Psychiatric illness following childbirth in Southampton: a case register study.

The Southampton case register and maternity records were used to identify all Southampton women who had babies in 1976 and 1977 and who had been in psychiatric care in the 2 years before and after the birth date. 127 such women were identified out of a total of 5200 having babies. An analysis of the timing of referral and the total number in care at various stages of the study period confirmed an increased rate of psychosis following childbirth. Rates for other diagnoses showed no such clear relationship. Obstetric and social factors were not related to postpartum morbidity. These results are discussed.

Extent, timing and persistence of emotional disorders following childbirth.

A three-stage community survey of a representative group of Southampton mothers was carried out. A semi-structured psychiatric interview was administered at 3, 9 and 15 months post-partum. The results of these interviews are presented and used to assess the extent and timing of psychiatric disorders arising in this period. In contrast to previous studies, it was found that the highest incidence of new cases, variously defined, occurred between the third and ninth month post-partum and not immediately following childbirth. These results are discussed in the context of previous studies using the same definition of caseness.

Presenile dementia: the difficulties of early diagnosis.

A follow-up of 35 patients first diagnosed as having presenile dementia at York Clinic is described. In only 15 cases did progressive deterioration confirm the diagnosis. A retrospective case note study of all the patients is described comparing the clinical features and results of special investigations of those patients in whom the diagnosis was confirmed in this way and those in whom it was not. The results of this study are used to illuminate some of the special difficulties in the early diagnosis of presenile dementia.

Validation of the 30-item General Health Questionnaire in postpartum women.

Two hundred consecutive women from five Southampton general practices who were between 8 and 14 weeks postpartum were visited at home. Each subject was given the 30-item General Health Questionnaire (GHQ-30) and a standardized psychiatric interview. Thirty-seven (18%) were identified as 'cases' by the psychiatric interview. Eighty-nine (44.5%) scored highly on the GHQ. Analysis of the results indicates that slight modification of the content and a raised cut-off point of the GHQ-30 make it a useful screening instrument for postpartum psychiatric disorder.

Hormonal changes and mood in the puerperium.

This investigation is an attempt to test the common supposition that postpartum emotional disturbance is related to hormone changes. A group of 27 normal pregnant women were assessed three times before delivery and sixteen times in the six weeks following delivery. During the first two interviews baseline data on personality and other personal variables were obtained. On each occasion blood was taken and three measures of clinical status and mood were completed. Plasma LH, FSH, total oestrogen and progesterone results are presented in detail and the results of prolactin assays mentioned more briefly. An attempt to correlate hormone findings and clinical findings is described. This failed to produce any strong evidence that hormones are related to mood at this time, although hormone changes were correlated weakly with a few specific symptoms. Some of the unexpected clinical findings and technical difficulties of the study are discussed, with special reference to possible further research in this area.

Effect of breast-feeding on pituitary-ovarian function after childbirth.

Pituitary and ovarian function at the end of pregnancy and during the first six weeks after delivery was investigated serially in women who fully breast-fed their infants and in women who did not. In the women who did not breast-feed the plasma prolactin level decreased rapidly and from the third day after delivery was significantly lower than in the breast-feeding mothers, reaching the normal range of the menstrual cycle by the third week of the puerperium. In the breast-feeding mothers the plasma prolactin was still raised six weeks after delivery. The levels of FSH in both groups were identical and increased over the third week of the puerperium. Plasma oestrogen fell steeply in both groups during the first two weeks after delivery. In the breast-feeding mothers plasma oestrogen remained depressed but increased in the non-lactating women, reflecting follicular development in the ovary in response to FSH; the plasma oestrogen levels were significantly higher in the non-lactating women from the 17th day of the puerperium onwards. These findings support the concept that in breast-feeding women prolactin delays the return of ovulation by inhibiting the ovarian response to FSH stimulation.

Unilateral electroconvulsive therapy and cerebral dominance: effect of right- and left-sided electrode placement on verbal memory.

Unilateral electroconvulsive therapy was given to 32 right-handed patients for relief of depression. Sixteen patients received electrode placement on the right side for the first treatment and on the left side for the second treatment. For the other 16 patients the order of sides was reversed. The word Associate Learning subtest of the Wechsler Memory Scale was administered about 20 minutes after each treatment (Wechsler, 1945). Results supported the hypothesis that performance on this test would be better when the electrodes were applied over the right than when they were applied over the right than when they were applied over the left cerebral hemisphere. It is suggested that investigation along these lines could assist in establishing the cerebral dominance of individual patients.