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Outpatient epilepsy care can often be straightforward. This is because around 65% of patients are seizure-free on their antiseizure medicines (ASMs). Management decisions that can simplify patient care prominently include minimizing ASM dosing complexity, preferably with monotherapy and once daily dosing. Choosing ASMs with lower side effect profiles and interaction potential is also ideal. Proactively addressing comorbidities of epilepsy and its treatment can improve quality of care. Some ASMs can negatively affect bone health so routine calcium and vitamin D supplementation is useful.Psychiatric care is comprehensively discussed in Chapter 9. The relative lack of need for ASM level monitoring is discussed. The decision to stop ASM therapy and how to do it is discussed. Lastly, the chapter concludes with a concise and thorough discussion of specific management considerations for women with epilepsy. Topics include the hormone cause of the catamenial pattern as well as ASMs and contraception, pregnancy, and breast feeding.
Menstrual psychosis was first described in the 18th century. Brockington defined its characteristics: acute onset; brief duration with full recovery; confusion, stupor and mutism, delusions, hallucinations, or a manic syndrome and periodicity in temporal association with the menstrual cycle.
Objectives
Description of a clinical case of menstrual psychosis and review of the literature.
Methods
Description of a clinical case. Non systematic review of the literature, searching the terms “psychosis”; “menstrual”; “catamenial” in the databases Pubmed, Medline and Cochrane.
Results
Female, 39-year-old patient. No psychiatric history until the postpartum period of a traumatic vaginal birth, when she developed stupor and mutism which lasted for two days. During the following 2 years, she progressively presented with sadness, asthenia, anhedonia, insomnia and incapacity for self-care. She was prescribed paroxetine and olanzapine, with partial recovery. Subsequently, she had at least 6 episodes with about 3-day duration of asthenia, food refusal, insomnia, incapacity for self-care, disorganization of thought and behavior and mystical and persecutory delusions, coincident with the beginning of menstruation. She was hospitalized in two of them and received treatment with venlafaxine 75mg and paliperidone 6mg, with psychotic symptoms remission after a week.
Conclusions
This case presents the characteristics of menstrual psychosis. This is a rare condition, with only 30 reported cases worldwide. According to current classification systems, this condition fulfills diagnostic criteria for brief psychotic disorder. Nonetheless, studying in more detail this disorder could be interesting, with the goal of deepening the knowledge of the neurobiology of psychosis, particularly the effects of estrogen on this disorder.
Disclosure
No significant relationships.
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