The relationship between postpartum psychosis and bipolar disorder: a review.
BACKGROUND
The evidence for a spectrum of bipolar disorders is mounting. Of particular interest and importance is the evolution and recurrence of bipolar disorder in the postpartum period and its relationship to postpartum psychosis. Understanding whether such a phenomenological link exists has diagnostic, prognostic, and treatment implications.


OBJECTIVE
A comprehensive review of (1) the literature regarding the relationships between postpartum psychosis and bipolar affective disorder, (2) the data regarding prophylactic treatment and acute management of postpartum psychosis and bipolar disorder in the puerperium, and (3) critical areas for future research.


METHODS
MEDLINE and PubMed (1966-2002) databases were searched for English-language articles using the keywords postpartum/puerperal depression, puerperal/postpartum psychosis, bipolar disorder, lithium, anticonvulsants, antipsychotics, and breastfeeding.


RESULTS
Evidence from studies of women with a history of bipolar disorder, longitudinal studies of women with puerperal episodes of psychosis, and family studies support a link between postpartum psychosis and bipolar disorder.


CONCLUSIONS
Understanding the relationship between postpartum psychosis and bipolar disorder has implications for perinatal and long-term treatment. Prophylactic treatment of women with bipolar disorder and/or a history of postpartum psychosis may be indicated. Epidemiological, genetic, and pharmacologic research must be completed to understand, prevent, and adequately treat postpartum psychosis.
Chaudron
Linda H
LH
Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. linda_chaundron@urmc.rochester.edu
Pies
Ronald W
RW
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D010375:Pedigree; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011379:Prognosis; D011618:Psychotic Disorders / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology*
D014150:Antipsychotic Agents