Postpartum Psychosis

Chapter

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 

Notes

Disclosure

None of the authors report a competing interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of PsychiatryErasmus Medical CenterRotterdamThe Netherlands

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