Postpartum Psychosis
Postpartum psychosis is a severe and potentially life-threatening disorder that warrants acute clinical intervention. The initial clinical evaluation for postpartum psychosis requires a thorough medical and psychiatric history, physical and neurological e
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Veerle Bergink and Steven A. Kushner
Abstract
Postpartum psychosis is a severe and potentially life-threatening disorder that warrants acute clinical intervention. The initial clinical evaluation for postpartum psychosis requires a thorough medical and psychiatric history, physical and neurological examination, and comprehensive laboratory analysis to exclude known organic causes for acute psychosis. Unfortunately, little is known about what interventions are most effective, as research has been very limited and no randomized trials have been performed. Antipsychotic medication, lithium, and ECT have been described in case series and are frequently used in clinical practice as treatment options for postpartum psychosis. Prevention of postpartum psychosis is a major challenge for mental health practitioners and obstetricians. Recently, we have proposed distinct clinical treatment algorithms for women with bipolar disorder versus women with a history of psychosis limited to the postpartum period. In bipolar women, prophylaxis during pregnancy appears critically important for maintaining mood stability during pregnancy and postpartum. In contrast, we recommend initiating prophylactic treatment immediately postpartum in women with a history of psychosis limited to the postpartum period. Considering together the available phenomenological, epidemiological, and treatment outcome data, we believe that postpartum psychosis should not be considered as a primary psychotic disorder as its name might otherwise suggest, but rather as a diagnostically independent entity within the group of bipolar affective disorders. Keywords
Bipolar disorder • Mood stabilizers • Postpartum psychosis • Pregnancy
V. Bergink (*) • S.A. Kushner Erasmus Medical Center, Department of Psychiatry, ‘s Gravendijkwal 230, 3000 CA Rotterdam, The Netherlands e-mail: [email protected] M. Galbally et al. (eds.), Psychopharmacology and Pregnancy, DOI 10.1007/978-3-642-54562-7_10, # Springer-Verlag Berlin Heidelberg 2014
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V. Bergink and S.A. Kushner
Epidemiology, Phenomenology and Diagnosis
After childbirth, women are vulnerable to the onset of serious psychiatric symptomatology. Women are approximately 22 times more likely to experience the onset of a manic or psychotic episode in the first month postpartum than at any other time in their lives. Postpartum psychosis is the most severe form of childbirthrelated psychiatric illness. The prevalence of postpartum psychosis in the general population is estimated as 1–2 per 1,000 childbirths (Munk-Olsen et al. 2006). In the majority of cases, the onset is rapid and within 2 weeks postpartum. The early symptoms include insomnia, mood fluctuation, and sometimes obsessive concerns regarding the newborn, followed by more severe symptoms such as delusions, hallucinations, disorganized behavior, and serious mood symptoms. The occurrence of these severe mood symptoms such as mania, depression, or a mixed state is very prominent in postpartum psychosis. Affective phenomenology seems to be a
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