Understanding the pathophysiology of postpartum psychosis: Challenges and new approaches

Abstract

Postpartum psychosis is a severe psychiatric condition which affects 1-2 of every 1000 mothers shortly after childbirth. Whilst there is convincing evidence that the condition is precipitated by a complex combination of biological and environmental factors, as yet the pathophysiological mechanisms remain extremely poorly defined. Here, I critically review approaches that have been, or are being, employed to identify and characterise such mechanisms; I also review a recent animal model approach, and describe a novel biological risk model that it suggests. Clarification of biological risk mechanisms underlying disorder risk should permit the identification of relevant predictive biomarkers which will ensure that “at risk” subjects receive prompt clinical intervention if required.

Do Defective Immune System-Mediated Myelination Processes Increase Postpartum Psychosis Risk?

“…The behavioural abnormalities and the Ccn3 overexpression in the mouse model could be attenuated through administration of the antipsychotic drug ziprasidone, supporting its face and predictive validity. The finding that manipulation of placental gene activity in mice gives rise to altered maternal behaviours and increased brain (hippocampal) Ccn3 expression [38] further supports the notion of CCN3 as a mediator of postpartum psychopathology 9 , 36 .…”

“…Key obstacles in identifying biological risk and protective factors for PP include low disorder prevalence, high between-patient symptom heterogeneity, lack of accessibility to patient brain tissue, and a historical lack of amenable model systems [9] . However, understanding the pathophysiology of PP is crucial for identifying both novel therapeutic targets (for more efficacious drugs with fewer adverse effects) and predictive biomarkers (for identification of the most ‘at risk’ women before, or during, pregnancy, thereby facilitating earlier, more individualised clinical interventions).…”

Postpartum psychosis and management: a case study

“…With an incidence rate of 1:1000 births (Tinkelman, Hill and Deligiannidis, 2017), and the reduced capacity of women to consent; conducting research and collecting data is challenging (Davis, 2017). Hence, PP aetiology remains poorly understood, however, a reduction in oestrogen levels after delivery and/or increased endocrine sensitivity may be to blame (Davis, 2017).…”

Akute psychotische Störungsbilder

“…Pathophysiologisch wird ein Zusammenhang mit einem abrupten Abfall des Östrogenspiegels in der Postpartalperiode vermutet, aber auch immunologische Mechanismen, Störungen des Tryptophan-Stoffwechsels und eine Imbalance im Serotonin-Transmittersystem werden diskutiert [5]. Das Auftreten einer Post-partum-Psychose ist mit einem signifikant erhöhten Suizid-und Infantizid-Risiko assoziiert, weswegen betroffene Mütter einer unmittelbaren psychiatrischen Behandlung zugeführt werden müssen, idealerweise auf spezialisierten Mutter-Kind-Einheiten.…”