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Gestational diabetes in women with mental illness Chee Cheen Yeong1, Roisin Worsley2, Heather Gilbert2 and Jayashri Kulkarni2 1Central
Clinical School,Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia 2The Monash Alfred Psychiatry Research Centre, Melbourne, Australia Corresponding author: Jayashri Kulkarni, The Monash Alfred Psychiatry Research Centre, Level 4, 607 St Kilda Road, Melbourne, VIC 3004, Australia. DOI: 10.1177/0004867414528591
To the Editor Information on the safety of antipsychotic medication in pregnancy and breastfeeding is both limited and inconclusive and hence its use during pregnancy has brought about much debate. True prevention of mental illness begins with optimising maternal well-being during pregnancy and ensuring the best possible outcome for the baby. The following case study presents Sally, a participant in the National Register of Antipsychotic Medication in Pregnancy (NRAMP) (Kulkarni et al., 2008). Sally is a 29-year-old woman with schizophrenia and morbid obesity (body mass index of 50). She has a family history of diabetes. Her medications during pregnancy included risperidone (Consta) 37.5 mg intramuscularly fortnightly. Quetiapine (Seroquel XR) 50 mg/day was added at 34 weeks’ gestation. Throughout pregnancy she gained 25 kg, well above the recommended weight
Agomelatine-associated manic switch in bipolar depression: A case report Michael Thorpe, Joel Pannell and Michael Nance Flinders Medical Centre, Bedford Park, Australia Corresponding author: Michael Nance, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia Email: [email protected] DOI: 10.1177/0004867414529339
ANZJP Correspondence Table 1. Maternal perinatal weight/BMI. Weight pre-pregnancy
130 kg
BMI pre-pregnancy
50
Weight full term
155 kg
BMI full term
61
Weight 6 months postnatal
143 kg
BMI postnatal
56
Overall weight gain during pregnancy
25 kg
Height
159 cm
gain in pregnancy (Cogswell et al., 1999) (Table 1). Gestational diabetes mellitus (GDM) was diagnosed during routine screening at 28 weeks’ gestation. Dietary management was trialled initially. However, at 32 weeks’ gestation her glycaemic control was suboptimal, requiring the institution of basal-bolus insulin therapy: aspart (NovoRapid) with meals and isophane (Protophane) before bed. Insulin therapy was ceased at the onset of labour. Her postpartum oral glucose tolerance test confirmed that her diabetes had resolved. Sally’s son was born at 36 weeks’ gestation by elective caesarean section (due to maternal obesity, GDM and anxiety). At 4100 g he was large for gestational age (birth weight 99th percentile). He was admitted to the neonatal intensive care unit and then the special care nursery for a total of 8.5 weeks due to neonatal respiratory distress. The baby had neonatal abstinence syndrome and neonatal hypoglycaemia. He was breastfed at birth; however, his poor suckling reflex meant he required nasogastric feeding for 2 weeks. He was noted to be progressing well at 12 months of age. Sally and her son highlight some of the difficulties encountered by women who require antipsychotics in pregnancy. GDM is associated with obesity and
excess weight gain in pregnancy. Poorly controlled GDM is also associated with neonatal hypoglycaemia and high birth weight. GDM is noted in 22.1% of NRAMP mothers compared with the Australian population rate of 5.5% (Worsley et al., 2012). It is clear, therefore, that research in this area should be made a priority to achieve better health outcomes for mothers and babies.
To the Editor
when she developed intolerable nausea, this was changed to the melatonergic antidepressant agomelatine at a dose of 25mg nocte. Approximately two months later she was referred to mental health services by her counsellor, who was concerned by her mental state. At this time she demonstrated abundant confidence, pressure of speech, episodic irritability, an irregular eating pattern, and reduction in sleep to four hours per night. She had begun to engage in excessive cleaning and spending behaviours.
The potential for antidepressants from a number of classes to precipitate manic switch in unipolar and bipolar depression has been well described and reviewed (Tondo et al., 2010). We describe here a 31-year-old female sales assistant who became anxious, avoidant, socially withdrawn and depressed following an assault. She was initially managed by her regular GP and a counsellor. Sertraline was trialled, but
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Cogswell ME, Scanlon KS, Fein SB, et al. (1999) Medically advised, mother’s personal target and actual weight gain during pregnancy. Obstetrics & Gynaecology 94: 616–622. Kulkarni J, McCauley-Elsom K, Marston N, et al. (2008) Preliminary findings from the National Register of Antipsychotic Medication in Pregnancy. Australian and New Zealand Journal of Psychiatry 42: 38–44. Worsley R, Gilbert H and Kulkarni J (2012) Gestational diabetes in women who take antipsychotic medication. Poster presented at the Australian Diabetes Society Conference, Gold Coast Convention Centre, Queensland, Australia, 29–31 August.
Australian & New Zealand Journal of Downloaded Psychiatry, 48(10) from anp.sagepub.com at UNIV OF CO HEALTH SCIENCE CTR on March 30, 2015
Gestational diabetes in women with mental illness Chee Cheen Yeong1, Roisin Worsley2, Heather Gilbert2 and Jayashri Kulkarni2 1Central
Clinical School,Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia 2The Monash Alfred Psychiatry Research Centre, Melbourne, Australia Corresponding author: Jayashri Kulkarni, The Monash Alfred Psychiatry Research Centre, Level 4, 607 St Kilda Road, Melbourne, VIC 3004, Australia. DOI: 10.1177/0004867414528591
To the Editor Information on the safety of antipsychotic medication in pregnancy and breastfeeding is both limited and inconclusive and hence its use during pregnancy has brought about much debate. True prevention of mental illness begins with optimising maternal well-being during pregnancy and ensuring the best possible outcome for the baby. The following case study presents Sally, a participant in the National Register of Antipsychotic Medication in Pregnancy (NRAMP) (Kulkarni et al., 2008). Sally is a 29-year-old woman with schizophrenia and morbid obesity (body mass index of 50). She has a family history of diabetes. Her medications during pregnancy included risperidone (Consta) 37.5 mg intramuscularly fortnightly. Quetiapine (Seroquel XR) 50 mg/day was added at 34 weeks’ gestation. Throughout pregnancy she gained 25 kg, well above the recommended weight
Agomelatine-associated manic switch in bipolar depression: A case report Michael Thorpe, Joel Pannell and Michael Nance Flinders Medical Centre, Bedford Park, Australia Corresponding author: Michael Nance, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia Email: [email protected] DOI: 10.1177/0004867414529339
ANZJP Correspondence Table 1. Maternal perinatal weight/BMI. Weight pre-pregnancy
130 kg
BMI pre-pregnancy
50
Weight full term
155 kg
BMI full term
61
Weight 6 months postnatal
143 kg
BMI postnatal
56
Overall weight gain during pregnancy
25 kg
Height
159 cm
gain in pregnancy (Cogswell et al., 1999) (Table 1). Gestational diabetes mellitus (GDM) was diagnosed during routine screening at 28 weeks’ gestation. Dietary management was trialled initially. However, at 32 weeks’ gestation her glycaemic control was suboptimal, requiring the institution of basal-bolus insulin therapy: aspart (NovoRapid) with meals and isophane (Protophane) before bed. Insulin therapy was ceased at the onset of labour. Her postpartum oral glucose tolerance test confirmed that her diabetes had resolved. Sally’s son was born at 36 weeks’ gestation by elective caesarean section (due to maternal obesity, GDM and anxiety). At 4100 g he was large for gestational age (birth weight 99th percentile). He was admitted to the neonatal intensive care unit and then the special care nursery for a total of 8.5 weeks due to neonatal respiratory distress. The baby had neonatal abstinence syndrome and neonatal hypoglycaemia. He was breastfed at birth; however, his poor suckling reflex meant he required nasogastric feeding for 2 weeks. He was noted to be progressing well at 12 months of age. Sally and her son highlight some of the difficulties encountered by women who require antipsychotics in pregnancy. GDM is associated with obesity and
excess weight gain in pregnancy. Poorly controlled GDM is also associated with neonatal hypoglycaemia and high birth weight. GDM is noted in 22.1% of NRAMP mothers compared with the Australian population rate of 5.5% (Worsley et al., 2012). It is clear, therefore, that research in this area should be made a priority to achieve better health outcomes for mothers and babies.
To the Editor
when she developed intolerable nausea, this was changed to the melatonergic antidepressant agomelatine at a dose of 25mg nocte. Approximately two months later she was referred to mental health services by her counsellor, who was concerned by her mental state. At this time she demonstrated abundant confidence, pressure of speech, episodic irritability, an irregular eating pattern, and reduction in sleep to four hours per night. She had begun to engage in excessive cleaning and spending behaviours.
The potential for antidepressants from a number of classes to precipitate manic switch in unipolar and bipolar depression has been well described and reviewed (Tondo et al., 2010). We describe here a 31-year-old female sales assistant who became anxious, avoidant, socially withdrawn and depressed following an assault. She was initially managed by her regular GP and a counsellor. Sertraline was trialled, but
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Cogswell ME, Scanlon KS, Fein SB, et al. (1999) Medically advised, mother’s personal target and actual weight gain during pregnancy. Obstetrics & Gynaecology 94: 616–622. Kulkarni J, McCauley-Elsom K, Marston N, et al. (2008) Preliminary findings from the National Register of Antipsychotic Medication in Pregnancy. Australian and New Zealand Journal of Psychiatry 42: 38–44. Worsley R, Gilbert H and Kulkarni J (2012) Gestational diabetes in women who take antipsychotic medication. Poster presented at the Australian Diabetes Society Conference, Gold Coast Convention Centre, Queensland, Australia, 29–31 August.
Australian & New Zealand Journal of Downloaded Psychiatry, 48(10) from anp.sagepub.com at UNIV OF CO HEALTH SCIENCE CTR on March 30, 2015
