[Postpartum psychosis in clinical practice: diagnostic considerations, treatment and prevention]. / Postpartumpsychose in de klinische praktijk: diagnostiek, behandeling en preventie.

BACKGROUND: Postpartum psychosis is a severe psychiatric disease which occurs in the early postpartum period after 1 - 2 per 1000 deliveries. Patients with a history of postpartum psychosis and/or bipolar disorder are at extreme high risk of relapse postpartum. AIM: To discuss diagnostic considerations, treatment and the prevention of postpartum psychosis, and to give clinical recommendations. METHOD: Literature search with PubMed and relevant textbooks. RESULTS: Inpatient psychiatric admission enables the clinician to ensure the safety of mother and baby, perform physical and neurological examination, and laboratory analysis to exclude known organic causes for acute psychosis. Antipsychotic and lithium and ECT are effective treatment options. Women with postpartum psychosis compared to those with bipolar disorder had a substantial difference in their clinical outcomes and prophylaxis requirements. CONCLUSION: Inpatient screening for somatic (co)morbidity is essential in patients with postpartum psychosis. With adequate treatment, almost all patients achieve complete remission and the prognosis is optimistic. Initiation of prophylaxis immediately postpartum in women with a history of postpartum psychosis with lithium was highly effective for preventing postpartum relapse.

[Bálint's syndrome: seeing blind]. / Het syndroom van Bálint: 'ziende blind'.

Bálint's syndrome consists of simultanagnosia, ocular apraxia and optical ataxia. Although various disorders may underlie this syndrome, the most frequent is Alzheimer's disease in its early stages. Because so few people are familiar with this syndrome the first reaction is often to attribute it to underlying problems that are primarily of a psychological nature. As a result treatment and support may be inadequate or given too late. The case study reported here concerns a female patient with Bálint's syndrome. The case is supported by comparable symptoms found in three other patients.

Extraocular light therapy in winter depression: a double-blind placebo-controlled study.

BACKGROUND: It has been hypothesized that the circadian pacemaker is phase delayed in seasonal affective disorder, (SAD) winter type, and that the phase advance resulting from morning ocular light accounts for the efficacy of light therapy. Extraocular light has been reported to produce phase-shifts of the human circadian pacemaker. This allows a double-blind, placebo-controlled study of light therapy in SAD. METHODS: Twenty-nine SAD patients participated. Clinical state was measured on days 1, 8, and 15 of the protocol. From days 4 through 8, 15 patients (4 M, 11 F) received extraocular light by fiberoptic illumination, and 14 (4 M, 10 F) placebo (no light) in the popliteal fossae, from 8 AM to 11 AM. In the evenings of days 3 and 8, the salivary dim light melatonin onset (DLMO) was assessed. Patients completed daily self-ratings on mood, alertness, and sleep. RESULTS: Both conditions showed a progressive improvement of clinical state over time. Between conditions, no significant differences were observed in clinical scores, the self-ratings on mood and alertness, and in timing of the DLMO before and directly after treatment. CONCLUSIONS: The response to extraocular light therapy in SAD patients did not exceed its placebo effect. Extraocular light did not induce a phase shift of the circadian pacemaker.

Body temperature and mood variations during forced desynchronization in winter depression: a preliminary report.

BACKGROUND: It has been suggested that certain abnormalities (e.g., in phase or amplitude) of the circadian pacemaker underlie seasonal affective disorder. METHODS: One male seasonal affective disorder patient (blind to the study design) participated in two 120-hour forced desynchrony experiments and was subjected to six 20-hour days, once during a depressive episode and once after recovery. Core body temperature was continuously measured. During wakefulness, the Adjective Mood Scale was completed at 2-hour intervals. RESULTS: Sleep-wake as well as pacemaker-related variations of mood were found, both when the subject was depressed and when he was euthymic. Compared with recovery, during the depressive episode the circadian temperature minimum and the circadian mood variation showed phase delays of approximately 1 and 2 hours, respectively. CONCLUSIONS: The data of this first seasonal affective disorder patient, participating in forced desynchrony experiments, may indicate a phase delay of the circadian pacemaker during a seasonal affective disorder episode.