Interventions for the prevention and treatment of postpartum psychosis: a systematic review

Abstract

Postpartum psychosis is a serious disorder that can cause negative consequences for the mother, infant, and entire family. While reports of this condition date back for centuries, little is known about what interventions are most effective for this population. The purpose of this systematic review was to examine the research evidence on interventions for the prevention and treatment of postpartum psychosis. Studies were searched using CINAHL, EMBASE, MEDLINE, PsycINFO, and PubMed databases. All primary research studies published in English since 1970 that explored interventions for the prevention or treatment of postpartum psychosis were included. The search resulted in 26 studies on interventions for postpartum psychosis, with 10 focusing on prevention and 17 focusing on treatment. Studies on the prevention of postpartum psychosis have examined the effects of mood stabilizers, antipsychotics, and hormone therapy, while those examining treatment have included electroconvulsive therapy, mood stabilizers, antipsychotics, hormones, and the beta blocker propranolol. Only preliminary evidence suggests which interventions may be effective strategies to prevent (e.g., lithium) and treat (e.g., electroconvulsive therapy) postpartum psychosis. Due to methodological limitations in the studies reviewed, extensive evidence-based recommendations for the prevention and treatment of postpartum psychosis cannot be made. The known risk factors and negative consequences of postpartum psychosis point to the importance of preventative and acute treatment measures. Well-designed prospective studies are needed to determine the efficacy of prevention and treatment interventions for women who experience postpartum psychosis.

Sex and schizophrenia: a review of gender differences

“…Perhaps surprisingly due to the plethora of pharmacological complications, women nevertheless demonstrate better treatment compliance (Morken, Widen, & Grawe, 2008). Pregnancy and postpartum psychosis introduce more female-specific drug complications, though most antipsychotic use during breastfeeding is safe for the neonate (Fortinguerra, Clavenna, & Bonati, 2009), as decreasing medication to prevent adverse effects on offspring increases risk for relapse and postpartum psychosis in mothers (Doucet, Jones, Letourneau, Dennis, & Blackmore, 2011).…”

The perinatal period: A literature review from the biopsychosocial perspective

“…These disorders can range in severity from the mild and transient "baby blues" (experienced by 50% to 80% of women) to postpartum psychosis, a major psychiatric condition that affects one to two per 1000 deliveries [103] . Amongst these disorders is postnatal depression, a condition affecting around 15% of women [104] , and having potentially serious consequences for maternal, partner and infant well-being and development [105,106] .…”

The relationship between sleep and postpartum mental disorders: A systematic review

“…For example, it is well known that women who have symptoms of depression and/or anxiety during pregnancy or who have personal or family histories of depression are at high risk for developing PPD and PPA (Matthey et al, 2003;Steiner, 2002). Marital conflict, low socioeconomic status, stressful life events, and lack of social support are also known to be strongly associated with increased risk for PPD, PPA and PPP (Beck, 2001;Kendell et al, 1987;McKee et al, 2001;O'Hara and Swain, 1996;Steiner, 2002), while a history of bipolar disorder or postpartum psychosis (PPP) are significant risk factors for PPP (Doucet et al, 2011). Despite this and other research, no single causative factor has been isolated for PPD, PPA or PPP.…”