Faculty Bibliography

The literature on postpartum psychiatric disorders is limited to descriptions of depressive and/or psychotic syndromes. The authors describe three cases of panic disorder presenting for the first time in the early postpartum period. Clinicians should differentiate between postpartum panic disorder and the well-recognized presentation of postpartum depression.

The authors report on four patients with disabling bowel obsessions who responded to tricyclic antidepressant medication despite the absence of depressive symptoms. The relationship of this symptom constellation to DSM-III obsessive-compulsive disorder and social phobia is discussed.

Five of 29 obsessive-compulsive disorder patients were dexamethasone suppression test (DST) nonsuppressors, all of whom met standard Hamilton Depression Rating scale criteria for at least mild depression. None of 24 nondepressed obsessive-compulsive disorder patients had an abnormal DST. The relationship of the DST to specificity of psychiatric diagnoses is discussed

The psychostimulants remain controversial agents for the diagnosis and treatment of depression. One promising area of investigation involves the use of a brief trial of a stimulant to predict patient response to subsequent treatment with a tricyclic antidepressant. Five of 10 studies have demonstrated the predictive value of the stimulant challenge test in depression; however, these studies have varied significantly in method. Studies in which oral doses of stimulant were given over an extended time have demonstrated greater predictive value than studies using a single intravenous challenge dose. Additional factors which differ between studies and may affect the predictive value of the stimulant challenge test are identified. The literature on the neuroendocrine responses to stimulant administration, direct stimulant effects on mood and activity, and stimulant neurotransmitter effects is summarized to further understanding of stimulant action in relation to affective disorders.

Seven psychotic patients' plasma haloperidol levels, determined with gas-liquid chromatography, fell a mean of 60% when carbamazepine treatment was instituted. Two patients' levels became undetectable, and their symptoms worsened. Haloperidol level monitoring may be required for patients given both haloperidol and carbamazepine.

The combination of L-tryptophan and a monoamine oxidase inhibitor (MAOI) has been reported to be an effective antidepressant regimen. Neurotoxicity has previously been associated with this combination. The author presents two cases of hypomania following the addition of L-tryptophan to an MAOI.

A healthy 25-year-old woman experienced probable ranitidine-induced confusion that partially resolved with intravenous physostigmine. The only known prior report of confusion associated with this relatively new agent was in a severely ill 86-year-old woman. Clinicians should be alert for mental status changes with ranitidine and consider a trial of physostigmine when indicated.