In a recent article, Margaret Spinelli, MD describes a proposal to the DSM-V committee of the American Psychiatric Association in 2020 arguing for the inclusion of postpartum psychosis as a unique diagnosis...
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It is well-established that women with a history of bipolar disorder or postpartum psychosis are at extremely high risk of postpartum psychiatric illness. Several studies have indicated that lithium prophylaxis can dramatically reduce the risk of postpartum relapse; however, the studies have varied in terms of the timing of prophylaxis, with some initiating treatment during pregnancy and others initiating treatment immediately after delivery. A recent study published in the American Journal of Psychiatry gives more information on the clinical management of these high risk populations.
Because postpartum psychosis is a relatively rare event, we do not have as much information on this illness as we have on postpartum depression. In addition, most of the literature we have on postpartum psychosis [...]
Postpartum psychosis is a rare but serious psychiatric illness, occurring in about 1 to 2 per 1000 women after delivery. Because postpartum psychosis carries significant risks for both the mother and her child, most women with this illness are psychiatrically hospitalized. Electroconvulsive therapy (ECT) is an effective treatment for postpartum psychosis and may reduce the risks associated with medication exposure in the nursing infant; however, very few research studies have focused on the use of ECT in this setting and it is less commonly used in the United States than in other countries. A recent study explores the safety and advantages of ECT for the treatment of women hospitalized for postpartum psychosis.
Postpartum psychosis is the most severe form of postpartum psychiatric illness, occurring in approximately 1 to 2 per 1000 women after childbirth. Although bipolar disorder is a risk factor for postpartum psychosis, a substantial number of women who develop postpartum psychosis have no history of psychiatric illness and experience psychiatric illness only in the context of childbearing. What may cause or trigger postpartum psychosis in this population is not well understood.
Postpartum psychosis is rare, occurring in about 1 to 2 per 1000 women after delivery. While there appears to be a strong link between postpartum psychosis and bipolar disorder, it is estimated that about half of women who present with postpartum psychosis have no psychiatric history prior to delivery, making it difficult to identify those women who are at greatest risk for this illness. A recent study, using data from the Swedish Medical Birth Registry, has examined possible risk factors that may be used to identify women at risk for postpartum psychosis.
The most recent issue of the New England Journal of Medicine includes the presentation of a case from the Center for Women's Mental Health of a woman with bipolar disorder who developed postpartum psychosis after the birth of her child. The case highlights some of the clinical challenges in treating patients with bipolar disorder during pregnancy and the postpartum period and reviews the current literature on postpartum psychosis.
Previous studies have identified primiparity as a significant risk factor for postpartum psychosis and especially bipolar affective disorders. This is the first study to quantify the risk of psychiatric illness after the first as compared to subsequent pregnancies.
While the role that COVID-19 plays in the pathophysiology of PP is not established, this study offers preliminary evidence that provides us a stronger grasp of how certain viral infections, like coronavirus, can predispose to postpartum psychiatric illnesses.
In studies of psychosis unrelated to childbirth, there is evidence linking stress to the onset of psychosis.