Reduced beta-casein levels in milk samples from patients with postpartum psychosis

Prognosis of postpartum psychiatric disorders in a Turkish sample

Objective The postpartum period represents a time of increased risk for psychiatric disorders. Postpartum depression is especially very common. Many aetiological risk factors have been reported for postpartum psychiatric disorders. The purpose of this study was to evaluate the postpartum psychiatric disorders in a Turkish sample and discuss their course. Methods The files of 6000 inpatients who were admitted to Gazi University School of Medicine Psychiatry Department were evaluated retrospectively, and 67 patients were chosen whose psychiatric illness had began puerperally. These patients were grouped according to age of onset of the illness, number of episodes and the type of these episodes, their postpartum psychiatric diagnoses and illness prognosis. Results Of 6000 patients, 67 (1.11%) were diagnosed as having a postpartum psychiatric disorder: 56.7% (n=38) were diagnosed as having a postpartum psychotic disorder, while 35.8% (n=24) as having an affective disorder. Forty-seven patients (70.1%) received a diagnosis of major psychiatric disorder during their follow-up. Conclusion These results show that postpartum diagnoses may show a chronic course and cause a life-time psychiatric illness and therefore patients should be monitored carefully for psychotic symptoms even after the acute period is over.

Milk protein-derived opioid receptor ligands

Milk is mammalian characteristic and is of particular importance for humans: Mother's milk or its substitutes from cows' milk are absolutely essential nutriments for the neonate and cows' milk also represents a basic foodstuff for adults. However, in addition to their well-known nutritive role, milk constituents apparently are also able to carry specific information from the milk producer's to the milk receiver's organism: Thus, a number of milk protein fragments has been shown to behave like opioid receptor ligands able to address opioidergic systems in the adult's or in the neonate's organism. With respect to the proteins, which they are derived off these peptides have been named alpha-casein exorphins or casoxin D (alpha-casein), beta-casomorphins or beta-casorphin (beta-casein), casoxin or casoxin A, B, or C (k-casein), alpha-lactorphins (alpha-lactalbumin), beta-lactorphin (beta-lactoglobulin) or lactoferroxins (lactoferrin). Only casoxins and lactoferroxins display antagonistic properties; the other peptides behave like opioid receptor agonists. Most of the information available so far has been collected about beta-casomorphins. These peptides obviously can be released from beta-casein in the adult's or in the neonate's organism, where they might elicit opioid effects in the frame of a regulatory role as "food hormones". Several synthetic beta-casomorphin derivatives have been shown to be highly specific and potent mu-type opioid receptor ligands which frequently have been used as standard tools in opioid research.

Micropurification and amino acid sequence of beta-casomorphin-8 in milk from a woman with postpartum psychosis

Milk was obtained from a woman with acute postpartum psychosis and with ongoing lactation. Defatted samples were subjected to micropurification and collected fractions were analyzed by means of their beta-casomorphin-8 immunoreactivity. Immunoreactive material with the same chromatographic properties as synthetic human beta-casomorphin-8 was determined by amino acid sequence analysis to be Tyr-Pro-Phe-Val-Glu-Pro-Ile-Pro. Its molecular mass was determined by fast atom bombardment-mass spectrometry to be 962.3 Da. These determinations, which ultimately identify the immunoreactive material as human beta-casomorphin-8, represent the first structural identification of a beta-casomorphin peptide from a body fluid.

Fingerprinting of molecular components in individual human cerebrospinal fluid samples with a new micropurification system

This paper reports a rapid and sensitive microtechnique for fingerprinting as little as 20 microliters of cerebrospinal fluid (CSF) from individual humans. Different molecular components were also isolated from the fluid. The SMART system, a new system optimized for high-recovery micropurification, was used for this purpose. The CSF sample, obtained by lumbar puncture, was applied directly into the system, and the patterns recorded for different individuals under various physiological conditions were compared. The results indicate that the procedure provides a powerful tool for the identification or recovery of CSF components and may also be of importance for diagnostic use.

Postpartum psychiatric disorders

The literature on postpartum psychiatric disorders (PPD) is reviewed with particular reference to recent advances in the field. Despite the prevailing tendency to consider PPD as a manifestation of other pre-existing psychiatric disorders (i.e. affective, schizophreniform, organic, neurotic, etc.) a growing number of studies point to the uniqueness and specificity of postpartum symptomatology. Theories of etiology, psychosocial as well as biological, are still wide-ranging and unconvicing. Attempts to predict PPD and/or to identify mothers-to-be at risk are based largely on retrospective studies or else are hindered by the use of nonspecific instruments. Society's implicit belief in the "joys of motherhood" may have further contributed to the obscurity surrounding these frequently occurring disorders. Interventions follow conventional methods of psycho- and pharmacotherapy but the multidisciplinary treatment approach especially for women with acute PPD who require hospital admission is gaining wider acceptance. The inpatient psychiatric mother-baby intensive care unit model is part of this approach.

Endocrine aspects of postnatal mental disorders

Biological research in postnatal mental illness has only a short history and few encouraging data have yet emerged. The most promising positive findings are perhaps preliminary evidence for an increase of postnatal depression in women with postpartum thyroid dysfunction, some evidence for an enhanced sensitivity to changes in progesterone levels in postnatal depression, and the presence of an opioid peptide with unknown function in the cerebrospinal fluid of women with puerperal psychosis. Although steroid hormones are generally thought to be aetiologically relevant since they freely enter the brain and are known to interact with central monoamine neurotransmitter systems, attempts to demonstrate abnormal levels in postnatal disorders have been disappointing. An important reason for this outcome may be the usually employed approach of isolated hormone measurements. Ovarian steroid levels show marked interindividual variations. Thus significant between-group differences may only be obtained when large numbers of subjects are tested. Since only the unbound fraction can enter the brain, its measurement should be included in such studies. In the case of cortisol, single values are insufficient because of the pulsatile nature and the circadian pattern of its release. Thus serial sampling over 24 hours is more appropriate to detect secretory abnormalities. Measurements of circulating peptides are difficult to interpret since the amount reaching the brain is at best small. What is needed here are estimations of peptides in the cerebrospinal fluid which, however, pose ethical problems. Another explanation for the dearth of consistent positive data may be that women with postnatal mental disorders react to normal postnatal changes differently to women who remain well after childbirth. There is already evidence that patients at high risk of puerperal manic-depressive illness develop a hypersensitivity of central D2 receptors which may be related to the effects of oestrogen withdrawal on the function of DA systems. Further investigations of central neurotransmitter function are needed. In many ways postnatal mental disorders provide a unique opportunity for psychosomatic research since their onset can almost be predicted and follows an event which is associated with changes in many physiological systems. Results of recent neuropharmacological and behavioural investigations into the central effects of steroid and peptide hormones provide the basis for a multitude of pathogenetic hypotheses to be tested in postnatal mental disorders and research in this area may see exciting times ahead.