Postpartum psychosis: A proposed treatment algorithm

Abstract

Background: Postpartum psychosis (PPP) is a psychiatric emergency that generally warrants acute inpatient care. PPP is marked by the sudden onset of affective and psychotic symptoms with a rapid deterioration in mental state. Evidence suggests that PPP is a discrete disorder on the bipolar disorder spectrum with a distinct treatment profile and prognosis. Methods: We conducted a PubMed database search for various terms involving PPP and its treatment and included peer-reviewed articles published in English. Objective: To provide a treatment algorithm for the management of PPP based on available evidence. Results: Pharmacological therapy is the mainstay of PPP management in the acute phase. Evidence points to a combination of antipsychotics and lithium in the acute treatment of PPP. Electroconvulsive therapy can offer a rapid treatment response where required. Lithium appears to have the best evidence for relapse prevention and prophylaxis in PPP. Psychoeducation is essential and psychosocial interventions used in bipolar disorder may be effective in PPP. Conclusion: Early detection and prompt treatment with antipsychotics and lithium, followed by maintenance treatment with lithium, is associated with a favourable prognosis in PPP.

Genetic and Epigenetic Factors Associated with Postpartum Psychosis: A 5-Year Systematic Review

“…PPP is considered to have a multifactorial origin, as various risk factors can trigger its development, including a history of PPP in previous pregnancies, a personal or family history of psychosis or bipolar disorder (BD), a history of schizoaffective disorder, and stopping psychiatric medications during pregnancy [10]. Genetic and epigenetic alterations, conditions during childbirth, and sleep deprivation are considered risk factors for the development of PPP.…”

“…Additionally, if the woman wants to breastfeed her child, lithium might not be the best option. Lithium crosses into breast milk in large quantities and thus may affect the infant [10].…”

“…SGAs include olanzapine, quetiapine, risperidone, and clozapine. It has been suggested that both olanzapine and quetiapine are the best options for women who want to breastfeed their children [10,38,43]. Clozapine is considered unsafe while breastfeeding.…”

“…Zopiclone is another treatment option; however, it is important that breast-fed infants are monitored for sedation, hypotonia, and respiratory distress, especially with regular use of large doses of hypnotics [10].…”

Postpartum Psychosis as a Consequence of Thyroiditis Versus Relapse: A Diagnostic Dilemma

“…Postpartum thyroiditis and postpartum psychosis are often both considered in the differentials of patients presenting with postpartum psychosis and become primary diagnoses only after medical conditions are ruled out [ 1 ]. However, unique cases have been reported of the co-occurrence of these pathologies in postpartum women and successfully treated using antipsychotics loxapine and amoxapine for psychosis alongside propanol and propylthiouracil for thyroiditis [ 2 ].…”