Sertraline in paired blood plasma and breast-milk samples from nursing mothers.

Paired blood and breast-milk samples were collected from 10 nursing mothers receiving sertraline. Samples were collected at steady state when the patients had been taking stable doses of 50-150 mg/day over several weeks. Sertraline concentrations in both fluids were determined using a specific, validated HPLC method. Plasma and milk concentrations showed a wide inter-individual variability for the same dose. Mean plasma concentrations were linearly related to dose, but this was not the case for breast-milk concentrations. An overall milk to plasma ratio of 1.76+/-1.72 was recorded. The average dose to the infants ranged from 1.1 to 31.1 &mgr;g/kg, which is less than 2 per cent of the maternal dose per day. Further studies are necessary to determine if these doses are detrimental to the development of the infant. Copyright 2000 John Wiley & Sons, Ltd.

Managing schizophrenia in general practice.

BACKGROUND: The lifetime risk of schizophrenia is about one in 100. It is an illness associated with substantial disability and increased risk of physical illness. OBJECTIVE: This article updates general practitioners on the physical, psychological and social management of patients with schizophrenia. DISCUSSION: General practitioners have a key role in managing patients with schizophrenia, including early detection of prodromal symptoms, monitoring and preventing relapses, and providing high quality primary and secondary prevention for common physical problems. Effective care requires a thorough understanding of local specialist services, pharmacotherapies, and familiarity with psychosocial interventions that will genuinely benefit patients.

Maternal perinatal mental health and multiple births: implications for practice.

Women's mental health can be compromised during reproductive life, but to date there has been relatively little specific investigation of the links between multiple births and perinatal psychiatric illness. There has been more comprehensive examination of some of the psychological sequelae of multiple gestations and births, but many of the studies have small samples and are descriptive in nature. Most of the literature is drawn from investigations of the psychological aspects of multiple births following assisted conception. Current conceptualizations of the determinants of maternal perinatal mental health, with particular reference to multiple gestations and births are discussed and implications for clinical practice suggested. Overall there is evidence that women with multiple gestation and multiple births may be at elevated risk for pregnancy anxiety, postpartum depression and complicated grief reactions. Much less is currently known about the associations between multiple birth and either maternity blues or postpartum psychosis. The relationships between personal or family psychiatric history, past experience of childhood abuse, intimate partner intimidation and psychological adjustment to multiple births are not known. The interactions between multiple births, operative delivery, prematurity, neonatal illness and separation of mother and infant as contributing factors to maternal postpartum mental health are not known. There is very limited evidence about the psychological functioning of fathers of multiple infants. Routine antenatal, intrapartum and postnatal health care for women with multiple infants needs to take into account the additional psychological demands they face.