Understanding the relationship between cesarean birth and stress, anxiety, and depression after childbirth: A nationwide cohort study.

BACKGROUND: Women who undergo cesarean birth might have an increased risk for poor mental health after childbirth, possibly because of maternal and neonatal physical problems, low parental confidence, and decreased levels of oxytocin. However, this relationship remains controversial and requires further examination. The study aimed to examine the effect of cesarean birth on postpartum stress, anxiety, and depression. METHODS: This nationwide population-based cohort study was conducted using the Taiwan National Health Insurance Database. A total of 12 619 women who underwent cesarean birth and 12 619 control women who underwent vaginal birth were matched by propensity score based on age, socioeconomic status, residential urbanicity, antepartum comorbidity, and index year of delivery. We compared the incidence of stress, anxiety, and depression during the first postpartum year between cesarean and comparison groups by calculating incidence rate ratios (IRRs). RESULTS: The cesarean group showed a significantly higher risk for stress symptoms (IRR 1.4 [95% confidence interval {CI} 1.02-1.92]), but not anxiety (IRR 1.14 [95% CI 0.95-1.38]) or depression (IRR 1.32 [95% CI 0.94-1.87]), although the IRRs were also greater than one. The cesarean group had a significantly higher risk of any of the above-listed three disorders than the comparison group (incidence 27.6 vs 23.4 per 1000 person-years; IRR 1.18 [95% CI 1.01-1.38]). CONCLUSIONS: Cesarean birth was associated with an increased risk of postpartum stress symptoms. Health professionals should avoid unnecessary cesarean birth, pay attention to women who deliver by cesarean, and intervene appropriately in an attempt to improve mental health among postpartum women.

Congenital rubella syndrome with autistic disorder.

Congenital rubella syndrome (CRS) consists of a group of abnormalities that develop in children as a result of maternal infection with rubella virus. CRS may lead to new physical symptoms during adolescence or adulthood, referred to as "late manifestations". Psychiatric disorders are often seen among CRS patients, with an incidence of 4.12-7.3% for autism. We report a case of adolescent CRS with autism. A 20-year-old man had received treatment with antipsychotics and antidepressants since the age of 12 years because of unstable moods, violence, and stereotypic behavior. During follow-up, he developed some insidious-onset physical problems, including hyperlipidemia, dyspnea, constipation, torticollis and a tilted trunk. Under careful survey and evaluation, some physical problems were recognized as side effects of psychotropics, which gradually subsided after adjustment of the medications, and some of the problems were considered partially as manifestations of CRS, such as progressive pulmonary artery stenosis-related dyspnea. We managed some of the patient's physical problems and then he received catheterization for pulmonary artery stenosis. His general physical condition improved and some further improvement in psychiatric status was noted thereafter. Because of a high comorbidity rate for patients with autistic disorder, the clinician should be aware of the possibility of CRS if the patient has multiple congenital physical abnormalities with a history of maternal rubella infection. If patients develop physical symptoms in adolescence, awareness of late manifestations of CRS and differentiation from the adverse effects of psychotropic medications are essential. In addition to psychiatric treatment, management of physical problems associated with CRS would be beneficial for the patients' psychiatric condition.

Choking incidents among psychiatric inpatients: a retrospective study in Chutung Veterans General Hospital.

BACKGROUND: Choking incidents have long been recognized as a cause of death in people with mental illness. This study attempted to determine the rate of choking incidents and deaths among psychiatric inpatients and identify the risk factors associated with choking incidents. Some preventive measures are also suggested. METHODS: All choking incidents recorded over 3 years in 3 psychiatric wards of Chutung Veterans General Hospital (total of 210 beds) were retrospectively analyzed for demographic variables, psychiatric and medical diagnoses, and drug therapy at the time of the incidents. RESULTS: During the 3-year period, 16 incidents were recorded, involving 11 patients at a rate of 1 incident every 451.4 months of hospitalization per person. Men were 3 times more likely to experience choking incidents than women, and the mean age of choking patients was higher than that of all patients (59.7 vs. 44.4 years). Among the 16 incidents, 3 fatal cases were noted, giving an annual choking death rate of 5.05 per 1,000 persons hospitalized. A high re-choking rate of up to 40.0% was noted, and patients with organic mental disorder had 3.4 times the choking incidence of all patients. The mean antipsychotic dosage of the choking cases was similar to that of all inpatients, but the mean hypnotic dosage of the fatal choking cases was significantly higher. Up to 62.5% of the choking accidents occurred at breakfast, and mantou (a type of steamed bun) was the most common food (9/16) that resulted in the accidents. Of the 11 patients, 9 were rated as "poor" or "very poor" with regard to self-care before the accidents. CONCLUSION: Compared with studies in Western psychiatric inpatients, we have a lower choking incident rate but higher death rate due to choking. We found that older age, male sex, higher dosage of hypnotics, previous choking attacks, organic mental disorder, poor self-care, breakfast time and mantou were possible risk factors associated with choking, in which older age, poor self-care, and higher dosage of hypnotics for fatal cases were statistically significant.