Cases reported "Puerperal Disorders"

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1/59. Severe cardiac dysrhythmia in patients using bromocriptine postpartum.

    Used worldwide since 1980 for the prevention of breast engorgement in the puerperium, in 1994 bromocriptine mesylate was withdrawn from the American market as an agent suitable for ablactation. The relevant recommendation of the food and Drug Administration rested on case reports that described severe vasospastic reactions among users of the drug. Some patients so affected suffered stroke, intracranial bleeding, cerebral edema, convulsions, myocardial infarction, and puerperal psychosis. More recently, it has been suggested that the side effects of the drug may also include circulatory collapse secondary to cardiac dysrhythmia. This report describes two additional cases in this category. The antepartum clinical evaluation of these women suggested that they were predisposed to arrhythmias.
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ranking = 1
keywords = psychosis
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2/59. Ob-Gyn interactive case challenge--a case of sadness and anxiety 9 months postpartum.

    If you were the primary care provider, how would you diagnose and treat postpartum anxiety and depression in this young, first-time mother? After a normal, uncomplicated pregnancy, this 27-year-old woman developed anxiety and depressed mood, which she was still struggling to control 9 months after the birth of her child. Among the diagnostic possibilities to consider are occult malignancy, diabetes mellitus, and thyroid disorder, as well as major depression/anxiety disorder and postpartum depression.
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ranking = 0.016573022633132
keywords = depression
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3/59. Effect of oestradiol on postpartum depression.

    RATIONALE: The months following childbirth are a time when women are susceptible to depressive disorders, which may be severe and have long-lasting serious adverse consequences. The illnesses remain often unrecognized and untreated, and can be resistant to conventional psychiatric treatment methods. OBJECTIVE: We report two patients with postpartum depression, who had low serum oestradiol together with psychiatric symptoms, and who responded successfully to treatment with oestradiol. methods: The serum oestradiol concentration was measured at baseline and weekly during treatment with sublingual 17-beta oestradiol for 8 weeks. The treatment effect was evaluated using the Montgomery-Asberg depression Rating Scale. RESULTS: Both patients had a low pretreatment oestradiol concentration (36-120 and 31 pmol/l). During treatment with oestradiol, the decline of depressive symptoms coincided with a rise in serum oestradiol. CONCLUSIONS: Oestradiol may be causally related to postpartum depression and have significance in the treatment of this condition.
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ranking = 0.033146045266264
keywords = depression
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4/59. 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.
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ranking = 0.0055243408777107
keywords = depression
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5/59. Recurring short delirium with postpartum onset in two sisters.

    We report on a 30-year-old woman who twice developed a short postpartum psychosis with organic signs, but without obvious organic cause. Extensive investigations only yielded a state of moderate hypercoagulability. Her sister had developed similar signs and symptoms during her second puerperium and died 5 days after her delivery. We discuss the combination of various precipitating factors for postpartum psychosis, the possible impact of the findings on its cause and its classification. copyright copyright 1999 S. Karger AG, Basel
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ranking = 2
keywords = psychosis
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6/59. association between oestradiol and puerperal psychosis.

    OBJECTIVE: Postpartum psychiatric disorders with long-lasting adverse sequelae are common during the childbearing years. These disorders can be severe and resistant to conventional psychiatric treatment methods. We present two consecutive cases with puerperal psychosis who were refractory to conventional treatment methods but responded successfully to oestrogen therapy. METHOD: serum oestradiol concentration was measured by radioimmunoassay and the documented oestradiol deficiency replaced with physiological oestradiol sublingually. The treatment effect was evaluated by the brief psychiatric rating scale. RESULTS: In both cases the baseline oestradiol concentration was low (28 and 69 pmol/L). During the treatment with oestradiol, there was a concomitant elevation of the concentration of serum oestradiol, which coincided with the decline in psychotic symptoms. CONCLUSION: The observation of low serum oestradiol together with psychotic symptoms and successful treatment with oestradiol suggests that oestradiol may have a causal relevance to puerperal psychosis and significance in the treatment of this condition.
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ranking = 6
keywords = psychosis
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7/59. A case of monthly unipolar psychotic depression with suicide attempt by self-burning: selective response to bupropion treatment.

    A second case of monthly, unipolar, psychotic depression is presented, involving a 26-year-old woman whose illness had a postpartum onset, recurred premenstrually for 33 consecutive months, and involved a suicide attempt by self-burning. Whereas various antidepressant, antipsychotic, and hormonal treatments were ineffective, bupropion (together with low-dose trifluoperazine) induced an immediate and complete remission that was maintained at a 16-month evaluation.
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ranking = 0.027621704388554
keywords = depression
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8/59. Acute postpartum mental status change and coma caused by previously undiagnosed ornithine transcarbamylase deficiency.

    BACKGROUND: Acute postpartum mental status change usually represents postpartum blues or depression. Psychosis and coma are rare. This is a case report of a patient with previously undiagnosed ornithine transcarbamylase deficiency presenting as postpartum acute mental status change and coma. CASE: A 28-year-old multipara developed acute mental status change and coma 3 days after cesarean delivery. A metabolic profile and neurologic workup were unrevealing. An electroencephalogram revealed diffusely slow brain activity. She developed hyperammonemia and hyperglutaminemia and was diagnosed with ornithine transcarbamylase deficiency. Her newborn son was diagnosed with ornithine transcarbamylase deficiency on the previous day. Treatment with oral lactulose resulted in normalization of her ammonia level and resolution of her coma within 48 hours. She suffers no long-term sequelae. Dietary avoidance of protein was advised; outpatient treatment with sodium benzoate, sodium phenylacetate, and lactulose was initiated. A pedigree analysis is ongoing. CONCLUSION: ornithine transcarbamylase deficiency should be included in the differential diagnosis of acute postpartum coma. hyperammonemia, hyperglutaminemia, and orotic aciduria are diagnostic, facilitate early treatment, and mitigate the risk of permanent neurologic impairment or death.
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ranking = 0.0055243408777107
keywords = depression
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9/59. 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.
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ranking = 6
keywords = psychosis
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10/59. Response to sleep deprivation in three women with postpartum psychosis.

    BACKGROUND: Postpartum psychotic disorders are rare and poorly understood phenomena occurring after approximately 1 in 2000 births. Increasing attention has been given to the concept of postpartum psychosis as an affective spectrum disorder. We sought to characterize the responses to sleep deprivation of three women with postpartum psychotic and mood symptoms. METHOD: Three hospitalized postpartum women with no prior history of psychotic disorder were treated according to a partial sleep deprivation protocol. Each patient was awakened at 2:00 a.m. and kept awake until 9:00 p.m. the following night. A full and an abbreviated Hamilton Rating Scale for depression (HAM-D) were completed for each patient before and after partial sleep deprivation. RESULTS: Two of the three patients became transiently manic and the third became hypomanic after sleep deprivation. HAM-D scores decreased drastically for each patient. After recovery sleep, each patient de-escalated but required further treatment with mood-stabilizing agents. CONCLUSION: These findings suggest that postpartum psychosis in our patients may represent a variant of bipolar affective disorder.
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ranking = 6.0175580955238
keywords = psychosis, affective
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