From the Editor
May 2018. “Multiples” could mean many things, such as multiple choices, multiple achievements, multiple injuries. In this case, it refers to multiple births and to a most interesting paper in this issue of the Journal by Wenze and Battle, entitled “Perinatal mental health treatment needs, preferences, and barriers in parents of multiples.”
I confess that I have a personal reason for singling out this paper for this From the Editor: I have an identical twin brother. Brother James is a tenured professor at Georgetown Law School in Washington, DC, where he has had a marvelous career as a legal historian, educator, and contracts and labor law expert, and, in his spare time, he serves as an arbitrator for high profile cases and has been President of the National Academy of Arbitrators. (Not that we’re competitive or anything!) Don’t worry, I’m not going to itemize all of the unique “twinning” experiences we have had (but we have, indeed, had them). The reason I mention my status as a twin is that, remarkably, after reading Wenze and Battle’s paper, I realized that I hadn’t previously thought very much about the multiple burdens and stresses that our parents surely had to deal with, perhaps especially in the immediate postpartum period. And it dawned on me how little there is in the literature on this special challenge, while at the same time the number of multiple births is steadily increasing in the country because of the growing use of fertility enhancement strategies.
Wenze and Battle studied 241 parents of multiples, surveying their histories during the perinatal period of the multiple births. Strikingly, approximately half of the participants indicated that they would have welcomed counseling or treatment for mental health issues, yet fewer than 10% of the participants received such interventions. Also strikingly, only about one third of the participants reported any inquiry from any health care provider about any mental health concerns. The authors emphasize that many parents of multiples wished they had had professional mental health help during the peripartum period, and they were particularly receptive to “eHealth” options, which could be accessed from home and at convenient times. I believe that this survey by Wenze and Battle is an important one, and I hope that it can serve as a “wake-up call” for the teams of medical experts participating in prenatal care, the multiple birth process, and the postnatal period.
Also in this issue of the Journal, several other special clinical concerns are elucidated. Zuschlag and colleagues report on an important aspect of the condition for further research in DSM-5 called “attenuated psychosis syndrome”—ie, whether or not this prodromal phase serves as a predictor of future suicide attempts. The authors identified 6 factors in their study population that appear to be risk factors for future suicidality. Peters and colleagues focus on pediatric bipolar disorder, another area of some controversy during the deliberations leading to the publication of DSM-5—particularly with the introduction of the new diagnostic category of disruptive mood dysregulation disorder (DMDD). These authors identified two main symptom profiles in a group of patients with DSM-IV-diagnosed bipolar spectrum disorder—one group with a “classic presentation” and a second group with a “dysregulated/defiant” pattern of behavior. They then consider consensus recommendations for treatment strategies with these distinct subtypes of young people with pathology in the bipolar spectrum. Bipolar disorder is also the focus of the case report by Yehl and colleagues, in which they compare and contrast bipolar symptoms with those of patients with temporal lobe epilepsy. In addition, Kelly and colleagues study patterns of involuntary hospitalization for patients with bipolar disorder compared with patients with schizophrenia and related disorders, concluding that, in these study populations, the need for and use of involuntary hospitalization were quite similar.
John M. Oldham, MD