Dermatological manifestations in pregnancy with primary psychiatric findings

2016 ◽  
Vol 33 (S1) ◽  
pp. S413-S413
Author(s):  
A. Wahab ◽  
N. Kalar ◽  
F. Hassan ◽  
M. Alzaabi ◽  
K. Hira Bibi ◽  
...  
Keyword(s):  
Intrahepatic Cholestasis ◽  
Psychiatric Illness ◽  
Depressive Disorders ◽  
Skin Diseases ◽  
Cutaneous Manifestations ◽  
Diagnostic And Statistical Manual ◽  
Atopic Eruption Of Pregnancy ◽  
Impetigo Herpetiformis ◽  
Competing Interest ◽  
In Pregnancy

IntroductionEven though the association between dermatological conditions in pregnancy with psychiatric findings is vital for patient management, studies on these issues are limited.ObjectiveTo determine the frequency and nature of dermatological problems in pregnant women having primary psychiatric illness.AimTo establish an association between cutaneous manifestations in pregnancy with the hypothesis that psychiatric illness also has a role in pregnancy.MethodsThis was a case control study and non probability convenient sampling was used on 50 pregnant patients with cutaneous manifestations along with psychiatric illness and 50 age matched non pregnant patients free from dermatological conditions and psychiatric illness. The Diagnostic and Statistical Manual of Mental Disorders (DSM IV) Criteria was used to diagnose psychiatric illness and for skin manifestations patients underwent a physical examination of skin.ResultsPregnant patients with depressive disorders were associated with atopic eruption of pregnancy [odds ratio (OR) 1.19; 95% (CI): 1.13–1.49], pruritic urticarial papules [(OR) 2.89; 95% (CI): 2.55–2.97], plaques of pregnancy [(OR) 2.14; 95% (CI): 2.01–2.39], prurigo of pregnancy [(OR) 1.33; 95% (CI): 1.17–1.45], intrahepatic cholestasis of pregnancy [(OR) 2.45; 95% (CI): 2.29–2.67], pemphigoid gestationis [(OR) 1.57; 95% (CI): 1.50–1.68], impetigo herpetiformis [(OR) 1.83; 95% (CI): 1.65–2.24], and pruritic folliculitis of pregnancy [(OR) 2.34; 95% (CI): 2.20–3.62], psoriasis [(OR) 1.75; 95% (CI): 1.64–2.37], melasma [(OR) 1.88; 95% (CI): 1.63–2.49], intrahepatic cholestasis [(OR) 2.77; 95% (CI): 2.14–3.48].ConclusionThe results of the study support the hypothesis, that there is an association between psychiatric and skin diseases in pregnancy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Associations among immune activation, the clinical characteristics, and the current severity of the “with anxious distress” specifier in patients with depressive disorders

2016 ◽  
Vol 33 (S1) ◽  
pp. S405-S406
Author(s):  
W.M. Bahk ◽  
I.H. Shim ◽  
Y.S. Woo ◽  
S.Y. Lee ◽  
Y.J. Kwon ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Course Of Illness ◽  
Reactive Protein ◽  
Diagnostic And Statistical Manual ◽  
Medical Disorders ◽  
Significant Difference ◽  
Immune Factors ◽  
Competing Interest

IntroductionThis study assessed the levels of immune factors, demographic and clinical characteristics, and pharmacological treatments of patients with depressive disorders and compared them between patients with mild-to-moderate and moderate/severe-to-severe anxiety.MethodsThis study included 177 patients diagnosed with a depressive disorder who were hospitalized between March 2012 and April 2015. The patients were categorized into mild-to-moderate anxious distress and moderate/severe-to-severe anxious distress groups, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) based on the “with anxious distress” specifier. The current severity of symptoms was determined using the Hamilton Depression Rating Scale (HAM-D) scores on the Agitation and Anxiety-Psychic subscales. The charts of the patients were reviewed to evaluate immune factors, including C-reactive protein (CRP) and white blood cell (WBC) levels, confounding factors, such as smoking, other general medical disorders, and body mass index (BMI), and demographic and clinical characteristics.ResultsThe moderate–severe to severe anxious distress group tended to have higher CRP and monocyte levels compared with the mild to moderate anxious distress group. However, after adjusting for the total HAM-D scores, there was a significant difference only in monocyte levels. After this adjustment, patients with moderate–severe to severe anxious distress had a significantly greater trend toward significance for suicidality and a higher rate of antipsychotic use.ConclusionsHigh levels of anxiety symptoms may influence various underlying pathophysiological factors and modulate the inflammatory response and course of illness, affecting treatment planning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Dermatoses Específicas da Gravidez

2013 ◽  
Vol 26 (5) ◽  
pp. 593
Author(s):  
Vera Teixeira ◽  
Inês Coutinho ◽  
Rita Gameiro ◽  
Ricardo Vieira ◽  
Margarida Gonçalo
Keyword(s):  
Intrahepatic Cholestasis ◽  
Skin Diseases ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Vascular Changes ◽  
Safe Treatment ◽  
Timely Diagnosis ◽  
Polymorphic Eruption Of Pregnancy ◽  
Atopic Eruption Of Pregnancy ◽  
Cholestasis Of Pregnancy

During pregnancy immunological, metabolic, hormonal and vascular changes occur, and can cause specific skin diseases. The specificdermatoses of pregnancy have undergone numerous changes in nomenclature and classification, partly due to advances in the knowledge of the pathogenesis of these skin diseases. Currently the following diseases are considered specific dermatoses of pregnancy:pemphigoid gestations, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy and atopic eruption of pregnancy. Timely diagnosis and specific and safe treatment are essential to prevent complications which, although rare, may be associated with significant maternal-fetal comorbidity.

scholarly journals Dermatoses of pregnancy. A prospective study from Benghazi, Libya

2019 ◽  
Vol 3 (6) ◽  
pp. 166
Author(s):  
Safa Suleman Elfaituri
Keyword(s):  
Prospective Study ◽  
Intrahepatic Cholestasis ◽  
Skin Diseases ◽  
Fetal Mortality ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Pemphigoid Gestationis ◽  
Fetal Risk ◽  
Atopic Eruption Of Pregnancy ◽  
A Prospective Study ◽  
Cholestasis Of Pregnancy

Introduction: Cutaneous findings in pregnancy can be physiologic, coincidental, alterations in pre-existing skin diseases or pregnancy specific. The Pregnancy dermatoses can impact the health of the pregnant woman and the fetus Objectives: Our objective was to determine the spectrum of skin disease associated with pregnancy and to identify the various types of pregnancy specific dermatoses and their fetal risk. Materials & methods: A prospective study was performed at dermatology out-patient department of Jumhoria hospital and Ibn Sina polyclinic, Benghazi-Libya over a period of 2 years. A total of 200 pregnant women presented with dermatological complaint were included. History, skin examination, and relevant investigations were performed. The patients with pregnancy specific dermatoses were followed up till delivery and the pregnancy outcome was recorded. The results were analyzed using SPSS. Results: Mean age was 32 years, 62% was multigravidae and 54% of pregnancy dermatoses occurred during third trimester. The highest number of cases presented with coincidental or preexisting diseases (71%); infections (34%), pre-existing skin diseases included eczema (13%), acne vulgaris (4%) and psoriasis (3%) Hyperpigmentation and strieagravidarum represented the main physiological changes (17%). Specific pregnancy dermatoses were present in 12%, these were intrahepatic cholestasis of pregnancy (4%), atopic eruption of pregnancy (3%), pemphigoid gestationis (3%) and polymorphic eruption of pregnancy (2%). Fetal complications including fetal mortality were reported with pemphigoid gestationis (30%) and intrahepatic cholestasis of pregnancy (25%). Conclusions: This study provides important data on the spectrum of pregnancy dermatoses in Libyan patients. Most of the reported pregnancy dermatoses were benign with no adverse effect on the fetus. Pemphigoid gestationis and intrahepatic cholestasis of pregnancy can be a source of significant fetal risk. To the best of our knowledge this is the first study carried out on pregnancy dermatoses in Benghazi, Libya.

scholarly journals Dermatological changes in pregnancy in central India: a cross sectional study

2019 ◽  
Vol 5 (2) ◽  
pp. 411
Author(s):  
Abhijit Chakraborty ◽  
Vaishali H. Wankhade ◽  
Bhagyashree B. Supekar ◽  
Apoorva D. Chopkar ◽  
R. P. Singh
Keyword(s):  
Skin Diseases ◽  
Correct Diagnosis ◽  
Central India ◽  
Cross Sectional Study ◽  
Laboratory Evaluation ◽  
Sectional Study ◽  
Cross Sectional ◽  
Cutaneous Manifestations ◽  
Changes In Pregnancy ◽  
In Pregnancy

<p class="abstract"><strong>Background:</strong> Pregnancy is a period of profound endocrine and metabolic alterations which make the pregnant woman susceptible to changes in the skin and its appendages. These changes in pregnancy can be either physiological, development of pregnancy specific dermatoses or changes in pre-existing skin diseases. The aim of the study to study the dermatological manifestations of pregnancy.</p><p class="abstract"><strong>Methods:</strong> This was a cross sectional study design. All pregnant females with cutaneous manifestations attending outpatient department of Dermato-Venereo-Leprology and Obstetrics and Gynaecology were recruited during December 2015 to October 2017. They were subjected to general, local and systemic examination. Statistical analysis was done with the help percentage, mean and standard deviation.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 400 patients, 216 (54%) were primigravidae and 184 (46%) were multigravidae. Majority of the patients (55%) were in the age group of 21-25 years. Physiological changes were present in all patients and specific dermatoses in 8.75% of patients. The commonest mucosal change was Jacquemier-Chadwick Sign (96.5%) followed by gingivitis (2.5%). Most common pigmentary change recorded was linea nigra. Most common specific dermatoses reported was prurigo of pregnancy (8%) followed by pruritic urticarial papules and plaques of pregnancy (0.5%). Prurigo of pregnancy was more frequently recorded in multigravida patients and more frequently in third trimester of pregnancy. The commonest dermatosis not specific to pregnancy observed was dermatophyte infection.</p><p class="abstract"><strong>Conclusions:</strong> Awareness about various cutaneous changes in pregnancy is important for correct diagnosis that will direct the most appropriate laboratory evaluation and careful management in an effort to minimize maternal and fetal morbidity.</p>

Depressive Disorders: Update on Diagnosis, Etiology, and Treatment

2018 ◽  
Author(s):  
Isabelle E. Bauer ◽  
Antonio L Teixeira ◽  
Marsal Sanches ◽  
Jair C. Soares
Keyword(s):  
Depressive Disorder ◽  
Depressive Disorders ◽  
Treatment Strategies ◽  
Premenstrual Dysphoric Disorder ◽  
Brain Volumes ◽  
Somatic Therapy ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
History Of ◽  
Persistent Depressive Disorder

This review discusses the changes in the diagnostic criteria for depressive disorders as outlined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and recent findings exploring the etiology of and treatment strategies for these disorders. Depressive disorders are typically characterized by depression in the absence of a lifetime history of mania or hypomania. New developments in the DSM-5 include the recognition of new types of depressive disorders, such as disruptive mood dysregulation disorder, persistent depressive disorder, premenstrual dysphoric disorder, and the addition of catatonic features as a specifier for persistent depressive disorder. These diagnostic changes have important implications for the prognosis and treatment of this condition. A thorough understanding of both the clinical phenotype and the biosignature of these conditions is essential to provide individualized, long-term, effective treatments to affected individuals.  This review contains 1 table and 52 references Key words: brain volumes, depressive disorders, DSM-5, hormones, inflammation, neuropeptides, somatic therapy, stress

scholarly journals Predictive value of the aspartate aminotransferase to platelet ratio index and aspartate aminotransferase to alanine aminotransferase ratio in early diagnosis of intrahepatic cholestasis in pregnancy

2021 ◽  
Vol 8 (11) ◽  
pp. 650-654
Author(s):  
İbrahim Kale
Keyword(s):  
Platelet Count ◽  
Intrahepatic Cholestasis ◽  
Predictive Value ◽  
Aspartate Aminotransferase ◽  
Alanine Aminotransferase ◽  
First Trimester ◽  
Control Group ◽  
Third Trimester ◽  
Apri Score ◽  
In Pregnancy

Objective: We aimed to investigate the predictive value of the first-trimester aspartate aminotransferase/platelet count ratio index (APRI) and aspartate aminotransferase/alanine aminotransferase ratio for intrahepatic cholestasis in pregnancy (ICP). Material and Methods: The clinical data of patients who admitted to the Obstetrics Department of Umraniye Training and Research Hospital, between 2015-2020 were analyzed retrospectively. The study group consisted of 44 patients with ICP and the control group consisted of randomly selected 92 healthy pregnant women. Results: The two groups were similar in terms of age, BMI, first and third-trimester platelet count and third-trimester hemoglobin level. Patients with ICP had a significantly higher first-trimester APRI and a lower first trimester AST/ALT ratio than the healthy controls (p <0.001, p = 0.001, respectively). According to the ROC analysis, the optimal cut-off value of the APRI to predict ICP was 0.191, with the sensitivity of 0.66 and specificity of 0.66 (AUC: 0,727), and the optimal cut-off value for AST/ALT ratio was 1.07, with the sensitivity of 0.64, and specificity of 0.62 (AUC: 0,681). Conclusion: The first-trimester APRI score and AST/ALT ratio is an easy, inexpensive, and non-invasive tool that may be useful in predicting ICP early.

scholarly journals Obstetric Cholestasis: A Review and Update

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Olawumi Adaramodu ◽  
Anthony Kodzo-Grey Venyo
Keyword(s):  
Liver Function ◽  
Bile Acids ◽  
Intrahepatic Cholestasis ◽  
Liver Function Tests ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Third Trimester ◽  
Serum Bile Acids ◽  
Function Tests ◽  
Cholestasis Of Pregnancy ◽  
In Pregnancy

Obstetric cholestasis (OC) is a liver disorder that occurs in the late second and early third trimester of pregnancy characterized by pruritus with increased serum bile acids and other liver function tests. The pathophysiology of OC is still not completely understood. The symptoms and biochemical abnormality rapidly resolve after delivery. OC is associated with an increased risk of adverse obstetrical outcomes. The aetiology of obstetric cholestasis of pregnancy is poorly understood and is thought to be complicated and multifactorial.  OC typically occurs in the late second trimester when the oestrogen levels are the highest in pregnancy. The most common complaint is generalized intense pruritus, which usually starts after the 30th week of pregnancy. Pruritus can be more common in the palms and soles and is typically worse at night. Other symptoms of cholestasis, such as nausea, anorexia, fatigue, right upper quadrant pain, dark urine, and pale stool, can be present. Clinical jaundice is rare but may present in 14% to 25% of patients after 1 to 4 weeks of the onset of pruritus. Some patients also complain of insomnia as a result of pruritus. Generally, physical examination is unremarkable except for scratch marks on the skin from pruritus. Pruritus is a cardinal symptom of intra-hepatic cholestasis of pregnancy (ICP) and may precede biochemical abnormalities. The diagnosis of intrahepatic cholestasis of pregnancy is via the presence of clinical symptoms pruritus in the third trimester with elevated maternal total serum bile acids and excluding other diagnoses, which can cause similar symptoms and lab abnormalities. Fasting blood samples should be used to check for the total bile salt acid level as it can become elevated in the postprandial state. Once the diagnosis of OC of pregnancy is confirmed, immediate treatment is necessary, and the primary goal of therapy is to decrease the risk of perinatal morbidity and mortality and to alleviate maternal symptoms. Maternal pruritus can be alleviated with use of moisturisers and oral antihistamines. Ursodeoxycholic acid (UDCA) is the drug of choice for the treatment of ICP. Many authors have advocated elective early delivery of women with intrahepatic cholestasis of pregnancy to reduce the risk of sudden foetal death. The Royal College of Obstetricians and Gynaecologists recommends induction of labour after 37+0 weeks of gestation. Obstetric cholestasis of pregnancy is not an indication for Caesarean delivery. Postpartum pruritus typically disappears in the first 2 to 3 days following delivery, and serum bile acid concentrations will normalize eventually. ICP is not a contraindication to breastfeeding, and mothers with a history of ICP in pregnancy can breastfeed their infants. Postpartum monitoring and follow up of bile acids and liver function tests should be done in 4-6 weeks to ensure resolution. Women with the persistent abnormality of liver function test after 6 to 8 weeks require investigation for other aetiologies.

Whither Psychiatric Diagnosis

1999 ◽  
Vol 33 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Allen J. Frances ◽  
Helen Link Egger
Keyword(s):  
Psychiatric Disorders ◽  
Psychiatric Illness ◽  
Biological Effects ◽  
Genetic Research ◽  
Explanatory Models ◽  
Psychiatric Research ◽  
Diagnostic And Statistical Manual ◽  
Current State ◽  
System Method ◽  
Dsm Iv

Objective: The aim of this paper is to describe the development of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), its purposes and limitations, and the psychiatric nosologies which may emerge from advances in psychiatric research and which may supersede the current classification system. Method: A review of the methodology used to develop DSM-IV, considered in the context of current and future psychiatric, neurobiological, and genetic research, was undertaken. Results: The DSM-IV is a descriptive nosology that has shaped psychiatric research and clinical practice by providing agreed-upon definitions of psychiatric disorders based on the current state of empirical data. Despite the critical importance of the DSM system of classification, this complex yet limited nosology will eventually be replaced by simpler, more incisive explanatory models of psychiatric illness that reflect the interplay of biological, psychological, environmental and social variables affecting the expression and treatment of psychiatric disorders. Conclusions: As we continue to understand the pathophysiology of brain disorders, as well as the biological effects of psychiatric interventions, we will be able to move from a descriptive model to an integrative, explanatory model of psychiatric illness.

A journey across perversions history – from Middle Age to DSM

2016 ◽  
Vol 33 (S1) ◽  
pp. S588-S588
Author(s):  
A. Amaral ◽  
I. Ferraz ◽  
M. Mota
Keyword(s):  
Middle Age ◽  
Sexual Interest ◽  
Cultural Dimensions ◽  
Sexual Practices ◽  
Sexual Deviance ◽  
Diagnostic And Statistical Manual ◽  
Family Pedigree ◽  
Pubmed Database ◽  
Paraphilic Disorders ◽  
Competing Interest

IntroductionPsychiatry's viewpoint of sexual deviance has waved between the normal and the pathological. “Normal” is not determined by nature but by the values of a specific society.AimsTo review the main landmarks in paraphilias history and the importance of social and cultural dimensions to it.MethodsPubMed database was searched using the keywords perversion, sexual deviance, paraphilia, culture and society.ResultsThroughout Middle Age and Renaissance any sexual act that differed from the natural/divine law was considered a vice. Unnatural vices (masturbation, sodomy, bestiality) were the most severely punished, as they could not result in conception. In 1886, Krafft-Ebing stated perversions were functional diseases of the sexual instinct caused by “hereditary taintedness” in the family pedigree and worsened by excessive masturbation. Proper perversions were sadism, masochism, antipathic sexuality (homosexuality, transvestism, transsexuality) and fetishism. Later, Havelock Ellis and Hirschfeld claimed sexual interest in the population followed a statistical norm, opposed the idea that masturbation led to diseases and demanded the decriminalization of homosexuality. Freud believed the “perverse disposition” to be universal in the childhood giving rise to healthy and pathological adult behaviors. In 1950's, Albert Kinsey surprised America when he proved many supposedly deviant sexual practices were quite common. The first Diagnostic and Statistical Manual (1952) was mainly psychoanalytic. Later, by 1973, homosexuality was removed from classifications. Recently, DSM-5 distinguishes between paraphilias and paraphilic disorders.ConclusionA progress in the paraphilic instincts’ acceptance has occurred. We hypothesize, in the future, paraphilias will follow homosexuality out of the diseases’ classifications.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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