Francis J. Kane

Regional ileitis and psychiatric disorder.

&NA; Psychiatric disturbance in a group of 39 persons with proved regional ileitis is investigated retrospectively. Reference to all sources of information in the hospital records indicates a psychiatric morbidity within the group of 62.5%, with a clear temporal relationship between psychological stress and an exacerbation of the disease process in 64% of the group. The major psychiatric symptom seen during hospitalization was that of depression (38% of the group). The development of this symptomatologic picture appeared to be linked with the duration and severity of the disease process. No specific personality characteristic in persons developing regional ileitis could be defined from the available data‐‐although 40% of the group did exhibit a predominantly passive‐dependent personality constellation. Of the group, 38% had symptoms of other psychosomatic disorders. This finding, together with the interdependence of psychic and somatic factors in regional ileitis, is discussed.

Psychiatric reactions to oral contraceptives.

There are grounds to expect behavioral and emotional changes during use of oral contraceptives, in the known frequency of premenstrual, postpartum and menopausal psychoses. A review of 11 studies on the effect of the pill on psychiatric symptoms yielded a low but definite incidence of adverse reactions, notably depression and other mood and behavior changes, but generally an improvement, particularly for patients with premenstrual exacerbation of their psychosis. In case reports, 4 women have suffered psychotic episodes on withdrawal from the pill and 3 have become psychotic on starting oral contraception. The author interviewed and tested 50 women in one study: 28 reported adverse effects, usually depression, decreased libido, and decreased ability to cope with stress. Another interview study of 101 pill users and 90 pregnant controls produced 34% with depression, 29% with irritability, 23% with lethargy, 15% with decreased libido, 64% with adverse effects and 25% discontinued. 11% reported increased well-being in addition to reporting adverse symptoms, which the author interpreted as increased emotional lability. Other systems through which oral contraceptives may exert these effects include catecholamine metabolism, tryptophan metabolism, corticoid hormones, drug interactions, susceptibility of EEG to progesterones depressant effects, and unconsious and conscious attitudes of the patient.

Evaluation of emotional reactions to oral contraceptive use

A review of available clinical studies indicates that 10 to 40 per cent of oral contraceptive users may suffer mild to moderate depression syndromes. Clinical and animal data indicate that a variety of mechanisms may be involved, including alterations in folate, pyridoxine, and vitamine B12 metabolism, as well as related effects on biogenic amine metabolism. Interactive effects may result, such as impairment of usual coping mechnisms and psychological defenses by altered central nervous system function.

Emotional change associated with oral contraceptives in female psychiatric patients

Abstract The occurrence of psychosis in six women associated with their use of combined or sequential hormone oral contraceptive agents, five of whom had a previous psychiatric history, suggested the possibility that there was increased risk in oral contraceptive hormone use in psychiatric patients. This report concerns the data gathered from an interview study on 130 nonpsychiatric patients and 64 women who had undergone psychiatric care. Psychiatric patients more often reported change related to drug use. Depression, irritability, and lethargy occurred most often in both groups, and, while psychiatric patients reported more of these symptoms, the differences did not reach statistical significance. Psychiatric patients were significantly different with regard to feeling increased well-being, increased sexual desire, and capacity for orgasm as well as increased sensitivity to stopping drugs to permit the menses. While these changes would seem to reflect a beneficial effect on psychiatric patients, they seldom occurred without more undersiable symptoms. Psychiatric patients were different from both groups of nonpsychiatric patients with regard to reported irregularity of menses, anxiety during the menses, disability at the menses, and infrequency of sexual intercourse. The nonpsychiatric symptomatic group was significantly different from the asymptomatic control group on ratings of disability at the menses, lessened frequency of sexual intercourse, infrequent orgasm, and menstrual symptoms relieved by drug use. On the latter two factors, the psychiatric patients were also different from the asymptomatic group. The symptomatic nonpsychiatric group, therefore, seemed to fall intermediate in position between the asymptomatic group and the psychiatric group, suggesting the possibility that drug use had enhanced the expression of latent neurotic traits. The interaction of the drug induced pseudopregnant endocrine state with personality factors reported here seems very similar to that associated with pregnancy, where changes in catecholamine metabolism have recently been demonstrated. Similar clinical experiences have been reported with antihypertensive agents where psychologically predisposed individuals have suffered serious depressive illness with drug use. Our data suggest that further investigation of the effect of natural and synthetic hormonal substances on biogenic amine metabolism may be fruitful in assisting the understanding these reactions.

Motivational factors affecting contraceptive use

95% of married and unmarried women who were delivered at North Carolina Memorial Hospital during the summers of 1968-1969 were interviewed on Day 2 or 3 postpartum to determine: 1) knowledge of contraceptive methods, 2) consistency of contraceptive use related to this and other pregnancies, 3) reason for desired family size, 4) number of planned pregnancies, and 5) demographic data relating to age, sex, and education. From a Negro southern rural population in North Carolina, 126 Negro and 132 Caucasian married women were interviewed and completed the Neuroticism Scale Questionnaire (NSQ) which is derived from items on the 16 Personality Factor Questionnaire discriminating neurotic from normal patients. The NSQs 4 factors are: 1) submissiveness vs. dominance, 2) sensitivity vs. practicality and/or insensitivity, 3) depression vs. happy-go-lucky cheerfulness, and 4) anxiety. Both groups were similar in age but there were significant educational differences (education beyond high school: Negroes, 8%; Caucasians, 58%). While knowledge of contraception was similar, Negro women reported more unwanted pregnancies, more inconsistent use of contraception, and a higher response to the NSQ. There were significant differences on 4 of the 5 NSQ items; only anxiety showed no difference in the groups studied. Negro women 1) clustered themselves at the extremes of the sensitivity factor, 2) scored themselves as significantly more cheerful and extroverted, 3) scored themselves as more submissive, and 4) scored significantly higher on the total neuroticism score. Nearly 1/2 of the Negro women reported significant opposition from husbands regarding use of contraception, and evidence seemed to indicate that these women found an important source of self-esteem in childbearing. Measures to prevent conception in these women must provide alternate modes of gratification to replace that of motherhood.