1/9. Can critically timed sleep deprivation be useful in pregnancy and postpartum depressions?BACKGROUND: The aim of this study was to test the efficacy of critically timed sleep deprivation in major mood disorders (MMD) occurring during pregnancy and postpartum. methods: Nine women who met DSM-IV criteria for a MMD with onset during pregnancy or within 1 year postpartum underwent a trial of either early-night sleep deprivation (ESD), in which they were sleep deprived in the early part of one night and slept from 03:00-07:00 h, or late-night sleep deprivation (LSD), in which they were deprived of sleep in the latter part of one night and slept from 21:00-01:00 h. Mood was assessed before the night of sleep deprivation, after the night of sleep deprivation, and after a night of recovery sleep (sleep 22:30-06:30 h) by trained clinicians, blind to treatment condition, using standardized scales. RESULTS: More patients responded to LSD (nine of 11 trials: 82%) compared with ESD (two of six trials: 33%) and they responded more after a night of recovery sleep (nine of 11 nights: 82%) than after a night of sleep deprivation (six of 11 nights: 55%). pregnant women were the only responders to ESD and the only nonresponders to LSD. LIMITATIONS: The small and heterogeneous sample size prevents us from making more definitive conclusions based on statistical analyses. CONCLUSIONS: Although the findings are preliminary, the results suggest that with further study, critically timed sleep deprivation interventions may benefit women with pregnancy or postpartum major mood disorders and potentially provide a viable alternative treatment modality for those women who are not candidates for pharmacologic or psychotherapeutic interventions. Such interventions are needed to help prevent the devastating effects of depression during pregnancy and the postpartum period on the mother, infant, her family and society.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/9. Kangaroo (skin-to-skin) care with a postpartum woman who felt depressed.The mother in this case study had numerous known risk factors for postpartum depression and was in rehabilitation for drug abuse. She was crying at 2 hours postbirth and expressing feelings of sadness as her baby was being unwrapped for her first kangaroo care (KC) experience. Thereafter, during our research protocol, her self-reported depression scores decreased rapidly and had disappeared by 32 hours postbirth. A benefit of KC requiring systematic study is that KC may lessen maternal depression. There is new knowledge that some functions of the maternal HPA axis become dampened during the last trimester of pregnancy as the placenta increases its secretion of corticotrophin-releasing hormone. The sudden loss of the placenta following delivery, accompanied by a suppressed HPA axis, may have an effect on mood during the immediate postpartum period. Perhaps appropriate reactivation of the maternal HPA axis can be triggered following birth by the stimulation inherent in KC, thereby minimizing risk for postpartum depression.- - - - - - - - - - ranking = 0.125keywords = pregnancy (Clic here for more details about this article) |
3/9. grief, anxiety, stillbirth, and perinatal problems: healing with kangaroo care.A young, anxious mother's first pregnancy was eclamptic, her placenta was underperfused, and her son was stillborn. She carried grief, guilt, anxiety, and hypervigilance into her next preeclamptic pregnancy, birth (of her small-for-dates son), and early postpartum period. When breastfeeding difficulties developed, the authors intervened with three consecutive (skin-to-skin) breastfeedings. During the first skin-to-skin breastfeeding, the mother stopped crying, shared self-disparaging emotions, and then began relaxing and "taking-in" her new baby. Breastfeeding continues at 1 year.- - - - - - - - - - ranking = 0.25keywords = pregnancy (Clic here for more details about this article) |
4/9. Postpartum "psychosis" in mild argininosuccinate synthetase deficiency.BACKGROUND: urea cycle disorders are relatively rare but well-established causes of postpartum coma and death. Such clinical presentations have been reported previously in ornithine transcarbamylase and carbamyl phosphate synthetase deficiencies. CASE: We describe a woman, without prior symptoms of metabolic disease, who presented with hyperammonemia and psychiatric symptoms in the postpartum period. Initial diagnoses included acute fatty liver of pregnancy and postpartum psychosis. She was later found to have argininosuccinate synthetase deficiency after further metabolic investigations. Rare heterozygous mutations in the argininosuccinate synthetase gene were identified. CONCLUSION: urea cycle disorders may present initially with postpartum psychiatric symptoms and may represent an underrecognized cause of "postpartum psychosis." We recommend obtaining metabolic studies in women with neurologic or severe psychiatric symptoms in the postpartum period.- - - - - - - - - - ranking = 0.125keywords = pregnancy (Clic here for more details about this article) |
5/9. Abrupt discontinuation of psychotropic drugs following confirmation of pregnancy: a risky practice.A number of pregnant women suffer from psychiatric disorders that require treatment with psychotropic drugs. A literature review suggests that these medications are relatively safe to use during pregnancy. Abrupt discontinuation of these drugs can have both physiological and psychological ramifications, which include unpleasant physical symptoms and re-emergence of the psychiatric condition. Therefore, it is not good practice to discontinue these medications abruptly upon diagnosis of pregnancy.- - - - - - - - - - ranking = 0.75keywords = pregnancy (Clic here for more details about this article) |
6/9. meningocele and ankyloblepharon following in utero exposure to olanzapine.Although atypical antipsychotics are widely used during pregnancy, their safety is not well established. This case highlights the possible teratogenic effect of olanzapine, in which the baby was born with meningocele and ankyloblepharon. It is suggested that olanzapine may interfere with embryonic development at different stages of pregnancy.- - - - - - - - - - ranking = 0.25keywords = pregnancy (Clic here for more details about this article) |
7/9. Effect of pregnancy on three patients with bipolar disorder.Case histories of three bipolar II disorder patients who had periods of sustained euthymia during all their pregnancies are described. The clinical and research implications of these observations are discussed.- - - - - - - - - - ranking = 0.5keywords = pregnancy (Clic here for more details about this article) |
8/9. Pathological fear of cot death.Cot death (sudden infant death syndrome) is one of the most common causes of death in the first year of life. Four cases with a pathological fear of cot death are presented. All the patients were depressed and in 2 cases the fear of cot death had an obsessional quality. In all cases there were complications during pregnancy (miscarriage, threatened abortion, recurrent vomiting in last trimester). In 1 case, the patient knew 3 mothers who had suffered cot deaths; in another, the infant was gravely ill in the neonatal period. Pathological fear of cot death can be recognised by the presence of two central features - overvigilance and excessive nocturnal checking of the baby's breathing. Therapeutic interventions are discussed.- - - - - - - - - - ranking = 0.125keywords = pregnancy (Clic here for more details about this article) |
9/9. Dysphoric disorders in women: a case of perinatal depression.During her third pregnancy, a woman becomes preoccupied with illness and death. When the dysphoria continues after her child is born, how would you evaluate and manage the problem?- - - - - - - - - - ranking = 0.125keywords = pregnancy (Clic here for more details about this article) |