Prenatal maternal stress has been shown to impair functioning in nonhuman primate offspring. Little is known about the effects of prenatal stress on intellectual and language development in humans because it is difficult to identify sufficiently large samples of pregnant women who have been exposed to an independent stressor. We took advantage of a natural disaster (January 1998 ice storm in Québec, Canada) to determine the effect of the objective severity of pregnant women's stress exposure on general intellectual and language development of their children. Bayley Mental Development Index (MDI) scores and parentreported language abilities of 58 toddlers of mothers who were exposed to varying levels of prenatal stress were obtained at 2 y of age. The hierarchical multiple regression analyses indicated that the toddlers' birth weight and age at testing accounted for 12.0% and 14.8% of the variance in the Bayley MDI scores and in productive language abilities, respectively. More importantly, the level of prenatal stress exposure accounted for an additional 11.4% and 12.1% of the variance in the toddlers' Bayley MDI and productive language abilities and uniquely accounted for 17.3% of the variance of their receptive language abilities. The more severe the level of prenatal stress exposure, the poorer the toddlers' abilities. The level of prenatal stress exposure accounted for a significant proportion of the variance in the three dependent variables above and beyond that already accounted for by non-ice storm-related factors. We suspect that high levels of prenatal stress exposure, particularly early in the pregnancy, may negatively affect the brain development of the fetus, reflected in the lower general intellectual and language abilities in the toddlers. The effects of prenatal maternal stress (PNMS) on offspring abilities have been examined extensively in nonhuman primates in well-controlled studies. In general, increases in PNMS are related to elevated levels of inhibited behavior and decreases in cognitive and neuromotor functioning (1, 2). For example, both chronic stress during pregnancy (1) and 2 wk of ACTH administration at midgestation (2) predict poorer attention during infancy. Moreover, mild prenatal maternal stress is associated with delayed object permanence (3). In human populations, maternal anxiety (4) and moderate to severe life events (5, 6) during pregnancy increase the risk of obstetric complications such as preeclampsia, fetal distress, preterm birth, and low birth weight and predict an increase in neonatal crying (7), acute health problems during the first year (8), and behavioral and/or emotional problems at 4 y of age (9). Moreover, Apgar scores at 5 min were 2 SD lower in newborns of anxious mothers (4), indicating birth trauma. In terms of cognitive functioning in humans, PNMS has been linked to poorer performance. For example, a study of the long-term effects of PNMS associated with a major earthquake demonstrated that 18-y-olds who were exposed prenatally had signif- Received February ...

The results of this study suggests that nondetection of delirium in the ED may be associated with increased mortality within 6 months after discharge. Further research is necessary to examine the effectiveness of improving detection on subsequent prognosis of older patients with delirium.

Immigrant status is associated with lower rates of use of mental health services, even with universal health insurance. This lower rate of use likely reflects cultural and linguistic barriers to care.

This study confirms the higher prevalence of migraine among those with bipolar disorder compared to the general population. Migraine in patients with bipolar disorder is underdiagnosed and undertreated. Bipolar disorder with migraine is associated with differences in the clinical course of bipolar disorder, and may represent a subtype of bipolar disorder.