Background: A dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been proposed as an important pathogenic factor in depression. Genetic variants of FKBP5, a protein of the HPA system modulating the glucocorticoid receptor, have been reported to be genetically associated with improved response to medical treatment and an increase of depressive episodes.

Puerperal psychoses do not represent a nosological entity, but rather a selection of puerperally triggered "ordinary" functional psychoses with cycloid psychoses predominating and schizophrenias occurring very rarely. The prognosis is basically favorable concerning symptom remission and social and occupational functioning. However, there is a considerable frequency of relapses and an increased suicide rate. The most important risk factors for an episode of a puerperal psychosis are being primiparous and having suffered a previous episode of a psychosis, particularly a cycloid psychosis. Controlled treatment studies up to now are absent. Case studies suggest in acute episodes the efficacy of a symptom-oriented pharmacologic treatment where ablactation is recommended. With respect to prophylactic treatment some authors propose to apply lithium in late pregnancy or immediately after delivery. Because of its possible teratogenic effects and the altogether rather sparse data, the authors however cannot recommend the use of lithium during pregnancy. Applying estradiol after delivery may be beneficial and safe, but further studies are necessary to clarify these issues.

In previous studies, low amplitudes and asymmetrical topography with right-sided peaks of the P300-evoked response have been repeatedly described in schizophrenic patients. A total of 18 patients with cycloid psychosis fulfilling the criteria of Perris and Brockington and 18 controls were investigated with a standard auditory odd-ball paradigm and multichannel-evoked potential recordings. Patients had normal P300 topographies and latencies but significantly higher amplitudes than controls. Higher than normal P300 amplitudes have not been described in any other psychiatric disorder until now, and indicate an enhanced level of arousal. Future studies are expected to shed light on the question of whether high P300 amplitudes are transitory sequelae of the acute psychotic episode or a trait of cycloid psychosis.

In previous studies, low amplitudes and asymmetrical topography with right-sided peaks of the P300-evoked response have been repeatedly described in schizophrenic patients. A sample consisting of 18 patients with cycloid psychosis fulfilling the criteria of Perris and Brockington and 18 controls was investigated with a standard auditory odd-ball paradigm and multichannel evoked potential recordings. Patients had normal P300 topographies and latencies but significantly higher amplitudes than the controls. Higher than normal P300 amplitudes have not been described in any other psychiatric disorder until now, and indicate an enhanced level of arousal. Future studies are expected to shed light on the question of whether high P300 amplitudes are transitory sequelae of the acute psychotic episode or a trait of cycloid psychosis.

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