Acute Onset or Worsening of Psychiatric Symptoms Following Breastfeeding Cessation: An Illustrative Case and Literature Review.

IF 2.7 4区 心理学 Q2 PSYCHIATRY Journal of the Academy of Consultation-Liaison Psychiatry Pub Date : 2024-10-19 DOI:10.1016/j.jaclp.2024.10.001
Katherine A Meidl, Bailey N Brooks, Stacey A Pawlak, Melissa B Ludgate
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Abstract

Background: Breastfeeding shares a complex, occasionally contradictory relationship with maternal mental health. Both positive and negative mood impacts have been noted in relation to breastfeeding initiation as well as cessation. Though popular magazines and online forums discuss the onset of psychiatric symptoms following weaning, there is limited medical literature detailing this relationship.

Objective: To increase awareness regarding psychiatric symptom development in the context of breastfeeding cessation.

Methods: We describe the case of a patient who developed psychiatric symptoms shortly after weaning, including acute-onset insomnia and worsening anxiety. A literature review of psychiatric symptom development following breastfeeding cessation was conducted using the search engines PubMed, PsycINFO (EBSCOhost), and Embase. Search terms included controlled vocabulary, keywords (within title and abstract fields), synonyms, and related concepts for postpartum period, postpartum depression, postpartum anxiety, breastfeeding cessation, breastfeeding weaning, lactation, dysphoric milk ejection reflex, and insomnia. Relevant case reports were reviewed and compared to this case. Information including the patient's age, psychiatric symptoms, past psychiatric history, medical workup, treatment, and outcome was extracted from each article.

Results: Nine patients who developed psychiatric symptoms following breastfeeding cessation were identified in six case reports. Three patients experienced recurrent symptoms in multiple pregnancies. This led to documentation of 13 discrete postweaning syndromes. All cases involved either first-time parents, those new to breastfeeding, or those experiencing symptoms during multiple weaning periods. Synthesizes data from the article review. As with our case, 11 clinical cases describe sleep changes (primarily insomnia) and 4 discuss anxiety symptoms. Treatment varied based upon symptoms experienced, with no consistently effective treatments identified across cases.

Conclusions: This case of unspecified insomnia and anxiety disorders following abrupt weaning adds to the limited literature in the field and suggests that physiologic and psychologic factors associated with breastfeeding cessation may play a role in the development or worsening of postpartum mood disorders. Intensive psychiatric treatment resulted in resolution of the patient's symptoms. The relationship between weaning and psychiatric disorders is evident in the lay press but is underrepresented in medical literature. Additional research is needed to better understand this relationship so that physicians can counsel, diagnose, and treat patients more effectively.

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停止母乳喂养后精神症状的急性发作或恶化:例证与文献综述。
背景:母乳喂养与产妇的心理健康有着复杂的关系,有时甚至是相互矛盾的。人们注意到,母乳喂养的开始和停止都会对情绪产生积极和消极的影响。尽管流行杂志和在线论坛讨论了断奶后精神症状的出现,但详细阐述这种关系的医学文献却很有限:我们描述了一例断奶后不久即出现精神症状的患者,包括急性失眠和焦虑加重。我们使用 PubMed、PsycINFO (EBSCOhost) 和 Embase 等搜索引擎对停止母乳喂养后出现精神症状的文献进行了综述。检索词包括控制词汇、关键词(在标题和摘要字段内)、同义词和相关概念:产后时期、产后抑郁、产后焦虑、停止母乳喂养、断母乳喂养、泌乳、排乳反射障碍和失眠。我们查阅了相关病例报告,并与本病例进行了比较。从每篇文章中提取了包括患者年龄、精神症状、既往精神病史、医学检查、治疗和结果在内的信息:结果:在六篇病例报告中发现了九名在停止母乳喂养后出现精神症状的患者。其中有三位患者在多次妊娠中反复出现症状。由此记录了 13 种不同的断奶后综合征。所有病例均涉及初次为人父母者、刚开始母乳喂养者或在多次断奶期间出现症状者。表 1 综合了文章综述中的数据。与我们的病例一样,11 个临床病例描述了睡眠变化(主要是失眠),4 个病例讨论了焦虑症状。根据症状的不同,治疗方法也不尽相同,在不同病例中没有发现一致有效的治疗方法:本病例在突然断奶后出现不明原因的失眠和焦虑症,为该领域有限的文献资料增添了新的内容,并表明与停止母乳喂养相关的生理和心理因素可能在产后情绪障碍的发展或恶化中起作用。强化精神治疗后,患者的症状得到了缓解。断奶与精神障碍之间的关系在非专业媒体中很明显,但在医学文献中却很少见。需要进行更多的研究来更好地了解这种关系,以便医生能更有效地为患者提供咨询、诊断和治疗。
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CiteScore
5.80
自引率
13.00%
发文量
378
审稿时长
50 days
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