A Review of Postpartum Psychosis

University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213, USA.
Journal of Women's Health (Impact Factor: 2.05). 06/2006; 15(4):352-68. DOI: 10.1089/jwh.2006.15.352
Source: PubMed


The objective is to provide an overview of the clinical features, prognosis, differential diagnosis, evaluation, and treatment of postpartum psychosis.
The authors searched Medline (1966-2005), PsycInfo (1974-2005), Toxnet, and PubMed databases using the key words postpartum psychosis, depression, bipolar disorder, schizophrenia, organic psychosis, pharmacotherapy, psychotherapy, and electroconvulsive therapy. A clinical case is used to facilitate the discussion.
The onset of puerperal psychosis occurs in the first 1-4 weeks after childbirth. The data suggest that postpartum psychosis is an overt presentation of bipolar disorder that is timed to coincide with tremendous hormonal shifts after delivery. The patient develops frank psychosis, cognitive impairment, and grossly disorganized behavior that represent a complete change from previous functioning. These perturbations, in combination with lapsed insight into her illness and symptoms, can lead to devastating consequences in which the safety and well-being of the affected mother and her offspring are jeopardized. Therefore, careful and repeated assessment of the mothers' symptoms, safety, and functional capacity is imperative. Treatment is dictated by the underlying diagnosis, bipolar disorder, and guided by the symptom acuity, patient's response to past treatments, drug tolerability, and breastfeeding preference. The somatic therapies include antimanic agents, atypical antipsychotic medications, and ECT. Estrogen prophylaxis remains purely investigational.
The rapid and accurate diagnosis of postpartum psychosis is essential to expedite appropriate treatment and to allow for quick, full recovery, prevention of future episodes, and reduction of risk to the mother and her children and family.

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Available from: Anthony J Rothschild, Oct 09, 2015
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    • "Today, 1–2 in every 1000 women experience psychotic or manic symptoms in the first 4 weeks after childbirth and are diagnosed with postnatal psychosis, also known as postpartum or puerperal psychosis (Austin & Highet 2011, American Psychiatric Association 2013, Essali et al. 2013). Postnatal psychosis is characterized by the rapid onset of hallucinations, delusions, confused thinking and mood swings and is a risk factor for maternal suicide and infanticide (Brockington 1996, Sit et al. 2006, Heron et al. 2008, Oates 2008, Doucet et al. 2009, Posmontier 2010, Oates & Cantwell 2011, Glover et al. 2014). It is treated with antipsychotic and mood stabilizers; however, admission is often required to prevent harm to the woman or to any other person, including the child (Doucet et al. 2009, Posmontier 2010). "
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    ABSTRACT: Aim: This study analysed historical healthcare records to investigate how women diagnosed with mania or psychosis and admitted to two mental health facilities in Australia following childbirth, were described in the late Victorian (1885 to 1895) and inter-war period (1925 to 1935). Background: Although historians have examined the history of mental health systems in Australia, there is no published scholarship that considers the healthcare records of these women. This was a unique opportunity to explore these documents. Design: An historical study examining healthcare records. The data collection occurred in 2012. Methods: Women admitted to mental health facilities with a diagnosis of psychosis or mania were identified in the admission registers found in the State Record Office of New South Wales and, if available, their healthcare record was transcribed verbatim. The records were imported into NVivo 10 for content analysis to determine the range and scope of information. A further textual analysis was conducted to see if the woman’s diagnosis was congruent with the outcome of her admission. Results/Findings: 155 cases were identified across the two periods. Although, demographic data and the description of the women on admission were remarkably similar, 17% of women were physically, rather than mentally, ill and died soon after admission. The findings demonstrate the importance of current practices such as taking a comprehensive healthcare assessment and the use of antibiotics and sanitary measures during labour and in the postnatal period. Conclusion: Historical investigations of healthcare records provide legitimacy for current healthcare practices.
    Journal of Advanced Nursing 08/2015; DOI:10.1111/jan.12761 · 1.74 Impact Factor
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    • " screening , suicide risk assessment ( Joiner et al . , 2007 ; Oquendo et al . , 1997 ) , and access to mental health treatment once women begin to receive obstetrical care . Mothers known to have MDD or puerperal recurrences must be flagged for clinical safety monitoring and preventive treatment at the time of delivery ( before symptoms recur ) ( Sit et al . , 2006 ; Wisner et al . , 2004 ) ."
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    ABSTRACT: Suicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women. This secondary analysis included 628 depressed mothers at 4-6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms. Of the depressed mothers, 496 (79%) 'never' had thoughts of self-harm; 98 (15.6%) 'hardly ever'; and 34 (5.4%) 'sometimes' or 'quite often'. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR = 1.68, 95% CI = 1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR = 1.15, 95% CI = 1.02, 1.29) and anxiety symptoms (OR = 1.11, 95% CI = 1.01, 1.23). Because women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Psychiatric Research 05/2015; 66-67. DOI:10.1016/j.jpsychires.2015.04.021 · 3.96 Impact Factor
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    • "Thyrotoxicosis leading to postpartum psychosis often manifests with delirium, catatonia and transient psychotic symptoms [17] [20]. Autoimmune thyroid dysfunction is likely to worsen during the postpartum period [18], and the postpartum state by itself is a risk factor for occurrence or relapse of psychiatric illnesses [19]. In hyperthyroidism, adrenergic hyperactivity is considered as a major cause of psychiatric symptoms, and beta blockers are effective in ameliorating symptoms [20]. "
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    ABSTRACT: Objective: Thyroid dysfunction is common during pregnancy and the postpartum period and is known to cause psychiatric disturbances. A woman with Graves' disease and psychosis in the postpartum period is described. Methods: A 22-year-old woman with Graves' disease developed fluctuating orientation, catatonia, delusions of persecution and auditory hallucinations 3 days following childbirth. Results: The report discusses the clinical presentation. Treatment of both conditions led to the resolution of symptoms. Conclusion: Graves' disease with postpartum psychosis may present with delirium, catatonia and prominent auditory hallucinations and responds well to a combination of psychotropic and antithyroid drugs. Thyroid dysfunction should be assessed for and managed adequately in postpartum psychosis.
    General Hospital Psychiatry 11/2014; 36(6). DOI:10.1016/j.genhosppsych.2014.07.003 · 2.61 Impact Factor
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