RESUMEN

Managing depression and anxiety during pregnancy and the postpartum period is challenging. Both pharmacological treatment and the lack thereof can pose threats to a fetus. SSRIs are the drugs of choice for use during pregnancy, but there is considerable evidence for the safety and efficacy of older antidepressants during pregnancy as well. This study highlights a single case of the use of the tricyclic nortriptyline during pregnancy and postpartum. The subject involved had an unexpectedly high ratio of serum level to drug dose during the postpartum period. We monitored the subject for a significantly greater portion of the postpartum period than has been done in previous studies, and explored medical and lifestyle changes that could account for the level-to-dose ratios we observed. Differences in smoking patterns, coupled with the patient's status as a genetic poor metabolizer, were the most likely explanations.

Asunto(s)

Antidepresivos Tricíclicos/administración & dosificación , Depresión/tratamiento farmacológico , Trastorno Depresivo/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/administración & dosificación , Adulto , Antidepresivos Tricíclicos/uso terapéutico , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Periodo Posparto , Embarazo , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Factores Socioeconómicos , Resultado del Tratamiento

RESUMEN

The authors describe their recent experience in using a standardized patient (SP) to illustrate the mental status examination (MSE) to 170 second-year medical students in a large classroom setting. An SP was trained to portray a patient with schizophrenia who was interviewed during the MSE lecture. A six-question survey was distributed to the students to evaluate how the students felt about the learning experience. Results show that the majority of students felt that using an SP in a large classroom setting helped them to understand the material better and was a useful teaching tool. Follow-up studies are under way to objectively measure students' integration and retention of the lecture material.