1/31. Delusion of infestation with post-partum onset: case report. Compared with men, women have a greater lifetime risk of delusions of infestation, with the risk appearing to increase around the menopause, when the blood levels of reproductive hormones are decreasing. Women also have a greater lifetime risk of depression and an increased incidence of depressive symptoms post partum, when the blood levels of these hormones are decreasing as well. The first case of a delusion of infestation with post-partum onset is described, and possible associations with reproductive function in women are discussed. ( info) |
2/31. role of estradiol in puerperal psychosis. RATIONALE: postpartum period has been considered a time of increased risk for the development of psychiatric disorders with long-lasting adverse consequences. Psychoses are the most severe of these illnesses and can be resistant to psychiatric medication. OBJECTIVE: We present two women with puerperal psychosis who had low serum estradiol, were refractory to neuroleptic medication but responded successfully to estradiol treatment. methods: serum estradiol concentration was measured at baseline and during the treatment with sublingual 17-beta estradiol. Treatment effect was evaluated using Brief Psychiatric Rating Scale. RESULTS: Both patients had a low pretreatment estradiol concentration (28 and 54 pmol/l). During treatment with estradiol, the rise in serum estradiol coincided with a decline of psychotic symptoms. Discontinuation of estradiol treatment resulted in a rebound of florid psychotic symptoms in both cases. CONCLUSIONS: estradiol may have a causal relation to postpartum psychosis and significance in the treatment of this illness. ( info) |
3/31. Becoming whole: a pastoral story. In my role as parish priest, I am present in the daily life of my community to acknowledge, nurture, celebrate, reflect, witness, and listen to the people around me. hearing stories, helping people see and live in their stories, find meaning in them is my life work, and this is what happened when I met Eva. Together we will tell you her story of depression, her revelations in therapy, and piecing together the new meanings in her life through creating a quilt to symbolize and reflect her healing process. Eva's life, similar to the lives of each woman who has entered into her own suffering and there found healing, is perpetually becoming whole. Sharing our stories as Eva has opens possibilities for each of us who hears, believes, and witnesses our own pain and that of our sisters, allowing us to shape and give meaning to our stories, our selves, our wholeness, and our holiness. ( info) |
4/31. 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. ( info) |
5/31. Drowsiness and poor feeding in a breast-fed infant: association with nefazodone and its metabolites. OBJECTIVE: To investigate whether adverse effects in a premature neonate could be attributed to nefazodone exposure via breast milk. CASE SUMMARY: The breast-fed white infant (female, 2.1 kg, 36 weeks corrected gestational age) of a 35-year-old woman (60 kg) taking nefazodone 300 mg/d was admitted to the hospital because she was drowsy, lethargic, unable to maintain normal body temperature, and was feeding poorly. A diagnosis of exposure to nefazodone via breast milk was considered only after other more likely diagnoses had been excluded. After breast feeding was discontinued, the infant's symptoms resolved slowly over a period of 72 hours. The maternal plasma and milk concentration-time profiles for nefazodone and its metabolites, triazoledione, HO-nefazodone, and m-chlorphenylpiperazine, were quantified by HPLC. The calculated infant dose for nefazodone and its active metabolites (as nefazodone equivalents) via the milk was only 0.45% of the weight-adjusted maternal nefazodone daily dose. DISCUSSION: Our data suggest a putative association between maternal nefazodone ingestion and adverse effects in a premature breast-fed neonate. The measured amount of drug exposure would normally be considered safe in a full-term infant. However, there was a temporal relationship between resolution of adverse effects in the infant and cessation of breastfeeding. CONCLUSIONS: This case highlights the importance of individualizing the risk-benefit analysis for exposure to antidepressants in breast milk, especially when dealing with premature neonates. ( info) |
6/31. Postpartum depression and factitious disorder: a new presentation. This article discusses a presentation of munchausen syndrome by proxy. It is believed this factitious disorder was precipitated and grew out of the context of a postpartum depression. To our knowledge, no such case has been reported in the past and implications for new exclusion criteria defining a fictitious disorder are raised. Furthermore, reintegration of the perpetrator back to family is discussed and suggestions are made for follow-up. ( info) |
7/31. 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. ( info) |
8/31. St. John's wort (hypericum perforatum)--is it safe during breastfeeding? Both doctors and patients often treat postnatal depression with herbal preparations derived from St. John's wort. Because these preparations are available to patients as "natural" over-the-counter drugs for depression, they are popularly assumed to be safe. However, no systematic information exists regarding treatment of postnatal depression, infant's safety or pharmacokinetics of hypericum constituents in human breast milk or infant plasma. A mother with post-natal depression was admitted at our service. Her pharmacist had recommended taking a St. John's wort preparation three times a day (Jarsin 300, Lichtwer Pharma AG, berlin, germany). Four breast-milk samples (fore and hind milk) during an 18-hour period were analyzed to measure concentration of hypericin and hyperforin. Only hyperforin is excreted into breast milk at a low level, hyperforin and hypericin (two major active components) were below the lower limit of quantification (BLQ: below lower limit of quantification, LQ hypericin: 0.20 ng/ml, LQ hyperforin: 0.50 ng/ml) in this infant's plasma. No side effects were seen in the mother or infant. Before recommending St John's wort for the treatment of depression to women who breastfeed, long-term studies of outcome in infants are needed. ( info) |
9/31. Dementia presenting as postpartum depression. BACKGROUND: Other conditions that can mimic postpartum depression are rare but must be considered. CASE: A 37-year-old woman developed mood symptoms as well as progressive hyperphagia, hypersexuality, disinhibition, and impairment of judgment after delivery of her third child. She was unresponsive to multiple treatments for depression and was evaluated for frontal lobe syndromes. CONCLUSION: frontotemporal dementia, formerly known as Pick disease, is a primary degenerative dementia for which no cause is clearly established. family history or genetic abnormalities are found in about 50% of cases. The diagnosis is frequently missed or delayed, as in this case, because it occurs in a younger age group, presents with unusual signs and symptoms, and is far less prevalent than alzheimer disease. ( info) |
10/31. serum bupropion levels in 2 breastfeeding mother-infant pairs. BACKGROUND: These are the first reported data on bupropion and hydroxybupropion levels in infants whose treated mothers were breastfeeding. The information will assist physicians and parents in the risk-benefit decision-making process for bupropion treatment during breastfeeding. METHOD: serum samples were obtained by venipuncture from 2 mother-infant pairs. The serum was assayed for levels of bupropion and its most active metabolite, hydroxybupropion. RESULTS: Neither infant had quantifiable serum levels of bupropion or its metabolite at steady state. Neither infant had medical problems during the time of maternal therapy. CONCLUSION: We recommend obtaining and publishing additional serum level findings for breastfeeding mother-infant pairs since data for bupropion are favorable but limited. ( info) |