Donkin psychosis

S100B as a predictor of delirium in critically ill obstetric patients: A nested case-control study

Background

Delirium is a neuropsychiatric illness that lasts for a short period of time. The incidence of delirium in the intensive care unit (ICU) varies from 20% to 80%.

Methods

A nested case-control study was carried out in the obstetric ICU. Individuals were divided into three groups: critically ill obstetric women who had delirium on admission (Group A), women who developed delirium within follow-up of 7 days (Group B), and women who did not develop delirium after follow-up of 7 days (Group C). The APACHE II score was used to assess critical illness severity. The Richmond Agitation-Sedation Scale was used to assess the alertness or sedation level of patients, and the Confusion Assessment Method (ICU scale) was used to assess the presence of delirium. S100B was measured by human S100B calcium-binding protein B ELISA kit (Elabscience Biotechnology, Houston, USA).

Results

Severe preeclampsia and antepartum eclampsia were significantly associated with delirium. S100B levels in Group B were found to be significantly higher than those in Group C. S100B levels were higher in patients with >2 morbidities in comparison to patients with two morbidities. At a cutoff value of >169.25 pg/ml, S100B had a sensitivity of 74% and a specificity of 87.2% to discriminate cases of delirium from nondelirium.

Conclusion

The rise in S100B levels was approximately three times greater in those who developed delirium as compared to those who did not. It is a more specific predictor of delirium.

C-L Case Conference: A 33-year-old Bhutanese Woman with Postpartum Hallucinations

We present the care of a 33-year-old pre-eclamptic Bhutanese woman who presented with post-partum hallucinations. We discuss our concern for postpartum psychosis versus a culturally appropriate phenomenon, with her diagnostic picture complicated by our use of interpreters and the intersection of culture and medicine. Top experts in the consultation-liaison (CL) field provide guidance for this clinical scenario based on their experience and a review of the available literature. This case highlights both the impact of language barriers and the challenges of interpreting psychiatric symptoms within a cultural context. Key teaching points include differential diagnoses for postpartum hallucinations, the importance of interpreting patient presentations within their unique cultural contexts and identities, and the impact of language interpretation on patient care. Specifically, we offer guidance on differentiating postpartum psychosis from a culturally appropriate phenomenon.

Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review

Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1–2 in every 1000 deliveries. These episodes typically present as acute mania or depression with psychosis within the first few weeks of childbirth, which, as life-threatening psychiatric emergencies, can have a significant adverse impact on the mother, baby and wider family. The nosological status of postpartum psychosis remains contentious; however, evidence indicates most episodes to be manifestations of bipolar disorder and a vulnerability to a puerperal trigger. While childbirth appears to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum psychosis occurs are poorly understood. This review examines the current evidence with respect to potential aetiology and childbirth-related triggers of postpartum psychosis. Findings to date have implicated neurobiological factors, such as hormones, immunological dysregulation, circadian rhythm disruption and genetics, to be important in the pathogenesis of this disorder. Prediction models, informed by prospective cohort studies of high-risk women, are required to identify those at greatest risk of postpartum psychosis.

Puerperal Psychosis: A brief review and unusual case report

This is a brief review of puerperal (post-partum) psychosis and contains a case report of Donkin Psychosis, an unusual form which is associated with pre-eclampsia, from Queen Elizabeth Central Hospital in Blantyre, Malawi. It includes considerations for treatment of Donkin Psychosis, in particular. It is the first reported case of Donkin Psychosis from Africa, to our knowledge.