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In this study, we assess competing interpretations of a burnt ceremonial structure from the terminal Middle Formative period (ca. 300–100 BCE) by analyzing the stepped platform mound at Chiripa, Bolivia, through a systematic reconstruction of the fire that destroyed it. We developed a model of potential fire pathways, their social contexts, and material indicators. Our approach contrasts incipient fires from accident or arson to planned fires initiated for functional or social ends. We assessed these pathways for the Chiripa mound fire through experimental, geoarchaeological, faunal, and botanical data. Experiments were aimed at deducing the temperature, duration, and oxidation conditions of the fire. The fire temperature and duration were approximated from geoarchaeological analyses of construction materials in comparison with controls, and thermal alteration of faunal bone. Fuels were reconstructed through paleoethnobotanical analysis of charred remains from discrete areas within the burnt structure. We conclude that an intentional fire burned the structures on the Chiripa mound to temperatures of 700 °C or higher under oxidizing conditions for several hours. The pattern of heat-altered materials recovered would have required a substantial supplemental fuel load. At the 3840 masl elevation of Chiripa, the effective control of a high temperature oxidizing fire demonstrates technical expertise in fire management. Our findings indicate the fire appears intentional, likely a ritual event. We believe the structures were burned to facilitate a socio-political change during a period of social transition at the end of the Middle Formative period in Bolivia.

Background: To examine clinician perspectives on the acceptability, appropriateness/suitability, and feasibility of video telehealth as a way to deliver mental health services during the COVID-19 pandemic. Materials and Methods: Mental health clinicians were surveyed with 27 Likert questions, using previously validated measures, on satisfaction and implementation experience with video telehealth visits between March and June 2020. Results: A total of 112 of 193 clinicians completed the survey (58.0%), including psychiatrists, psychologists, trainees (i.e., residents and fellows), advanced practice providers, and licensed mental health counselors. Clinicians reported high levels of acceptability, feasibility, and appropriateness of video telehealth; they also reported high levels of satisfaction with video telehealth visits. Seventy-nine and a half (79.5%) reported that their patients seemed highly satisfied with video telehealth visits, and 107 (95.5%) of clinicians responded that they would like video telehealth visits to represent at least 25% of their practice in the future. Discussion: Mental health clinicians showed positive attitudes toward the implementation of video telehealth visits, high levels of satisfaction with this care, and indicated strong interest in continuing this modality as a significant portion of clinical practice. Conclusion: This study demonstrates the ability of mental health clinicians to embrace new technology to expand access to care during the COVID-19 pandemic. Results indicate that telemental health is likely to be an integral part of clinic practice in the future.

Long-term lithium therapy (LTLT) has been associated with chronic kidney disease (CKD). We investigated changes in clinical characteristics, pharmacotherapeutic treatments for medical/psychiatric disorders, and outcomes among patients with bipolar disorder (BD) and CKD on LTLT in a 2-year mirror-image study design.Adult BD patients on LTLT for ≥1 year who enrolled in the Mayo Clinic Bipolar Disorder Biobank and developed CKD (stage 3) were included, and our study was approved by the Mayo Clinic Institutional Review Board. The primary outcome was the time to the first mood episode after CKD diagnosis among the lithium (Li) continuers and discontinuers. Cox proportional hazards models were used to estimate the time to the first mood episode. We tested for differences in other medication changes between the Li continuers and discontinuers group using Mantel-Haenszel χ2 tests (linear associations).Of 38 BD patients who developed CKD, 18 (47%) discontinued Li, and the remainder continued (n = 20). The median age of the cohort was 56 years (interquartile range [IQR], 48-67 years), 63.2% were female, and 97.4% were White. As compared with continuers, discontinuers had more psychotropic medication trials (6 [IQR, 4-6] vs 3 [IQR, 2-5], P = 0.02), a higher rate of 1 or more mood episodes (61% vs 10%, P = 0.002), and a higher risk of a mood episode after CKD diagnoses (Hazard Ratio, 8.38; 95% confidence interval, 1.85-38.0 [log-rank P = 0.001]].Bipolar disorder patients on LTLT who discontinued Li had a higher risk for relapse and a shorter time to the first mood episode, suggesting a need for more thorough discussion before Li discontinuation after the CKD diagnosis.

Bipolar Disorder (BD) is known to be equally distributed among males and females. The well-documented increased risk of medical comorbidities in patients with BD, in comparison to BD patients without medical comorbidities, shows a negative impact on the course of illness. There is some evidence suggesting that women with BD have higher psychiatric and medical comorbidities in comparison to men with BD, however there is no evidence in comparison to women without BD or other major psychiatric illness. These comorbidities, along with various psychosocial factors, are known to affect the course of BD.We aimed to systematically review the literature on cardiovascular, metabolic and endocrine comorbidities in women with BD in comparison to men with BD and control women. A comprehensive search of electronic databases including PubMed, PsycINFO, Embase, and SCOPUS was conducted, and a total of 61 identified studies were included in this review.Women with BD had higher rates of cardiovascular risk factors/mortality, diabetes mellitus II and thyroid disorders compared to women in the general population. In comparison to men with BD, women with BD had comparable cardiovascular risk but higher prevalence of metabolic and thyroid disorders.Gender specific data was limited in multiple studies.Results present a need for gender-specific screening and interventions for various medical comorbidities in patients with BD.

AIMS Long-term lithium therapy (LTLT) has been associated with kidney insufficiency in bipolar disorder (BD). We aimed to investigate the risk factors of chronic kidney disease (CKD) development and progression among BD patients receiving LTLT. METHODS We included adult patients with BD on LTLT (≥1 year) who were enrolled in the Mayo Clinic Bipolar Biobank, Rochester, Minnesota. We reviewed electronic medical records to extract information related to lithium therapy and kidney-related data to assess changes in the estimated glomerular filtration rate (eGFR). CKD severity was assessed based on eGFR. RESULTS Among 154 patients who received LTLT, 41 patients (27%) developed CKD, of whom 20 (49%) patients continued lithium (continuers) and 19 (46%) discontinued it (discontinuers). The median time to stage 3 CKD development was 21.7 years from the start of Li treatment. Type-2 diabetes mellitus and benzodiazepine use were independent predictors for CKD development in the survival analysis, after controlling for age. The subsequent CKD progression rate did not differ between continuers and discontinuers (mean GFR 48.6 vs. 44.1, p = 0.13) at the end of follow-up duration (mean duration: 3.5 ± 4.4 years for continuers and 4.9 ± 5.3 years for discontinuers). CONCLUSION CKD was observed in one fourth of patients with BD receiving LTLT. There was no significant difference in the progression of CKD among Li continuers versus discontinuers, at the mean follow-up duration of 4.2 years, after the CKD diagnosis. Progression of CKD could be influenced by existing comorbidities and may not necessarily be due to lithium alone.

OBJECTIVES: Recognizing bipolar disorder as a multi-system metabolic condition driven, in part, by binge eating behavior and atypical depressive symptoms, this study aimed to quantify diet quality and evaluate clinical correlates in a bipolar disorder cohort. METHODS: Participants from the Mayo Clinic Bipolar Disorder Biobank (n = 734) completed the Rapid Eating Assessment for Participants – Shortened version (REAP-S) to determine diet quality. The average REAP-S score for a U.S. omnivorous diet is 32 (range 13 to 39) with higher scores indicating healthier diet. Demographic variables were collected in a standardized clinical questionnaire. Depressive symptoms were assessed by the Bipolar Inventory of Symptoms Scale. Cardiometabolic variables were retrieved from the electronic health record. Associations between continuous variables and REAP-S scores (total, ‘healthy foods’ and ‘avoidance of unhealthy foods’) were assessed using linear regression. RESULTS: Overall, our sample had a mean REAP-S score of 27.6 (4.9), suggestive of a lower diet quality than the average general population in the US. There was a significant inverse relationship between mean REAP-S lower scores with increased BMI, waist circumference, disordered eating and depression. All these associations were significantly stronger in female participants. LIMITATIONS: EHR cross-sectional data. CONCLUSIONS: Our data suggest unhealthy diet quality in bipolar disorder is associated with depression, obesity and cardiometabolic abnormalities. Additional work is encouraged to prospectively track mood and diet quality to further understand the bidirectional relationship and clarify if dietary interventions can positively impact mood. Further delineating potential sex differences in diet quality and depression may provide greater appreciation of modifiable risk factors for future cardiometabolic burden.

Background: This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. Methods: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. Results: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. Conclusions: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.

Restless legs syndrome (RLS) affects about 20% of all pregnant women. RLS symptoms are usually moderate to severe in intensity during pregnancy and can result in insomnia, depression, and other adverse outcomes. Although iron deficiency has been implicated as a potential etiological factor, other mechanisms can also play a role. Nonpharmacologic methods are the primary recommended form of treatment for RLS in pregnancy and lactation. Iron supplementation may be considered when the serum ferritin is low; however, several patients are unable to tolerate iron or have severe symptoms despite oral iron replacement. Here, we describe a case of severe RLS in pregnancy and illustrate the dilemmas in diagnosis and management. We review the literature on the prevalence, diagnosis, course, possible underlying pathophysiologic mechanisms and complications of RLS in pregnancy. We describe current best evidence on the efficacy, and safety of nonpharmacologic therapies, oral and intravenous iron supplementation, as well as other medication treatments for RLS in pregnancy and lactation. We highlight gaps in the literature and provide a practical guide for the clinical management of RLS in pregnancy and during breastfeeding.

Knowing the epidemiological data regarding rates of burnout, depression, suicide, and substance use disorders in physicians – and specifically in women physicians – is a crucial first step in understanding and confronting this very important issue. Although studies vary widely in their reported rates of burnout due to a number of methodological differences, most evidence shows high levels of burnout among the majority of physicians across the training, life, and career spectrum. Burnout rates are correlated strongly to rates of depression, suicide, and substance use disorders. Evidence suggests that burnout is more commonly experienced in women physicians than their male counterparts, with some data suggesting that women physicians experience up to double the rate of burnout. More research is needed to fully understand and track rates of these topics in physician populations – particularly to understand gender differences and the impact of potential interventions.

Background Concurrent liothyronine treatment has been shown to accelerate time to response in patients treated for major depression. However, the relationship between genetic variation in deiodinase and T3 treatment response has received little investigation. Methods This is a post-hoc analysis of a randomized, double-blind, placebo-controlled trial of concurrent liothyronine (T3-Cytomel®, n = 23; mean dose 46.3 ± 3.3 mcg) in patients with major depression where a clinical recommendation was made to pursue ECT. The primary outcome measure was time to 50% reduction in depressive symptoms. Multivariable linear models were used to examine effect of T3 and placebo and genetic variants as predictors of change in HAMD24 and number of ECT treatments. Results Survival analysis did not show a significant effect for the T3 + ECT group achieving a faster time to response compared to placebo + ECT (p + ECT). Survival analysis for RUL lead placement alone showed a significant effect for the T3 + ECT group achieving a faster time to response compared to p + ECT (p = 0.01) with significantly fewer ECT treatments (p = 0.03). Carriers of the functional SNP rs11206244 gene DI01-C785T minor allele (TT and CT) vs. non-carriers (CC), showed fewer ECT treatments in the T3 + ECT group, compared to p + ECT (5.3 ± 1.0 vs. 8.3 ± 2.1, p = 0.045). Conclusions These pilot data identify clinically relevant genetic variation in DI01- C785T contributing to an accelerated response time, but not an overall greater symptom reduction. Exogenous T3 supplementation may be therapeutic by attenuating a baseline DI01 relative functional deficit which functionally reduces peripheral conversion of T4 to biologically active T3. Further work is encouraged to assess genetic variation of thyroid deiodinase enzymes in larger samples of depressed patients to better optimize accelerating strategies to ECT and more broadly, thyroid augmentation strategies in major depressive and bipolar disorders.

Objective The aim of this study was to evaluate the efficacy and safety of the dopaminergic-enhancing agent modafinil/armodafinil (MoArm) as adjunctive treatment for bipolar depression. Methods A comprehensive search of major electronic databases was conducted to identify randomized controlled trials (RCTs) of adjunctive MoArm that included patients with bipolar I (BP-I) or bipolar II (BP-II) depression. Data for response/remission and all-cause discontinuation were analyzed. Effect size was summarized by relative risk (RR) using a random effect model. Results Of 58 studies, five RCTs (N = 795 drug, N = 792 placebo) met inclusion criteria. Four armodafinil studies included only BP-I patients and one modafinil study included both bipolar subtypes with limited heterogeneity (I2 = 34%, P = .19; I2 = 18%, P = .30). Compared to placebo, augmentation with MoArm was associated with significantly greater rates of treatment response (RR, 1.18; 95% CI, 1.01-1.37; P = .03) and remission (RR, 1.38; 95% CI, 1.10-1.73; P = .005). All-cause discontinuation was not different than placebo (RR, 1.08; 95% CI, 0.89-1.30; P = .45) with no evidence of increased risk of mood switch or suicide attempts with MoArm (RR, 0.99; 95% CI, 0.39-2.5; P = .98; RR, 1.02; 95% CI, 0.37-2.85; P = .97). Conclusion This narrower scope meta-analysis of one drug for one disease suggests that adjunctive MoArm may represent a novel therapeutic intervention. Further studies delineating the subtypes of bipolar depression responsive to these novel dopaminergic-enhancing agents are encouraged.

Background Treatment in bipolar disorder (BD) is commonly applied as a multimodal therapy based on decision algorithms that lack an integrative understanding of molecular mechanisms or a biomarker associated clinical outcome measure. Pharmacogenetics/genomics study the individual genetic variation associated with drug response. This selective review of pharmacogenomics and pharmacogenomic testing (PGT) in BD will focus on candidate genes and genome wide association studies of pharmacokinetic drug metabolism and pharmacodynamic drug response/adverse event, and the potential role of decision support tools that incorporate multiple genotype/phenotype drug recommendations. Main body We searched PubMed from January 2013 to May 2019, to identify studies reporting on BD and pharmacogenetics, pharmacogenomics and PGT. Studies were selected considering their contribution to the field. We summarize our findings in: targeted candidate genes of pharmacokinetic and pharmacodynamic pathways, genome-wide association studies and, PGT platforms, related to BD treatment. This field has grown from studies of metabolizing enzymes (i.e., pharmacokinetics) and drug transporters (i.e., pharmacodynamics), to untargeted investigations across the entire genome with the potential to merge genomic data with additional biological information. Conclusions The complexity of BD genetics and, the heterogeneity in BD drug-related phenotypes, are important considerations for the design and interpretation of BD PGT. The clinical applicability of PGT in psychiatry is in its infancy and is far from reaching the robust impact it has in other medical disciplines. Nonetheless, promising findings are discovered with increasing frequency with remarkable relevance in neuroscience, pharmacology and biology.

This article reviews the pharmacological profile and available efficacy and tolerability/safety data for vortioxetine, one of the most recent antidepressant drugs to be approved in the USA for the treatment of major depressive disorder (MDD) in adults. The efficacy of vortioxetine for treating MDD in adults is supported by eight positive short-term (6- to 12-weeks) randomized, placebo-controlled trials, and one positive randomized, double-blind, 52-week relapse prevention trial. Based on pooled data from short-term randomized trials and from longer-term studies, vortioxetine appears to be well tolerated and to have a low incidence of adverse effects on sexual functioning. Vortioxetine also appears to be effective for treating symptoms of MDD in the elderly based on the results of one randomized trial for which recruitment was focused on this specific population. Nevertheless, effectiveness studies that directly compare the clinical effects of vortioxetine with other established antidepressant drugs are lacking, and there is no evidence as yet that vortioxetine is more clinically effective than other types of antidepressants. Some preliminary suggestions concerning the place of vortioxetine among the broad range of pharmacological treatments for adults with MDD are provided.

Few published studies have examined the relationship between exercise during pregnancy, quality of life (QOL), and postpartum depressive symptoms in healthy pregnant women. A prospective cohort of 578 healthy pregnant women were followed during their pregnancy through 6 months postpartum. Levels of self-reported exercise and QOL before, during, and following pregnancy were assessed using standardized questionnaires during each trimester of pregnancy and 6 months postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 28 weeks gestation and 6 weeks postpartum. Participants were classified as having "sufficient exercise" if they achieved at least 150 min of exercise per week. Sufficient exercisers reported significantly higher ratings on most domains of QOL during each trimester of pregnancy and in the postpartum follow-up, compared with insufficient exercisers. There were no significant between-group differences in depressive symptoms. In examining the impact of exercise during each trimester, active women who became sedentary during their third trimester demonstrated a decline in their QOL. Achieving recommended levels of exercise during pregnancy was associated with higher QOL during pregnancy and the postpartum in healthy pregnant women. Decreasing the amount of exercise during pregnancy was associated with reduced QOL. These results suggest that it may be important for health care professionals to counsel healthy pregnant women about both the benefits of being physically active during pregnancy, and to provide guidance on how to remain physically active during a healthy pregnancy.

Despite the predominant illness burden, evidence-based treatment, and by extension regulatory approved, for acute bipolar depression is significantly less than evidence bases in acute mania and maintenance treatment. Complicating this deficit has been persistent use of unimodal antidepressant therapy without clear and convincing benefit. Successful regulatory-approved drug development has focused on atypical antipsychotic therapy. Evidence-based treatments also include lamotrigine and divalproex by meta-analyses and a number of manual-based psychotherapies. In contrast, unimodal antidepressants as a class for bipolar depressed patients as a group appear to provide substantial benefit and may pose risk for mood destabilization. Promising novel and neuromodulatory treatments while encouraging require further systematic investigation. Understanding unimodal antidepressant response and risk patterns in bipolar disorder has immediate clinical implications. Moreover, evidence-based guidelines will need to bridge more individualized or precision-based treatment interventions.

Treating pregnant women with bipolar disorder is among the most challenging clinical endeavors. Patients and clinicians are faced with difficult choices at every turn, and no approach is without risk. Stopping effective pharmacotherapy during pregnancy exposes the patient and her baby to potential harms related to bipolar relapses and residual mood symptom-related dysfunction. Continuing effective pharmacotherapy during pregnancy may prevent these occurrences for many; however, some of the most effective pharmacotherapies (such as valproate) have been associated with the occurrence of congenital malformations or other adverse neonatal effects in offspring. Very little is known about the reproductive safety profile and clinical effectiveness of atypical antipsychotic drugs when used to treat bipolar disorder during pregnancy. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated or undertreated maternal bipolar disorder during pregnancy, the effectiveness of interventions for bipolar disorder management during pregnancy, and potential obstetric, fetal, and neonatal risks associated with core foundational pharmacotherapies for bipolar disorder.

The Lake Titicaca Basin is one of the regions in the world where both primary village and state formation occurred in prehistory. Although agriculture has been discussed as the central engine fueling these processes, fish and other aquatic resources were significant but little-understood components of the region's ancient economy. In this paper, we use zooarchaeological analysis of faunal remains from 367 flotation samples recovered from five archaeological sites to discuss the interplay between fishing, environmental change, and the emergence of sociopolitical complexity in the Taraco Peninsula of Lake Titicaca. Our results suggest that fishing comprised a significant component of the local inhabitants' diet between 1500 BC and 1100 AD. The intensity of fish procurement, however, varied through time and independently of both climatic and population change. We interpret variation in fish consumption through time as a product of group and individual decisions to optimize resource use in a context of dynamic environmental and sociopolitical variability. © 2014 Elsevier Inc.

INTRODUCTION:Obesity is associated with postnatal depression; however, the prevalence of postnatal depression in women after bariatric surgery has not been further evaluated.METHODS:For this observational investigation, women, ages 18-45 years, with pregnancy from 1989-2015 and bariatric surgery wer

This paper presents a detailed zooarchaeological study of fish remains from the site of Kala Uyuni, Bolivia. The fish remains of 31 flotation samples from different archaeological contexts and dated to the Formative Period (1000 BC–AD 400) are described in terms of frequency, weight, taxa distribution, sizes, skeletal representations, and exposure to heat. The results confirm the importance of fish in the diet of the inhabitants of the site and provide insights about the particularities of their exploitation, consumption, and differential discard across the site throughout time. A strong decline in the procurement and consumption of fish is observed for the Late Formative which seems to be a consequence of both environmental and social processes.

Long-acting injectable antipsychotics provide the delivery of medication over an extended period of time requiring administration typically only every 2 to 4 weeks. The side effect profile of a long-acting injectable antipsychotic is predictable and similar to the oral formulation. However, injection site reactions may occur with this novel delivery system. The risk of an injection site reaction may be greater with the repeated administration of a lipophilic decanoate formulation and include pain, development of indurations, and fibrosis. Severe complications from injection site reactions have rarely been described in the literature with newer agents. We report the first case of a patient prescribed paliperidone palmitate every 3 weeks that developed severe sepsis requiring vasopressors and intubation due to delayed relayed recognition of a necrotizing infection at an injection site. Clinicians should be alerted to screen for injection site reactions when there is an unknown source infection in a patient receiving a long-acting injectable antipsychotic.

Previous research has established that parents commonly experience intrusive harm-related thoughts pertaining to their infants (e.g., "My baby might die from SIDS"). Cognitivebehavioral models of obsessive-compulsive disorder (OCD) posit that maladaptive strategies for managing such thoughts play a role in the development and maintenance of obsessional problems. In the present study, we examined (1) the strategies parents used to manage unwanted infant-related thoughts and (2) the relationships between thought control strategies and obsessional and depressive symptoms. Non-treatment-seeking parents (n = 75) of healthy newborns completed measures of intrusive thoughts, thought control strategies, and obsessional and depressive symptoms. Mothers and fathers did not differ in their use of various thought control strategies. Strategies involving distraction, self-punishment, and reappraisal of the intrusive thought were positively related to the severity of obsessional symptoms. Punishment was also positively associated with depressive symptoms. Results are discussed in terms cognitive-behavioral models of OCD. Keywords: obsessions; postpartum; thought control; cognitive-behavioral theory; depression; postpartum depression Although obsessive-compulsive disorder (OCD) affects about 2.5% of the adult population (Karno, Golding, Sorenson, & Burnam, 1988), a growing number of studies suggests that this disorder occurs at a higher than expected rate among postpartum females (for a review, see Abramowitz, Schwartz, Moore, & Luenzmann, 2003). Despite this increased attention from researchers, the exact incidence or prevalence rates of postpartum-onset OCD remain unknown. The main symptoms of OCD are persistent intrusive thoughts, images, or impulses that evoke anxiety (i.e., obsessions) and the deliberate performance of behavioral or mental acts to neutralize this anxiety (i.e., compulsive rituals). Although the themes of obsessions and compulsions vary widely and typically concern contamination, violence, sex, religion, morality, or orderliness/symmetry (McKay et al, 2004), researchers have recognized that when it occurs during the postpartum period, OCD most often involves repugnant obsessional thoughts concerning harm befalling the infant (Abramowitz, Schwartz, & Moore, 2003; Jennings, Ross, Popper, & Elmore, 1999; Wisner, Peindl, Gigliotti, & Hanusa, 1999). Given that postpartum-onset OCD may place a strain on the infant-parent relationship (e.g., because of related avoidance) and is associated with an increased risk of postpartum depression (Williams & Koran, 1997), there is a need to detect and treat this form of OCD. Research indicates that most healthy parents of infants-mothers and fathers alike-experience unpleasant or senseless intrusive thoughts pertaining to their babies (Abramowitz, Schwartz, & Moore, 2003; Abramowitz et al., 2006). Examples of postpartum intrusions reported by nonpatients included unacceptable impulses to look at the baby's genitals when changing a diaper, 1 unwanted thoughts about the neighbor's dog attacking the infant, and unwelcome images of the baby lying dead in her crib. Although the composition of such intrusions appears identical to clinical obsessions reported by individuals with OCD, the so-called normal postpartum intrusions were fairly infrequent and associated with minimal distress. These findings are consistent with numerous studies demonstrating that 80% to 99% of mentally healthy individuals experience intrusive thoughts that are indistinguishable from clinical obsessions in terms of their form and content (e.g., Rachman & deSilva, 1978), and the occurrence of such normal intrusions is precipitated by life experiences (deSilva & Marks, 1999; Horowitz, 1975). The study of postpartum obsessional symptoms is of interest for at least two reasons. First, OCD occurring in the postpartum period has captured only scant research attention, which likely contributes to the fact that it is often undetected and untreated. …

Only a few studies have examined the development or exacerbation of obsessive–compulsive disorder (OCD) during pregnancy and the postpartum. Although the available literature suggests that OCD symptoms, particularly obsessional problems, develop at higher than expected rates among postpartum females, the overall prevalence of such symptoms in the postpartum remains unknown. Previous findings also suggest that intrusive distressing thoughts related to situational stressors are common in the general population. Therefore, the present study was designed to assess the presence and phenomenology of postpartum obsessive-like intrusive thoughts, images, and impulses in a large sample of parents with very young infants. Surveys were mailed to 300 childbearing women and their partners. Results were obtained from approximately one fifth of the sample; and 65% of respondents indicated the presence of obsessional intrusive thoughts. Intrusions were similar to “normal obsessions” as reported in previous research. Results are discussed in terms of the content of intrusive thoughts, their relationship to depression, and implications for etiological models of OCD and perinatal education.

In this article, we review the available research on postpartum obsessive-compulsive disorder (OCD). Most studies are retrospective in nature, thus not answering questions as to overall prevalence of such symptoms. However, there are consistent findings with regard to symptom profile: obsessional thoughts in postpartum OCD tend to concern fears of harm to the infant. We discuss distinctions between postpartum OCD symptoms and postpartum depression and psychosis. Although preliminary, research on treatments for postpartum OCD indicates the effectiveness of medications and cognitive-behavioral therapy. We explore the relationship between OCD symptoms and postpartum depression and offer possible directions for future study. We also consider the proposed etiological models and offer a fresh conceptualization of this condition.

Background Depression is the predominant pole of illness disability in bipolar disorder and, compared with acute mania, has less systematic research guiding treatment development. The aim of this review is to present the therapeutic options currently available for managing bipolar depression and to highlight areas of unmet need and future research. Methods Literature search of PubMed, PsycINFO, and Cochrane databases and bibliographies from 2000 to August 2013 for treatments that have regulatory approval for bipolar depression or early controlled preliminary data on efficacy. Results Treatment options for bipolar depression have increased over the last decade, most notably with regulatory approval for olanzapine/fluoxetine combination, quetiapine, and lurasidone. Conventional mood stabilizers lamotrigine and divalproex have meta-analyses suggesting acute antidepressant response. Manual-based psychotherapies also appear to be effective in treating bipolar depression. The therapeutic utility of unimodal antidepressants, as a class, for the treatment of patients with bipolar depression, as a group, remains to be confirmed. There is a substantially unmet need to develop new interventions that are efficacious, effective, and have low side effect burden. Limitations Additional compounds are currently being developed that may ultimately be applicable to the treatment of bipolar depression and early open-trial data encourage further studies, but both of these topics are beyond the scope of this review. Conclusion Future registrational trials will need to establish initial efficacy, but increasing interest for personalized or individualized medicine will encourage further studies on individual predictors or biomarkers of response.

EI sitio precerámico de Panaulauca, ubicado en la puna de Junín en la Sierra Central del Perú, es un sitio de mucha importancia para entender la adaptación de cazadores de altura y su eventual transición al pastoreo. Nuestras excavaciones en la boca de la cueva de Panaulauca y en su talud, han demostrado una larga ocupación, comenzando significativamente antes de 7000 A.N.E., y siguiendo quizás hasta tiempos históricos. Se recuperaron datos muy extensos de la industria lítica y restos de fauna y flora que se usaron para definir los cambios económicos y sociales a través de tiempo. Las fases del Precerámico Temprano tienen evidencia de camélidos con un patrón de uso que crece a través del tiempo, especialmente la vicuña, dentro de un patrón de asentamiento que en principio muestra evidencia de cierta movilidad estacional que enfatiza la época de lluvias para Panaulauca. En contraste, llegando al Precerámico Medio y Tardío se reconocen una ocupación del sitio a través de todo el año y un creciente sedentarismo. La evidencia para una vida principalmente basada en el pastoreo en Panaulauca no viene sino hasta el Formativo, aunque siempre se tiene que tener en cuenta que tales cuevas no fueron los centros de ocupación en tiempos post-precerámicos.

The authors describe the electroconvulsive therapy (ECT) treatment of seven patients who had intracranial masses or mass effect and one patient who was status post mass resection. None suffered any neurological deterioration during ECT. They provide recommendations for clinical practice with such patients.

Figures Tables Contributors Foreword Preface Introduction: Sustainable Lifeways -Naomi F Miller and Katherine M. Moore 1 "Living with a Moving Target": Long-term Climatic Variability and Environmental Risk in Dryland Regions -Neil Roberts 2 Prehistoric Pastoralists and Social Responses to Climatic Risk in East Africa -Fiona Marshall, Katherine Grillo, and Lee Arco 3 Spreading Risk in Risky Environments: An East African Example -Kathleen Ryan and Karega-Munene 4 Risk and Resilience among Contemporary Pastoralists in Southwestern Iran -Lois Beck and Julia Huang 5 Change and Stability in an Uncertain Environment: Foraging Strategies in the Levant from the Early Natufian through the Beginning of the Pre-Pottery Neolithic B -Arlene M. Rosen 6 Explaining the Structure and Timing of Formation of Pueblo I Villages in the Northern U.S. Southwest -Timothy A. Kohler and Charles Reed 7 Mitigating Environmental Risk in the U.S. Southwest -Katherine A. Spielmann, Margaret Nelson, Scott Ingram, and Matthew A. Peeples 8 Farmers' Experience and Knowledge: Utilizing Soil Diversity to Mitigate Rainfall Variability on the Taraco Peninsula, Bolivia -Maria C. Bruno 9 Grace Under Pressure: Responses to Changing Environments by Herders and Fishers in the Formative Lake Titicaca Basin, Bolivia -Katherine M. Moore 10 Periodic Volcanism, Persistent Landscapes, and the Archaeofaunal Record in the Jama Valley of Western Ecuador -Peter W. Stahl 11 Managing Predictable Unpredictability: Agricultural Sustainability at Gordion, Turkey -Naomi F. Miller Index

L'A. s'interesse a l'economie de subsistance pratiquee par la civilisation de l'Oxus (2100-1800), a savoir l'agriculture et l'activite pastorale. Cette etude a ete realisee a partir de donnees archeologiques, botaniques et osteologiques obtenues lors des fouilles de l'habitat de Gonour tepe (Turkmenistan)

Research on postpartum onset obsessive-compulsive disorder (OCD) has focused exclusively on females. However, the authors present four cases of males with OCD onset that coincide with a spouse's pregnancy or delivery. The rapid onset and content of obsessions and compulsions are remarkably similar to those reported in previous studies of postpartum OCD in females. Each patient also responded to cognitive-behavioral therapy using exposure procedures. The implications of these cases for etiological models of postpartum OCD and future research directions are discussed.

Measurement of carbon and nitrogen stable isotope ratios (613C and 615N) in samples of human bone collagen (n = 93) from a temporal series of four prehistoric (early preagricultural, late preagricultural, early agricultural, late agricultural) and two historic (early contact, late contact) periods from the Georgia Bight, a continental embayment on the southeast- ern U.S. Atlantic coast, reveals a general temporal trend for less negative S13C values and less positive 615N values. This trend reflects a concomitant de- crease in emphasis on marine resources and increased reliance on C,-based resources, especially maize. This dietary reorientation is most apparent for the early agricultural sample (AD 1150-1300), coinciding with the Mississip- pian florescence in the eastern United States. There is, however, a shift toward the use of C3 (non-maize) foods during the last prehistoric period (AD 1300-14501, which is likely related to environmental stress and social disrup- tion. A heavier use of maize and terrestrial resources in general after the establishment of mission centers on barrier islands is indicated. A reduced dietary breadth during the mission period may have contributed to the extinc- tion of these populations in the eighteenth century. 6 1992 Wiley-Liss, Inc.

Stable isotope ratios of carbon and nitrogen in bone have become increasingly frequent inclusions in archaeological reports over the past few decades. The majority of such studies has been done in North America, where the use of marine foods and the introduction of maize have been monitored. Similar questions have been addressed in Mesoamerica and South America. In Europe, stable isotope ratios have documented the shift from marine fishing and gathering to agriculture in coastal areas and the introduction of millet in parts of eastern and southern Europe. Much work remains to be done in Asia, where millet replaced early C3 plant foods and, in turn, was replaced by rice. In Africa marine adaptations, freshwater fishing, agriculture, and pastoralism all yield diagnostic isotopic signatures. We review these studies, discuss areas requiring further study, and close with discussions of areas promising interesting future developments.

Background Pharmacogenomic testing (PGT) has applicability in psychosomatic medicine (PM) practice where medical comorbidity and polypharmacy present particularly difficult challenges of drug–drug and drug–disease interactions. No guidelines currently exist for cost-effective use of PGT in PM practice. Objective The authors tested the hypothesis that naturalistically observed PGT ordering patterns and clinical data on test utility derived from a PM practice where PGT is readily available may inform the development of clinical guidelines for cost-effective use of PGT. Method Two sets of data were collected from an outpatient PM practice staffed by seven PM-certified psychiatrists. Psychiatrists were surveyed regarding their indications for ordering PGT. Medical records of patients seen in the PM practice during 2008 were reviewed. Patients who had PGT were compared with two sets of case controls who were not tested, one matched by demographics, the other by ordering psychiatrist. Psychiatrists' ordering indications were compared with clinical data derived from the case-control analyses. Results Psychiatrists listed treatment-resistance as the most common reason for PGT, ahead of intolerance to previous medications. Tested patients differed from controls on measures of both clinical severity and treatment-resistance, including higher self-reported anxiety and depression levels, greater likelihood of family history of mood or anxiety disorders, and larger numbers of prior antidepressant, mood stabilizer, and antipsychotic medication trials. Conclusion Ordering guidelines that emphasize markers of clinical severity and early indicators of treatment-resistance may provide a useful rationale for PGT in outpatient PM practice. Prospective investigations of this proposition are warranted.

OBJECTIVE To determine the risk of congenital cardiac abnormalities associated with use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. PATIENTS AND METHODS We conducted a retrospective review of the medical records of all pregnant women presenting at Mayo Clinic's site in Rochester, MN, from January 1, 1993, to July 15, 2005, and identified 25,214 deliveries. A total of 808 mothers were treated with SSRIs at some point during their pregnancy. We reviewed the medical records of the newborns exposed to SSRIs during pregnancy to analyze their outcomes, specifically for congenital heart disease and persistent pulmonary hypertension of the newborn. RESULTS Of the study patients, 808 (3.2%) took an SSRI at some point during the antenatal period. Of the 25,214 deliveries, 208 newborns (0.8%) were diagnosed as having congenital heart disease. Of the 808 women exposed to SSRI during pregnancy, 3 (0.4%) had congenital heart disease compared with 205 (0.8%) of the 24,406 women not exposed to an SSRI ( P =.23). Of the total number of deliveries, 16 newborns were diagnosed as having persistent pulmonary hypertension of the newborn, none of whom had exposure to SSRIs ( P >.99). CONCLUSION Our data are reassuring regarding the safety of using SSRIs during pregnancy.

This chapter begins with a review of the prevalence, assessment, and clinical presentation of anxiety in the perinatal period. Next, we discuss two forms of treatment for anxiety that have been found effective in clinical research: cognitive-behavioral therapy and certain classes of medication. The effectiveness of these treatments with each of the anxiety disorders is discussed, as is the issue of how medication might affect the unborn and breast-feeding infant. Finally, we present a case study of a representative patient with postpartum obsessive-compulsive disorder who was evaluated and treated in our anxiety disorders program.

Using bone-chemistry data, this project sought to assess the degree of dietary change that occurred among eastern border Pueblo populations due to prehistoric food exchange with hunter-gatherers on the Plains and to the arrival of Spanish colonists. In so doing we introduce a technique for dietary reconstruction that determines the range of diets compatible with bone-chemistry data from a particular population. The data are derived from samples of modern and archaeological plants and animals collected from the area surrounding Pecos Pueblo, and from archaeological humans recovered from Pecos itself. Bone-strontium concentrations were measured to monitor the relative proportions of meat to vegetables in the diet. Carbon and nitrogen stable-isotope ratios in food items and in bone collagen were measured to monitor the dependence on maize and bison meat. The results do not provide support for the hypothesis that bison replaced mule deer in the diet during the period of significant Plains-Pueblo trade. If bison, whose diets are relatively enriched in 13C had replaced mule deer, an increase in average δ13C values should have occurred. This, however, was not observed. A decrease in carbon-isotope values in the historic period suggests that either bison meat or maize or both decreased in importance in the Pecos diet and that dependence on wild plants increased.