Incidence of seizures during pregnancy, labor and puerperium in epileptic women: a prospective study

154 pregnancies of 140 epileptic patients were observed in a prospective study. The number of seizures during pregnancy and 3 first puerperal months was compared with the number of seizures during the 12 months preceding pregnancy. An increase in the number of seizures was noticed in 32% of the cases, a decrease in 14% and unchanged frequency in 23% of the cases, 31% being seizure-free during the study period. The highest incidence of major convulsive seizures occurred during the last trimester of pregnancy, while the incidence of complex partial seizures was highest during puerperium. No factors were found which may predict the increase in seizures.     

The relapse rate of multiple sclerosis changes during pregnancy: a cohort study

Objective – To evaluate the influence of pregnancy and puerperium on the relapse rate of multiple sclerosis (MS).
Methods – We determined retrospectively the yearly mean relapse rate (MRR) during pregnancies occurring in the course of relapsing–remitting MS. We compared the MRR of pregnancy-time with that of non-pregnancy time by paired t -test. Relative risk (RR) of relapses during the pregnancy-time was also compared with that of non-pregnancy time by χ ² analysis and 95% confidence intervals.
Results – From a population of 351 women affected by clinically definite MS, only 70 reported pregnancies during their relapsing–remitting phase of MS for a total of 98 pregnancies. Both MRR ( P  = 0.006) and RR (RR = 0.63, 95% CI = 0.40–0.94) decreased during the three trimesters of pregnancy. RR increased in the first 3 months of puerperium, although this was not statistically significant (RR = 1.36, 95% CI = 0.79–2.20).
Conclusion – Our study confirms that in MS the relapse rate decreases throughout pregnancy and increases during puerperium. This suggests a complex interplay between hormonal and immune factors.     

孕产期因素影响339例儿童智力发展的10年随访结果

目的为了解孕产期因索对儿童智力发展的影响。方法采用自编《孕产期因素调查表》对408例儿童及其家庭情况进行调查并定期随访。10年后再采用《韦氏五合一智商测定表》对随访资料完整的339例进行智商测定。结果IQ≤85者为62例（18．29％）,IQ≤75者为11例（3．24％）;经多元逐步回归分析发现,母亲文化程度、家庭经济水平及城乡差别与儿童智力发展呈显著相关;Logistic回归分析发现,母孕产期妊娠剧吐、母亲文化程度、早破水、以及是否混合喂养是影响儿童智力发展的主要因素。结论加强母孕产期保健及重视后天环境回素是儿童智力发展的重要条件。     

Clinical interventions for women with schizophrenia: pregnancy

Objective: A comprehensive treatment program for schizophrenia needs to include services to women of childbearing age that address contraception, pregnancy, and postpartum issues, as well as safe and effective parenting. To update knowledge in these areas, a summary of the recent qualitative and quantitative literature was undertaken. Method: The search terms ‘sexuality,’‘contraception,’‘pregnancy,’‘postpartum,’‘custody,’ and ‘parenting’ were entered into PubMed, PsycINFO, and SOCINDEX along with the terms ‘schizophrenia’ and ‘antipsychotic.’ Publications in English for all years subsequent to 2000 were retrieved and their reference lists further searched in an attempt to arrive at a distillation of useful clinical recommendations. Results: The main recommendations to care providers are as follows: take a sexual history and initiate discussion about intimate relationships and contraception with all women diagnosed with schizophrenia. During pregnancy, adjust antipsychotic dose to clinical status, link the patient with prenatal care services, and help her prepare for childbirth. There are pros and cons to breastfeeding while on medication, and these need thorough discussion. During the postpartum period, mental health home visits should be provided. Parenting support is critical. Conclusion: The comprehensive treatment of schizophrenia in women means remembering that all women of childbearing age are potential new mothers.     

Cerebrovascular complications during pregnancy and postpartum: clinical and prognosis observations in 240 Hispanic women

Background and purpose: Although pregnancy and postpartum have long been associated with stroke, there is a dearth of information in Latino‐American populations. The aim of this study was to describe the cerebrovascular complications occurring during pregnancy/postpartum and compare the characteristics amongst stroke types occurring in this period in Hispanic women. Patients and methods: We studied 240 women with cerebrovascular complications during pregnancy and the first 5 weeks postpartum, from our stroke registry. Patients were classified into three groups: cerebral venous thrombosis (CVT), ischaemic stroke (IS), and intracerebral hemorrhage (ICH). For each group, clinical data, timing of the event, and outcome were analyzed. Results: Of the 240 women, 136 had CVT (56.7%), 64 IS (26.7%), and 40 ICH (16.6%). In 72 women (30%), the event occurred during pregnancy, in 153 (64%) during postpartum, and in 15 (6%) closely related to labor. CVT was more common in the first trimester of pregnancy and in the second and third weeks following delivery; whilst IS and ICH were seen mainly during pregnancy and the first 2 weeks following delivery. Pre‐eclampsia/eclampsia was more common in patients with ICH (57.5%) and IS (36%) than in those with CVT (9.6%) (P < 0.001). An excellent recovery (modified Rankin Scale: 0–1) was observed amongst women with CVT (64%) and IS (50%) compared to ICH (32%), (P = 0.004). Conclusions: Pre‐eclampsia/eclampsia is a frequent risk factor in patients with ICH and IS, but not in CVT. Stroke types clustered different within the pregnancy‐postpartum period. A good prognosis is observed in patients with CVT.     

Serum phenytoin during pregnancy, labor and puerperium

111 pregnancies of epileptic women on phenytoin therapy were observed in a prospective study. Maternal serum phenytoin concentrations were measured monthly or bi-weekly during pregnancy, labor and puerperium. The concentration decreased towards the end of pregnancy and was lowest at delivery. In 48% of the patients the drug dosage had to be increased to combat the increased seizure frequency.     

A preliminary study of possible psychoactive effects of intravenous forskolin in depressed and schizophrenic patients

Summary Forskolin is a unique activator of adenylate cyclase that bypasses membrane receptors and directly raises levels of the second messenger cyclic AMP. Depressed patients and schizophrenic patients with negative symptoms have been reported to have reduced cyclic AMP levels. In the first study of forskolin in psychiatry, we gave iv forskolin in a 75 minute infusion to four depressed and five schizophrenic patients. All four depressed patients showed a transient mood elevation or stimulation, as did two of the five schizophrenic patients.     

The sexual function of women during puerperium: a qualitative study

This study aimed to explore women's sexual function during the puerperal period. Based on a qualitative methodology with a phenomenological focus, 30 women were interviewed eight weeks after childbirth. Childbirth and puerperium modify the sexual function of women, causing issues that can be divided into the following categories: (1) the expression of sexual desire after childbirth, (2) dealing with changes that interfere in arousal, (3) changes in exploring the energy and character of the orgasm and (4) the perceptions of puerperal women of their relationships with their partners. Although sexual function was negatively perceived by women, their assessments of their relationships tended to be positive, with increased levels of emotional intimacy between partners contributing to the strength of the relationship.     

Cerebrovascular events during pregnancy and puerperium

Though cerebrovascular complications of pregnancy remain relatively rare, they represent a potentially devastating event that necessitates prompt identification and treatment. Eighteen percent of strokes occurring in young women are linked to pregnancy. They occur mostly in the third trimester or during the post-partum period. Their biggest risk factors are hypertension, preeclampsia/eclampsia and migraine. Cerebrovascular events occurring during this period may involve specific pathophysiological processes that include embolic phenomena or endothelial dysfunction, but can also have common etiologies that are simply favored by the context of pregnancy. Thus, posterior encephalopathy and vasoconstriction cerebral syndrome are relatively frequently involved in cerebrovascular complications of pregnancy. Other very specific causes like amniotic fluid embolism or postpartum cardiomyopathy can also be responsible for such events. The management of stroke during pregnancy must be multidisciplinary and include a neurovascular expertise. Some conditions can lead to a long-life follow-up and modify the management of a future pregnancy.     

Temporal variation of validity of self-rating questionnaires: repeated use of the General Health Questionnaire and Zung's Self-rating Depression Scale among women during antenatal and postnatal periods

The 30-item General Health Questionnaire (GHQ) and Zung's Self-Rating Depression Scale (SDS) were distributed to 120 pregnant women 4 times – in early and late pregnancy and 5 days and 1 month after the child was born. The validity of the questionnaires was assessed against the subjects’ Research Diagnostic Criteria (RDC) diagnoses. Both the GHQ and SDS sufficiently identified cases of minor mental disorder and depressive disorders respectively in early pregnancy; they lost their validity on the subsequent two occasions, but gained it again 1 month after the birth; the optimal cut-off points varied accordingly. This study suggests that the optimal cut-off point for a questionnaire should be validated against an externally determined clinical diagnosis whenever the instrument is used repeatedly on the same population.     

Incidence and etiologies of stroke during pregnancy and puerperium as evidenced in Taiwanese women

BACKGROUND: Pregnancy is a known risk factor for stroke, but relatively few studies have been conducted in Asian populations to document the risk. This study aimed to analyze the incidence and etiologies of stroke occurring during pregnancy and puerperium in Taiwanese women. METHODS: From 1984 to 2002, female patients 15 through 40 years of age with first-ever stroke during pregnancy or within 6 weeks of delivery were recruited. Stroke was classified as ischemic stroke (IS), cerebral venous thrombosis (CVT), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). The incidence, time of stroke onset (1st through 3rd trimester or puerperium), and etiologies of different stroke subtypes were analyzed. RESULTS: Of 402 young female stroke patients, 49 had stroke during pregnancy and puerperium, including 16 with IS, 11 with CVT, 19 with ICH and 3 with SAH. After excluding referral patients, the incidences of pregnancy-related stroke were 46.2 (95% CI 30.7-69.5) per 100,000 pregnancies. 67% developed stroke in the 3rd trimester and puerperium, and 73% of CVT occurred in the puerperium period. Etiologies were well defined in 78% of patients. Eclampsia (37%) and arteriovenous malformation (26%) were the most important etiologies of ICH. For IS and CVT, rheumatic heart disease (44%) and coagulopathy (64%) were the major etiologies respectively. CONCLUSIONS: The incidence of stroke occurrence during pregnancy and puerperium in Taiwanese women is higher than that of Caucasian populations; the majority of strokes occurred in the 3rd trimester and puerperium, particularly CVT.     

Social support and pregnancy:II. Its relationship with depressive symptoms among Japanese women

Abstract In a questionnaire survey among 1329 first-trimester pregnant women, both the husband support measures and unwanted pregnancy ('stressor' agent in pregnancy) showed significant effects on an elevated score of the cognitive disturbance subscale of the Zung's self-rating depression scale (SDS), while only unwanted pregnancies showed an effect on an elevated score of the dysphoric mood subscale of the SDS. However, no interaction was observed between the husband support measures and unwanted pregnancy, therefore the effect of the husband's social support on the cognitive disturbance score was not that of a buffer, but rather a main effector. Finally, multiple regression analyses showed that the dysphoric mood score was preceded by unwanted pregnancy, premenstrual irritability, public self-consciousness, and maternal overprotection; while the cognitive disturbance score was preceded by unwanted pregnancy, husband reduced 'given' and 'giving' support, maternal reduced care and overprotection, paternal reduced care, low annual income, low private self-consciousness, and smoking. These findings suggest that the husband's support for a pregnant woman is effective only in reducing cognitive symptoms, and that different symptomatic constellations have different sets of psychosocial correlates.     

A housing support programme for the mentally ill: need profile and satisfaction among users

Housing support has become an integrated part of the community psychiatric service during the past years. In this study, the need profile, satisfaction rates and clinical characteristics of the users of a housing support programme in Copenhagen are described. Among the 45 residents interviewed, schizophrenia was by far the dominant diagnosis. The Camberwell Assessment of Needs procedure revealed a total of 8.3 needs, including 3.4 unmet needs per resident, within the 22 need areas investigated. The needs were most prevalent within the areas of psychological and social functioning. Agreement between residents and staff on the presence of needs was generally low. Satisfaction rates were moderate to high, and a substantial proportion of the residents reported their general quality of life to be improved during participation in the programme. The type of support provided seemed to fit important need areas, suggesting that the programme is appropriate.     

Effectiveness of Shakuyaku-kanzo-to in neuroleptio induced hyperprolactinemia: A preliminary report

Abstract We investigated the efficacy of Shakuyaku-kanzo-to (TJ-68) in neuroleptic-induced hyperprolactinemia in 11 treated schizophrenic patients. The mean plasma prolactin level decreased significantly from 28.9 ± 14.5 ng/mL at baseline to 22.0 ± 15.2 ng/mL at 4 weeks. Potassium levels did not change significantly. Neither the exacerbation of psychosis nor other adverse effects occurred.     

Needs for care of chronic schizophrenic patients in long-term community treatment

Abstract.Background: Specific problems of long-term community care of chronic schizophrenic patients are an under-researched area interesting for the provision of regional mental health care.Methods: This study focuses on a 4 1/2-year prospective assessment of normative needs for care in a cohort (initially N = 115) living in the Dresden care region (Germany). At six time-points, normative needs for care were assessed with the Needs for Care Assessment (NFCAS).Results: The total number of problems did not change significantly over the study period. The average number of met needs was lower at the longer-term follow-up assessments,due particularly to a decrease in the social section. This trend is also demonstrated for the average number of unmet needs. In contrast, the mean number of unmeetable needs increased. Consistently, 70–80% of the patients exhibit problems in positive psychotic and negative symptoms, household affairs and recreational activities. Communication, occupation and recreational activities constitute a trio of social needs not met for nearly one-third of the patients disabled in these respects. Logistic analyses of regression could not identify a predictive model for the total needs development within the 4 1/2-year community treatment.Conclusion: The rather stable pattern of needs for care seems to define clear long-lasting tasks for community mental health services. For chronic schizophrenic patients, services should especially focus on social skills training and psychoeducational approaches. Due to a wide range of possible factors of influence, however, planning long-term context-dependent processes of care in the community lacks a clear evidence base.     

Risk Factors for the Increased Seizure Frequency during Pregnancy and Puerperium

Abstract: Possible factors affecting the seizure frequency during pregnancy and puerperium were prospectively studied on 125 cases, paying particular attention to the drug compliance and the antiepileptic drug disposition. Of the subjects, 27% were under the poor compliance category. As the reasons for the poor compliance, anxiety about the side effects of antiepileptic drugs including teratogenecity and the harmful effects on their newborns by breast feeding were found in about half of them. In the cases with regular drug taking, 80% showed no change in the seizure frequency whereas only 16% exhibited an increase and 4% a decrease. The apparent serum clearance of phenytoin, primidone, phenobarbitone derived from primidone and valproic acid increased during pregnancy and puerperium. In some cases, the lowering of the serum level of drugs was associated with the aggravation of seizures.