Postpartum psychoses: prognosis, risk factors, and treatment.
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.
Pfuhlmann
Bruno
B
Department of Psychiatry, University of Würzburg, Füchsleinstrasse 15, D-97080 Würzburg, Germany. bruno.pfuhlmann@mail.uni-wuerzburg.de
Stoeber
Gerald
G
Beckmann
Helmut
H
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D019052:Depression, Postpartum / Q000523:psychology*; D005260:Female; D006801:Humans; D011379:Prognosis; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000209:etiology*; D012307:Risk Factors
D014150:Antipsychotic Agents