title: Prevalence of autoimmune thyroid dysfunction in postpartum psychosis.
abstract: BACKGROUND
  Postpartum psychosis is a life-threatening psychiatric emergency, which  often occurs without significant premorbid symptoms. Although many studies  have postulated an involvement of the immune and endocrine systems in the  onset of postpartum psychosis, the specific aetiological factors have remained  unknown.
  
  
  OBJECTIVE
  To examine the hypothesis that autoimmune thyroid dysfunction may be  associated with the onset of postpartum psychosis.
  
  
  METHODS
  Thirty-one consecutive primiparous women with no prior psychiatric history  were referred to our in-patient unit for postpartum psychosis. The control  group (n = 117) comprised primiparous women with consecutive deliveries at a  community practice. Blood samples were obtained from all participants at 4  weeks and 9 months postpartum. Thyroperoxidase antibody levels were quantified  as immunological measures of autoimmune thyroid disease (AITD).  Thyroid-stimulating hormone and free thyroxine levels were measured to assess  clinical thyroid dysfunction.
  
  
  RESULTS
  At 4 weeks postpartum and prior to the initiation of mood stabiliser  therapy, 19% of women with postpartum psychosis had AITD compared with only 5%  in the control group. Women with both postpartum psychosis and AITD had a  dramatically higher risk of progression to clinical thyroid dysfunction (67%)  than control participants with AITD (20%).
  
  
  CONCLUSIONS
  Women with postpartum psychosis are at higher risk not only of AITD but  also of clinical thyroid failure. These data implicate thyroid function as an  important clinical outcome in patients with postpartum psychosis. Further,  AITD represents a potentially strong aetiological factor for the development  of postpartum psychosis. Therefore, screening for thyroperoxidase antibodies  is warranted in patients with postpartum psychosis.
authors.affiliation: Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, The Netherlands. V.Bergink@erasmusmc.nl
authors.forename: Veerle
authors.initials: V
authors.lastname: Bergink
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kushner
authors.forename: Victor
authors.initials: V
authors.lastname: Pop
authors.forename: Hans
authors.initials: H
authors.lastname: Kuijpens
authors.forename: Mijke P
authors.initials: MP
authors.lastname: Lambregtse-van den Berg
authors.forename: Roos C
authors.initials: RC
authors.lastname: Drexhage
authors.forename: Wilmar
authors.initials: W
authors.lastname: Wiersinga
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
authors.forename: Hemmo A
authors.initials: HA
authors.lastname: Drexhage
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000378:metabolism; D016022:Case-Control Studies; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D007453:Iodide Peroxidase / Q000276:immunology; D053208:Kaplan-Meier Estimate; D018020:Lithium Compounds / Q000627:therapeutic use; D010298:Parity; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D015995:Prevalence; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D011644:Puerperal Disorders / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors; D013967:Thyroiditis, Autoimmune / Q000150:complications / Q000453:epidemiology* / Q000378:metabolism; D013972:Thyrotropin / Q000378:metabolism; D013974:Thyroxine / Q000378:metabolism
chemical_list: D018692:Antimanic Agents; D001323:Autoantibodies; D018020:Lithium Compounds; D013972:Thyrotropin; D007453:Iodide Peroxidase; D013974:Thyroxine