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PubMed1996

Hypothalamic corticotropin-releasing hormone suppression during the postpartum period: implications for the increase in psychiatric manifestations at this time.

The third trimester of human pregnancy is characterized by a hyperactive hypothalamic-pituitary-adrenal axis, possibly driven by progressively increasing circulating levels of placental CRH and gradually decreasing levels of CRH-binding protein. The postpartum period, on the other hand, is characterized by an increased vulnerability to psychiatric manifestations (postpartum "blues," depression, and psychosis), a phenomenon compatible with suppressed hypothalamic CRH secretion. To investigate the hypothesis that the postpartum period is associated with suppression of hypothalamic CRH secretion, we studied prospectively 17 healthy euthymic women (mean +/- SE age, 32.0 +/- 1.1 yr) with no prior history of depression, starting at the 20th week of gestation. Psychometric testing was performed monthly during pregnancy and postpartum on day 2 and weeks 2, 3, 6, 8, 12, 16, and 20, whereas serial ovine (o) CRH tests were performed postpartum at 3, 6, and 12 weeks. While pregnant, all 17 subjects remained euthymic; in the postpartum period, 7 women developed the "blues," and 1 developed depression. Overall, the mean plasma ACTH response to an iv bolus of 1 microgram/kg oCRH was markedly blunted at 3 and 6 weeks, but normal at 12 weeks postpartum, whereas the mean plasma cortisol response was at the upper limit of normal at all 3 times. These data are compatible with a suppressed hypothalamic CRH neuron that gradually returns to normal while hypertropic adrenal cortexes are progressively down-sizing. When the postpartum ACTH responses to oCRH were analyzed separately for the euthymic women and the women who had the "blues" or depression, the blunting of ACTH was significantly more severe and long lasting in the latter group; this was observed at all 3 times of testing. We conclude that there is central suppression of hypothalamic CRH secretion in the postpartum, which might explain the increased vulnerability to the affective disorders observed during this period. The suppressed ACTH response to oCRH might serve as a biochemical marker of the postpartum "blues" or depression.

Adrenocorticotropic Hormone↗
PubMed1995

Does recombinant human erythropoietin not only treat anemia but reduce postpartum (emotional) distress as well?

Based on the established rhEPO treatment of anemia in endstage renal failure, which results in improved quality of life, and on the clinical observation that patients with postpartum anemia treated with rhEPO seemed to gain a more stable mood, we inferred that there is a beneficial side-effect of rhEPO on postpartum blues. The aim of this study was to test the hypotheses 1) that postpartum anemia aggravates, and 2) that treatment of postpartum anemia with rhEPO reduces maternity blues. The results show that on the fifth day postpartum anemic patients score consistently worse than nonanemic women on the Symptom Checklist SCL-90-R, indicating more symptoms and distress in general, and also more symptoms characteristic of maternity blues (p < 0.05). On a "Blues Questionnaire," postpartum anemia expresses itself with a reduced "well-being" (p < 0.001). Thus, our first hypothesis was verified. There were no differences by the fifth day postpartum between anemic patients receiving either rhEPO or placebo. Our second hypothesis was thus not confirmed within this limited time. We conclude as clinicians that postpartum anemia should be treated effectively to reduce distress and hence the risk for postpartum affective disorders. Follow-up studies after rhEPO treatment beyond the first week post partum are needed. In addition, in investigations on postpartum affective disorders, the hemoglobin concentration should be considered.

Anemia↗
PubMed1998

Postpartum psychiatric illness: the role of the pediatrician.

PPD occurs in 10% to 20% of postpartum women. Maternal depression can affect a child's development significantly. Pediatricians can screen for maternal psychiatric illness with little effort; of all the health care professionals, they may be in the best position to do so. Pediatricians can help affected mothers obtain appropriate treatment and help mobilize social resources. This simple process can minimize morbidity to pediatric patients.

Antidepressive Agents↗
PubMed2006

[Factors associated with minor psychiatric disorders among women selected from a healthcare center in Rio de Janeiro, Brazil].

The aim was to investigate factors potentially associated with minor psychiatric disorders, including maternal nutritional status variables. A cohort was studied with 479 women 15-45 years of age. The reduced General Health Questionnaire (GHQ-12 items) was applied at nine months post-partum with the 312 women who had completed follow-up. Minor psychiatric disorder was defined as a GHQ score of > or = 4 points and was treated as the response variable. Statistical analysis used hierarchical multivariate logistic regression models. The prevalence of minor psychiatric morbidity was 54.2% (95%CI: 48.6-59.7). According to the final model, the following variables remained statistically associated with minor psychiatric morbidity: level 1: total family income (1st quartile: OR = 2.71, 95%CI: 1.42-5.19; 2nd quartile: OR = 2.13; 95%CI: 1.13-4.04); level 3: body fat > or = 30% (OR = 1.66; 95%CI: 1.03-2.65). In conclusion, low income and obesity were the only factors potentially associated with minor psychiatric disorders, even after adjusting for confounding variables, while there are few studies relating maternal nutritional status and minor psychiatric morbidity.

Adolescent↗
PubMed1989

Effect of pregnancy on psychosis: life circumstances and psychiatric symptoms.

As part of an ongoing prospective study to correlate mother and infant outcome with social isolation during pregnancy, the Schedule for Affective Disorders, SADS-C, was administered to twenty-seven psychotic patients late in pregnancy. Extensive standardized evaluation of life stresses and social supports included a Prenatal Interview with sixty items relating to demographics, drug use, health and obstetrical history, family involvement and development expectations of the infant, and a thirty-item Difficult Life Circumstances questionnaire. In this sample the patients' previous life adjustments were stabilized by their pregnancy unless the pregnancy itself created personal stress for the patient. Higher scores on Difficult Life Circumstances were found to be associated with more psychiatric symptomatology. Symptoms of pregnancy confounded SADS-C items measuring vegetative signs of depression. One group of items on the SADS-C appeared to selectively identify a subset of women whose underlying affective symptomatology was potentiated by pregnancy. A second group of items identified women whose symptoms appeared to be reactive to current situational strains.

Adaptation, Psychological↗
PubMed1997

Imaging of puerperal septic thrombophlebitis: prospective comparison of MR imaging, CT, and sonography.

OBJECTIVE: Our objective was to compare prospectively the abilities of MR imaging, CT, and sonography to reveal puerperal septic thrombophlebitis in the pelvis. SUBJECTS AND METHODS: Seventy-six women with puerperal fever for 5 days refractory to antimicrobial therapy underwent MR imaging, CT, and sonography. We obtained unenhanced axial CT images followed by enhanced images after the administration of an oral contrast agent for which we followed a specific protocol. Axial T1- and T2-weighted spin-echo MR images with phase reconstruction and sagittal T1-weighted MR images were obtained. Real-time sonography was performed using Doppler color flow mapping and spectral waveform analysis. RESULTS: Of the 76 women, 64 completed studies with all three techniques. Ovarian vein thrombosis was diagnosed in 12 women. True-positive results were indicated when at least two of the three studies showed the presence of a clot; true-negative results were indicated when at least two of the three studies showed a lack of thrombosis. MR imaging and CT revealed both ovarian veins in all cases (64/64). Sonography revealed 33 (52%) of 64 right ovarian veins and 15 (23%) of 64 left ovarian veins. MR imaging (sensitivity, 92%; specificity, 100%) and CT (sensitivity, 100%; specificity 99%) were comparable in all but two cases. In one such case, MR imaging showed patency, CT revealed findings interpreted as thrombosis, and sonography showed flow in the partially occluded vein. In the second such case, bilateral thrombosis was seen on CT, but interpretations based on sonography and MR imaging were left-sided thrombosis only. Sonography correctly revealed six of the 12 cases of ovarian vein thrombosis. CONCLUSION: CT and MR imaging proved to be the studies of choice in the evaluation of ovarian vein thrombosis.

Adult↗
PubMed1987

Chylothorax as a complication after delivery.

A 23-year old female who developed a chylothorax as a probable complication after delivery is described and a possible mechanism is proposed. Conservative treatment was unsuccessful and the surgical management was complicated by an anatomical variation with the thoracic duct presenting as a plexiform system instead of a single duct.

Adult↗
PubMed1978

Mothers and children in hospital.

Between 1965-1972 244 individual mothers were admitted on 283 occasions accompanied by 287 children to a general hospital unit. This cohort has been followed up to ascertain re-admission to any New Zealand psychiatric facility for two follow-ups at 1-8 years and 5-12 years. A postal survey of attitudes was also carried out. The content of the replies has been analysed, with statistical and anecdotal accounts of patients' and husbands' expressed feelings and attitudes. These are compared with observations in the literature about themes of hostility and anxiety. The circumstances surrounding the homicide of a baby in this series together with our various rationalisations, value judgements and assessment of the situations are described.

Adult↗
PubMed1990

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↗