Department of Psychiatry and IVF Unit, Lis Women's Hospital, Tel Aviv Souraski Medical Center, Tel Aviv, Israel.
J Clin Psychiatry. 2013 Apr;74(4):386-92. doi: 10.4088/JCP.12m07805.
Knowledge regarding the emotional and physiologic response of women with psychiatric disorders undergoing in vitro fertilization (IVF) treatments is rather limited. We evaluated psychological adjustment and cortisol reactivity to IVF treatment in women with a lifetime diagnosis of a unipolar mood or anxiety disorder compared to those without such a diagnosis.
Women undergoing IVF treatments (N = 121) were interviewed from January 2006 to December 2007 to assess for the presence of a history of a lifetime DSM-IV-TR unipolar mood or anxiety disorder. They were evaluated prospectively at baseline, at ovulation, and before the pregnancy test. Primary outcome measures included assessments of depressive and anxiety symptoms (Center for Epidemiologic Studies Depression Scale and State-Trait Anxiety Inventory, respectively) and plasma cortisol levels.
Of 108 participants included in the study, 19.4% (n = 21) were determined to have a lifetime Axis I unipolar mood or anxiety diagnosis. Women with lifetime Axis I psychopathology showed significantly greater symptom elevation for depression (F2,194 = 10.97, P < .001) and for anxiety (F2,194 = 3.4813, P = .033) compared to the group without psychopathology. A different physiologic pattern was observed for cortisol response: whereas the group without psychopathology responded physiologically to the stressful treatment with continuously elevated cortisol levels, a blunted cortisol response was observed for the group with lifetime psychopathology (F2,200 = 2.9, P = .05).
Women diagnosed with a lifetime unipolar mood or anxiety disorder developed robust symptom exacerbation during IVF treatment compared to women without an Axis I diagnosis. Conversely, the women with a lifetime diagnosis are characterized by a blunted cortisol response, indicating a pattern of dissociation between the robust increase in anxiety and depression and cortisol response to the acute psychological stress. This study emphasizes the need for a psychiatric screening prior to IVF treatment and for the utilization of preventive psychiatric and psychological interventions.
关于经历体外受精（IVF）治疗的精神障碍女性的情绪和生理反应的知识相当有限。我们评估了与没有此类诊断的女性相比，患有单相心境或焦虑障碍的女性在接受 IVF 治疗时的心理调整和皮质醇反应。
从 2006 年 1 月至 2007 年 12 月，对接受 IVF 治疗的女性（N=121）进行了访谈，以评估她们是否有过 DSM-IV-TR 单相心境或焦虑障碍的终生病史。她们在基线、排卵时和怀孕测试前进行了前瞻性评估。主要结局指标包括抑郁和焦虑症状的评估（分别采用流行病学研究中心抑郁量表和状态特质焦虑量表）和血浆皮质醇水平。
在纳入研究的 108 名参与者中，19.4%（n=21）被确定为有过单相心境或焦虑障碍的终生轴 I 诊断。与无精神病理学的女性相比，有过终生轴 I 精神病理学的女性抑郁（F2,194=10.97，P<.001）和焦虑（F2,194=3.4813，P=0.033）的症状明显升高。皮质醇反应表现出不同的生理模式：虽然无精神病理学的组对有压力的治疗反应生理上表现为皮质醇水平持续升高，但有终生精神病理学的组观察到皮质醇反应减弱（F2,200=2.9，P=0.05）。
与没有轴 I 诊断的女性相比，被诊断为单相心境或焦虑障碍的女性在接受 IVF 治疗期间出现了明显的症状加重。相反，患有终生诊断的女性表现出皮质醇反应减弱，表明焦虑和抑郁的急剧增加与皮质醇对急性心理压力的反应之间存在分离模式。这项研究强调了在 IVF 治疗前进行精神科筛查的必要性，以及利用预防性精神科和心理干预的必要性。
