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Risk for postpartum psychosis higher in mothers with bipolar disorder
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Postpartum psychosis most frequently occurs in mothers with bipolar disorder, but is often missed due to rarity and lack of research, according to a recent review.
“More often than not, the risk of the medication is less than the risk of the uncontrolled disorder,” Katherine Wisner, MD, MS, of the Northwestern University Feinberg School of Medicine, said in a press release. “This is a really serious disorder, and no one likes to treat women with medication during pregnancy or breastfeeding, but there's certainly very high risk in not treating as well, such as the risk for suicide.”
To characterize the epidemiology, phenomenology, pathophysiology, course and prognosis of postpartum psychosis, researchers reviewed epidemiologic and genetic research and physiological postpartum triggers (ie, endocrine, immunological, circadian) of psychosis. They also assessed all systematic review and clinical studies to establish diagnostic recommendations, treatment options and prevention strategies.
Incidence of first-lifetime onset postpartum psychosis/mania ranged from 0.25 to 0.6 per 1,000 births, according to population-based register studies of psychiatric admissions.
After the incident episode, 20% to 50% of women had isolated postpartum psychosis. The remainder of women had episodes outside the perinatal period, usually associated with bipolar disorder.
Researchers presumed the mechanism of onset is related to physiological changes after birth, which spur disease in women with genetic risk for psychosis.
Some women had treatable causes and comorbidities, such as autoimmune thyroiditis or infections. N-methyl--aspartate-encephalitis or genetic metabolism errors may present after birth with psychosis, according to researchers.
Less than 30 publications assessed treatment of postpartum psychosis. The largest study (n = 64) indicated that lithium was highly effective for acute and maintenance treatment.
Another study, among 34 individuals, indicated efficacy of electroconvulsive therapy.
Inpatient treatment is often required to ensure safety, complete diagnostic evaluations and initiate treatment.
Risk for relapse after a subsequent pregnancy among women with isolated postpartum psychoses was 31% (95% CI, 22-42).
Prevention strategies for postpartum psychosis include lithium prophylaxis immediately following childbirth and proactive safety monitoring.
“Everyone knows a woman with bipolar disorder — it’s about 1% to 5% of the population,” Wisner said in the release. “These women need to be aware that postpartum psychosis is a possibility and that there are preventive treatments that are highly effective.” – by Amanda Oldt
Disclosure: Bergink reports receiving support from the Netherlands Organization for Scientific Research (NWO, clinical fellow and VENI incentive. Please see the full study for a list of all authors’ relevant financial disclosures.