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A 25-year-old white woman was hospitalized with a postpartum psychosis presenting as an affective disorder with the delusion of Capgras. She was treated with electroconvulsive therapy with resolution of her affective and delusional states.
Two multigravida patients with no prior psychiatric history were seen with postpartum psychosis, having received bromocriptine for inhibition of lactation. Bromocriptine given in high doses has been associated with psychosis in patients receiving the drug for Parkinson's disease. These cases demonstrate that bromocriptine may cause psychosis even when given in low doses.
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Plasma beta-endorphin-like immunoreactivity was studied in 43 pregnant women at 36 weeks gestation and in 23 of these at delivery and 24 h post-partum; an attempt made to correlate changes with various social, psychological and obstetric factors, including the 'post-natal blues'. Beta-endorphin levels were elevated at 36 weeks gestation and term, increased to very high levels during labour and fell rapidly within 1 h of delivery. A negative correlation was observed between the woman's estimate of her pain in labour and the beta-endorphin levels post-partum, suggesting an analgesic role for beta-endorphin in labour. A positive correlation was also observed between the levels of beta-endorphin at delivery and the woman's attitude to her pregnancy at 36 weeks and a negative correlation between the 'post-natal blues score' and the beta-endorphin level at 36 weeks. However, the 'blues' did not correlate either with the beta-endorphin level at delivery or 24 h post-partum nor with its rate of fall in the first 24 h. Our general finding that there was no consistent social, psychological or obstetric factor which predisposes women to develop 'post-natal blues' still supports the hypothesis that humoral factors, of which beta-endorphin may be one, rather than psychological factors are important in the genesis of this syndrome.
OBJECTIVES: The use of olanzapine (OLZ) in the prevention of postpartum psychosis (PP) and mood episodes in women with bipolar disorder was investigated in a naturalistic, prospective study. METHODS: Eleven women received OLZ alone or in combination with an antidepressant or mood stabilizer, and 14 women received either antidepressants, mood stabilizers, or no medication for a minimum of 4 weeks after delivery. RESULTS: Two (18.2%) of the women in the OLZ group experienced a postpartum mood episode, whereas eight (57.1%) of the women in the No-OLZ group did. CONCLUSIONS: The role of OLZ in the prophylaxis of PP and mood episodes, particularly in women at high risk, clearly warrants further investigation.
The purpose of the present study was to investigate the prevalence, distribution of psychiatric diagnoses, and treatment responses of patients with post-partum mental illness at an emergency unit at Chang Gung Memorial Hospital at Kaohsiung in Taiwan. During a 1 year period a total of 636 Taiwanese women received psychiatric consultation on their visits to the emergency room. Fifteen of these were noted to have post-partum mental illnesses. All subjects were followed up for a minimum of 3-6 months. The prevalence of patients with post-partum mental illness at an emergency unit at Chang Gung Memorial Hospital at Kaohsiung was 2.4% (15/636). The distribution of psychiatric diagnoses according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria included eight cases of major depressive disorders (53.3%), three cases of bipolar I disorder (20%), three cases of schizophrenia (20%), and one case of psychotic disorder due to a general medical condition (6.7%). Four subjects manifested catatonic features. Of these four, three had complete remission in catatonic symptoms after receiving intramuscular injection of lorazepam. The fourth subject died of multiple medical diseases. The treatment results suggest that most of the clinical presentations in patients with post-partum mental illness could be relieved by antipsychotics, mood stabilizers or antidepressants. In addition, it was found that intramuscular injection of lorazepam was also effective in patients with catatonic features and post-partum depression or psychosis.
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Septic pelvic thrombophlebitis is an uncommon but serious postpartum complication occurring in about 1 in 2,000 pregnancies, characterized by pain, antibiotic resistant fever and tachycardia. In about 50% of cases a pelvic mass is present which is usually right-sided (especially when the ovarian vein is involved). It is estimated to cause 18 maternal deaths per million pregnancies in the United States. Use of contrast enhanced CT scanning and a trial of heparin therapy increases the diagnostic certainty. It is particularly important because surgical management which may otherwise be suggested because of a spiking fever and a mass seems to be associated with a poorer prognosis than does conservative management.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The diagnostic issues, classification, incidence, genetic factors, and theories of etiology of psychiatric illness associated with childbirth are reviewed. Psychologic influences, psychosocial factors and the concept of biologic maladaptation associated with prospective motherhood are discussed. Postpartum mental distress is not a unitary phenomenon. The physiology of the puerperium is thus not a cause in itself of any of the symptoms, but rather must be regarded as a contributing or triggering factor acting upon an underlying predisposition. Clinical research of postpartum psychiatric syndromes (PPS) and animal behavior studies are inconclusive. It is suggested that major neuroendocrine research strategies currently used in studying affective disorders and schizophrenia should be applied in studying PPS.
This article describes the development of a prospective, longitudinal study of 88 "high-risk" offspring of pregnant index women with a history of nonorganic psychoses and 104 offspring of demographically-similar pregnant control women. The maternal psychoses represented the diagnostic categories, Schizophrenia, Cycloid Psychosis, Affective Illness, Psychogenic Psychosis, Postpartum Psychosis and Other (remaining) Psychoses. The first phase of the study began during pregnancy and continued until the offspring reached 2 years of age. Selected characteristics of the mothers, the offspring and their environments were investigated during this project phase.
Rates of mental disturbance during pregnancy were studied in 88 index women with a history of nonorganic psychosis and 104 demographically similar control women. The sources of information were the woman's own report at interview during pregnancy, the interviewer's assessment and, for index cases, psychiatric record notations relevant to the pregnancy period. Highly significantly increased rates of active mental disturbance were identified for index women, as compared with controls, based both on the woman's own report and on the interviewer's assessment. Most disturbed were women with a history of Schizophrenia, Cycloid, Postpartum and Other Psychoses, and only those index women with a history of Affective Illness did not differ from controls. Only one third of the index cases were in contact with a psychiatrist during pregnancy, and high rates of active mental disturbance were identified at interview even in those index women without psychiatric contact.
The effect of pregnancy on women's mental health during pregnancy was studied by interview with 88 pregnant index cases with a history of nonorganic psychosis and 104 demographically similar pregnant controls, and by psychiatric records for the subsample of index cases with relevant information. Controls generally reported experiencing no change or only a slight worsening of mental health due to pregnancy, while index differentially reported improved or considerably worsened health. In total, worsening was more common than improvement in the index cases, and especially in those with a history of Schizophrenic, Psychogenic, Postpartum and Other Psychoses. Psychiatric record information suggested predominantly more improvement in the subsample with information, but this bore little systematic relation to the same women's reports at interview during pregnancy.
Mother-infant interaction during a feeding was studied at about 3 days of age in 51 index mother-infant pairs in which the mother had a history of nonorganic psychosis and in 73 demographically similar control pairs. Interaction was significantly more negative and deviant in index than control cases, index mothers establishing a significantly more negative emotional climate and less harmony in feeding, evidencing more tension and uncertainty, and showing less social contact toward the infant. Index infants showed significantly less social contact toward the mother and index pairs less reciprocal visual contact than did controls. While the Schizophrenic, Cycloid and Nonendogenous Psychoses groups each differed from their matched controls on a number of variables, the Affective group was not in any way more negative than its controls on interaction.