Gabapentin may have a role in the treatment of mild alcohol withdrawal, but future studies should focus on adequate dosing strategies. Gabapentin should be considered for the treatment of alcohol dependence when barriers prevent the use of traditional agents. Additional studies should be conducted to further validate findings from the research conducted to date, but the current literature is promising for gabapentin in the treatment of alcohol dependence.

IntroductionStudies show alcohol-preferring mice reduce their alcohol intake during pregnancy; this study questions if the same is true for humans. The current investigation compares women's pre-pregnancy and first trimester alcohol consumption, examines if women with problem drinking diminish their alcohol intake during pregnancy, and determines if prenatal alcohol reduction is associated with characteristics of pregnancy, patients or smoking.Methods126 participants in weeks 1–12 of pregnancy, recruited from Obstetric and Family Practices, completed a survey during their initial prenatal visit including two gender-specific AUDITs (Alcohol Use Disorders Identification Tests) querying current and pre-pregnancy alcohol use. AUDIT-C (AUDIT items 1–3) scores measuring pre-pregnancy and first trimester alcohol consumption were compared, analyzed and tested using general linear model repeated. A p ≤ 0.05 was accepted as significant.ResultsMost participants were multiparous, Caucasian high school graduates experiencing nausea and vomiting. Pre-pregnancy alcohol use was significantly (p = 0.019, Fisher's exact) higher among women seeing obstetricians. Pre-pregnancy AUDIT-C scores (m (mean) = 2.22, sd (standard deviation) = 2.19) were significantly higher (p < 0.001) than first trimester scores (m = 0.143, sd = 0.532). Among 49 with pre-pregnancy AUDIT-C scores ≥ 3, 45/49 (92%) reduced their alcohol use to zero during the first trimester. Age, race, education, marital status, parity, nausea and vomiting, gestational age and smoking were non-factors in score reduction.ConclusionsWomen reported reducing their alcohol consumption during pregnancy, including those screening positive for pre-pregnancy problem drinking. First trimester alcohol reduction cannot be accounted for by smoking, patient or pregnancy characteristics; public health initiatives, psychological factors and hormonal mechanisms may be implicated.

Spinal dural arteriovenous fistula (SDAVF) consists of an acquired arteriovenous shunt between a dural artery and perimedullary veins. 1 This results in arterialization of radicular veins, venous hypertension, and decreased spinal cord perfusion.1 The condition has a male predominance and presents as a myelopathy in the fifth or sixth decade. Initial misdiagnosis is common. [1][2][3] We present a man with a SDAVF and associated intramedullary cord hemorrhage. Case reportA 36-year-old man was admitted with a 4-month history of lower extremity numbness and weakness. His symptoms began with left followed by right foot paresthesias. Subacute onset of lower limb weakness 2 months after symptom onset prompted him to seek medical attention locally. There was no sphincteric dysfunction. Spine MRI showed a centrally located T1 hyperintensity (figure, A) with surrounding susceptibility-related hypointensity (figure, B) at T9-T10 and edema-related central T2 hyperintensity of the cord from T7 to L1 (figure, B). CSF studies were remarkable only for a slightly elevated protein. A vascular myelopathy was suspected. MRI showed abnormal perimedullary vascular flow voids suggesting a SDAVF. A cord arteriovenous malformation (AVM) and cavernous malformation were also in the differential diagnosis. Magnetic resonance angiography (MRA) and 2 spinal angiograms did not identify a vascular abnormality. A diagnosis of transverse myelitis or hemorrhagic demyelination was then proposed.A 5-day course of IV methylprednisolone was given for presumed transverse myelitis. The patient reported lower extremity "stunning" immediately following steroid administration. He used the word stunning to describe worsening of his motor and sensory deficits. Days later, he noted recovery from the steroid-induced worsening. This was mistakenly interpreted as steroid-related improvement. This recurred with a repeat steroid trial. Practical ImplicationsA myelopathy with fluctuations should prompt consideration of a spinal dural arteriovenous fistula; steroid induced worsening may be a clue.

BackgroundThis case chronicles the unique presentation of psychotic mixed mania in a female 5 months after parturition and 1 week following breastfeeding discontinuation, highlighting a rarely recognized mania risk factor that is temporally delayed from parturition: breastfeeding discontinuation.Case presentationA 25-year-old G1P1 female with a past psychiatric history of a depressive episode in adolescence presented to the Emergency Department with her 5-month-old daughter, fiancée, and family 1 week after breastfeeding cessation. She endorsed sleep-deprived energy enhancement, unfulfilled goal-oriented productivity, hyper-talkativeness, hyper-sexuality and increased nicotine use. Concurrent depressive symptoms included hopelessness, worthlessness, poor concentration, lack of appetite, and ego-dystonic intrusive thoughts that she may kill herself or her child. She exhibited pressured speech, affective lability, expansiveness, distractibility, and tangential, grandiose, delusional self-referential content. Transient thoughts of self-harm and harm to her child were not associated with intent. Her family history was significant for a deceased mother who had bipolar I disorder. The patient was hospitalized for 5 days and diagnosed with bipolar disorder, type I, current episode manic with psychotic features with a mixed-feature specifier. Olanzapine and lithium were initiated and the patient’s acute episode of mania resolved prior to discharge.ConclusionsThis case extends the limited literature on mania following weaning and highlights the role of rapid serum dopamine rise following breastfeeding cessation in mania.