The Impact of Hysterectomy During Adolescence in a Woman of Reproductive Age

There is extensive psychiatric literature on the psychological effects of hysterectomy on both pre-menopausal and post-menopausal women, but a careful search covering the last ten years and beyond reveals no references to the impact of hysterectomy during adolescence. There is also nothing on this subject in the gynecological literature of the last ten years. Obviously, the incidence of severe pathology necessitating hysterectomy is extremely rare. However, there can be little doubt that a procedure of such symbolic magnitude at an age when a young woman is trying to integrate her personality, emerge as an autonomous sexual being, and experiencing a recrudescence of her infantile conflicts must have tremendous impact

Use of Clozapine in Women of Childbearing Age: A Literature Review and Recommendations

Concerns about medications in women of childbearing age include impact on fertility, pregnancy, neonatal outcome, breastfeeding, and behavioral teratogenesis. The objectives were to examine possible risks of clozapine on these parameters. PsycINFO and MEDLINE searches were performed and Novartis was contacted regarding their clozapine pregnancy registry. Since prolactin levels are not elevated with clozapine as they are with typical antipsychotics, there is not interference with fertility. Adverse pregnancy outcomes included gestational diabetes, should dystocia, seizure, and mild floppy infant syndrome. Higher concentrations of clozapine were present in breast milk than in maternal blood. Despite a lack of case-control prospective data, available information raises some questions regarding the safety of clozapine in pregnancy. Suggestions for treatment are made. Reproductive counseling should be given to women starting on clozapine. Individual risk-benefit assessments must be performed. In pregnant women taking clozapine, the clinician should screen for gestational diabetes and advise against breastfeeding

Post Psychotic Depression in a Patient who Castrated Himself

With this article we inaugurate our efforts to expand the scope of the Journal beyond the walls of Jefferson. We thus open the Journal to residents of all programsand invite them to share their clinical experience and research. Circulation will include contributing programs. Introduction The differential diagnosis of psychosis associated with depression includes schizophrenia, schizoaffective and major affective disorders. Depression associated with schizophrenia may be a prominent feature of the patient\u27s early presentation (I), or manifest itself only as the psychotic symptoms resolve (2, 3). Neuroleptics may play a causal role in the development of post-psychotic depression . This drug effect may be linked to genetic factors (4). In the following case , the patient presented in a floridly psychotic state after having castrated himself. Depression did not appear to be a prominent feature of hisinitial presentation. Only later in the course of his treatment did depressive symptoms manifest themselves

Population Pharmacokinetic and Pharmacodynamic Analysis of Buprenorphine for the Treatment of Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a condition affecting newborns exposed to an opioid in utero. Symptoms of NAS include excessive crying, poor feeding, and disordered autonomic control. Up to 2/3 of infants will require pharmacologic therapies to reach symptom control. Opioids including morphine and methadone are the current first-line treatments. Buprenorphine is being investigated as a treatment of NAS. The purpose of this analysis was to evaluate the pharmacokinetics (PK) and pharmacodynamics (PD) of BUP in infants with NAS. Poster presented at American Society for Clinical Pharmacology and Therapeutics (ASCPT) 2017 Annual Meeting, March 15-18, 2017 in Washington DC.https://jdc.jefferson.edu/petposters/1004/thumbnail.jp

A Rare but Life Threatening Case of Labile Blood Pressures in Pregnancy

Pheochromocytoma is a rare but life threatening adrenal secreting tumor. The infrequency with which it is encountered makes pheochromocytoma, especially in pregnancy, a formidable diagnostic challenge. Although a pheochromocytoma is rare, it is good to keep it in differential diagnosis as a possible cause of labile BP with headaches and significant orthostatic BP. It is critical to recognize this condition to institute an appropriate therapy & surgical intervention to prevent mortality