Epilepsy cases in pregnant and postpartum women: a practical approach

Approximately one million women with epilepsy in the United States are in their active reproductive years. Many women with epilepsy require treatment during pregnancy, and many antiepileptic drugs (AEDs) are potential teratogens. Unfortunately, many pregnancies are often not identified until after organ formation has occurred. However, most women with epilepsy will have a normal pregnancy and a favorable outcome. Effective control of maternal seizures with the least risk to the fetus is ideal, but maternal and fetal risks are still likely increased over the general population. In 2009, the American Academy of Neurology (AAN) and the American Epilepsy Society (AES) published Practice Parameter Updates on the pregnant woman with epilepsy. These guidelines reviewed medications, teratogenicity, obstetric outcomes, vitamins, breastfeeding, and other management issues in the pregnant woman with epilepsy. Through a case-based approach, these guidelines will be reviewed, and approaches to diagnosis and management of the pregnant woman with epilepsy will be discussed.     

Parental representation in young women who attempt suicide

A reliable and valid Parental Bonding Instrument was administered to young women who had attempted suicide. Results indicated low parental care and high overprotection. These results are consistent with theoretical formulations of suicidal behaviour, and taken with other studies help provide a profile of parental characteristics which may be associated with such behaviour.     

Migraine in transient global amnesia: a meta-analysis of observational studies

Journal of Neurology - Although many studies have investigated the relationship between transient global amnesia (TGA) and migraine, to date, no meta-analysis has confirmed the existence and size...     

Depression in postpartum and non-postpartum women: prevalence and risk factors

OBJECTIVE: The aim of the study was to assess the prevalence of depression in postpartum women as compared with non-postpartum women, and to identify risk factors of depression in both groups. METHOD: A population based questionnaire study was performed among women 18-40 years in two municipalities in Norway in 1998-1999. A total of 2,730 women were included, of whom 416 were in the postpartum period. RESULTS: The prevalence of depression was higher in non-postpartum as compared with postpartum women. High scores on the life event scale, a history of depression and a poor relationship to the partner were associated with depression in both postpartum and non-postpartum women. When controlling for the identified risk factors of depression the odds-ratio for depression in the postpartum period was 1.6 (95% CI: 1.0-2.6). CONCLUSION: The risk for depression was increased in the postpartum period, when controlling for the uneven distribution of risk factors.     

Lifetime prevalence of suicide ideation, plan, and attempt in metropolitan China

Objective: This is the first community‐based epidemiological study examining the prevalence of suicidal behaviors, their transitional pathways, and their relationship with mental disorders in metropolitan China. Method: Suicidal behaviors, including ideation, plans, and attempts were assessed by face‐to‐face household interviews among 5201 respondents in Beijing and Shanghai in 2001–2002. Lifetime prevalence and risk factors were examined using multivariate discrete‐time survival models. Results: The lifetime prevalence estimates of suicidal ideation, plans, and attempts were 3.1%, 0.9%, and 1.0% respectively. Among suicide ideators, the conditional probability of ever making a plan and an attempt was 29.5% and 32.3% respectively. Progression from ideation to plan and attempt was the highest during the first year after onset. Suicide attempt was predicted by young adulthood, being unmarried, recent onset of ideation and plan, and the presence of mental disorders, especially mood disorder. Conclusion: Suicidal behaviors in metropolitan China exhibit a low prevalence and an epidemiological profile resembling that found in Western countries.     

Prevalence of suicide risk and comorbidities in postpartum women in Pelotas

ObjectivesTo evaluate the prevalence of suicide risk and comorbidities in postpartum women.MethodsThis is a cross-sectional study of postpartum women. The sample comprised mothers who have received prenatal care from the Brazilian National System of Public Heath in the city of Pelotas. Suicide risk and other mental disorders were evaluated using the Mini International Neuropsychiatric Interview (MINI). A yes answer on one of the six interview questions was considered a sign of suicide risk.ResultsThe sample consisted of 919 postpartum women. The 11.5% suicide prevalence was 4.62 (CI 2.45, 8.73) times higher in women with low educational levels. Women with comorbid depression or an anxiety disorder showed a 17.04 (CI 2.27; 19.96) times greater risk of suicide than those who did not suffer from any mood disorder.ConclusionLower education levels and psychiatric disorders are associated with suicide risk. Bipolar disorder is the psychiatric disorder with the highest impact on suicide risk.     

Completed suicide after a suicide attempt: a 37-year follow-up study

OBJECTIVE: Attempted suicide is the strongest known predictor of completed suicide. However, suicide risk declines over time after an attempt, and it is unclear how long the risk persists. Risk estimates are almost exclusively based on studies of less than 10 years of follow-up. METHOD: The authors followed a cohort of 100 consecutive self-poisoned patients in Helsinki in 1963, for whom forensically classified causes of death during the following 37 years were investigated. RESULTS: They found that suicides continued to accumulate almost four decades after the index suicide attempt. CONCLUSIONS: A history of a suicide attempt by self-poisoning indicates suicide risk over the entire adult lifetime.     

Statins in the prevention of venous thromboembolism: a meta-analysis of observational studies

Introduction

Studies have established a relationship between inflammation and venous thromboembolism (VTE). Though statins modulate inflammation, it is uncertain if they prevent VTE in heterogeneous populations. A recent randomized trial demonstrated that statins prevent VTE in healthy older adults, yet this has not been well established in other groups, including younger individuals and individuals with comorbidities. The objective of this meta-analysis was to estimate the effect of statins on VTE in a heterogeneous group of adults.

Methods

We systematically reviewed the effect of statins in preventing VTE in adult inpatients and outpatients. We systematically searched MEDLINE (1966-Jan 2010), EMBASE (1980-Jan 2010), Google Scholar, Cochrane Library, PapersFirst, ProceedingsFirst, and ISI Web of Science, manually reviewed references, and contacted experts. Observational studies that compared any dose of statin to no statin or placebo, examined inpatients or outpatients, and assessed VTE, pulmonary embolism, and/or deep vein thrombosis were included. Study selection, data abstraction and study quality evaluation (using the Newcastle-Ottawa Scale) were independently conducted in duplicate.

Results

Four cohort studies and four case-control studies met criteria. Comparing statins to control, the odds ratio for VTE was 0.67 (95% confidence interval 0.53, 0.84), and for deep vein thrombosis was 0.53 (95% confidence interval 0.22, 1.29). The association was attenuated in lower-quality studies and studies enrolling older individuals.

Conclusions

Further well-designed trials are needed to evaluate the risks and benefits of statins in preventing VTE in heterogenous populations of adults, identify high-risk subgroups, and analyze cost-effectiveness of statin use for this indication.     

Parental loss and reported childhood stress in young women who attempt suicide

For young women aged 18 to 30 years who attempted suicide, and whose suicide attempts were of widely differing physical threat to life, the experience of parental death and separation or divorce, and of reported childhood stress, was similar, irrespective of the lethality of the suicide attempt. Taken as a group, the suicide attempters reported significantly greater childhood stress and more often had experienced parental loss through separation or divorce than young women in a control group. The association between parental loss and suicidal behaviour did not appear to be an artefact of a primary relationship between parental loss and depression. Five of eight reported childhood stress factors significantly distinguished the suicidal and control subjects. Those who attempted suicide were more likely to report a childhood broken home, that their parents quarrelled often, that they had frequent disagreements with their parents, that they had poor physical health, and that they perceived their parents' character negatively.     

Hospitalization for suicide attempt and completed suicide: epidemiological features in a managed care population

BACKGROUND: Understanding factors that contribute to high suicide risk holds important implications for prevention. We aimed to examine the sociodemographic and medical predictors of attempted suicide (severe enough to require hospitalization) and of completed suicide in a large population-based sample from a health maintenance organization (HMO) in northern California, USA. METHOD: We designed a cohort study, including 87,257 women and 70,570 men aged 15 through 89 years old at baseline (in 1977-1985) with follow-up for hospitalizations and mortality through the end of 1993. RESULTS: After a median of 10 years, 169 first hospitalizations for attempted suicide (111 among women, 58 among men) and 319 completed suicides (101 among women, 218 among men) were identified. There was a greater incidence of hospitalization for suicide attempt in women than in men and, conversely, a greater incidence of completed suicide in men than in women. The predominant methods of attempted and completed suicides were ingestion of psychotropic agents and use of firearms, respectively. In gender-specific multivariate analysis of hospitalization for suicide attempt, statistically significant associations were seen for age 15-24 years (women), 65-89 years (men), white race (women), 12th grade or less education (both genders), technical/business school education (men), never being married (men), history of emotional problems (both genders), history of family problems (women), history of job problems (men) and presence of one or more comorbidities (men). The independent predictors of completed suicide were: age 15-24 years (both genders), Asian race (women), Caucasian race (both genders), never being married (both genders), being separated/divorced (women), prior inpatient hospitalization for suicide attempt (both genders) and history of emotional problems (both genders). CONCLUSION: These findings could help health professionals be more effective in the prevention of suicide morbidity and mortality.     

Systematic review and meta-analysis of observational studies to understand the prevalence of restless legs syndrome in multiple sclerosis: an update

ObjectiveMultiple sclerosis (MS) is related to the demyelination of intracranial nerves at multiple sites, while restless legs syndrome (RLS) appears to be caused by dysfunction of the dopaminergic system. Since RLS prevalence is higher among MS patients than in the general population, we carried out an updated meta-analysis to understand whether the two diseases might be associated.MethodWeb of Science, PubMed, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed databases were searched for observational and case-controlled studies of RLS prevalence in MS. Eligible studies were meta-analyzed using Stata 12.0.ResultsPooled RLS prevalence among MS patients of various ethnicities was 26%, and prevalence was lower in Asia (20%) than outside Asia (27%). Prevalence was higher among cross-sectional studies (30%) than among case–control studies (23%). RLS prevalence was higher among female than male MS patients (26% vs. 17%), and it was higher among MS patients than among healthy controls (OR 3.96, 95%CI 3.29–4.77, p < 0.001).ConclusionOur meta-analysis updates the most recent meta-analysis in 2013 and provides perhaps the first reliable pooled estimate of RLS prevalence in MS. The available evidence strongly suggests that RLS risk is higher among MS patients than healthy controls.