[Puerperal insanity:a comparative reading of Argentina and Colombia, 1880-1950]. / Las locuras puerperales: una lectura comparada entre Argentina y Colombia, 1880-1950.

Our goal is to understand the appearance and spread of forms of puerperal insanity in Argentina and Colombia in the late nineteenth and early twentieth century, as well as their decline or disappearance around the 1940s. This is a historical and hermeneutical study, which uses the concepts of "field of visibility" and "ecological niche" for a transitory disease. There was no correlation between pregnancy, childbirth and puerperium and the state of delirium that led to commitment, which was attributed to predisposing factors; furthermore, forms of puerperal insanity were nosographically distinct due to their unique etiopathogeneses. As clinical cases of puerperal insanity started to emerge, the disciplinary field of obstetrics converged with psychiatry, with the former exerting more weight.

El objetivo es comprender la aparición y propagación de locuras puerperales en Argentina y Colombia, a finales del siglo XIX y principios del XX, así como su decadencia o desvanecimiento hacia la década de 1940-1950. Investigación histórico-hermenéutica, según los conceptos de "campo de visibilidad" y "nicho ecológico" de una enfermedad transitoria. No existió correlación entre embarazo, parto y puerperio con el estado delirante que motivaba la internación, atribuido a factores predisponentes y, asimismo, tuvieron una autonomía nosográfica en virtud de etiopatogenias singulares. Al tiempo que empezó a emerger el tipo clínico locura puerperal, se entrecruzaron el campo disciplinar de la obstetricia con el alienismo, con una mayor preponderancia del primero.

Las locuras puerperales: una lectura comparada entre Argentina y Colombia, 1880-1950 / Puerperal insanity: a comparative reading of Argentina and Colombia, 1880-1950

Resumen El objetivo es comprender la aparición y propagación de locuras puerperales en Argentina y Colombia, a finales del siglo XIX y principios del XX, así como su decadencia o desvanecimiento hacia la década de 1940-1950. Investigación histórico-hermenéutica, según los conceptos de "campo de visibilidad" y "nicho ecológico" de una enfermedad transitoria. No existió correlación entre embarazo, parto y puerperio con el estado delirante que motivaba la internación, atribuido a factores predisponentes y, asimismo, tuvieron una autonomía nosográfica en virtud de etiopatogenias singulares. Al tiempo que empezó a emerger el tipo clínico locura puerperal, se entrecruzaron el campo disciplinar de la obstetricia con el alienismo, con una mayor preponderancia del primero.

Abstract Our goal is to understand the appearance and spread of forms of puerperal insanity in Argentina and Colombia in the late nineteenth and early twentieth century, as well as their decline or disappearance around the 1940s. This is a historical and hermeneutical study, which uses the concepts of "field of visibility" and "ecological niche" for a transitory disease. There was no correlation between pregnancy, childbirth and puerperium and the state of delirium that led to commitment, which was attributed to predisposing factors; furthermore, forms of puerperal insanity were nosographically distinct due to their unique etiopathogeneses. As clinical cases of puerperal insanity started to emerge, the disciplinary field of obstetrics converged with psychiatry, with the former exerting more weight.

Continuation of postpartum antiretroviral therapy in a cohort of women infected with human immunodeficiency virus.

A common dilemma for HIV-positive pregnant women is the issue of continuation or cessation of antiretroviral therapy (ART) postpartum. Current guidelines for ART during pregnancy offer no specific recommendations for postpartum ART care. The objective of this study was to ascertain characteristics that would predict cessation or continuation of ART postpartum. In this study, prenatal and medical clinic records were reviewed retrospectively for a cohort of 29 HIV-infected pregnant women who were seen in the Temple University High Risk obstetrics practice from 1997 to 1998. All women took ART during pregnancy, except for one who received i.v. AZT and nevirapine during labor. HIV-specific medical care was provided concurrently during the time of the woman's obstetrics visit by a nurse practitioner and a clinical nurse specialist in consultation with the physician. Factors that were included for review included race, age, use of ART at the time of pregnancy diagnosis, type of ART during pregnancy, CD4 count, HIV-1 ribonucleic acid polymerase chain reaction (RNA PCR) levels, current substance use, disclosure of HIV status to current partner, years of HIV infection, prior HIV infected child, and whether this was a first pregnancy. The two groups of women were divided between those who discontinued ART postpartum and those who continued ART. The data were analyzed with the Kruskal-Wallis test for two groups, or calculations of risk ratios with Fisher's exact test. Study results indicated that 15 out of 29 women (51%) continued ART postpartum. The significant factors for continuation included Latina ethnicity (risk ratio = 0.24, confidence interval = 0.06-0.87), CD4 < 200 mm3 (p = .04), and a greater number of drugs in the antiretroviral regimen 3 versus 2 (p = .05). This study showed that postpartum continuation of ART was associated with identified Latina ethnicity, lower CD4 counts, and a greater number of drugs in the pregnancy regimen. Further study is recommended to understand the clinical impact of intermittent ART, the strategies for postpartum therapy adherence, and clinical follow-up.

A comparison of clinical response to electroconvulsive therapy in puerperal and non-puerperal psychoses.

BACKGROUND: There is a widespread belief that puerperal psychosis is particularly responsive to electroconvulsive therapy (ECT), but research evidence for this is lacking. METHOD: We have conducted a retrospective case-note study of clinical improvement following ECT in puerperal and non-puerperal psychosis. The main outcome measure was improvement in mental state at the end of a course of ECT, rated by a blind rater on a simple four-point scale. Additional indicators of responsiveness to ECT were improvement in mental state 4 weeks after stopping ECT, duration of in-patient stay following ECT and number of ECT received. RESULTS: Women with puerperal psychosis showed greater clinical improvement than women with non-puerperal psychosis. The results were not explained by the greater preponderance of depressive illness in the puerperal group, as the same results were also found when the analysis was confined to women with a clinical diagnosis of depressive illness. CONCLUSION: These findings are the first evidence of a particular sensitivity of ECT in puerperal psychosis. However, they are preliminary and a number of explanations are possible, including good responsiveness to treatment in general. A prospective study using standardised clinical ratings and definitions of key variables is now required. CLINICAL IMPLICATIONS: Clinicians treating severe postpartum illness should continue to regard ECT as a treatment option. LIMITATIONS OF THE STUDY: The study is limited by its reliance on retrospective examination of information recorded in case notes. Ratings of clinical improvement were not standardised.