Denial of pregnancy: a review and case reports.

This paper describes the characteristics of women who deny awareness of their pregnancies, the underlying causes and conflicts, and specific interventions required to address these issues. Case reports illustrate this complication of pregnancy. The absence of many physical symptoms of pregnancy, inexperience, general inattentiveness to bodily cues, intense psychological conflicts about the pregnancy, and external stresses can contribute to the denial in otherwise well-adjusted women. Assessment should include the possible contribution of painful reactivation of memories concerning childhood or adult trauma and the effect of dissociative states on the development of denial of pregnancy. Psychotherapy is recommended to resolve these conflicts, and to prevent future pregnancy denials and child abuse or neglect. Denial of pregnancy is easier to understand in women with psychosis or serious cognitive impairment than in those without such disorders. The underlying illness requires treatment by a psychiatrist. Psychological conflicts also exist in psychotic women, such as the intense wish to have a baby while fearing loss of the infant to child-protection services. Acknowledging the conflict and supporting the mother despite her puzzling behavior is an important task for health caregivers.

Teaching women's issues in psychiatric residency: residents' attitudes.

There is increasing interest in psychiatry in women's and gender issues. This article evaluates psychiatric residents' interest in women's issues during training. The authors surveyed residents at four psychiatric residency programs to evaluate their opinions on the teaching of women's issues. Residents rated this topic an important one, but felt training could be improved. The authors review one program's curriculum and suggest ways in which women's mental health issues might be incorporated into residency training.

A Psychiatric Residency Curriculum About Gender and Women's Issues.

Over the last 30 years, major advances have been made in our understanding of how bio-logical factors and sociocultural influences contribute to gender differences, gender identity formation, and gendered role behavior. Sensitivity to the psychological effects of changing family structure and workforce composition, the contribution of reproductive events, and the high rates of exposure to trauma in women is essential for optimal psychiatric assessment and treatment planning. This knowledge has not been systematically integrated into residency training. The authors present an outline for a curriculum in gender and women's issues, including educational objectives, learning experiences through which residents could meet these objectives, and recommended readings. The authors also discuss potential obstacles and suggest helpful strategies for implementing the proposed curriculum.

Vitamin D-mediated intestinal calcium transport. Effects of essential fatty acid deficiency and spin label studies of enterocyte membrane lipid fluidity.

Vitamin D-3 and its metabolites regulate the transport of calcium across the intestinal epithelial cell via a mechanism which is as yet unknown. The purpose of this study was to evaluate the effect of an essential fatty acid deficiency on vitamin D-stimulated intestinal calcium transport as measured by both in vivo and in vitro techniques. We also describe in this report a procedure for the isolation of chick intestinal epithelial cell brush border and basal lateral membranes and an assessment of the effect of dietary vitamin D on the lipid fluidity of these membranes. An essential fatty acid deficiency in both vitamin D-replete and deficient chicks resulted in a decrease in intestinal mucosal levels of linoleic acid, with a compensatory increase in the levels of the short chain fatty acid, myristic acid, and the unsaturated fatty acids, palmitoleic and eicosatrienoic acids. An essential fatty acid deficiency did not affect the ability of vitamin D-deficient chicks to respond to vitamin D with a 2-fold increase in serum calcium and a 4-5-fold increase in intestinal calcium transport, measured in vivo. However, an essential fatty acid deficiency resulted in an inability of vitamin D to increase calcium efflux in vitamin D-deficient chick ileum as measured under in vitro conditions. Dietary vitamin D resulted in no detectable change in the protein composition in either the brush border or basal lateral membranes as evidenced by SDS-polyacrylamide electrophoresis. In addition, vitamin D did not alter the levels of brush border membrane cholesterol or lipid phosphorus (0.27 +/- 0.03 and 0.19 +/- 0.01 mumol/mol protein, respectively). Brush border and basal lateral membranes were labeled with the 5-nitroxide stearate spin probe I(12,3). The polarity of the environment of the probe in the brush border membranes is much greater than that of the basal lateral membranes. In addition, the lipid environment of the brush border membrane is much less fluid (S = 0.650) that that of the basal lateral membrane (S = 0.583). The data concerning membrane lipid fluidity is qualitatively similar to fluorescence polarization studies of rat intestinal epithelial cell membranes and confirms the concept that a given cell may contain plasma membrane regions having discrete lipid structures/fluidities. Dietary vitamin D had no detectable effect on the lipid fluidity or polarity in either the brush border or basal lateral membranes. The results do not support a role for an alteration in essential fatty acid composition or gross changes in the lipid fluidity of the brush border or basal lateral membranes as mechanisms by which vitamin D regulates intestinal calcium transport.

Evidence for the identity of nuclear and cytoplasmic adenosine-3':5'-monophosphate-dependent protein kinase from porcine ovaries and nuclear translocation of the cytoplasmic enzyme.

Protein phosphokinase activity from a 0.5 M NaCl extract of purified porcine ovary nuclei has been resolved by Sephadex G-200 gel filtration into three forms of kinase, protein kinase I and III, both independent of adenosine 3':5'-monophosphate (cyclic AMP), and cyclic-AMP-dependent protein kinase II. Cyclic AMP-binding activity was associated with protein kinase II but not with protein kinases I and III. Protein kinases I, II, and III exhibited different cyclic nucleotide dependency and substrate specificity. Protein kinase II was inhibited by a heat-stable protein from rabbit skeletal muscle, whereas protein kinases I and III were not inhibited. According to previously established criteria [Traugh, J.A., Ashby, C.D. and Walsh, D.A. (1974) nuclear protein kinase II can be classified as cyclic-AMP-dependent protein kinase consisting of regulatory and catalytic subunits. Nuclear protein kinases I and III are cyclic-AMP-independent enzymes. Evidence for the identity of nuclear cyclic-AMP-dependent protein kinase II with cytosol (105 000 X g supernatant fraction) cyclic-AMP-dependent protein kinase was obtained in several ways. Nuclear and cytosol cyclic-AMP-dependent protein kinases exhibited identical elution characteristics on DEAE-cellulose and Sephadex G-200 indicating that both kinases are of similar molecular size and possess similar ionic charge. Both kinases exhibited an identical Km for ATP of 8 muM, showed similar substrate specificity, and revealed similar antigenic properties. Cyclic-AMP-dependent protein kinase II was also identified in nuclei isolated in nonaqueous media, eliminating the possibility that the cyclic-AMP-dependent protein kinase activity identified in nuclei isolated in aqueous media may have arisen as the result of cytoplasmic contamination. After incubation of neonatal porcine ovaries which lack nuclear cyclic-AMP-dependent protein kinase with 0.1 muM 8-p-chlorophenylthio cyclic AMP, considerable cyclic-AMP-dependent protein kinase II activity was identified in nuclei isolated in nonaqueous media. From these data it is concluded that the nuclear cyclic-AMP-dependent protein kinase II is related to or identical with the ovary cytoplasmic cyclic-AMP-dependent protein kinase, supporting the concept that nuclear cyclic-AMP-dependent protein kinase is of cytoplasmic origin.