Embry, Steven

Engle, Andrew

English

University of Nebraska Medical Center Research: DigitalCommons@UNMC

Graduate Medical Education Research Journal Volume 2 Issue 1 Article 50 September 2020 Catamenial Psychosis: A Forgotten Cause of Psychosis Andrew Engle et al. Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj  Part of the Higher Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Engle, A. Catamenial Psychosis: A Forgotten Cause of Psychosis. Graduate Medical Education Research Journal. 2020 Sep 29; 2(1). https://digitalcommons.unmc.edu/gmerj/vol2/iss1/50 This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. Catamenial Psychosis: A Forgotten Cause of Psychosis Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol2/iss1/50 Graduate Medical Education Research Journal48 Poster Presentations*Names in bold type indicate presenting author.Catamenial Psychosis: A Forgotten Cause of PsychosisAndrew Engle1, Steven Embry1, Kevin Sisk11University of Nebraska Medical Center, Department of Family MedicineMentor: Kevin SiskProgram: Family MedicineType: Original ResearchBackground: Catamenial psychosis is a rare subtype of menstrual psychosis which shares clinical features with bipolar disorder. It is characterized by acute, periodic, and remitting psychosis associated with the onset of a woman’s menstrual cycle. The pathophysiology, while incompletely understood, is hypothesized to involve the hypothalamic-pituitary-ovarian axis and management includes menstrual suppression. Treatment typically yields prompt and dramatic symptom resolution. Consent was obtained from the patient.Methods: A 40 year old female presented for evaluation of chronic, cyclical episodes of abnormal mentation with associated visual and auditory hallucinations. She had previously been diagnosed with Bipolar 1 Disorder and despite medical therapy continued to experience episodes psychosis which included auditory hallucinations. However, given her new onset visual hallucinations, she was admitted for further workup.Results: Neurology and Psychiatric services were consulted and a thorough medical and neurologic workup including brain MRI, lumbar puncture, electrolyte, and infectious studies failed to reveal an organic cause of her symptoms. Further history revealed her recurring symptoms frequently aligned with the initiation of her menstrual cycle, and she had experienced improvement in her symptoms in the past while on OCPs. Due to her recurring, cyclical episodes of psychosis with a temporal relationship to the onset of menstruation, the presumptive diagnosis of catamenial psychosis was made and the patient was referred for menstrual suppression.Conclusion: Catamenial psychosis is rare, but likely underrecognized. All women of reproductive age with symptoms of psychosis should be screened for a correlation with their menstrual cycle as treatment results in drastic and prompt improvement. https://doi.org/10.32873/unmc.dc.gmerj.2.1.049Risk of Subsequent Atherosclerotic Cardiovascular Disease After the First Unprovoked Venous Thromboembolism in Patients With Rheumatoid Arthritis Gulsen Ozen1	2, Rebecca Schumacher2, Teresa A. Simon3, Kaleb Michaud1,21 University of Nebraska Medical Center, Department of Internal Medicine  2FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS 3Physicians Research Center LLC, Toms River, NJMentor: Kaleb MichaudProgram: Internal MedicineType: Original ResearchObjective: To determine the risk of subsequent ASCVD in RA patients with 	Methods: 		participation in FORWARD from 1998 through 2018 were assessed for incident nonfatal and fatal ASCVD (myocardial infarction and stroke) validated from hospital/death records. We excluded patients with prior VTE/ASCVD and active cancer. We 				VTE. We calculated event rates and estimated the risk of subsequent ASCVD in these patients compared to patients with no history of VTE and ASCVD by using Cox proportional hazards with adjustment for sociodemographics, comorbidities, and RA severity measures.Results: In 25,070 RA patients with no VTE or ASCVD and 506 patients with 				!"#		$%	(IQR) 4.7 (2.4-8.9) years of follow-up. The incidence rate (95% CI) of ASCVD was higher in patients with VTE vs. patients "#'*+3*:*;<**=3;**<	>>>>		?*After multivariable adjustment, we found that patients with an unprovoked VTE had a $@G@		J!"#'L3:=U"X<*>=3*Y*:=<?*	@		 persisted in patients with only DVT (HR 3:=U"X<*:3**>+<?	 	Z		$	'L3:=U"X<*=3*=;Y*>Y<?'[G	?*Conclusion: RA patients with unprovoked 	"#JGJASCVD. RA patients with unprovoked VTE should be evaluated carefully for ASCVD in the presence of concerning symptoms and CV risk screening and management should be optimized. https://doi.org/10.32873/unmc.dc.gmerj.2.1.072Table 1.Crude incidence rates and risk of ASCVD in patients with RA by unprovoked VTE. Events/Patients Patient-yearsIncidence Rate (95% CI)*Unadjusted (HR (95% CI)	 (95% CI)Patients without VTE or ASCVD 1,283/25,070 147,7358.68  (8.22-9.17) - -		VTE (no prior ASCVD or VTE) 38/506 16,15223.53  (17.12-32.33)2.50  (1.81-3.44)2.05  (1.43-2.95)DVT only 21/325 11,150 18.83  (12.28-28.87)2.03  (1.32-3.12)1.93  (1.22-3.06)Pulmonary emboli 17/181 5,002 33.99  (21.13-54.67)3.78  (2.50-5.70)2.52  (1.57-4.04)*Per 10,000 patient-years						!"		"residency), ethnicity, smoking, hypertension ,diabetes, comorbidity index, BMI, HAQ, patient global and pain scores, glucocorticoid use DMARDs including MTX, HCQ, TNFi and nonTNFi bDMARDs, NSAIDs, statins, fracture, pulmonary disease, prior count of csDMARDs and bDMARDs, calendar year

Catamenial Psychosis: A Forgotten Cause of Psychosis

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Catamenial Psychosis: A Forgotten Cause of Psychosis

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