6 research outputs found
Couvade syndrome: more than a toothache
No full textBackground Couvade Syndrome is best characterized as a somatic symptom disorder where the partner experiences somatic symptoms during their partner’s pregnancy most often during the first and third trimesters. Several psychoanalytical theories have been proposed for this disorder. There are well studied mood changes that correspond to hormonal shifts that occur in response to anticipated parenthood which serve as a physiologic mechanism for this pathology. Case The following is a case of Couvade syndrome in the setting of a high risk pregnancy complicated by pre-eclampsia with severe features necessitating a preterm delivery. Conclusion Expectant fathers should be screened for symptoms of Couvade Syndrome throughout the pregnancy in order to better support the familial unit
Psychotic pregnancy denial: a review of the literature and its clinical considerations
No full textBackground Pregnancy denial can be broken into two major types, non-psychotic and psychotic deniers, and further classified into pervasive, affective and persistent sub-types. It can lead to increased morbidity and mortality of the mother and neonate. Psychotic pregnancy denial is rare and the medical literature existing on the subject is limited to a small number of case reports and case series. No formal recommendation exists on the clinical management of psychotic pregnancy denial in the antenatal or postpartum period. The authors provide a comprehensive review of the literature regarding psychotic pregnancy denial, present an example of an unpublished case and provide suggestions for clinical management. Case A 33-year-old primigravida at 37 6/7 weeks gestation presented with new-onset psychotic pregnancy denial with no prior history of psychosis. She had a negative medical work-up for organic causes of psychosis. Using a multidisciplinary approach, the decision was made to deliver the fetus at 38 1/7 weeks via cesarean section due to concerns for patient and fetal safety. Following delivery, she was admitted to an inpatient psychiatric facility and underwent 16 bilateral electroconvulsive therapy (ECT) treatments to which she showed complete response. Conclusion Psychotic pregnancy denial is rare and potentially dangerous. Delivery prior to 39 weeks gestation is reasonable for worsening psychiatric disease but careful consideration of the risk–benefit analysis and ethical framework must be deliberated. Teaching points: In cases of worsening psychiatric disease in pregnancy, a multidisciplinary approach is necessary for comprehensive care. Psychotic denial of pregnancy leads to increased maternal and neonatal morbidity and mortality. Delivery prior to 39 weeks gestational age is reasonable to expedite psychiatric treatment. Precis Using a multidisciplinary approach, the decision to deliver before 39 weeks gestation is reasonable for worsening psychiatric disease
Psychotropic Management in Cotard Syndrome: Case Reports Supporting Dual Medication Management
No full textCotard syndrome is a rare presentation where patients present with nihilistic thoughts of dying or already being dead. These delusions manifest from either a medical or psychiatric etiology and can be difficult to treat. Recently Couto and Gonçalves purposed that treatment should include an atypical antipsychotic alone or in combination with either a mood stabilizer or antidepressant. Here the authors advocate for a more specific but well-known psychotropic regimen, namely the combination of olanzapine and fluoxetine. We conducted a literature review and of 246 papers identified, only three reported using a combination of fluoxetine and olanzapine with many of them having limited or confounding information that make it difficult for us to comment on the historically efficacy of this medication combination. Therefore, the authors provide two case examples of patients being treated successfully with olanzapine and fluoxetine. One, a 66-year-old male veteran and another 76-year-old male veteran. Both of these cases hold significance as the patient’s psychotic depression was so severe as to warrant ECT as a possible treatment. In both cases, this medication combination was able to avoid the procedure. Overall, with the addition of our cases and the sparse information available in the literature, we propose the combination of fluoxetine and olanzapine as an effective Cotard syndrome treatment
