scholarly journals Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis

2005 ◽  
Vol 186 (3) ◽  
pp. 258-259 ◽  
Author(s):  
Emma Robertson ◽  
Ian Jones ◽  
Sayeed Haque ◽  
Roger Holder ◽  
Nick Craddock
Keyword(s):  
Mental Illness ◽  
Value Of Information ◽  
Psychiatric Illness ◽  
Post Partum ◽  
Positive Family History ◽  
Psychotic Episode ◽  
Clinical Value ◽  
Puerperal Psychosis ◽  
History Of

SummaryThe clinical value of information on the risk of future psychiatric illness in women who have experienced puerperal (post-partum) psychosis has been limited by inconsistencies in terminology and nosology. Here we report rates of subsequent puerperal and non-puerperal episodes, in a well-characterised sample of women diagnosed with clearly defined bipolar affective puerperal psychosis (n=103). Out of 54 women having further children, 31 (57%; 95% Cl 44–69) experienced an additional puerperal psychotic episode, and 64 of 103 women (62%; 95%Cl 52–71) experienced a non-puerperal affective episode during the follow-up period (mean duration 9 years). A history of bipolar episodes prior to the puerperal psychosis did not predict risk following subsequent pregnancies, but positive family history of mental illness predicted shorter time to non-puerperal relapse.

Gestational diabetes mellitus: are mothers being followed-up? A retrospective study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697469
Author(s):  
Rebecca Ward ◽  
Fahmy W Hanna ◽  
Ann Shelley-Hitchen ◽  
Ellen Hodgson ◽  
Adrian Heald ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Median Time ◽  
Post Partum ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Tertiary Referral Centre ◽  
Alternative Approach ◽  
Nice Guidance ◽  
History Of

BackgroundWomen with gestational diabetes (GDM) have an elevated risk of developing type 2 diabetes (T2DM). NICE Guidance recommends women who develop GDM are screened 6 weeks post-partum and annually thereafter.AimTo evaluate conformity to guidance of screening in women with GDM by 6-week post-partum fasting plasma glucose (FPG) and annual FPG and determine time between delivery and development of T2DM.MethodRecords at a tertiary referral centre were used to identify women (n = 54) diagnosed with GDM by antenatal oral glucose tolerance test between July 1999 and January 2007. Data from laboratory records were used to collect investigations of glycaemic status during the follow-up period (median follow-up 12.4 years, range 9.5–17.1 years).ResultsOf 252 women, 102 (40.2%) did not have a FPG at 6 weeks (+/−2 weeks). Of these, median time to first test was 1.2 years (range 0.04–10.8 years), with only 43.1% followed-up within 1 year. In those who had a 6-week FPG, 17 (11.3%) women had no further tests. A total of 84 (33% of those with gestational diabetes in the index pregnancy) women were diagnosed with T2DM; median time from delivery to diagnosis was 5.2 years (range 0.35–15.95). We found the only significant factor for a follow-up test at 1-year post-partum was the use of insulin.ConclusionOur data suggest an alternative approach is needed for monitoring women with a history of GDM. This needs to be appropriate for a generally healthy group in which traditional screening mechanisms may not be adequate or sufficient.

Coeliac crisis mimicking nephrotic syndrome in a post-partum patient

2019 ◽  
Vol 64 (3) ◽  
pp. 116-118
Author(s):  
Özant Helvacı ◽  
Seyma Yıldız ◽  
Berfu Korucu ◽  
Ulver Derici ◽  
Turgay Arinsoy
Keyword(s):  
Nephrotic Syndrome ◽  
Coeliac Disease ◽  
Post Partum ◽  
Lower Extremity Weakness ◽  
Case Presentation ◽  
Multisystem Involvement ◽  
Life Threatening ◽  
History Of ◽  
Rare Occasion

Background Coeliac crisis is a life-threatening presentation of coeliac disease. Severe diarrhoea, weight loss, electrolyte imbalances and malnutrition are prominent features. Although mainly a disease of childhood, it can on the rare occasion be diagnosed in adults. Case presentation A 25-year-old female with severe generalised oedema, lower extremity weakness, hypokalemia and profound hypoalbuminemia was referred with an initial diagnosis of nephrotic syndrome. Three months previously she had given birth to a healthy child following an uneventful pregnancy. She did not have proteinuria. She had a history of diarrhoea with gluten-containing food since childhood but lacked a formal diagnosis of coeliac disease. A duodenal biopsy confirmed the suspected diagnosis. Coeliac crisis was diagnosed with life-threatening multisystem involvement. Introduction of a gluten-free diet abolished all disease symptoms and ameliorated laboratory parameters at six months’ follow-up. Conclusion Coeliac crisis is a rare, yet dangerous presentation of coeliac disease in adults. As this case suggests, it can present with generalised oedema and hypoalbuminemia mimicking nephrotic syndrome. Rapid diagnosis is the key to successful treatment.

scholarly journals The risks of motherhood

1991 ◽  
Vol 15 (4) ◽  
pp. 220-220
Author(s):  
Rosalind Ramsay
Keyword(s):  
Mental Illness ◽  
Maternal Morbidity ◽  
Psychiatric Illness ◽  
Post Partum ◽  
Psychiatric Morbidity ◽  
Obstetric Care ◽  
Prevention And Treatment ◽  
Multidisciplinary Group ◽  
Set Up ◽  
The 19Th Century

The Marcé Society, a multidisciplinary group set up in 1980 to advance the understanding, prevention and treatment of post-partum mental illness, met in York for its biennial meeting last September to celebrate its tenth birthday. In the middle of the 19th century, Louis Marcé first drew attention to the special nature of psychiatric illness in the puerperium. Since then, as opening speaker, Dr Channi Kumar pointed out, although maternal morbidity has dropped dramatically, in particular over the last 40 years with improvements in obstetric care together with social, cultural and educational changes, psychiatric morbidity in the puerperium remains as prevalent as it was 100 years ago.

Predictors of ICU admission and long-term outcomes in overdose presentations to Emergency Department

2020 ◽  
Vol 28 (1) ◽  
pp. 75-79
Author(s):  
Mark Savage ◽  
Ross Kung ◽  
Cameron Green ◽  
Brandon Thia ◽  
Dinushka Perera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Psychiatric Illness ◽  
Atypical Antipsychotics ◽  
Long Term Outcomes ◽  
Icu Admission ◽  
History Of

Objective: To describe the characteristics of patients presenting to an Emergency Department (ED) following overdoses; to identify risk factors for intensive care unit (ICU) admission among these patients; and to identify the rate of mortality and repeat overdose presentations over four years. Methods: Adult patients presenting to ED following drug overdose during 2014 were included. Data were collected from medical notes and hospital databases. Results: During the study period, 654 patients presented to ED 800 times following overdose. Seventy-eight (9.8%) resulted in ICU admission, and 59 (7.4%) required intubation; 57.2% had no history of overdose presentations, and 72.9% involved patients with known psychiatric illness. Overdose of atypical antipsychotics (AAP), age and history of prior overdose independently predicted ICU admission. A third of patients ( n = 196, 30%) had subsequent presentations to ED following overdose, in the four years from their index presentation, with an all-cause four-year mortality of 3.4% ( n = 22). Conclusion: A history of overdose, use of AAP and older age were risk factors for ICU admission following ED presentations. Over a third of patients had repeat overdose presentation in the four-year follow-up with a mortality of 3.4%.

scholarly journals Stability of early-phase primary psychotic disorders with concurrent substance use and substance-induced psychosis

2007 ◽  
Vol 190 (2) ◽  
pp. 105-111 ◽  
Author(s):  
Carol L. M. Caton ◽  
Deborah S. Hasin ◽  
Patrick E. Shrout ◽  
Robert E. Drake ◽  
Boanerges Domínguez ◽  
...  
Keyword(s):  
Mental Illness ◽  
Substance Use ◽  
Early Phase ◽  
Psychotic Disorders ◽  
History Of ◽  
Dsm Iv ◽  
The Stability ◽  
Primary Substance ◽  
Diagnostic Changes

BackgroundThe stability of the diagnostic distinction between a substance-induced psychosis and a primary psychotic disorder co-occurring with substance use is not established.AimsTo describe DSM – IV diagnostic changes over 1 year and determine the predictive validity of baseline indicators of the substance-induced psychosis v. primary psychosis distinction.MethodWe conducted a 1-year follow-up study of 319 psychiatric emergency department admissions with diagnoses of early-phase psychosis and substance use comorbidity.ResultsOf those with a baseline DSM—IV diagnosis of substance-induced psychosis, 25% had a diagnosis of primary psychosis at follow-up. These patients had poorer premorbid functioning, less insight into psychosis and greater family mental illness than patients with a stable diagnosis of substance-induced psychosis. Reclassifying change cases to primary psychoses on follow-up, key baseline predictors of the primary/substance-induced distinction at 1 year also included greater family history of mental illness in the primary psychosis group.ConclusionsFurther study of substance-induced psychoses should employ neuroscientific and behavioural approaches. Study findings can guide more accurate diagnoses at first treatment.

scholarly journals LUNG NODULE 25 YEARS AFTER LOBECTOMY – RECURRENCE OF BRONCHIAL CARCINOID

2020 ◽  
Vol 73 (10) ◽  
pp. 2309-2312
Author(s):  
Aleksandra Bełz ◽  
Violetta Rosiek ◽  
Joanna Głogowska- Szeląg ◽  
Katarzyna Stęplewska ◽  
Beata Kos-Kudła
Keyword(s):  
Positive Family History ◽  
Lung Nodule ◽  
Typical Carcinoid ◽  
Thoracic Computed Tomography ◽  
Pathological Result ◽  
Second Tumors ◽  
History Of ◽  
Distant Spread ◽  
The Right

Introduction: Bronchopulmonary (BP) carcinoids are low and intermediate grade tumors, seen in adults between fourth to sixth decade, where no clear association with tobacco smoking is established. Most often they are sporadic lesions (95%). Half of patients have no symptoms and the tumor is incidentally found on a chest x- ray. BP carcinoids have a good prognostic, however there is a risk of distant metastasis and the recurrences are frequent. Therefore a crucial role of vigilant follow- up, extending far beyond 5 years. Case presentation: We report a case of 73 years old women, with history of recurrent pulmonary infections, and positive family history for lung cancer. Patient underwent left inferior lobectomy for BP carcinoid 25 years before and completed a 5 years long follow- up. On a thoracic computed tomography scan a nodule in the right lung was detected. Patient benefited from surgery and the pathological result was typical carcinoid with Ki67<1%. Follow- up CT scans showed stable images, with no signs of spread or recurrence. Conclusions: Although there is a low risk of distant spread in such tumors, the recurrences are frequent. Moreover, patients may exhibit a higher risk of development of second tumors and there is a risk of metachronous tumors. The post-operative follow-up should be prolonged.

Predictors of Readmission Following Outpatient Treatment for Alcohol Use Disorder

2020 ◽  
Vol 55 (3) ◽  
pp. 291-298
Author(s):  
Emmanuel Mangkornkaew Hansen ◽  
Anna Mejldal ◽  
Anette Søgaard Nielsen
Keyword(s):  
Alcohol Use ◽  
Outpatient Treatment ◽  
Psychiatric Illness ◽  
Alcohol Use Disorder ◽  
Addiction Severity Index ◽  
Drop Out ◽  
Younger Age ◽  
History Of ◽  
Index Treatment

Abstract Aims To identify predictors of readmission to outpatient treatment for alcohol use disorder (AUD) with a view to identifying underlying mechanisms for preventing relapse. Methods A consecutive clinical cohort of 2130 AUD outpatients treated between 1 January 2006 and 1 June 2016 was studied. Data were collected by means of the Addiction Severity Index upon treatment entry and at discharge. Outcome measures were readmission to outpatient treatment and time to readmission. Potential predictors were tested for significance using Cox Proportional Hazards multivariate analysis. Results A total of 22% were readmitted during the follow-up time. Patients readmitted within 1 year of treatment conclusion differed significantly from those not readmitted on age, cohabitation status and completion status of index treatment. Significant predictors of readmission during follow-up time were younger age (hazard ratio (HR) = 0.99, 95% confidence interval (CI), 0.98–1.00), history of psychiatric illness (HR = 1.24, 95% CI, 1.02–1.50), drop-out from index treatment (HR = 1.41, 95% CI, 1.15–1.72) and length of index treatment (HR = 1.02, 95% CI, 1.00–1.04). Conclusion Premature drop-out from treatment, a history of psychiatric illness, younger age and longer treatment episodes appear to be the most important predictors of readmission.

Abstract 12688: Long Term Use of Calcium Channel Blockers and Risk of Breast Cancer Development

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Uyen T Lam ◽  
Stacey Knight ◽  
Tami L Bair ◽  
Viet T Le ◽  
Joseph B Muhlestein ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Positive Family History ◽  
Channel Blockers ◽  
Increased Risk ◽  
History Of ◽  
Incident Breast Cancer

Introduction: Calcium channel blockers (CCBs) are a mainstay in treating hypertension (HTN). Recently, Li et-al published a population based case-control study (JAMA 2013; 289:2354) reporting CCB use to be associated with incident breast cancer (odds ratio 2.6). We prospectively analyzed 2 Intermountain Healthcare (IHC) databases (db) to confirm or refute this provocative report. Methods: Two separate analyses were conducted using general patients (GP) seen at IHC and patients undergoing coronary angiography (CV) at IHC facilities. Subjects were females aged 50-70 with no history of breast cancer. Those prescribed CCB were matched 1:1 to subjects not on CCB based on age, race, tobacco, alcohol, body mass index, HTN and follow up time. Multivariable Cox proportional hazards regression was used for the primary analysis of time to incident breast cancer by CCB use adjusting for history of other cancers and family history of breast cancer. Results: A total of 2612 GP subjects (cases/controls) and 1106 CV subjects (cases/controls) were studied. In the GP db, there was a statistically significant increased risk of breast cancer for subjects using CCB (HR=1.58; 95% CI: 1.10-2.26). Risk was also associated with a positive family history (HR=2.79; 1.96-3.97) and a personal history of cancer (HR=1.87; 1.07-3.26). Breast cancer predominantly developed in <5 y of follow up (64% of cases). However, a reverse relationship was found in the CV db, where the HR was 0.51 (95% CI: 0.27-0.97). This observation was found despite consistent associations with several secondary outcomes, including for incident diabetes, coronary and renal disease. Conclusion: A modest association between CCB use and incident breast cancer was observed in the GP db, but results were not reproducible in the CV db. Given lack of a credible mechanism and failure of previous randomized CCB studies to detect a signal, we interpret these modest and conflicting associations to likely represent uncorrected confounding, e.g. prescriber bias or drug interactions. Similarly, we believe the results of Li et-al may represent confounding. Given the important role of CCBs in clinical medicine, further studies are warranted, including randomized trials to assess CCB safety with respect to breast cancer risk.

Post-partum psychosis: socio-demographic and obstetric profile

2017 ◽  
Vol 6 (1) ◽  
pp. 106
Author(s):  
Sunil Kumar Ahuja ◽  
Nimisha Mishra ◽  
Pradeep Kumar
Keyword(s):  
Rural Areas ◽  
Nuclear Family ◽  
Post Partum ◽  
Economic Status ◽  
Cross Sectional Study ◽  
Vulnerable Groups ◽  
Puerperal Psychosis ◽  
Cross Sectional ◽  
Medical College ◽  
History Of

Background: Better knowledge of socio-demographic profile and obstetric features may help in early identification and treatment of patients with post-partum psychosis. The aim of present research is to study the age, parity, socio-demographic and obstetric and menstrual profile of patients suffering from post-partum psychosis. Setting and Design: A cross-sectional study at in-patient department of psychiatry, SS Medical College and associated SGMH Rewa.Methods: The study was conducted on sixty patients of post-partum psychosis admitted in psychiatry ward. Detailed socio-demographic characteristics, obstetric and menstrual profile along with psychiatric assessment were recorded in proforma specially designed for the study.Results: Bulk of our post partum psychotic subjects (60%) were in the age range of 18-25 years with 83.33% of women were residing at rural areas. Most of subjects (76.67%) of post partum psychosis were illiterate. 73.33% patient were belonging to low socio-economic status and remaining to middle and high socioeconomic status. Majority of subjects (13.33%) were house wife (86.67%) followed by laborer class. Family jointness reveal 80% and 20% of subjects trailed from joint and nuclear family respectively. the maximum number of subjects (60%) were primipara with only 13.33% of subjects had history of obstetric complication in form of prolonged labour and post-partum heamorrhage. 25% subjects had cesarean delivery. 40% patients of puerperal psychosis were having menstrual irregularity and 60% had regular menstruation.Conclusions: Screening of vulnerable groups i.e. younger age, primipara, history of irregular menstruation in post partum period for psychiatric sign and symptoms is requisite for early diagnosis and prompt and adequate management. As most of the patients were from rural areas it is necessary to establish psychiatric services in rural areas as well so that this group of population can be provided holistic care along with already existing medical services.

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