Retinopathy and bright light therapy.
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Contraindications↗
Biomedical subjects
L Dennerstein
Publications and source records attributed to L Dennerstein.
Breastfeeding and the use of psychotropic medication: a review.
The advisability of continuing breastfeeding is an important issue for women with postpartum depression or psychosis. A review of the literature on psychotropic drugs in breast milk is presented. All of the major classes of psychotropic drugs (antidepressants, antipsychotics, antianxiety agents, lithium, hypnotics) have been shown to pass into breast milk following maternal ingestion. Generally, the doses to which children are exposed from breast milk, calculated from measured milk/plasma ratios, are small. Nevertheless most authors err on the side of caution and suggest that breastfeeding be avoided. There is inadequate research on the excretion of drugs into breast milk and the effects on the infant.
Breast Feeding↗
Review of a mother-baby unit in a psychiatric hospital.
Admissions to a mother-baby unit in a psychiatric hospital were reviewed over a 51 month period. Forty-four mothers (3 admitted twice) and 44 babies were admitted. Eighteen women were diagnosed as having major depression (1 admitted twice), 14 with schizophreniform psychosis, 8 with schizophrenia (2 admitted twice), 4 with bipolar disorder, 2 with anxiety disorders and in 1 diagnosis was deferred. Data are presented from these women's background and that related to pregnancy, as well as duration of stay and treatment in the unit. A description of the unit is also included.
Adult↗
Practice patterns and family life--a survey of Melbourne medical graduates.
To investigate sex differences in the professional achievements and personal life-styles of graduates, a questionnaire survey was conducted. The sample comprised surviving female medical graduates of the University of Melbourne and an equal number of male medical graduates who were matched by year of graduation. The final response rate was 70% (1764 subjects returned questionnaires) and was representative for both age and sex. This article describes the practice patterns and family lives of graduates. Considerable sex-related differences were found in the professional achievements and personal life-styles of the surveyed medical graduates. Women's professional careers tended to be more circumscribed than were those of male colleagues. Women were less involved in areas outside clinical practice such as teaching or lecturing, committees, medical administration, and research and its publication. Female doctors earned significantly (P less than 0.0001) less than did male doctors and were more likely to work as employees, locums or in sessional employment (P less than 0.0001). Women were more involved in all aspects of household activities, especially during midlife (40-60 years of age)--the peak career years for male doctors. The career underachievement of female doctors is likely to continue unless considerable changes are made to current postgraduate training schemes and career structures.
Adult↗
Psychological aspects of hysterectomy. A prospective study.
Sixty women aged between 30 and 55 years, having hysterectomy for benign conditions, were prospectively studied to investigate psychological adjustment to operation, and to explore social, psychological and physical factors associated with psychological outcome. A further 30 women were included for prospective research on psychological outcome. Investigations took place within two weeks of operation and after four months and 14 months. The findings indicated a high prevalence of pre-operative psychological morbidity (55%), which reduced to 31.7% afterwards. There was no evidence that hysterectomy led to a greater psychological distress. The principal risk factors of poor psychological outcome were the previous scores on the mental health measures and personality inventory. Involvement in the research process did not appear to affect psychological outcome.
Adult↗
The factor structure of symptom reports in premenstrual syndrome.
Premenstrual Syndrome (PMS) is characterised by negative moods, physical changes and alterations in cognitions and behaviours during the latter part of the menstrual cycle. Symptoms diminish at the onset of menstruation or during the menstrual flow and the post-menstrual (follicular) phase is usually one of calm and well-being. The factor structure of self-reports from a group of 75 treatment-seeking women was examined for simple structure. Five factors emerged, of which the first general factor was represented by follicular distress and accounted for 22% of the total variance. Four group factors emerged and were characterised as premenstrual negative feelings, premenstrual activation, premenstrual stress-pain, and follicular anxiety accounting for 30% of total variance. The finding of the large general factor with greatest weights on follicular distress items was of particular interest. This finding has implications both for aetiology of PMS and for therapy. These aspects are discussed.
Adult↗
Menstrual migraine: a double-blind trial of percutaneous estradiol.
The present study investigated whether administration of percutaneous estradiol for the 7 days encompassing menstruation (the paramenstruum) would be effective in alleviating menstrual migraine. The study was a double-blind cross-over placebo comparison of percutaneous estradiol in gel form. Twenty-two women who suffered from regular recurring menstrual migraine were studied during 2 assessment menstrual cycles, 4 treatment cycles (2 of estradiol gel, 2 of placebo gel), and 1 follow-up (no treatment) cycle. Women completed daily records of the occurrence and severity of migraine and medication used. Eighteen women completed the study. There was a significant reduction in the frequency of migraine in the paramenstruum and in the amount of medication taken during use of percutaneous estradiol. Women expressed a significant preference for continuation of therapy with percutaneous estradiol.
Administration, Cutaneous↗
Depression in the menopause.
Epidemiologic studies have demonstrated an increase in complaints of depressed mood and other minor psychological changes from patients in the perimenopause. The etiology of these complaints has been the subject of much controversy. Current evidence supports a biopsychosocial etiological model. Underlying endocrinologic changes trigger emotional complaints in women who are vulnerable by virtue of developmental factors, personality, psychiatric history, known vulnerability to hormonally triggered mood changes, or current social problems.
Adult↗
Psychological effects of progestogens in the post-menopausal years.
Progestogens are increasingly being advocated as a necessary and integral part of hormone replacement therapy. Yet few studies have measured the acceptability of these regimes. One factor profoundly affecting acceptability, and thus patient compliance, is the presence of adverse psychological effects of progestogens. There have been few double-blind trials which have evaluated such effects of progestogens and compared them with the effects of oestrogen administration alone. There is some evidence of less favourable effects when certain progestogens are added to oestrogen or used alone. Whilst the literature is limited there is an indication that adverse effects of progestogens may relate to dosage, type of progestogen and individual sensitivity of women to hormone provocation of symptoms. Further studies are needed to test these hypotheses.
Affective Symptoms↗
A mother and baby unit in a psychiatric hospital.
Two rooms where women with puerperal psychiatric illness could be admitted together with their babies were provided in a general psychiatric unit. Over a 21-month-period demand for joint admission far exceeded capacity and most referrals could not be accepted. Women with various psychiatric disorders were referred to and managed in the unit. Greatest demand was for young women suffering from psychosis following childbirth.
Breast Feeding↗
Hysterectomy and tubal ligation.
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Adaptation, Psychological↗
Postpartum depression. A review of recent literature.
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Australia↗
Progesterone and the premenstrual syndrome: a double blind crossover trial.
A double blind, randomised, crossover trial of oral micronised progesterone (two months) and placebo (two months) was conducted to determine whether progesterone alleviated premenstrual complaints. Twenty three women were interviewed premenstrually before treatment and in each month of treatment. They completed Moos's menstrual distress questionnaire, Beck et al's depression inventory, Spielberger et al's state anxiety inventory, the mood adjective checklist, and a daily symptom record. Analyses of data found an overall beneficial effect of being treated for all variables except restlessness, positive moods, and interest in sex. Maximum improvement occurred in the first month of treatment with progesterone. Nevertheless, an appreciably beneficial effect of progesterone over placebo for mood and some physical symptoms was identifiable after both one and two months of treatment. Further studies are needed to determine the optimum duration of treatment.
Adolescent↗
Sexuality in the climacteric years.
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Climacteric↗
Antidepressant therapy: benefits and risks in perspective.
The introduction of second generation antidepressants, such as mianserin and nomifensine, was prompted by the desire to produce drugs which were safer, had fewer side-effects and were faster acting than the tricyclics. A brief review of the data on mianserin and nomifensine is presented in relation to these aims. Some advantages for the new drugs can be claimed and the risks of severe adverse effects relating to blood dyscrasias in the case of mianserin, and fever in the case of nomifensine, appear outweighed by the therapeutic gains.
Cardiovascular Diseases↗
The sexual side-effects of antidepressant medication: a double-blind comparison of two antidepressants in a non-psychiatric population.
Clinical reports have suggested that antidepressant medication may contribute to the sexual dysfunction experienced by some depressed patients. A double-blind trial in a non-psychiatric male population compared amitriptyline (tricyclic), mianserin (tetracyclic) and placebo for their effects on nocturnal sexual arousal. In a three-way crossover design active drug or placebo were taken for two weeks preceding measurement of the frequency, amplitude and duration of nocturnal penile tumescence and synchronous sleep indices. Both active compounds significantly decreased the amplitude and the total duration of nocturnal erections. The effects on sleep indices were as previously reported. Few differences were found between the tricyclic and tetracyclic drugs. Some implications of these findings are considered.
Adolescent↗
Psychological issues in IVF.
The role of psychological factors in IVF is complex. Psychological issues intertwine with physical ones, often with additive effects. The very diagnosis of infertility is likely to cause stress. In addition, the many investigations and procedures may have compounded distress. There are probably a small number of patients in whom psychological factors may induce infertility. But in the majority, psychological factors may exacerbate infertility and influence the patient's and partner's responses. Mental, sexual, marital and social adjustment may all be affected. The procedure of IVF is likely to have a further impact. A pilot study of couples entering an IVF programme revealed the women to be highly anxious and to conform strongly to feminine stereotypes. Many had received psychiatric help in the past. The idiopathic group appeared to cope less well with stress and had higher anxiety and neuroticism scores. Follow-up revealed that IVF had a profound impact on many of the women. Most had received no counselling in the interim. In those who completed questionnaires at follow-up, a differential effect was observed between the organic and idiopathic groups. State anxiety fell in the idiopathic group but so did marital adjustment. The clinician is advised to incorporate consideration of the psychological aspects of IVF into every aspect of the programme. The addition of a psycho-social team may assist the gynaecologist in this and help the couple to make an optimal adjustment.
Adaptation, Psychological↗
Mood and the menstrual cycle.
A majority of women are aware of menstrual cycle-related changes in mood and behaviour. Psychiatric disorders may also be influenced by the menstrual cycle. A premenstrual tension syndrome has been described. Research into the prevalence, aetiology and management of this condition has been hampered by additions and alterations to the original description and methodological difficulties involved in menstrual cycle research. Biological, psychological and sociological theories have been proposed to explain menstrual cycle-related mood changes. Our own studies have found evidence of ovarian steroid disturbances, and impaired psychological functioning in women with the premenstrual syndrome. Therapeutic approaches must consider both aspects. Medication often makes the patient more accessible and receptive to regimens aimed at increasing coping skills. More vigorous research into this disorder is needed.
Adult↗