This study examines relationships among military sexual trauma (MST), nonmilitary sexual trauma, and posttraumatic stress disorder (PTSD). A sample of 196 female veterans was assessed for trauma occurring before, during, and after military service, and for current PTSD. The prevalence of MST was higher than that of premilitary and postmilitary sexual trauma. Premilitary trauma did not significantly increase the odds of experiencing MST, but did increase the odds of experiencing postmilitary sexual trauma. Logistic regression analyses revealed MST was more strongly associated with PTSD than was premilitary or postmilitary trauma. Women with MST had the greatest increased odds of developing PTSD. Understanding risk factors for and taking steps to prevent MST may reduce cases of PTSD in female veterans.

BACKGROUND: This study compares rates of posttraumatic stress disorder (PTSD) in female veterans who had military sexual trauma (MST) with rates of PTSD in women veterans with all other types of trauma.

In this report, we discuss the case of a woman with paranoid schizophrenia who hoped to become pregnant. She was taking a stable daily dose of antipsychotic medication when she initially sought consultation about the safety of medication during pregnancy. This case examines 1) the challenges that arise when women with psychiatric disorders require treatment during pregnancy and lactation and 2) the balancing of competing needs that form the backbone of the risk-benefit analysis of medication use during pregnancy and the postpartum.Case Description "Ms. A" was a 38-year-old married woman with a history of psychosis who sought consultation about the safety of antipsychotic use during pregnancy and lactation. Ms. A had done well taking quetiapine for 5 years. A few years earlier, she had undergone an abortion after being told that her medication was not compatible with pregnancy. Subsequently, she and her husband sought consultation at a university hospital. HistoryMs. A had a history of psychiatric symptoms dating back to her teens. In high school, Ms. A remembered having depression, anorexia, and suicidal ideation. A music teacher at the time suggested to her parents that they seek psychiatric care. Her parents ignored the advice.In college, Ms. A became bulimic, and her depression worsened. She attempted suicide three times in her early 20s. At age 24, her weight fell to 90 lb, and she was severely depressed and developed delusions about communicating with God. She was initially diagnosed with bipolar disorder and treated with lithium and typical antipsychotics, including haloperidol and thiothixene. The addition of fluoxetine at one time caused such severe agitation that she again attempted suicide. She was diagnosed with schizophrenia after her final suicide attempt, which occurred when Ms. A thought she was the devil and that the world would be cured of evil if she died. Course of TreatmentThe initial psychiatric evaluation consisted of a detailed psychiatric and medical history followed by a discussion of the risks and benefits of medication use during pregnancy and the postpartum. The first consultant reviewed three possible courses of treatment: 1) discontinuation of medications before pregnancy, 2) use of medications until Ms. A had a positive pregnancy test and subsequent withdrawal of medication, and 3) use of antipsychotics throughout the pregnancy. Given Ms. A's severe history of psychosis and suicide attempts, she and her husband agreed with the consultant that medications should be continued throughout pregnancy and possibly during lactation. The consultant then reviewed the published literature on antipsychotics that existed at that time. Olanzapine had the most cases documented in the literature, and the consultant used this as a rationale for suggesting that Ms. A switch to olanzapine. Ms. A was titrated off of quetiapine and began taking olanzapine.Within 3 months, Ms. A had gained 20 lb. She was depressed, lethargic, anhedonic, and had severe memory and concentration difficulties. She slept at l...

No abstract

TO THE EDITOR: Risk-benefit analysis is central when forming a treatment plan for pregnant women with mental illness. This task is further complicated by limited data pertaining to the effects of antidepressants on the fetus, neonate, and child. To our knowledge, this is the first case report of in utero exposure to duloxetine. "Ms. A" was a 36-year-old Caucasian female with a history of recurrent major depression, anorexia, and chronic neck pain. When she sought psychiatric consultation at 34 weeks' gestation, she was 1) in complete remission, 2) being treated by an anesthesiologist, 3) and receiving monotherapy duloxetine (90 mg/day). She was educated about neonatal behavioral syndrome, and duloxetine was subsequently decreased to 60 mg/day.The child was delivered without complication at 38 weeks. Upon delivery, she was blue, with minimal respiratory effort and oxygen saturations in the 80s. Her Apgar scores were 7 and 9. After birth, she was transferred to the neonatal intensive care unit because she continued to require oxygen. The child was started on antibiotics while possible causes of transient tachypnea were assessed. Basic laboratory examination, blood gas, echocardiogram, and chest and abdominal x-rays were all normal on day 1. Breast feeding was discouraged because of concerns of exposure to duloxetine, and the mother was advised to switch to sertraline. Antibiotic treatment was discontinued after blood cultures remained negative.On day 3, the child was weaned to room air but developed "jerky rhythmic movements," or "twitchiness." An electroencephalogram (EEG) showed nonspecific encephalopathic findings. The child did have episodes of shaking, and the EEG revealed no correlated changes. Phenobarbital was started, and despite a high blood level the following day, the child continued to experience occasional twitching. Head computed tomography, magnetic resonance imaging, and lumbar puncture were all normal. A repeat EEG conducted at 7 days was suggestive of subclinical seizures. A follow-up EEG at 7 weeks was normal. Phenobarbital was discontinued, and the child was diagnosed with tremors and neonatal seizures associated with neonatal behavior syndrome. At age 2, the child is healthy with consistently normal neurobehavioral development.