 20 mg dose compared with a 10 mg daily pravastatin dose, but the apparent oral clearance, half-life, and time to reach maximum concentration were similar, which is consistent with the previously reported linear, dose-independent pharmacokinetics of pravastatin in nonpregnant subjects. Conclusion This study confirmed the overall safety and favorable pregnancy outcomes for pravastatin in women at high risk for preeclampsia. This favorable risk-benefit analysis justifies a larger clinical trial to evaluate the efficacy of pravastatin for the prevention of preeclampsia. Until then, pravastatin use during pregnancy remains investigational.

Participation in college classrooms remains low, despite evidence that increased participation contributes to better grades. Incorporating active student educational strategies may help combat poor participation. The Good Behavior Game is a tool for improving various behaviors of children and adolescents in schools. However, strategies similar to the Good Behavior Game have not yet been assessed with young adults in college classrooms. We used an alternating treatments design to evaluate effects of a modified version of the Good Behavior Game on participation across three introductory psychology courses at a public university. We collected baseline data on class participation and then compared two variations of the Good Behavior Game—one included delivering a preferred reward to individuals on the winning team and one did not include a reward. Incorporating components of the Good Behavior Game increased class participation with and without a preferred reward, relative to baseline. Students reported preferring the game with a reward relative to the game with no reward and not playing the game. Because class participation has been correlated with better course grades, incorporating features of the Good Behavior Game may be a feasible approach for improving college students’ education.