Role of estradiol in puerperal psychosis.
BACKGROUND
Postpartum period has been considered a time of increased risk for the development of psychiatric disorders with long-lasting adverse consequences. Psychoses are the most severe of these illnesses and can be resistant to psychiatric medication.


OBJECTIVE
We present two women with puerperal psychosis who had low serum estradiol, were refractory to neuroleptic medication but responded successfully to estradiol treatment.


METHODS
Serum estradiol concentration was measured at baseline and during the treatment with sublingual 17-beta estradiol. Treatment effect was evaluated using Brief Psychiatric Rating Scale.


RESULTS
Both patients had a low pretreatment estradiol concentration (28 and 54 pmol/l). During treatment with estradiol, the rise in serum estradiol coincided with a decline of psychotic symptoms. Discontinuation of estradiol treatment resulted in a rebound of florid psychotic symptoms in both cases.


CONCLUSIONS
Estradiol may have a causal relation to postpartum psychosis and significance in the treatment of this illness.
Ahokas
A
A
Department of Psychiatry, Helsinki City Hospital, Finland. antti.ahokas@kolumbus.fi
Aito
M
M
D000286:Administration, Sublingual; D000328:Adult; D019052:Depression, Postpartum / Q000188:drug therapy* / Q000523:psychology; D004958:Estradiol / Q000008:administration & dosage / Q000097:blood / Q000502:physiology* / Q000627:therapeutic use*; D004967:Estrogens / Q000172:deficiency; D005260:Female; D006801:Humans; D011374:Progesterone / Q000097:blood; D011569:Psychiatric Status Rating Scales; D011863:Radioimmunoassay
D004967:Estrogens; D011374:Progesterone; D004958:Estradiol