University of Birmingham, UK
Posters & Accepted Abstracts: J Clin Case Rep
In my early career, as a cardiologist working in tropical Africa, I experienced the value of single cases supported by a multilingual literature review: Two cases were sufficient to indicate that an idiopathic disease (endomyocardial fibrosis) was a complication of eosinophil leukocytosis. Since 1975, I have studied the psychoses of childbearing in the literature over 4,000 cases, of which 30% in the English language, plus a personal series of 320 mothers. The study of 600 recurrent cases has shown that the problem is more than the eruption of a psychosis shortly after childbirth: There is a group of reproductive triggers; prepartum, post-abortion (including mole pregnancies), early and late postpartum (onset 1-2 weeks and 4-13 weeks after the birth), after weaning and at two phases of the menstrual cycle. The history of individual patients demonstrates associations between all of them. Since 1981, I focused on menstrual psychosis; several hundred cases in the literature and 60 of my own. Periodic monthly psychoses occur before and at the menarche during phases of amenorrhea, in the early months of pregnancy, after childbirth, after the menopause, in men and (in one remarkable observation from Japan) without a pituitary. Everything worth knowing about childbearing and menstrual psychoses comes from case description and indicates involvement of the gonadorelin neuronal network (2000 neurons) in the anterior hypothalamus (a needle in the haystack!).
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