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PubMed1976

Clinical significance of plasma chlorpromazine levels. I. Plasma levels of the drug, some of its metabolites and prolactin during acute treatment.

Seventeen acute psychotic patients were studied in the course of chlorpromazine (CPZ) treatment. Blood samples were taken weekly both before and two hours after the morning CPZ dose. Plasma levels of CPZ, CPZ sulphoxide (CPZ SO) monodesmethylated CPZ (NOR1CPZ) and 7-hydroxy CPZ (7OH CPZ) were estimated by gas chromatography. Plasma prolactin, luteinizing hormone, testosterone and oestrogens were measured by radioimmunoassay. Six of the seven patients who showed no clinical improvement had plasma CPZ levels equal to or higher than those of patients who improved. 'Non-responders' has a greater proportion of CPZ SO in pre-dosage samples. The occurrence of parkinsonian side effects was associated with a mean plasma CPZ of greater than 50 ng/ml and a mean plasma prolactin of greater than 30 ng/ml two hours after dosage. The elevation of prolactin preceded the onset of parkinsonian symptoms by 1-2 weeks. There was a significant positive correlation between mean plasma prolactin and mean plasma CPZ levels. The prolactin response may prove a useful index of the central antidopaminergic effect of neuroleptic drugs.

Acute Disease↗
PubMed1982

Psychiatric illness following childbirth in Southampton: a case register study.

The Southampton case register and maternity records were used to identify all Southampton women who had babies in 1976 and 1977 and who had been in psychiatric care in the 2 years before and after the birth date. 127 such women were identified out of a total of 5200 having babies. An analysis of the timing of referral and the total number in care at various stages of the study period confirmed an increased rate of psychosis following childbirth. Rates for other diagnoses showed no such clear relationship. Obstetric and social factors were not related to postpartum morbidity. These results are discussed.

Adolescent↗
PubMed2006

Postpartum psychosis: two cohorts compared, 1875-1924 and 1994-2005.

BACKGROUND: There has been a long-standing debate as to whether postpartum psychoses are distinct from other psychoses. While the outcomes of postpartum psychosis are in general thought to be good, the disorder is linked to a high rate of suicide. METHOD: We have utilized a database of 3872 admissions to the North Wales Asylum during the period 1875-1924 to extract data on the prevalence, course and clinical features of postpartum psychoses during this period. We have collected first admissions for postpartum psychosis between 1994 and 2005 in North West Wales to establish a current incidence rate for the disorder. RESULTS: The incidence of psychoses with a first onset in the postpartum period in North West Wales has fallen in the modern period, while the incidence of postpartum psychoses in women with a pre-existing mental illness remains the same. Some features of the clinical picture and course of postpartum psychoses differ from other psychoses, but may be gender rather than disorder linked. CONCLUSIONS: These findings suggest that psychoses with their first onset in the postpartum period may be vanishing. If replicated, this would support claims that these disorders are distinct from other disorders. Alternately, if regarded as affective disorders, establishing the basis for the apparent decline in frequency of these disorders may have implications for other affective disorders.

Adult↗
PubMed1998

Neuroleptic drugs in breast-milk: a study of pharmacokinetics and of possible adverse effects in breast-fed infants.

BACKGROUND: Very little is known about the pharmacokinetics of neuroleptic drugs in breast-feeding mothers and their infants or about possible adverse effects in the infants. METHOD: Twelve mothers who breast-fed their infants were prescribed haloperidol, chlorpromazine or trifluoperazine. Two methods, enzyme immunoassay (EIA) and high performance liquid chromatography (HPLC) were used to assay these drugs in samples from mothers, but infants' samples were assayed only by the more sensitive EIA. Repeated clinical and developmental assessments of the breast-fed infants were carried out up to 30 months of age. The control subjects were 18 bottle-fed infants whose mothers were also prescribed neuroleptic or mood-stabilizing drugs. RESULTS: The total concentrations of neuroleptic drugs and their principal metabolites in maternal plasma were correlated with concentrations in fore-milk. Infants were ingesting up to 3% of the maternal daily dose per kg body weight and small amounts of the drugs were detected in infants' plasma and urine. Concentrations of haloperidol in the adult range were found in plasma from 2 of 5 infants assayed by EIA but there was no evidence of any acute or delayed adverse effects. Three other breast-fed infants whose mothers were prescribed both haloperidol and chlorpromazine showed a decline in their developmental scores from the first to the second assessment at 12-18 months. CONCLUSION: More extensive longitudinal studies are needed but, in the meantime, there appears to be grounds for caution if breast-feeding mothers are prescribed doses of single or two neuroleptic drugs at the upper end of their recommended ranges.

Adult↗
PubMed2006

Angioedema and maculopapular eruptions associated with carbamazepine administration.

Cutaneous rashes and eruptions can be caused by many medications, including carbamazepine. The presentation can be varied depending on severity. Cutaneous eruptions occur in 3% of individuals administered carbamazepine. Angioedema, a rare side effect of carbamazepine, involves vascular leakage in dermis and subcutis mediated by immunoglobulin E and/or bradykinins. Angioedema is more common in females and in the third decade of life. We report the case of a 27-year-old Indian woman who developed maculopapular rash and angioedema secondary to carbamazepine administration. The patient responded successfully to withdrawal of the drug and treatment with antihistamines. Due to the potentially life-threatening complications of this condition and the increasing use of anticonvulsants in the treatment of mood disorders, psychiatrists must be aware of the diagnosis and treatment of this condition.

Adult↗
PubMed2003

Bacteriological status of canine milk and septicaemia in neonatal puppies--a retrospective study.

Results of the bacteriological examination of milk samples from 46 bitches were evaluated retrospectively, and correlated with findings of the bacteriological examination of organs from dead, septicaemic puppies in their litters (n = 33). The aim of this study was to investigate, in how many cases of clinical and subclinical mastitis of the bitches, the same bacteria can be detected in their septicaemic neonates. One group of lactating bitches was clinically healthy (group I, n = 38), whereas in eight bitches different puerperal disorders were found (group II). Twenty-five septicaemic puppies were from group I, eight from group II. Out of a broad spectrum of bacteria isolated from the milk of clinically healthy and diseased bitches, only Escherichia coli, Klebsiella pneumoniae and/or ss-haemolytic (haem.) Streptococcus sp. could be isolated from organs of their septicaemic puppies. This was the case in three bitches with mastitis and in one clinically healthy bitch only. Staphylococcus intermedius, although frequently isolated from canine milk, does not seem to be a cause of septicaemia in neonates. It is assumed that in most cases of neonate septicaemia, bacteria from the bitches' milk are not the primary cause.

Animals↗
PubMed2000

Acute psychiatric disturbance in pregnancy and the puerperium.

Psychiatric disturbance occurring during pregnancy or the puerperium can occur as a first presentation or as a recurrence or deterioration of a previously diagnosed psychiatric illness. Whatever the history or aetiology, the occurrence of psychiatric disturbance during this period can have profound, long-term implications not only for the mental health of the mother, but also for her relationship with her child and other family members, as well as for the child's development. The treatment of psychiatric disturbance at this time can present difficult dilemmas and should always involve a careful analysis of the risks and benefits of treatment. Liaison between obstetricians and psychiatrists is to be strongly encouraged in order to ensure the best possible outcome for both mother and baby. The antenatal period offers a unique opportunity to identify individuals at risk and target them in order to promote psychological well-being during pregnancy and the puerperium.

Antidepressive Agents↗
PubMed2001

Drugs in pregnancy. Prescribing for psychiatric disorders in pregnancy and lactation.

The most recent Confidential Enquiry into the causes of maternal deaths during the perinatal period in England and Wales (1994-1996) revealed that psychological illness was at least as important as hypertensive disorders. It is therefore important for obstetricians to be aware of a variety of psychiatric conditions as well as the psychotropic medication prescribed and sequelae of continuation or withdrawal of these drugs. Best management, of this particularly vulnerable group of women, requires close liaison with the psychiatric team. This chapter considers four groups of women most likely to be prescribed psychoactive drugs during the perinatal period: (i) women with mental illness wishing to conceive, (ii) women with mental illness who conceive while taking medication, (iii) those who become mentally ill while pregnant, and (iv) those who become unwell postnatally. Guidelines for treatment are discussed.

Antipsychotic Agents↗
PubMedDate not supplied

[Psychic disturbances in the postpartum period: an increasing problem?].

Postpartum psychic disorders can be mainly divided into 3 groups: The so-called postpartum blues, the postpartum depression and the postpartum psychosis. The postpartum blues occurs 3 - 5 days postpartum in 50 - 70 % of deliveries mostly disappearing after one week without specific therapy. However, 20 - 30 % of patients will develop a depression in their further postpartum course so that a thorough evaluation concerning depression is warranted, if blues symptoms persist more than 2 weeks. Postpartum depression can be found in 10 - 15 % of deliveries and mostly occurs several weeks or months after delivery with symptoms of depressive mood, sleeping disorders, anxiety, loss of interest and accord and feelings of guilt up to suicidal ideas. In order not to misinterpret them as postpartum blues specific questions concerning the mood of the young mother during the postpartum examination - if necessary using the Edinburgh scale - are recommended. In patients with known risk factors for a postpartum depression (i. e. postpartum depression or psychosis in previous pregnancies, depression disorder, anxiety disorder, bipolar illness), a thorough survey is mandatory and - if necessary - a prophylactic treatment in cooperation with the psychiatrist. Less severe forms of postpartum depression can mostly be treated with psychotherapy and sociotherapy on an outpatient basis. In more severe cases, antidepressant drugs (selective serotonin reuptake inhibitors, SSRIs or some tricyclic drugs) are indicated. Postpartum anxiety and compulsive disorders respond well to psychotherapy; besides in anxiety disorders benzodiazepines are recommended, in compulsive disorders SSRIs. Postpartum psychoses (about 0.1 - 0.2 %) most often occur in bipolar or schizoaffective disorders or after postpartum psychosis. They require a hopitalization mainly because of the danger of suicide and homicide toward the newborn; ideally this is performed in mother-child-units.

Adult↗
PubMed1993

[Psychoses in puerperium: symptoms, course and long-term prognosis].

86 women who suffered from a psychotic disorder for the first time in their life within 6 weeks after parturition, were investigated regarding sociodemographic and gynaecological parameters, time of onset and initial symptomatology, psychopathological symptoms during hospitalisation, treatment and short-term outcome of the illness. The majority of patients became ill after the first (75%), full-term normal (63%) delivery and within the first two postpartum weeks (78%). The most frequent initial symptoms were anxiety, restlessness, depressive mood, sleep disturbances, behaviour disturbances, catatonic excitement, delusions and hallucinations. By the time of follow-up investigation, 16 women had died; 61 women were investigated on average 25.6 years after onset (minimum 12, maximum 41 years), using standardised instruments of evaluation. Nearly two-thirds of the patients had suffered re-manifestation of psychotic disorder during a long-term course (64%). The frequency of re-manifestations of illness after additional pregnancies and deliveries was found to be 1:4, which is also known to be the expected frequency during the course of other psychotic disorders. These results do not justify the global recommendation to avoid additional pregnancies or carry out an interruption of pregnancy, if the patient has a history of postpartum psychosis. The climacteric period also seems to be a vulnerable phase for the re-manifestation of illness. Nearly 3/4 of the investigated women displayed no disturbances in any of the evaluated dimensions (psychopathological, psychological, psychosocial status) at the time of follow-up.

Adult↗
PubMed1989

[Diagnosis of postpartum complications using CT and MRT].

Severe puerperal infections, iliacal and ovarian vein thrombosis are post-partum complications which are potentially life-threatening. They require prompt medical treatment. CT and MR enable diagnosis by noninvasive methods.

Female↗
PubMed1993

[Atrial septum aneurysm as the cause of a thromboembolic infarction of the brain stem and cerebellum?].

A 32-year-old woman with migraine for several years again had a migraine attack with headache, nausea, vomiting and eye-muscle disorder, 14 days after an uncomplicated delivery. Within 24 hours a left-dominant hemiparesis developed, followed 12 hours later by tonic-clonic seizure and deep unconsciousness (Glasgow score: 3); the patient could not be aroused. Cranial computed tomography revealed extensive infarction of the brainstem and cerebellum. Angiography demonstrated occlusion of the basilar artery but not other abnormalities of other vessels. There was no evidence for vascular anomalies and the clotting tests were normal. Transoesophageal echocardiography demonstrated an atrial septal aneurysm. But any interatrial shunt (e.g. through a patent foramen ovale) was excluded by colour Doppler sonography, making it highly unlikely that a paradoxical embolus was the cause of the infarction. The brainstem infarction resulting from the basilar artery occlusion did not respond to treatment and the patient died 10 days after the initial seizure.

Adult↗