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Journal of Inherited Metabolic Disease Nov 2019Urea cycle disorders (UCD) are a group of rare inherited metabolic conditions of amino acid catabolism caused by an enzyme deficiency within the hepatic ammonia... (Review)
Review
Urea cycle disorders (UCD) are a group of rare inherited metabolic conditions of amino acid catabolism caused by an enzyme deficiency within the hepatic ammonia detoxification pathway. The presentation of these disorders ranges from life-threatening intoxication in the neonate to asymptomatic status in adults. Late-onset UCDs can present for the first time in adulthood and may mimic other causes of acute confusion or psychiatric diseases, and are often associated with neurological symptoms. Late-onset UCDs may become apparent during periods of metabolic stress such as rapid weight loss, gastric bypass surgery, chronic starvation or the postpartum period. Early diagnosis is critical for effective treatment and to prevent long-term complications of hyperammonemia. The challenges of management of adults include for example: (a) poor compliance to dietary and medical treatment which can result in recurrent hospital admissions; (b) severe neurological dysfunction; (c) the management of pregnancy and the postpartum period; and (d) access to multidisciplinary care peri-operatively. In this review, we highlight a number of challenges in the diagnosis and management of adult patient with late-onset UCDs and suggest a systematic management approach.
Topics: Adult; Age Factors; Age of Onset; Diagnosis, Differential; Female; Humans; Hyperammonemia; Infant, Newborn; Male; Neurocognitive Disorders; Ornithine Carbamoyltransferase Deficiency Disease; Pregnancy; Puerperal Disorders; Treatment Outcome; Urea Cycle Disorders, Inborn
PubMed: 30932189
DOI: 10.1002/jimd.12096 -
Bipolar Disorders Apr 2005Research into postnatal mood disorders to date has concentrated on depressive syndromes of varying severity and full-blown acute puerperal mania. However, clinical... (Review)
Review
Research into postnatal mood disorders to date has concentrated on depressive syndromes of varying severity and full-blown acute puerperal mania. However, clinical experience, backed up by a review of the literature, indicates that milder hypomanic symptoms also occur in the early puerperium. Although these symptoms may often be regarded as clinically insignificant, there is evidence that the experience of minor puerperal elation may be a predictor of later postpartum depression. In addition, studying mild puerperal high mood may provide insights into the pathophysiology of more severe puerperal mania and psychosis. This paper critically reviews the literature on milder forms of high mood occurring in the puerperium and discusses the potential clinical and research significance of 'the highs'.
Topics: Bipolar Disorder; Euphoria; Female; Humans; Postpartum Period; Pregnancy; Puerperal Disorders; Risk Factors; Sleep Wake Disorders
PubMed: 15762850
DOI: 10.1111/j.1399-5618.2005.00185.x -
Frontiers in Bioscience (Landmark... Mar 2020Women may present with psychiatric disorders during pregnancy, normal labor, following delivery by caesarean section, or in the postpartum period. The accumulating... (Review)
Review
Women may present with psychiatric disorders during pregnancy, normal labor, following delivery by caesarean section, or in the postpartum period. The accumulating evidence suggests that these disorders may be due to changes in immune responses. During pregnancy complications such as the prolongation of cervical ripening or descent, placental abruption, premature labor, and preeclampsia increase the risk of postpartum psychiatric disorders. Women may exhibit depression and postpartum psychosis following either normal birth or caesarean section. Since psychiatric disorders like schizophrenia, major depression, and bipolar disorder are associated with both alterations in the immune response and changes in immune cell subpopulations, in this study we have chosen to examine whether the psychiatric disorders in women during labor or postpartum also lead to aberrant immune responses.
Topics: Adult; Female; Humans; Immunity; Mental Disorders; Obstetric Labor Complications; Postpartum Period; Pregnancy; Pregnancy Complications; Puerperal Disorders
PubMed: 32114440
DOI: 10.2741/4863 -
The American Journal of Psychiatry Nov 2009
Comparative Study
Topics: Bipolar Disorder; Cysteine Endopeptidases; Female; Genome-Wide Association Study; Humans; Immunoglobulins; Methyltransferases; Mood Disorders; Polymorphism, Single Nucleotide; Pregnancy; Protein Subunits; Psychotic Disorders; Puerperal Disorders
PubMed: 19884230
DOI: 10.1176/appi.ajp.2009.09081185 -
The Primary Care Companion For CNS... Sep 2018Recent studies document posttraumatic stress disorder (PTSD) symptoms in women following at-term deliveries with health baby outcomes. However, the notion that...
OBJECTIVE
Recent studies document posttraumatic stress disorder (PTSD) symptoms in women following at-term deliveries with health baby outcomes. However, the notion that childbirth can trigger PTSD remains controversial, and the symptom clusters are mostly unknown. The objective of this study was to examine the clustering of childbirth-induced postpartum PTSD (PP-PTSD) symptoms in comparison to DSM-5 clusters.
METHODS
We examined the symptom presentation of childbirth-related postpartum PTSD (PP-PTSD) in a sample of 685 women. The majority of these women delivered at term. Peritraumatic stress reactions to childbirth and PP-PTSD symptoms were assessed approximately 3 months after delivery. A hierarchical cluster analysis was used to detect grouping of the PP-PTSD symptoms.
RESULTS
Childbirth-related peritraumatic stress was strongly and positively associated with PP-PTSD symptom severity. Cluster modeling revealed 4 distinguished symptom groups: reliving (some reexperiencing symptoms), namely nightmares and flashbacks; avoidance coupled with unwanted memories (other reexperiencing symptoms); negative cognitions and mood; and hyperarousal reactivity.
CONCLUSIONS
Our findings show that the representation of symptoms of PTSD that develops following a stressogenic childbirth experience appears, for the most part, to resemble DSM-5 symptom clusters. More research integrating descriptive symptom assessment with biological measures is warranted to better characterize the symptom presentation of this neglected posttraumatic stress syndrome.
Topics: Adult; Cluster Analysis; Female; Humans; Labor, Obstetric; North America; Pregnancy; Puerperal Disorders; Stress Disorders, Post-Traumatic; Term Birth; Young Adult
PubMed: 30277674
DOI: 10.4088/PCC.18m02322 -
Health Care For Women International 1993Although limited in number, reported research studies indicate a relationship between maternal perceptions of infant temperament and postpartum depression. Excessive... (Review)
Review
Although limited in number, reported research studies indicate a relationship between maternal perceptions of infant temperament and postpartum depression. Excessive crying in particular and the extent of adaptability and predictability have been implicated as infant behavioral indices. In this article, we present the results of a review of the literature linking early infant temperament to postpartum depression. Measurement issues for both infant temperament and depression are discussed. Recommendations for future research are offered.
Topics: Crying; Depressive Disorder; Female; Humans; Infant, Newborn; Nursing Assessment; Pregnancy; Psychology, Child; Puerperal Disorders; Risk Factors; Temperament
PubMed: 8509323
DOI: 10.1080/07399339309516041 -
Obstetrics and Gynecology Nov 2020The rising maternal mortality rate has drawn increased focus to postpartum depression. However, other mental health conditions, such as birth-related postpartum...
The rising maternal mortality rate has drawn increased focus to postpartum depression. However, other mental health conditions, such as birth-related postpartum traumatic stress disorder, have not garnered the same level of attention. The majority of research about postpartum posttraumatic stress disorder (PTSD) is published in journals focused on psychiatry, psychology, and nursing, where this phenomenon is well recognized. In contrast, there is a lack of awareness among most obstetricians. Consequently, few recommendations are available to guide clinical practice. This commentary will present a clinical vignette, provide background that is key to the detection of PTSD, explore available data on postpartum PTSD, and provide recommendations for recognition and prevention of this disorder.
Topics: Adult; Female; Humans; Postpartum Period; Pregnancy; Puerperal Disorders; Stress Disorders, Post-Traumatic
PubMed: 33030876
DOI: 10.1097/AOG.0000000000004093 -
Annals of Clinical Psychiatry :... Dec 1993Considering the multiple issues affecting women and their experiences with mood disorders, several clinical observations may be pertinent: Because women are very... (Review)
Review
Considering the multiple issues affecting women and their experiences with mood disorders, several clinical observations may be pertinent: Because women are very vulnerable to depression, physicians in all patient care related specialties need to be familiar with the diagnosis of depression and related mood syndromes. Early intervention may be far more critical than previously considered in preventing chronic, tragic outcomes for major depression, bipolar disorder, and even severe premenstrual depression. Both dysphoric mania (because of its poor prognosis) and rapid cycling bipolar disorder (because the majority of cases involve women) distinguish bipolar illness in women. In these situations, anticonvulsants such as carbamazepine or valproic acid may offer treatment advantages over lithium. Premenstrual depression is very strongly linked to traditional psychiatric mood syndromes and is likely to benefit from appropriate antidepressant therapy. The serotonin-specific reuptake inhibitors are especially attractive in this situation because of their low side effect profiles (including low weight gain percentages) and safety in overdoses. Previous experience with psychiatric illness, especially bipolar disorder, is often predictive of postpartum mood episodes. Aggressive early treatment is critical to prevent or successfully manage postpartum episodes. Menopause cannot yet be linked to a specific or unique mood syndrome.
Topics: Adolescent; Adult; Bipolar Disorder; Child; Depressive Disorder; Female; Humans; Menarche; Menopause; Middle Aged; Premenstrual Syndrome; Psychotic Disorders; Puerperal Disorders
PubMed: 8312982
DOI: 10.3109/10401239309148824 -
The British Journal of Psychiatry : the... Nov 1992It is well known that women with a history of manic-depressive or puerperal affective psychosis are at particularly high risk of relapse in the puerperium. This paper...
It is well known that women with a history of manic-depressive or puerperal affective psychosis are at particularly high risk of relapse in the puerperium. This paper describes the use of lithium given during or after pregnancy to women with a history of bipolar illness or puerperal affective psychosis. The rate of puerperal relapse in these subjects was compared with that in a similar group of women not on lithium. The significantly better outcome of the treatment group highlights the need for a prospective controlled trial looking at the effectiveness of lithium in minimising puerperal bipolar relapse.
Topics: Adult; Bipolar Disorder; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Lithium; Puerperal Disorders; Recurrence; Risk Factors
PubMed: 1422621
DOI: 10.1192/bjp.161.5.692 -
Genetic, Social, and General Psychology... May 1987Though postpartum depression has been observed for years, research into it has increased recently, especially in England. Distinguishing the rarer, severe puerperal...
Though postpartum depression has been observed for years, research into it has increased recently, especially in England. Distinguishing the rarer, severe puerperal psychosis from milder, more frequent "maternity blues" has provided a clearer framework for new research. Hormonal changes, biogenic amines, stress, and lack of social support have been proposed as explanations for postpartum depression, but the etiology is still not clear. Hormones, tranquilizers, and antidepressants are some modern therapeutic measures employed, whereas electroconvulsive shock therapy was once the most frequent therapy. Fortunately, the mortality rate for childbirth-related psychiatric illness is low.
Topics: Cross-Sectional Studies; Depressive Disorder; Female; Gender Identity; Humans; Maternal Behavior; Pregnancy; Prognosis; Puerperal Disorders
PubMed: 3497074
DOI: No ID Found