Contraceptive choices for behaviorally disordered women.

Women with psychologic disturbances of depression, anxiety, or thought disorganization pose a special management problem when providing a safe and effective means of contraception. The difficulty is compounded by the fact that many mentally disturbed women also abuse drugs. Therefore, providing contraception to the many types of behaviorally disturbed women requires the full range of contraceptive options and protection from sexually transmitted diseases. When compliance can be assured, oral contraceptives are the preferred method. When compliance is questionable, progestin implants or injections may be tried. However, progestin-only preparations are associated with several side effects, including worsening of mood in depressive patients.

PIP: Psychiatrists must work to overcome barriers to effective contraception for their female patients because of the high incidence of unplanned pregnancy among these women and the multiple disadvantages facing the fetus/infant (e.g., the infant may also be afflicted with a mental illness, prenatal use of drugs adversely affects fetal development, and chronically ill women often cannot care for infants). These barriers include physicians neglecting the family planning of their patients; the inability of patients to institute reliable, long-term ways to prevent pregnancy; and fears of contraception. Physicians should consider all contraceptive methods for mentally ill patients and drug abusers. Oral contraceptives (OCs) may be the most appropriate contraceptive for mentally ill women who do not have any risk factors and are either institutionalized or closely supervised. Outpatient or intermittent psychiatric patients are less likely to have high compliance rates, so physicians should consider implants. Yet, these women may be upset by the irregular bleeding associated with progestin only contraceptives. Further, these contraceptives sometimes induce depression and should not be used in clinically depressed women. For outpatient or intermittent psychiatric patients who can not tolerate progestin-only contraceptives, the IUD is more appropriate. Female sterilization is unlikely to occur because of the problems with getting informed consent (e.g., obtaining a court order). Providing contraception to drug abusers is especially difficult because it is not as top priority, and they rarely seek medical care and reject outreach health providers. Regardless of the contraceptive chosen for mentally ill females and female drug abusers, condoms should be used to protect against sexually transmitted diseases.

Mental illness in the late 19th century at Elizabeth General Hospital.

In 1880, Elizabeth General Hospital and Dispensary opened its doors. The Hospital records, the daily newspapers of Elizabeth, and the medical journals often noted psychiatric symptomatology and concepts.

Neuropathology of the brain stem in psychiatric disorders.

The brain stem was examined in a series of 27 autopsy cases for a possible association of microscopic changes and primary psychiatric disorder. Seven cases were found to have brain stem microglial nodules or perivascular infiltrates in association with a range of CNS pathological conditions. One of eight schizophrenic and none of four primary affective disorder patients showed brain stem pathology. While evident in many forms of coarse brain disease, brain stem microscopic changes do not appear related to primary psychiatric disorder.

Why the healing gods are twins.

The association of twins with health-giving powers is widespread in mythology, folklore, and religion. The Ashvins of the Rig-Veda, the classical Dioscuri, and the early Christian saints Cosmos and Damian are among the many examples of twins divinely empowered in the area of health and fertility. A characteristic set of attributes of twins recurs in different mythologies of wide distribution. In addition to healing, divine twins are often empowered with the ability to revive the dead, increase the fertility of man, animals, and crops, influence the weather, predict the future, and insure victory in battle. In some traditional societies these special attributes are thought to extend to all of the twins and their parents in the tribe.Ancient and primitive societies supposed that the birth of twins was associated with divine influence, the mother having been visited or otherwise affected by supernatural powers. A frequent explanation was that twins were the result of superfetation, a divine impregnation occurring along with that by the lawful husband. The specific powers of divine twins appear to be a reflection of the particular form of origin of twins through divine interference with the fertilization process. The twins thus share some of the powers of the divine parent, particularly those pertaining to fertility. Their dual paternity and its inherent competition is related to their martial interests as well as their ability to resolve ambivalent or ambiguous situations and predict outcomes.

Categories of attempted suicide: a longitudinal study.

A series of 151 index suicide attempts was categorized on the basis of situation and motivation: (a) 56 per cent occurred in a state of heightened emotionality due to a relatively limited stress;(b) 9 per cent were characterized by a life crisis which seriously challenged the patient' emotional homeostasis; and (c) 35 per cent attempted suicide in relation to the symptomatology of a pre-existing serious psychiatric disorder. At the time of first contact, usually in the general hospital emergency room, 69 per cent were sent home, the remainder being admitted for medical care (18 per cent) or transferred to a psychiatric hospital (13 per cent). In follow-up ambulatory care, successful referral correlated with the intensity of staff efforts during the early post-attempt contacts. The findings suggest that a brief hospitalization, perhaps two to three days, might be regularly utilized as a bridgehead for further ambulatory care, particularly for stress category patients with a high appointment failure rate. In a two-year follow-up, 16 of the 151 index cases re-attempted and two committed suicide. At the time of the index attempt, 24 (16 per cent) were in ongoing treatment. Among these 24 patients were many substance abusers and prior attempters as well as the two committed suicides of the follow-up period. Ongoing treatment should be weighed as a high risk factor suggesting particular caution in arranging the disposition for such patients.